{
  "abstract": "Introduction Cigarette smoking continues to exert a major impact on morbidity and mortality. We aim to provide robust estimates of smoking dynamics and their effects on mortality in Tuscany, Italy, from 1993 to 2019, along with forecasts under alternative tobacco control policies (TCPs).Methods Smoking dynamics are modelled using a compartmental model combined with Monte Carlo (MC) simulations to propagate uncertainties. A variance-based global sensitivity analysis (GSA) quantifies the contribution of each input to output variance. TCPs are ranked according to the Surface Under the Cumulative Ranking Curve (SUCRA).Results The MC approach produces results consistent with those obtained when only sampling variability is considered, although with wider uncertainty intervals (UIs). We estimate that in 2023 smoking caused 3,348 deaths (90% UI 2,761 to 3,942) among men and 1749 deaths (90% UI 1,397 to 2,888) among women aged over 65. By 2063, these numbers are projected to decline to 1477 (90% UI 1,081 to 2,144) and 1,436 (90% UI 742 to 2,138), respectively. According to the GSA, the time period used for calibrating the model is the main source of uncertainty in the model outputs, suggesting that the phenomenon has changed over time. The tobacco-free generation policy (TCP1) shows the highest SUCRA for smoking prevalence, while cessation treatments rank highest for mortality impact.Discussion The approach shows promise for identifying key sources of uncertainty and guiding public health strategies. Although uncertainty limits the precise quantification of future dynamics and impacts, the TCP1 is likely to exert the strongest long-term effect on reducing smoking prevalence, while cessation interventions remain essential for achieving short-term reductions in smoking-attributable mortality.",
  "authors": [
    {
      "affiliations": [
        "Saint Camillus International University of Health and Medical Sciences, Rome, Italy"
      ],
      "name": "Alessio Lachi"
    },
    {
      "affiliations": [
        "ISPRO, Florence, Italy",
        "Meyer Children’s Hospital IRCCS, Florence, Italy"
      ],
      "name": "Giulia Carreras"
    },
    {
      "affiliations": [
        "Department of Economics and Statistics, University of Salerno, Fisciano, Italy"
      ],
      "name": "Cecilia Viscardi"
    },
    {
      "affiliations": [
        "UPF Barcelona School of Management, Pompeu Fabra University, Barcelona, Spain",
        "Centre for the Study of the Sciences and the Humanities, University of Bergen, Bergen, Norway"
      ],
      "name": "Andrea Saltelli"
    },
    {
      "affiliations": [
        "Department of Statistics, Computer Science, Applications “Giuseppe Parenti”, University of Florence, Florence, Italy",
        "Florence Center for Data Science, University of Florence, Florence, Italy"
      ],
      "name": "Michela Baccini"
    }
  ],
  "title": "What is the best tobacco control policy in Tuscany? An assessment using uncertainty analysis",
  "uid": "909120c5-659d-5d4f-b1ad-2f166fa45f74"
}