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For a cohort of year-olds in , the same scenario of absence of current and former smokers also results in maximum gains in terms of HLY and total LE: about 3. If Belgium had smoking prevalence of Sweden, the European country with the lowest smoking prevalence, the gain in terms of HLY and the reduction in ULY would be substantial for both genders in both reported years.

By , the increase in HLY would be greater for both sexes, while an additional decrease in ULY would be observed for females only. In , men would gain 1. By , this alternative scenario would gain 2. For women, these differences would be 0. Doubling the quit probabilities yields an increase of 0. In both scenarios and for both sexes, ULY decreases gradually over time with an increase in quit probabilities.

If the legal age of smoking rose from 16 up to 18, HLY would increase by 0.

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In , only a slight increase in HLY and a decrease in ULY for women and almost no change for men would be observed. To our knowledge, this is the first Belgian study aiming to compare how various reduced tobacco use scenarios may affect the length of HLY, ULY and overall LE of the Belgian population as a result of scenarios linked changes in the prevalence of current, former and never smokers. As most of our scenarios model maximum health gains, we provide valuable guidance to policy makers on which measures potentially have the highest impact. Furthermore, our study provides novel information on how reduced tobacco use can contribute to achieving the EU policy goal of increasing the number of HLYs Lagiewka Comparisons of modeled reduced tobacco use scenarios with the reference scenario indicate that the gains in HLY or LE and the reduction in ULY or in smoking prevalence differ in each scenario and over the projection period.

Interventions preventing smoking initiation mainly focus on never smokers among adolescents who possess low absolute risks of disability and mortality, and hence, their gains in terms of health are more observable in further future as the adolescents reach later adulthood. These results confirm the findings by Kulik et al. A possible explanation is that individuals in the smoking-free population without any smoking histories accumulate more ULYs over their prolonged overall life course than individuals in a population consisting of never and former smokers.

The fact that a combination of two different potential strategies for eradication of smoking is the most effective one is supported by findings from Rose that policies targeting the whole population are often the most effective ones Our results indicate that an implementation of a nationwide policy raising the legal age limits to buy tobacco products from 16 to 18 would only result in a negligible reduction in smoking prevalence among young people and in turn to an increase in HLY and LE.

These claims support findings of Fidler and West who investigated the impact on smoking prevalence after raising the minimum age of legal access to tobacco products from 16 to 18 in in England As adolescence is a sensitive developmental period, many risk factor behaviors peak during this time Office of the Surgeon General Preventing young people from experimenting with tobacco products when they are the most vulnerable should become priority of the policy makers in the government.

An important strength of our study is the use of nationally representative data from the Belgian population. Added value to this study also includes the use of disability indicator based on the GALI, allowing better comparability with international studies that use the same instrument. The key strength of our study relates to the use of a dynamic modeling tool exclusively developed for health impact assessment.

Our study has several limitations that must be considered when interpreting the results.

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Self-reported data on disability and smoking behavior were obtained from cross-sectional survey, and thus, assessing the causal relationship between smoking and disability prevalence may result in a temporal bias. Also, selection bias and underestimating of the true smoking exposure may have occurred in the BHIS and be further aggravated by the exclusion of individuals with missing information on smoking or the GALI.

The BHIS did not provide information on time since quitting for the former smokers; hence, the OR quantifying the association between smoking and disability does not take into account such information. Prior studies report conflicting findings on the impact of smoking cessation on disability. Some suggest that former smokers have similar disability hazards as current smokers, while others suggest that the smoking duration and time since quitting significantly affect the health-related quality of life and need to be considered Ostbye et al.

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This approach assumes constant transition rates between disability states and in case of rapid and sudden changes in the observed period may lead to biased results Sullivan Prior studies showed that the Sullivan method cannot detect sudden changes in disability transition rates, but can still provide good estimates if the changes in disability prevalence are smooth and relatively regular over longer period of time Mathers When comparing the results with the cohort life table approach, however, conclusions appeared to the robust.

In its current form, the software does not include probabilistic sensitivity analysis as its implementation into the model would be time-consuming and cost intensive. Future research should explore the role of frequency of smoking and time since quitting in the impact of tobacco control interventions on health expectancies.

Nonetheless, we can conclude that all modeled scenarios reduce the prevalence of smoking and prolong the years without disability. Int J Public Health 63 2 — Ambler G MFP: multivariable fractional polynomials. R package version 1. Accessed 23 Sept Arch Pub Health 76 1 — Demography 49 4 — Tob Control 10 3 — Soc Sci Med 74 9 — Arch Pub Health 71 1 Environ Impact Assess Rev — Am J Epidemiol 7 — Fidler JA, West R Changes in smoking prevalence in year-old versus older adults following a rise in legal age of sale: findings from an English population study.

Addiction 11 — Grignon M, Reddock J The effect of interventions targeting tobacco consumption: a review of literature reviews. Scand J Pub Health — J Am Stat Assoc — The Lancet — J Clin Epidemiol 63 8 — In: Seventh European conference on tobacco or health. Lagiewka K European innovation partnership on active and healthy ageing: triggers of setting the headline target of 2 additional healthy life years at birth at EU average by Arch Pub Health 70 1 Eur J Cancer Prev 17 6 — Accessed 25 Nov Am J Prev Med — Am J Prev Med 38 1 Its consonant system is more like Standard Dutch, although some phonemes are missing entirely.

Its vocabulary and grammar seem to be both a simplified and archaic version of many typical Dutch and Germanic root-words, with many French words intermixed.

To German ears, it has been described as sounding a bit like Swedish , while speakers of English have sometimes interpreted it as a very deviant form of Scots. The dialect will usually be understood by most Flemings, except those in Limburg. From Wikipedia, the free encyclopedia.

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