Health Benefits of Reducing Sugar-Sweetened Beverage Intake in High Risk Populations of California: Results from the Cardiovascular Disease (CVD) Policy Model

Background Consumption of sugar-sweetened beverage (SSB) has risen over the past two decades, with over 10 million Californians drinking one or more SSB per day. High SSB intake is associated with risk of type 2 diabetes, obesity, hypertension, and coronary heart disease (CHD). Reduction of SSB intake and the potential impact on health outcomes in California and among racial, ethnic, and low-income sub-groups has not been quantified. Methods We projected the impact of reduced SSB consumption on health outcomes among all Californians and California subpopulations from 2013 to 2022. We used the CVD Policy Model – CA, an established computer simulation of diabetes and heart disease adapted to California. We modeled a reduction in SSB intake by 10–20% as has been projected to result from proposed penny-per-ounce excise tax on SSB and modeled varying effects of this reduction on health parameters including body mass index, blood pressure, and diabetes risk. We projected avoided cases of diabetes and CHD, and associated health care cost savings in 2012 US dollars. Results Over the next decade, a 10–20% SSB consumption reduction is projected to result in a 1.8–3.4% decline in the new cases of diabetes and an additional drop of 0.5–1% in incident CHD cases and 0.5–0.9% in total myocardial infarctions. The greatest reductions are expected in African Americans, Mexican Americans, and those with limited income regardless of race and ethnicity. This reduction in SSB consumption is projected to yield $320–620 million in medical cost savings associated with diabetes cases averted and an additional savings of$14–27 million in diabetes-related CHD costs avoided. Conclusions A reduction of SSB consumption could yield substantial population health benefits and cost savings for California. In particular, racial, ethnic, and low-income subgroups of California could reap the greatest health benefits

Health Benefits of Reducing Sugar-Sweetened Beverage Intake in High Risk Populations of California: Results from the Cardiovascular Disease (CVD) Policy Model

BACKGROUND: Consumption of sugar-sweetened beverage (SSB) has risen over the past two decades, with over 10 million Californians drinking one or more SSB per day. High SSB intake is associated with risk of type 2 diabetes, obesity, hypertension, and coronary heart disease (CHD). Reduction of SSB intake and the potential impact on health outcomes in California and among racial, ethnic, and low-income sub-groups has not been quantified. METHODS: We projected the impact of reduced SSB consumption on health outcomes among all Californians and California subpopulations from 2013 to 2022. We used the CVD Policy Model – CA, an established computer simulation of diabetes and heart disease adapted to California. We modeled a reduction in SSB intake by 10–20% as has been projected to result from proposed penny-per-ounce excise tax on SSB and modeled varying effects of this reduction on health parameters including body mass index, blood pressure, and diabetes risk. We projected avoided cases of diabetes and CHD, and associated health care cost savings in 2012 US dollars. RESULTS: Over the next decade, a 10–20% SSB consumption reduction is projected to result in a 1.8–3.4% decline in the new cases of diabetes and an additional drop of 0.5–1% in incident CHD cases and 0.5–0.9% in total myocardial infarctions. The greatest reductions are expected in African Americans, Mexican Americans, and those with limited income regardless of race and ethnicity. This reduction in SSB consumption is projected to yield $320–620 million in medical cost savings associated with diabetes cases averted and an additional savings of$14–27 million in diabetes-related CHD costs avoided. CONCLUSIONS: A reduction of SSB consumption could yield substantial population health benefits and cost savings for California. In particular, racial, ethnic, and low-income subgroups of California could reap the greatest health benefits

Effect of the California Tobacco Control Program on Personal Health Care Expenditures

Background: Large state tobacco control programs have been shown to reduce smoking and would be expected to affect health care costs. We investigate the effect of California\u27s large-scale tobacco control program on aggregate personal health care expenditures in the state. Methods and Findings: Cointegrating regressions were used to predict (1) the difference in per capita cigarette consumption between California and 38 control states as a function of the difference in cumulative expenditures of the California and control state tobacco control programs, and (2) the relationship between the difference in cigarette consumption and the difference in per capita personal health expenditures between the control states and California between 1980 and 2004. Between 1989 (when it started) and 2004, the California program was associated with $86 billion (2004 US dollars) (95$28 billion to $151 billion) lower health care expenditures than would have been expected without the program. This reduction grew over time, reaching 7.3% (95% CI 2.7%-12.1%) of total health care expenditures in 2004. Conclusions: A strong tobacco control program is not only associated with reduced smoking, but also with reductions in health care expenditures

Predicted Effect of California Tobacco Control Funding on Smoking Prevalence, Cigarette Consumption, and Healthcare Costs, 2012-2016

This report contains the results of a new model of the effect of the California tobacco control program on smoking behavior and healthcare expenditure, and forecasts four alternative funding scenarios for the California tobacco control program.We use time series regression analysis of aggregate data on tobacco control program funding, smoking behavior and health care expenditures in California compared to control states. The estimates measure the difference in smoking behavior and health care expenditures between California and the control states that can be attributed to differences in tobacco control funding. We use two different estimation methods to check the analysis and find that both produce almost identical results.If the current funding levels are continued at 5 cents per pack (established by 1988’s Proposition 99), the baseline scenario, then California smoking prevalence will stop declining increase from 12.9% to 13.3% between 2012 and 2016 and cigarette consumption per smoker will increase from 233 to 253 packs per year from 2012 to 2016. By 2016, prevalence and consumption per smoker would increase by 9% and 14% from the level in 2011, respectively. The contribution of smoking to healthcare costs in California will also begin to increase.Cutting the funding level by half would to 2.5 cents per pack initially result in $39 million less in cumulative tobacco control spending per year. This reduction in spending will result in an increase in both prevalence and cigarettes consumed per smoker. Prevalence rises from about 13$508 million the tobacco industry in pre-tax sales) and a cumulative increase in total California healthcare costs between 2012 and 2016 would be $2.2 billion.An increase in funding by$0.20 per pack (to a total of $0.25 per pack) from the$1.00 tobacco tax increase (i.e., the proposed California Cancer Research Act initiative) would restore the decline in current smoking prevalence and cigarette consumption per smoker. Prevalence would decrease from about 11.2% to 10.9% between 2012 and 2016 and cigarette consumption per smoker would decrease from 199 to 189 cigarettes per year. By 2016, prevalence and consumption per smoker would decrease by 11% and 15% from the level in 2011, respectively. Compared to the baseline scenario, a total of 1.6 billion fewer packs of cigarettes would be smoked (worth $7.2 billion in pre-tax sales to the tobacco industry) and total healthcare costs would be reduced by$28.2 billion.An increase in per capita funding to the level recommended by the US Centers for Disease Control and Prevention (CDC)Best Practicesfor California ($12.12 per capita, or 56 cents per pack), would initiate a rapid decline in smoking prevalence and a drop in consumption. Doing so would require increasing annual funding for the California Tobacco Control Program from$77.8 million in 2009 to a about $481 million per year. Smoking prevalence would decrease from about 12$6.5 billion in pre-tax sales to the tobacco industry) and reduce cumulative total healthcare costs by $31.6 billion. Table. Changes in current smoking prevalence and consumption per smoker, California healthcare costs and tobacco industry revenues between 2011 and 2016 under four scenariosScenarioPercent change between 2011 and 2016Change in California Health Care CostsChange in Tobacco Industry SalesPrevalenceConsumption per Smoker1. Status quo (baseline):$0.05 per pack+9%+14%BaselineBaseline2. Cut program in half: $0.025 per pack+10$2.2 billion+$0.5 billion3. Enact Calif Cancer Res Act:$0.25 per pack and $1 tax increase-11$28.2 billion-$7.2 billion4. CDC recommended funding:$12.12 per capita ($0.056 per pack)-10$31.6 billion-$6.5 billion NOTE:  See Addendum at the end of this report for updated values for these estimates.            The forecast results indicate that if the current level of California tobacco control funding continues at the current 5 cents per pack, then smoking prevalence and consumption per smoker will slowly start to increase over time and estimated healthcare savings due to the reduction in smoking in California will be gradually eroded. In order to continue progress in reducing harmful smoking behaviors in California, per capita funding for tobacco control programs should be substantially increased. Increasing per capita funding with a$1 excise tax increase as proposed in the California Cancer Research Act that devotes an additional $0.20 per pack sold or increasing per capita funding to the level recommended for California by the CDC would reduce smoking behavior at rates similar to those seen in earlier years of the California program, together with the attendant large reductions in healthcare costs that the California Tobacco Control Program created

Smoking Behavior and Healthcare Expenditure in the United States, 1992-2009: Panel Data Estimates.

BACKGROUND:Reductions in smoking in Arizona and California have been shown to be associated with reduced per capita healthcare expenditures in these states compared to control populations in the rest of the US. This paper extends that analysis to all states and estimates changes in healthcare expenditure attributable to changes in aggregate measures of smoking behavior in all states. METHODS AND FINDINGS:State per capita healthcare expenditure is modeled as a function of current smoking prevalence, mean cigarette consumption per smoker, other demographic and economic factors, and cross-sectional time trends using a fixed effects panel data regression on annual time series data for each the 50 states and the District of Columbia for the years 1992 through 2009. We found that 1% relative reductions in current smoking prevalence and mean packs smoked per current smoker are associated with 0.118% (standard error [SE] 0.0259%, p < 0.001) and 0.108% (SE 0.0253%, p < 0.001) reductions in per capita healthcare expenditure (elasticities). The results of this study are subject to the limitations of analysis of aggregate observational data, particularly that a study of this nature that uses aggregate data and a relatively small sample size cannot, by itself, establish a causal connection between smoking behavior and healthcare costs. Historical regional variations in smoking behavior (including those due to the effects of state tobacco control programs, smoking restrictions, and differences in taxation) are associated with substantial differences in per capita healthcare expenditures across the United States. Those regions (and the states in them) that have lower smoking have substantially lower medical costs. Likewise, those that have higher smoking have higher medical costs. Sensitivity analysis confirmed that these results are robust. CONCLUSIONS:Changes in healthcare expenditure appear quickly after changes in smoking behavior. A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. State and national policies that reduce smoking should be part of short term healthcare cost containment

Predicted Effect of California Tobacco Control Funding on Smoking Prevalence, Cigarette Consumption, and Healthcare Costs, 2012-2016

This report contains the results of a new model of the effect of the California tobacco control program on smoking behavior and healthcare expenditure, and forecasts four alternative funding scenarios for the California tobacco control program.We use time series regression analysis of aggregate data on tobacco control program funding, smoking behavior and health care expenditures in California compared to control states. The estimates measure the difference in smoking behavior and health care expenditures between California and the control states that can be attributed to differences in tobacco control funding. We use two different estimation methods to check the analysis and find that both produce almost identical results.If the current funding levels are continued at 5 cents per pack (established by 1988’s Proposition 99), the baseline scenario, then California smoking prevalence will stop declining increase from 12.9% to 13.3% between 2012 and 2016 and cigarette consumption per smoker will increase from 233 to 253 packs per year from 2012 to 2016. By 2016, prevalence and consumption per smoker would increase by 9% and 14% from the level in 2011, respectively. The contribution of smoking to healthcare costs in California will also begin to increase.Cutting the funding level by half would to 2.5 cents per pack initially result in $39 million less in cumulative tobacco control spending per year. This reduction in spending will result in an increase in both prevalence and cigarettes consumed per smoker. Prevalence rises from about 13$508 million the tobacco industry in pre-tax sales) and a cumulative increase in total California healthcare costs between 2012 and 2016 would be $2.2 billion.An increase in funding by$0.20 per pack (to a total of $0.25 per pack) from the$1.00 tobacco tax increase (i.e., the proposed California Cancer Research Act initiative) would restore the decline in current smoking prevalence and cigarette consumption per smoker. Prevalence would decrease from about 11.2% to 10.9% between 2012 and 2016 and cigarette consumption per smoker would decrease from 199 to 189 cigarettes per year. By 2016, prevalence and consumption per smoker would decrease by 11% and 15% from the level in 2011, respectively. Compared to the baseline scenario, a total of 1.6 billion fewer packs of cigarettes would be smoked (worth $7.2 billion in pre-tax sales to the tobacco industry) and total healthcare costs would be reduced by$28.2 billion.An increase in per capita funding to the level recommended by the US Centers for Disease Control and Prevention (CDC)Best Practicesfor California ($12.12 per capita, or 56 cents per pack), would initiate a rapid decline in smoking prevalence and a drop in consumption. Doing so would require increasing annual funding for the California Tobacco Control Program from$77.8 million in 2009 to a about $481 million per year. Smoking prevalence would decrease from about 12$6.5 billion in pre-tax sales to the tobacco industry) and reduce cumulative total healthcare costs by $31.6 billion. Table. Changes in current smoking prevalence and consumption per smoker, California healthcare costs and tobacco industry revenues between 2011 and 2016 under four scenariosScenarioPercent change between 2011 and 2016Change in California Health Care CostsChange in Tobacco Industry SalesPrevalenceConsumption per Smoker1. Status quo (baseline):$0.05 per pack+9%+14%BaselineBaseline2. Cut program in half: $0.025 per pack+10$2.2 billion+$0.5 billion3. Enact Calif Cancer Res Act:$0.25 per pack and $1 tax increase-11$28.2 billion-$7.2 billion4. CDC recommended funding:$12.12 per capita ($0.056 per pack)-10$31.6 billion-$6.5 billion NOTE:  See Addendum at the end of this report for updated values for these estimates.            The forecast results indicate that if the current level of California tobacco control funding continues at the current 5 cents per pack, then smoking prevalence and consumption per smoker will slowly start to increase over time and estimated healthcare savings due to the reduction in smoking in California will be gradually eroded. In order to continue progress in reducing harmful smoking behaviors in California, per capita funding for tobacco control programs should be substantially increased. Increasing per capita funding with a$1 excise tax increase as proposed in the California Cancer Research Act that devotes an additional $0.20 per pack sold or increasing per capita funding to the level recommended for California by the CDC would reduce smoking behavior at rates similar to those seen in earlier years of the California program, together with the attendant large reductions in healthcare costs that the California Tobacco Control Program created

Effect of the Arizona tobacco control program on cigarette consumption and healthcare expenditures

This research investigates the relationship between per capita tobacco control expenditures, cigarette consumption, and healthcare expenditures in the state of Arizona. Arizona's tobacco control program, which was established in 1994, concentrates on youth uptake of smoking and avoids public policy and commentary on the tobacco industry. We use a cointegrating time series analysis using aggregate data on healthcare and tobacco control expenditures, cigarette consumption and prices and other data. We find there is a strong association between per capita healthcare expenditure and per capita cigarette consumption. In the long run, a marginal increase in annual cigarette consumption of one pack per capita increases per capita healthcare expenditure by $19.5 (SE$5.45) in Arizona. A cumulative increase of $1.00 in the difference between control state and Arizona per capita tobacco control expenditures increases the difference in cigarette consumption by 0.190 (SE 0.0780) packs per capita. Between 1996 and 2004, Arizona's tobacco control program was associated with a cumulative reduction in cigarette consumption of 200 million packs (95$500 million (95% CI: $99 million,$896 million) in pre-tax cigarette sales to the tobacco industry. The cumulative healthcare savings was $2.33 billion (95$0.37 billion, $5.00 billion) and the cumulative reduction in cigarette. Arizona's tobacco control expenditures are associated with reduced cigarette consumption and healthcare expenditures, amounting to about 10 times the cost of the program through 2004. This return on investment, while large, was less than the more aggressive California program, which did not limit its focus to youth and included tobacco industry denomalization messages.Medical economics Tobacco control Tobacco use (smoking) Environmental and public health Health education Healthcare costs USA