{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:37:18Z","timestamp":1789000638424,"version":"build-2803163510"},"reference-count":66,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2020,5,12]],"date-time":"2020-05-12T00:00:00Z","timestamp":1589241600000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005294","name":"Massachusetts General Hospital","doi-asserted-by":"publisher","award":["Steve and Deborah Gorlin MGH Research Scholars Awa"],"award-info":[{"award-number":["Steve and Deborah Gorlin MGH Research Scholars Awa"]}],"id":[{"id":"10.13039\/100005294","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["K01 DA042687"],"award-info":[{"award-number":["K01 DA042687"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K01 HL123349"],"award-info":[{"award-number":["K01 HL123349"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,4,16]]},"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background and objective<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In cross-validation, STOP-generated projections of current\/former\/never smoking prevalence fit CISNET-projected data well (coefficient of variation (CV)-RMSE\u226415%). 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 \u22641% compared with NHIS. In simulating those surveyed by NHIS in 1997, the STOP-projected prevalence of current\/former\/never smokers annually (1998\u20132009) was similar to that reported by NHIS (CV-RMSE 12%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-032579","type":"journal-article","created":{"date-parts":[[2020,5,13]],"date-time":"2020-05-13T05:46:30Z","timestamp":1589348790000},"page":"e032579","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Novel microsimulation model of tobacco use behaviours and outcomes: calibration and validation in a US population"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1832-2193","authenticated-orcid":false,"given":"Krishna P","family":"Reddy","sequence":"first","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander J B","family":"Bulteel","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas E","family":"Levy","sequence":"additional","affiliation":[{"name":"Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Torola","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily P","family":"Hyle","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taige","family":"Hou","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Osher","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liyang","family":"Yu","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatma M","family":"Shebl","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A David","family":"Paltiel","sequence":"additional","affiliation":[{"name":"Yale School of Public Health, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth A","family":"Freedberg","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milton C","family":"Weinstein","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Department of Health Policy and Management, Harvard T.H. 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