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;andotherhealthâcareârelatedbibliographicsources.Wealsoperformedhandsearchingofrelevantarticles,healthreports,andwhitepapersissuedbygovernmentbodies,internationalhealthorganizations,andhealthinterventioncampaignagencies.Selectioncriteria:Thepaperincludescostâeffectivenessstudiesfrommedicaljournals,healthreports,andwhitepaperspublishedbetween1992andJuly2014,butincludedonlyeightrelevantstudiesbefore1992.Mostofthepapersreviewedreportedoutcomesonsmokingprevalence,aswellasthedirectandindirectcostsofsmokingandthecostsandbenefitsofsmokingcessationinterventions.Weexcludedpapersthatmerelydescribedtheeffectivenessofaninterventionwithoutincludingeconomicorcostconsiderations.Wealsoexcludedpapersthatcombinesmokingcessationwiththereductionintheriskofotherdiseases.Datacollectionandanalysis:TheincludedstudieswereassessedagainstcriteriaindicatedintheCochraneReviewersHandbookversion5.0.0.Outcomesassessedinthereview:Primaryoutcomesoftheselectedstudiesaresmokingprevalence,directandindirectcostsofsmoking,andthecostsandbenefitsofsmokingcessationinterventions(eg,âcostperquitterâ,âcostperlifeyearsavedâ,âcostperqualityâadjustedlifeyeargained,ââpresentvalueâorânetbenefitsâfromsmokingcessation,andâcostsavingsâfrompersonalhealthcareexpenditure).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 US4,400perqualityâadjustedlifeyears(QALYs)saved.Theuseofpharmacotherapiessuchasvarenicline,NRT,andBupropion,whencombinedwithGPcounselingorotherbehavioraltreatmentinterventions(suchasproactivetelephonecounselingandWebâbaseddelivery),isbothclinicallyeffectiveandcosteffectivetoprimaryhealthcareproviders.5.Priceâbasedpolicymeasuressuchasincreaseintobaccotaxesareunarguablythemosteffectivemeansofreducingtheconsumptionoftobacco.A102 to US112perlifeyeargained(LYG)whilereducingsmokingprevalencebyupto306.Smokingcessationclassesareknowntobemosteffectiveamongcommunityâbasedmeasures,astheycouldleadtoaquitrateofupto35500 and US614perLYG.7.Advertisingmedia,telecommunications,andothertechnologyâbasedinterventions(suchasTV,radio,print,telephone,theInternet,PC,andotherelectronicmedia)usuallyhavepositivesynergisticeffectsinreducingsmokingprevalenceespeciallywhencombinedtodeliversmokingcessationmessagesandcounselingsupport.However,theoutcomesonthecosteffectivenessofTMTâbasedmeasureshavebeeninconsistent,andthismadeitdifficulttoattributeresultstospecificmedia.Thedifferencesinreportedcosteffectivenessmaybepartlyattributedtovaryingmethodologicalapproachesincludingvaryingparametricinputs,differencesinnationalcontexts,differencesinadvertisingcampaignstestedondifferentmedia,anddisparatelevelsofresourcingbetweencampaigns.Duetoitsuniversalreachandlowimplementationcosts,onlinecampaignappearstobesubstantiallymorecosteffectivethanothermedia,thoughitmaynotbeaseffectiveinreducingsmokingprevalence.8.Schoolâbasedsmokingprevalenceprogramstendtoreduceshortâtermsmokingprevalencebybetween3016,400 to US580,000dependingonthescaleandscopeofintervention.ThecosteffectivenessofschoolâbasedprogramsshowthatonecouldexpectasavingofapproximatelybetweenUS2,000 and US20,000perQALYsavedduetoavertedsmokingafter2â4yearsoffollowâup.9.Workplaceâbasedinterventionscouldrepresentasoundeconomicinvestmenttobothemployersandthesocietyatlarge,achievingabenefitâcostratioofupto8.75andgenerating12âmonthemployercostsavingsofbetween150 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 (ie, 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
http://dx.doi.org/10.1007/s12199-010-0139-0
The original publication is available at http://www. Springerlink.com.Objectives : We investigated dampness/mold in schools and dwellings, and food habits and subjective symptoms in elementary school pupils, in order to clarify the effect of dampness and food habits on subjective symptoms in elementary school pupils. Methods : Questionnaires were used to investigate dampness in classrooms and dwellings in Hokkaido, Japan, and its effect on subjective symptoms in 1,077 pupils in 8 elementary schools. We used a dampness index for both the home and classroom; the index was the sum of the presence of four dampness indicators: (1) visible mold, (2) moldy odor, (3) water leakage, and (4) condensation on windowpanes. The questionnaire also contained queries about food habits, as follows: the frequency of eating breakfast, whether the energy provided by the school lunch was sufficient, and whether eating too many snacks and/or sweets were consumed. Adjusted logistic regression was used to determine whether dampness and food habits were related to the subjective symptoms. Results : In fully adjusted models, the home dampness index was significantly related to cough, general symptoms, and having at least one symptom; the classroom dampness index was significantly related to nasal symptoms. In addition, usually not eating breakfast was significantly related to eye symptoms, and too many snacks and/or sweets was significantly related to eye, nasal, and general symptoms. Conclusions : Both home and classroom dampness can affect pupils' health. Home dampness, in particular, was significantly related to cough and general symptoms, and classroom dampness was significantly related to nasal symptoms. Furthermore, favorable food habits have a positive effect on pupilsâ subjective symptoms