Background:
Around the world, countries are setting endgame targets that look to bring smoking prevalence below a certain rate. Canada, for instance, has set a target of 5% smoking by 2035. However, what numbers of cigarettes smoked per day should countries expect as they approach these scenarios? The information is particularly important for government to understand the impacts of endgames on revenue.

Methods:
A population change model was developed to predict change in cigarettes per day under endgame scenarios for the Province of Ontario, Canada. Population predictions were obtained from Statistics Canada for the period 2014-2035 including expected births, deaths, and immigration by age group (12-19, 20-34, 35-44, 45-64, 65+). Smoking prevalence was obtained from the 2014 Canadian Community Health Survey. Change in cigarettes per day was modelled scenarios assuming that the effects on cigarettes per day was consistent with prevalence change.

Results:
To reach the tobacco endgame by 2035, it would be require for Ontario to go from 2.1 million smokers in 2014 to 700,000 smokers in 2035 with expected prevalence rates ranging from 1.8% among 12-19 year olds to 6.9% among 20-34 year olds. Average number of cigarettes per day was expected to be 4.0 cigarettes smoked per day on average by 2035 down from 13.3 cigarettes a day in 2014.

Conclusions:
In the province of Ontario, it would be expected that the average remaining smoker in an endgame scenario would smoke 4 cigarettes per day. This analysis uses the same assumptions used to estimate the effects of tax on prevalence, but the effect of prevalence change on cigarette consumption may differ with other interventions. However, this analysis presents a challenge to the hardcore hypothesis.