Novel microsimulation model of tobacco use behaviours and outcomes: calibration and validation in a US population
Background and objective Simulation models can project effects of tobacco use and cessation and inform tobacco control policies. Most existing tobacco models do not explicitly include relapse, a key component of the natural history of tobacco use. Our objective was to develop, calibrate and validate...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-05-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/5/e032579.full |
| _version_ | 1818507847893254144 |
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| author | Krishna P Reddy Alexander J B Bulteel Douglas E Levy Pamela Torola Emily P Hyle Taige Hou Benjamin Osher Liyang Yu Fatma M Shebl A David Paltiel Kenneth A Freedberg Milton C Weinstein Nancy A Rigotti Rochelle P Walensky |
| author_facet | Krishna P Reddy Alexander J B Bulteel Douglas E Levy Pamela Torola Emily P Hyle Taige Hou Benjamin Osher Liyang Yu Fatma M Shebl A David Paltiel Kenneth A Freedberg Milton C Weinstein Nancy A Rigotti Rochelle P Walensky |
| author_sort | Krishna P Reddy |
| collection | DOAJ |
| description | Background and objective Simulation models can project effects of tobacco use and cessation and inform tobacco control policies. Most existing tobacco models do not explicitly include relapse, a key component of the natural history of tobacco use. Our objective was to develop, calibrate and validate a novel individual-level microsimulation model that would explicitly include smoking relapse and project cigarette smoking behaviours and associated mortality risks.Methods We developed the Simulation of Tobacco and Nicotine Outcomes and Policy (STOP) model, in which individuals transition monthly between tobacco use states (current/former/never) depending on rates of initiation, cessation and relapse. Simulated individuals face tobacco use-stratified mortality risks. For US women and men, we conducted cross-validation with a Cancer Intervention and Surveillance Modeling Network (CISNET) model. We then incorporated smoking relapse and calibrated cessation rates to reflect the difference between a transient quit attempt and sustained abstinence. We performed external validation with the National Health Interview Survey (NHIS) and the linked National Death Index. Comparisons were based on root-mean-square error (RMSE).Results In cross-validation, STOP-generated projections of current/former/never smoking prevalence fit CISNET-projected data well (coefficient of variation (CV)-RMSE≤15%). After incorporating smoking relapse, multiplying the CISNET-reported cessation rates for women/men by 7.75/7.25, to reflect the ratio of quit attempts to sustained abstinence, resulted in the best approximation to CISNET-reported smoking prevalence (CV-RMSE 2%/3%). In external validation using these new multipliers, STOP-generated cumulative mortality curves for 20-year-old current smokers and never smokers each had CV-RMSE ≤1% compared with NHIS. In simulating those surveyed by NHIS in 1997, the STOP-projected prevalence of current/former/never smokers annually (1998–2009) was similar to that reported by NHIS (CV-RMSE 12%).Conclusions The STOP model, with relapse included, performed well when validated to US smoking prevalence and mortality. STOP provides a flexible framework for policy-relevant analysis of tobacco and nicotine product use. |
| first_indexed | 2024-12-10T22:23:43Z |
| format | Article |
| id | doaj.art-fe3de178d20d4a26b928992d3a32e7bb |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-12-10T22:23:43Z |
| publishDate | 2020-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-fe3de178d20d4a26b928992d3a32e7bb2022-12-22T01:31:15ZengBMJ Publishing GroupBMJ Open2044-60552020-05-0110510.1136/bmjopen-2019-032579Novel microsimulation model of tobacco use behaviours and outcomes: calibration and validation in a US populationKrishna P Reddy0Alexander J B Bulteel1Douglas E Levy2Pamela Torola3Emily P Hyle4Taige Hou5Benjamin Osher6Liyang Yu7Fatma M Shebl8A David Paltiel9Kenneth A Freedberg10Milton C Weinstein11Nancy A Rigotti12Rochelle P Walensky13Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USAMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USATobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USAMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USAMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USAMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USAMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USAMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USAMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USAYale School of Public Health, New Haven, Connecticut, USAMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USAHarvard Medical School, Boston, Massachusetts, USATobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USAMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USABackground and objective Simulation models can project effects of tobacco use and cessation and inform tobacco control policies. Most existing tobacco models do not explicitly include relapse, a key component of the natural history of tobacco use. Our objective was to develop, calibrate and validate a novel individual-level microsimulation model that would explicitly include smoking relapse and project cigarette smoking behaviours and associated mortality risks.Methods We developed the Simulation of Tobacco and Nicotine Outcomes and Policy (STOP) model, in which individuals transition monthly between tobacco use states (current/former/never) depending on rates of initiation, cessation and relapse. Simulated individuals face tobacco use-stratified mortality risks. For US women and men, we conducted cross-validation with a Cancer Intervention and Surveillance Modeling Network (CISNET) model. We then incorporated smoking relapse and calibrated cessation rates to reflect the difference between a transient quit attempt and sustained abstinence. We performed external validation with the National Health Interview Survey (NHIS) and the linked National Death Index. Comparisons were based on root-mean-square error (RMSE).Results In cross-validation, STOP-generated projections of current/former/never smoking prevalence fit CISNET-projected data well (coefficient of variation (CV)-RMSE≤15%). After incorporating smoking relapse, multiplying the CISNET-reported cessation rates for women/men by 7.75/7.25, to reflect the ratio of quit attempts to sustained abstinence, resulted in the best approximation to CISNET-reported smoking prevalence (CV-RMSE 2%/3%). In external validation using these new multipliers, STOP-generated cumulative mortality curves for 20-year-old current smokers and never smokers each had CV-RMSE ≤1% compared with NHIS. In simulating those surveyed by NHIS in 1997, the STOP-projected prevalence of current/former/never smokers annually (1998–2009) was similar to that reported by NHIS (CV-RMSE 12%).Conclusions The STOP model, with relapse included, performed well when validated to US smoking prevalence and mortality. STOP provides a flexible framework for policy-relevant analysis of tobacco and nicotine product use.https://bmjopen.bmj.com/content/10/5/e032579.full |
| spellingShingle | Krishna P Reddy Alexander J B Bulteel Douglas E Levy Pamela Torola Emily P Hyle Taige Hou Benjamin Osher Liyang Yu Fatma M Shebl A David Paltiel Kenneth A Freedberg Milton C Weinstein Nancy A Rigotti Rochelle P Walensky Novel microsimulation model of tobacco use behaviours and outcomes: calibration and validation in a US population BMJ Open |
| title | Novel microsimulation model of tobacco use behaviours and outcomes: calibration and validation in a US population |
| title_full | Novel microsimulation model of tobacco use behaviours and outcomes: calibration and validation in a US population |
| title_fullStr | Novel microsimulation model of tobacco use behaviours and outcomes: calibration and validation in a US population |
| title_full_unstemmed | Novel microsimulation model of tobacco use behaviours and outcomes: calibration and validation in a US population |
| title_short | Novel microsimulation model of tobacco use behaviours and outcomes: calibration and validation in a US population |
| title_sort | novel microsimulation model of tobacco use behaviours and outcomes calibration and validation in a us population |
| url | https://bmjopen.bmj.com/content/10/5/e032579.full |
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