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Open Access How Much Ongoing Smoking Reduction is an Echo of the Initial Mass Education?

This article is Open Access under the terms of the Creative Commons CC BY-NC-ND licence.

Objectives: In this paper, we attempt to quantify the "echo" effects of the downward shock in US smoking prevalence from mass education starting about 1965 through 2010. Methods: An agent- based population simulation replicates the observed effects of the initial education shock on smoking prevalence, and then estimates ongoing echo effects based on empirical estimates of the effects of parental smoking on initiation and peer-group quitting contagion. Further simulations estimate what additional echo effects would explain the entire historical reduction. Results: About one-third of the observed prevalence decline through 2010 can be attributed solely to fewer parents smoking after the initial education shock. Combining peer-group cessation contagion explains well over one-half of the total historical prevalence reduction. Plausible additional echo effects could explain the entire historical reduction in smoking prevalence. Conclusions: Ongoing anti-smoking interventions are credited with ongoing reductions in smoking, but most, or perhaps all that credit really belongs to the initial education and its continuing echoes. Ensuring that people understand the health risks of smoking causes large and ongoing reductions. The effect of all other interventions (other than introducing appealing substitutes) is clearly modest, and quite possibly, approximately zero, after accounting for the echo effects.


Document Type: Research Article

Affiliations: 1: Carl V. Phillips, Epiphi Consulting, Nashua, NH, United States;, Email: [email protected] 2: Marewa Glover, Centre of Research Excellence: Indigenous Sovereignty & Smoking, Auckland, New Zealand

Publication date: January 1, 2022

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  • The American Journal of Health Behavior seeks to improve the quality of life through multidisciplinary health efforts in fostering a better understanding of the multidimensional nature of both individuals and social systems as they relate to health behaviors.

    The Journal aims to provide a comprehensive understanding of the impact of personal attributes, personality characteristics, behavior patterns, social structure, and processes on health maintenance, health restoration, and health improvement; to disseminate knowledge of holistic, multidisciplinary approaches to designing and implementing effective health programs; and to showcase health behavior analysis skills that have been proven to affect health improvement and recovery.

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