BACKGROUND: Tobacco smoking is the cause of many preventable diseases and premature deaths in the UK and around the world. It poses enormous health- and non-health-related costs to the affected individuals, employers, and the society at large. The World Health Organization (WHO) estimates that, globally, smoking causes over US500billionineconomicdamageeachyear.OBJECTIVES:ThispaperexaminesglobalandUKevidenceontheeconomicimpactofsmokingprevalenceandevaluatestheeffectivenessandcosteffectivenessofsmokingcessationmeasures.STUDYSELECTIONSearchmethods:Weusedtwomajorhealthcare/economicresearchdatabases,namelyPubMedandtheNationalInstituteforHealthResearch(NIHR)databasethatcontainstheBritishNationalHealthService(NHS)EconomicEvaluationDatabase;CochraneLibraryofsystematicreviewsinhealthcareandhealthpolicy;andotherhealth−care−relatedbibliographicsources.Wealsoperformedhandsearchingofrelevantarticles,healthreports,andwhitepapersissuedbygovernmentbodies,internationalhealthorganizations,andhealthinterventioncampaignagencies.Selectioncriteria:Thepaperincludescost−effectivenessstudiesfrommedicaljournals,healthreports,andwhitepaperspublishedbetween1992andJuly2014,butincludedonlyeightrelevantstudiesbefore1992.Mostofthepapersreviewedreportedoutcomesonsmokingprevalence,aswellasthedirectandindirectcostsofsmokingandthecostsandbenefitsofsmokingcessationinterventions.Weexcludedpapersthatmerelydescribedtheeffectivenessofaninterventionwithoutincludingeconomicorcostconsiderations.Wealsoexcludedpapersthatcombinesmokingcessationwiththereductionintheriskofotherdiseases.Datacollectionandanalysis:TheincludedstudieswereassessedagainstcriteriaindicatedintheCochraneReviewersHandbookversion5.0.0.Outcomesassessedinthereview:Primaryoutcomesoftheselectedstudiesaresmokingprevalence,directandindirectcostsofsmoking,andthecostsandbenefitsofsmokingcessationinterventions(e.g.,“costperquitter”,“costperlifeyearsaved”,“costperquality−adjustedlifeyeargained,”“presentvalue”or“netbenefits”fromsmokingcessation,and“costsavings”frompersonalhealthcareexpenditure).MAINRESULTS:Themainfindingsofthisstudyareasfollows:1.Thecostsofsmokingcanbeclassifiedintodirect,indirect,andintangiblecosts.About15151 billion. 2. The costs of smoking notwithstanding, it produces some potential economic benefits. The economic activities generated from the production and consumption of tobacco provides economic stimulus. It also produces huge tax revenues for most governments, especially in high-income countries, as well as employment in the tobacco industry. Income from the tobacco industry accounts for up to 7.4% of centrally collected government revenue in China. Smoking also yields cost savings in pension payments from the premature death of smokers. 3. Smoking cessation measures could range from pharmacological treatment interventions to policy-based measures, community-based interventions, telecoms, media, and technology (TMT)-based interventions, school-based interventions, and workplace interventions. 4. The cost per life year saved from the use of pharmacological treatment interventions ranged between US128andUS1,450 and up to US4,400perquality−adjustedlifeyears(QALYs)saved.Theuseofpharmacotherapiessuchasvarenicline,NRT,andBupropion,whencombinedwithGPcounselingorotherbehavioraltreatmentinterventions(suchasproactivetelephonecounselingandWeb−baseddelivery),isbothclinicallyeffectiveandcosteffectivetoprimaryhealthcareproviders.5.Price−basedpolicymeasuressuchasincreaseintobaccotaxesareunarguablythemosteffectivemeansofreducingtheconsumptionoftobacco.A102 to US112perlifeyeargained(LYG)whilereducingsmokingprevalencebyupto30500 and US614perLYG.7.Advertisingmedia,telecommunications,andothertechnology−basedinterventions(suchasTV,radio,print,telephone,theInternet,PC,andotherelectronicmedia)usuallyhavepositivesynergisticeffectsinreducingsmokingprevalenceespeciallywhencombinedtodeliversmokingcessationmessagesandcounselingsupport.However,theoutcomesonthecosteffectivenessofTMT−basedmeasureshavebeeninconsistent,andthismadeitdifficulttoattributeresultstospecificmedia.Thedifferencesinreportedcosteffectivenessmaybepartlyattributedtovaryingmethodologicalapproachesincludingvaryingparametricinputs,differencesinnationalcontexts,differencesinadvertisingcampaignstestedondifferentmedia,anddisparatelevelsofresourcingbetweencampaigns.Duetoitsuniversalreachandlowimplementationcosts,onlinecampaignappearstobesubstantiallymorecosteffectivethanothermedia,thoughitmaynotbeaseffectiveinreducingsmokingprevalence.8.School−basedsmokingprevalenceprogramstendtoreduceshort−termsmokingprevalencebybetween3016,400 to US580,000dependingonthescaleandscopeofintervention.Thecosteffectivenessofschool−basedprogramsshowthatonecouldexpectasavingofapproximatelybetweenUS2,000 and US20,000perQALYsavedduetoavertedsmokingafter2–4yearsoffollow−up.9.Workplace−basedinterventionscouldrepresentasoundeconomicinvestmenttobothemployersandthesocietyatlarge,achievingabenefit−costratioofupto8.75andgenerating12−monthemployercostsavingsofbetween150 and $540 per nonsmoking employee. Implementing smoke-free workplaces would also produce myriads of new quitters and reduce the amount of cigarette consumption, leading to cost savings in direct medical costs to primary health care providers. Workplace interventions are, however, likely to yield far greater economic benefits over the long term, as reduced prevalence will lead to a healthier and more productive workforce. CONCLUSIONS: We conclude that the direct costs and externalities to society of smoking far outweigh any benefits that might be accruable at least when considered from the perspective of socially desirable outcomes (i.e., in terms of a healthy population and a productive workforce). There are enormous differences in the application and economic measurement of smoking cessation measures across various types of interventions, methodologies, countries, economic settings, and health care systems, and these may have affected the comparability of the results of the studies reviewed. However, on the balance of probabilities, most of the cessation measures reviewed have not only proved effective but also cost effective in delivering the much desired cost savings and net gains to individuals and primary health care providers
Summarizes research findings on best practices for interventions, policy developments, and future directions discussed at an October 2006 conference of RWJF's Smoke-Free Families: Innovations to Stop Smoking During and Beyond Pregnancy program
Despite the high prevalence of tobacco use among people with substance use disorders, tobacco dependence is often overlooked in addiction treatment programs. Several studies and a meta-analytic review have concluded that patients who receive tobacco dependence treatment during addiction treatment have better overall substance abuse treatment outcomes compared with those who do not. Barriers that contribute to the lack of attention given to this important problem include staff attitudes about and use of tobacco, lack of adequate staff training to address tobacco use, unfounded fears among treatment staff and administration regarding tobacco policies, and limited tobacco dependence treatment resources. Specific clinical-, program-, and system-level changes are recommended to fully address the problem of tobacco use among alcohol and other drug abuse patients
IntroductionEven though many adolescent smokers want to quit, it is difficult to recruit them into smoking cessation interventions. Little is known about which adolescent smokers are currently reached by these measures. In this study we compare participants of a group-based, cognitive behavioral smoking cessation intervention with adolescent smokers who decided against participating.MethodsWithin a non-randomized controlled trial, data of 1053 smokers (aged 11-19) from 42 German secondary schools were analyzed. Of these smokers, 272 were recruited into 47 courses of the intervention. An in-class information session, individually addressing potential participants, and incentives were used as means of recruitment. Personal predictors of participation were analyzed using regression analyses and multivariate path analyses to test for mediation.ResultsIn the path analysis model, nicotine dependence, quit motivation, and a previous quit attempt were directly positively related to participation. Heavier smoking behavior was indirectly positively associated with participation through nicotine dependence and negatively through quit motivation, yielding an overall positive indirect effect. The positive effect of a previous quit attempt on participation was partially mediated through nicotine dependence and quit motivation. The proportion of smoking friends were indirectly positively related to participation, mediated through nicotine dependence.ConclusionsSince adolescents with heavier smoking behavior and stronger nicotine dependence are less likely to undertake a successful unassisted quit attempt, the reach of these young smokers with professional cessation interventions is desirable. Further measures to improve the recruitment of those currently not motivated to quit have to be examined in future studies
Centre for Research in Economic Sociology and Innovation (CRESI)
Publication date
01/01/2010
Field of study
This report is the second deliverable of the ?Digital Inclusion and Social Knowledge Media for Health: Frameworks and Roadmaps? project. The first discussed the concept of social and digital exclusion whilst this report focuses on the emerging phenomenon of social media. The report outlines current knowledge on the users and usages of social media for health and goes on to discuss social media in the context of a continuing focus (ref. D1.1) on the areas of mental health, smoking cessation and teenage lifestyles. The report concludes with an outline of an approach to a ?social media strategy? and with suggestions for directions for future research
IntroductionThe National Comprehensive Cancer Control Program (NCCCP) and National Tobacco Control Program (NTCP) are both well-positioned to promote the use of population-based tobacco cessation interventions, such as state quitlines and Web-based interventions.AimsThis paper outlines the methodology used to conduct a comparative effectiveness research study of traditional and Web-based tobacco cessation and quitline promotion approaches.MethodsA mixed-methods study with three components was designed to address the effect of promotional activities on service usage and the comparative effectiveness of population-based smoking cessation activities across multiple states.Results/FindingsThe cessation intervention component followed 7,902 smokers (4,307 quitline users and 3,595 Web intervention users) to ascertain prevalence of 30-day abstinence rates 7 months after registering for smoking cessation services. User characteristics and quit success was compared across the two modalities. In the promotions component, reach and use of traditional and innovative promotion strategies were assessed for 24 states, including online advertising, state Web sites, social media, mobile applications, and their effects on quitline call volume. The partnership intervention component studied the extent of collaboration among six selected NCCCPs and NTCPs.ConclusionsThis study will guide program staff and clinicians with evidence-based recommendations and best practices for implementation of tobacco cessation within their patient and community populations and establish an evidence base that can be used for decision making.CC999999/Intramural CDC HHS/United States2017-03-01T00:00:00Z28243318PMC5325700vault:2346
Many modalities of tobacco use prevention programming have been implemented including various policy regulations (tax increases, warning labels, limits on access, smoke-free policies, and restrictions on marketing), mass media programming, school-based classroom education, family involvement, and involvement of community agents (i.e., medical, social, political). The present manuscript provides a glance at these modalities to compare relative and combined impact of them on youth tobacco use. In a majority of trials, community-wide programming, which includes multiple modalities, has not been found to achieve impacts greater than single modality programming. Possibly, the most effective means of prevention involves a careful selection of program type combinations. Also, it is likely that a mechanism for coordinating maximally across program types (e.g., staging of programming) is needed to encourage a synergistic impact. Studying tobacco use prevention as a complex system is considered as a means to maximize effects from combinations of prevention types. Future studies will need to more systematically consider the role of combined programming
Objective To evaluate the impact of telling patients their estimated spirometric lung age as an incentive to quit smoking.Design Randomised controlled trial.Setting Five general practices in Hertfordshire, England.Participants 561 current smokers aged over 35.Intervention All participants were offered spirometric assessment of lung function. Participants in intervention group received their results in terms of "lung age" (the age of the average healthy individual who would perform similar to them on spirometry). Those in the control group received a raw figure for forced expiratory volume at one second (FEV1). Both groups were advised to quit and offered referral to local NHS smoking cessation services.Main outcome measures The primary outcome measure was verified cessation of smoking by salivary cotinine testing 12 months after recruitment. Secondary outcomes were reported changes in daily consumption of cigarettes and identification of new diagnoses of chronic obstructive lung disease.Results Follow-up was 89%. Independently verified quit rates at 12 months in the intervention and control groups, respectively, were 13.6% and 6.4% (difference 7.2%, P=0.005, 95% confidence interval 2.2% to 12.1%; number needed to treat 14). People with worse spirometric lung age were no more likely to have quit than those with normal lung age in either group. Cost per successful quitter was estimated at 280 pound ((euro) 365, $556). A new diagnosis of obstructive lung disease was made in 17% in the intervention group and 14% in the control group; a total of 16% (89/561) of participants.Conclusion Telling smokers their lung age significantly improves the likelihood of them quitting smoking, but the mechanism by which this intervention achieves its effect is unclear.Trial registration National Research Register N0096173751