SimSmoke Model Evaluation of the Effect of Tobacco Control Policies in Korea: The Unknown Success Story

Objectives. We evaluated the effect of strict tobacco control policies, implemented beginning in 1995 in the Republic of Korea, on smoking prevalence and deaths.Methods. SimSmoke is a simulation model of the effect of tobacco control policies over time on smoking initiation and cessation. It uses standard attribution methods to estimate lives saved as a result of new policies. After validating the model against smoking prevalence, we used it to determine the Korean policies'' effect on smoking prevalence.Results. The model predicted smoking prevalence accurately between 1995 and 2006. We estimated that 70% of the 24% relative reduction in smoking rates over that period was attributable to tobacco control policies, mainly tax increases and a strong media campaign, and that the policies will prolong 104 812 male lives by the year 2027.Conclusions. Our results document Korea''s success in reducing smoking prevalence and prolonging lives, which may serve as an example for other Asian nations. Further improvements may be possible with higher taxes and more comprehensive smoke-free laws, cessation policies, advertising restrictions, and health warnings.Many Asian nations have smoking prevalence rates among males of at least 50%, leading to a large share of the world''s 5 million deaths attributable to smoking each year.¹ Worldwide, annual tobacco-related mortality is expected to increase to 10 million by 2030,¹ with an increasing share of those deaths in Asia, unless effective tobacco control measures are implemented.Most Asian nations have signed the Framework Convention for Tobacco Control, developed through the World Health Organization. This pact advocates high cigarette taxes, smoke-free indoor air laws, cessation treatment coverage, advertising bans, health warnings, and a well-organized media campaign. Thailand has implemented many of the suggested policies and has shown remarkable success in reducing male and female smoking rates.² Success in other Asian nations has not been documented.As recently as 1995, 67% of males smoked in the Republic of Korea.³ Taxes were increased gradually in the late 1990s, and some of the funds were allocated to tobacco control. The framework was ratified by Korea in May 2005. By the end of 2006, Korea had substantially increased the tax rate on cigarettes, implemented a strong antismoking campaign, strengthened clean air laws and health warnings, and made cessation treatments more accessible.³ No previous study evaluated the effect of these policies.When more than 1 policy is implemented, it is difficult for empirical studies to distinguish each policy''s effects.⁴ Simulation models combine information from diverse sources to examine the effects of different policies over time.^4,5 To determine these effects in Korea, we adopted the SimSmoke tobacco control policy model,^4,6–8 which simultaneously considers a broader array of public policies than do other smoking models.^9–14 The model has accurately explained trends in smoking rates for the United States as a whole and for several states,^7,15–17 as well as for other nations.²We used Korean data to develop a SimSmoke model for that country. We used the model to estimate the effect of individual and combined tobacco control policies implemented between 1995 and 2006 on male smoking prevalence and deaths.