Program, Policy, and Price Interventions for Tobacco Control: Quantifying the Return on Investment of a State Tobacco Control Program

摘要

Objectives . We examined health effects associated with 3 tobacco control interventions in Washington State: a comprehensive state program, a state policy banning smoking in public places, and price increases. Methods . We used linear regression models to predict changes in smoking prevalence and specific tobacco-related health conditions associated with the interventions. We estimated dollars saved over 10 years (2000–2009) by the value of hospitalizations prevented, discounting for national trends. Results . Smoking declines in the state exceeded declines in the nation. Of the interventions, the state program had the most consistent and largest effect on trends for heart disease, cerebrovascular disease, respiratory disease, and cancer. Over 10 years, implementation of the program was associated with prevention of nearly 36?000 hospitalizations, at a value of about $1.5 billion. The return on investment for the state program was more than $5 to $1. Conclusions . The combined program, policy, and price interventions resulted in reductions in smoking and related health effects, while saving money. Public health and other leaders should continue to invest in tobacco control, including comprehensive programs. Price increases, policies establishing smoke-free public places, and comprehensive tobacco control programs are all proven strategies for reducing smoking prevalence. 1,2 Furthermore, implementation of comprehensive programs that reduce smoking have been shown to reduce tobacco-related health conditions, such as heart disease 3 and cancer. 4,5 Laws mandating smoke-free air have also been associated with a reduction in health conditions caused by smoking or environmental tobacco smoke exposure. 6–13 A recent review of specific tobacco control interventions found that most are cost effective. 14 In the face of current economic conditions and limited budgets, policymakers may wonder whether implementing a tax on tobacco can produce revenue and decrease smoking without the cost of a program. Similarly, they may wonder whether a smoke-free policy may improve public health at little cost, while generating revenue. 15 They may also question the return on investment from tobacco control programs. State programs have declined in priority in recent years, and state funding remains substantially lower than levels recommended by the Centers for Disease Control and Prevention. 16 Washington State has effectively used all 3 cornerstone tobacco control interventions: program, policy, and price. The state has had a well-funded comprehensive tobacco prevention and control program since late 2000, a statewide smoke-free public places law since December 2005, 17 and multiple cigarette tax increases. A previous study reported that significant declines in smoking were achieved by the state's total tobacco control effort. 18 We examined the relative magnitude of effect on smoking and health from the 3 cornerstone tobacco control interventions and assessed the return on investment (ROI) for the state's tobacco control program after 10 years. Our study was the first that we are aware of to comprehensively examine the association between multiple specific health conditions and multiple proven tobacco control interventions.