Exploring scenarios to dramatically reduce smoking prevalence: A simulation model of the three-part cessation process

warned of the hazards of smoking tobacco,1 enormous strides have been made in reducing adult smoking prevalence. At the peak of US tobacco use in 1965, the adult smoking preva-lence was 42.4%2; now, only 19.8 % of adults smoke.3 Nevertheless, an estimated 44.4 million American adults continue to smoke, incurring 443000 premature deaths, with $97 billion in productivity losses and $96 billion in health care expenditures.4 In recognition of the problem, Healthy People 2010 set an ambitious goal of reducing smoking prevalence to 12 % by 2010.5 With that goal now almost certainly unattain-able,6 new approaches need to be explored. Smoking prevalence can be reduced in