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Tarride JE, Blackhouse G, Guindon GE, Chaiton MO, Planinac L, Schwartz R. Return on investment of Canadian tobacco control policies implemented between 2001 and 2016. Tob Control 2023; 32:233-238. [PMID: 34376563 DOI: 10.1136/tobaccocontrol-2021-056473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/12/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the return on investment (ROI) associated with tobacco control policies implemented between 2001 and 2016 in Canada. METHODS Canadian expenditures on tobacco policies were collected from government sources. The economic benefits considered in our analyses (decrease in healthcare costs, productivity costs and monetised life years lost, as well as tax revenues) were based on the changes in smoking prevalence and attributable deaths derived from the SimSmoke simulation model for the period 2001-2016. The net economic benefit (monetised benefits minus expenditures) and ROI associated with these policies were determined from the government and societal perspectives. Sensitivity analyses were conducted to check the robustness of the result. Costs were expressed in 2019 Canadian dollars. RESULTS The total of provincial and federal expenditures associated with the implementation of tobacco control policies in Canada from 2001 through 2016 was estimated at $2.4 billion. Total economic benefits from these policies during that time were calculated at $49.2 billion from the government perspective and at $54.2 billion from the societal perspective. The corresponding ROIs were $19.8 and $21.9 for every dollar invested. Sensitivity analyses yielded ROI values ranging from $16.3 to $28.3 for every dollar invested depending on the analyses and perspective. CONCLUSIONS This analysis has found that the costs to implement the Canadian tobacco policies between 2001 and 2016 were far outweighed by the monetised value associated with the benefits of these policies, making a powerful case for the investment in tobacco control policies.
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Affiliation(s)
- Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada .,Center for Health Economics and Policy Analysis (CHEPA), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,Programs for Assessment of Technologies in Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Gord Blackhouse
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,Center for Health Economics and Policy Analysis (CHEPA), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,Programs for Assessment of Technologies in Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - G Emmanuel Guindon
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,Center for Health Economics and Policy Analysis (CHEPA), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Michael O Chaiton
- Dalla Lana School of Public Health, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Center for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lynn Planinac
- Dalla Lana School of Public Health, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Robert Schwartz
- Dalla Lana School of Public Health, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Center for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Wen H, Xie C, Shi F, Liu Y, Liu X, Yu C. Trends in Deaths Attributable to Smoking in China, Japan, United Kingdom, and United States From 1990 to 2019. Int J Public Health 2022; 67:1605147. [PMID: 36188749 PMCID: PMC9519860 DOI: 10.3389/ijph.2022.1605147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: This study aimed to estimate the long-term trends of deaths attributable smoking in China, Japan, the United Kingdom (UK) and the United States (US). Methods: Using 2000–2019 death data from Global Burden of Disease (GBD) 2019, we estimated age-period-cohort effects on smoking attributable mortality, and decomposed of differences in smoking-attributable deaths in 1990 and 2019 into demographic factors. Results: From 1990 to 2019, smoking-attributable deaths increased in China, which was due to population growth and demographic aging. From 1990 to 2019, both age-standardized smoking attributable mortality rates trended downward across countries. Among four countries, age rate ratios (RRs) for smoking-attributable mortality increased with age, while period and cohort RRs decreased with year. Conclusion: The age-standardized mortality rates, period effects and cohort effects of smoking attributable mortality in China, Japan, UK, and US have been declining in both sexes from 1990 to 2019, which suggests that smoke-free policies, help to quit tobacco use, improved health education, more accessible healthcare service, and increased taxes have been effective. Additionally, increased smoking attributable deaths in elderly should got more attention.
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Affiliation(s)
- Haoyu Wen
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Cong Xie
- Hubei Provincial Center for Diseases Control and Prevention, Wuhan, China
| | - Fang Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Yan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Xiaoxue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
- *Correspondence: Chuanhua Yu,
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Hazard D, von Cube M, Kaier K, Wolkewitz M. Predicting Potential Prevention Effects on Hospital Burden of Nosocomial Infections: A Multistate Modeling Approach. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:830-838. [PMID: 34119081 DOI: 10.1016/j.jval.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/15/2021] [Accepted: 02/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Hospital-acquired infections (HAIs) place a substantial burden on health systems. Tools are required to quantify the change in this burden as a result of a preventive intervention. We aim to estimate how much a reduction in the rate of hospital-acquired infections translates into a change in hospital mortality and length of stay. METHODS Using multistate modelling and competing risks methodology, we created a tool to estimate the reduction in burden after the introduction of a preventive effect on the infection rate. The tool requires as inputs the patients' length of hospital stay, patients' infection information (status, time), patients' final outcome (discharged alive, dead), and a preventive effect. We demonstrated the methods on both simulated data and 3 published data sets from Germany, France, and Spain. RESULTS A hypothetical prevention that cuts the infection rate in half would result in 21 lives and 2212 patient-days saved in French ventilator-associated pneumonia data, 61 lives and 3125 patient-days saved in Spanish nosocomial infection data, and 20 lives and 1585 patient-days saved in German nosocomial pneumonia data. CONCLUSIONS Our tool provides a quick and easy means of acquiring an impression of the impact a preventive measure would have on the burden of an infection. The tool requires quantities routinely collected and computation can be done with a calculator. R code is provided for researchers to determine the burden in various settings with various effects. Furthermore, cost data can be used to get the financial benefit of the reduction in burden.
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Affiliation(s)
- Derek Hazard
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany.
| | - Maja von Cube
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
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4
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Hospitalization Trends in Adult Patients with COPD and Other Respiratory Diseases in Northeast China from 2005 to 2015. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1060497. [PMID: 29581961 PMCID: PMC5822913 DOI: 10.1155/2018/1060497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/05/2018] [Accepted: 01/14/2018] [Indexed: 11/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD), pneumonia, asthma, and lung cancer are four common respiratory diseases that impose a substantial economic burden on both patients and government in China. The objective of our study is to analyze the temporal trends of several clinical tracking metrics for hospitalization regarding these diseases. Hospital discharge data of 54 hospitals for the period 2005–2015 were derived from the Health and Family Planning Commission in Northeast China. The age-adjusted rate of discharge for the four respiratory diseases increased significantly (COPD, pneumonia, asthma: P trend < .001; lung cancer: P trend = .046). The mean LOS for the four diseases all showed a significant decline (P trend < .001), whereas the mean charge per stay and aggregate charge followed an upward trend over time (P trend < .001). There was a clear upward trend for the readmission rate for asthma patients (P trend = .001), while the trend for COPD patients was unclear (P trend = .224). Age-adjusted discharge rates, LOS, and charges for hospitalization regarding several common respiratory diseases in China showed different patterns of change over the past decade. Our results should aid government and administrators in making informed decisions about the management and treatment of respiratory diseases.
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Feirman SP, Glasser AM, Rose S, Niaura R, Abrams DB, Teplitskaya L, Villanti AC. Computational Models Used to Assess US Tobacco Control Policies. Nicotine Tob Res 2017; 19:1257-1267. [DOI: 10.1093/ntr/ntx017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 01/20/2017] [Indexed: 11/12/2022]
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6
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Marshall JR, Lotfipour S, Chakravarthy B. Growing Trend of Alternative Tobacco Use Among the Nation's Youth: A New Generation of Addicts. West J Emerg Med 2016; 17:139-42. [PMID: 26973738 PMCID: PMC4786232 DOI: 10.5811/westjem.2016.1.29383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/15/2016] [Indexed: 11/11/2022] Open
Abstract
The Centers for Disease Control and Prevention (CDC) has published significant data and trends related to the rising epidemic of usage of alternate forms of tobacco among the nation's youth. For the first time ever, the use of the electronic cigarette (e-cigarrette) has surpassed traditional cigarette usage in adolescents. E-cigarettes are battery-operated products designed to deliver aerosolized nicotine and other flavors to the consumer. Most look like conventional cigarettes but some resemble everyday items such as pens, USB drives, and memory sticks.1 In the following article, we present findings from the CDC's Morbidity and Mortality Weekly Report with commentary on the state of this growing epidemic and barriers to effective screening methods.
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Affiliation(s)
- John R Marshall
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Shahram Lotfipour
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Bharath Chakravarthy
- University of California, Irvine, Department of Emergency Medicine, Orange, California
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Feirman SP, Donaldson E, Glasser AM, Pearson JL, Niaura R, Rose SW, Abrams DB, Villanti AC. Mathematical Modeling in Tobacco Control Research: Initial Results From a Systematic Review. Nicotine Tob Res 2015; 18:229-42. [PMID: 25977409 DOI: 10.1093/ntr/ntv104] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/05/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The US Food and Drug Administration has expressed interest in using mathematical models to evaluate potential tobacco policies. The goal of this systematic review was to synthesize data from tobacco control studies that employ mathematical models. METHODS We searched five electronic databases on July 1, 2013 to identify published studies that used a mathematical model to project a tobacco-related outcome and developed a data extraction form based on the ISPOR-SMDM Modeling Good Research Practices. We developed an organizational framework to categorize these studies and identify models employed across multiple papers. We synthesized results qualitatively, providing a descriptive synthesis of included studies. RESULTS The 263 studies in this review were heterogeneous with regard to their methodologies and aims. We used the organizational framework to categorize each study according to its objective and map the objective to a model outcome. We identified two types of study objectives (trend and policy/intervention) and three types of model outcomes (change in tobacco use behavior, change in tobacco-related morbidity or mortality, and economic impact). Eighteen models were used across 118 studies. CONCLUSIONS This paper extends conventional systematic review methods to characterize a body of literature on mathematical modeling in tobacco control. The findings of this synthesis can inform the development of new models and the improvement of existing models, strengthening the ability of researchers to accurately project future tobacco-related trends and evaluate potential tobacco control policies and interventions. These findings can also help decision-makers to identify and become oriented with models relevant to their work.
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Affiliation(s)
- Shari P Feirman
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elisabeth Donaldson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ray Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Shyanika W Rose
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
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Masho SW, Bishop DL, Keyser-Marcus L, Varner SB, White S, Svikis D. Least explored factors associated with prenatal smoking. Matern Child Health J 2014; 17:1167-74. [PMID: 22903305 DOI: 10.1007/s10995-012-1103-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Poor pregnancy and birth outcomes are major problems in the United States, and maternal smoking during pregnancy has been identified as one of the most preventable risk factors associated with these outcomes. This study examines less explored risk factors of smoking among underserved African American pregnant women. A cross-sectional survey was conducted at an outpatient obstetrics-gynecology clinic of an inner-city university hospital in Virginia from March 2009 through January 2011 in which pregnant women (N = 902) were interviewed at their first prenatal care visit. Survey questions included items related to women's sociodemographic characteristics as well as their pregnancy history; criminal history; receipt of social services; child protective services involvement; insurance status; and history of substance abuse, domestic violence, and depression. Multiple logistic regression was conducted to calculate odds ratios and 95 % confidence intervals depicting the relationship between these factors and smoking during pregnancy. The analysis reported that maternal age [OR = 1.08, 95 % CI = 1.05-1.12], less than high school education [OR = 4.30, 95 % CI = 2.27-8.14], unemployed [OR = 2.33, 95 % CI = 1.35-4.04], criminal history [OR = 1.66, 95 % CI = 1.05-2.63], receipt of social services [OR = 2.26, 95 % CI = 1.35-3.79] alcohol use [OR = 2.73, 95 % CI = 1.65-4.51] and illicit drug use [OR = 1.97, 95 % CI = 1.04-3.74] during pregnancy were statistically significant risk factors associated with smoking during pregnancy. In addition to the well known risk factors, public health professionals should be aware that criminal history and receipt of social services are important factors associated with smoking during pregnancy. Social service providers such as WIC and prisons and jails may offer a unique opportunity for education and cessation interventions during the preconception or interconception period.
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Affiliation(s)
- Saba W Masho
- Department of Epidemiology and Community Health, VCU Institute of Women's Health, VCU Center on Health Disparities, Virginia Commonwealth University, Richmond, VA 23298-0212, USA.
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Fishman PA. Impact of Broadened Coverage of Smoking Cessation Treatments on Cardiovascular Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2012. [PMID: 23185645 DOI: 10.1007/s12170-012-0275-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
One third of all premature tobacco-attributable deaths are due to CVD and tobacco is the cause of approximately 15% of all CVD attributable. Primary and secondary prevention strategies that combine evidenced based tobacco dependence treatment programs along with cigarette taxes and media campaigns can result in hundreds of thousand of fewer excess deaths from smoking attributable CVD. Expanded insurance from both commercial and public insurers will be greatly expanded by the recently enacted federal health care reform but barriers to reducing the avoidable morbidity and mortality that is due to tobacco use is impacted by the potential for remaining financial barriers to full insurance coverage from Americans in regions of the country with the highest smoking prevalence rates.
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Affiliation(s)
- Paul A Fishman
- Group Health Research Institute, Group Health Cooperative
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10
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Dickter CL, Forestell CA. Peering through the smoke: the effect of parental smoking behavior and addiction on daily smokers' attentional bias to smoking cues. Addict Behav 2012; 37:187-92. [PMID: 22036056 DOI: 10.1016/j.addbeh.2011.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 09/16/2011] [Accepted: 09/30/2011] [Indexed: 12/16/2022]
Abstract
Although previous research has demonstrated that individuals with parents who smoke are more likely to become smokers and are less successful in smoking cessation efforts compared with those without a smoking parent, the reasons for this link have not been established. In the current study, implicit attentional bias to smoking-related cues was investigated in college-age smokers, based on models of addiction that suggest that attention to drug-related cues plays an important role in drug addiction. Sixty-one participants completed a dot-probe task to measure attentional bias to smoking-related and matched non-smoking-related control pictures. Results indicated that while those who reported smoking occasionally did not demonstrate an attentional bias, daily smokers who had a smoking parent showed more of an attentional bias to the smoking cues than those without a smoking parent, but only to cues that did not contain human content. In addition to parental influence, nicotine dependence explained a significant portion of the variance in the attentional bias for daily smokers. Implications for models of nicotine addiction and the development of smoking cessation programs are discussed.
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Jiang J, Liu B, Nasca PC, Han W, Zou X, Zeng X, Tian X, Wu Y, Zhao P, Li J. Comparative study of control selection in a national population-based case-control study: Estimating risk of smoking on cancer deaths in Chinese men. Int J Med Sci 2009; 6:329-37. [PMID: 19918375 PMCID: PMC2777271 DOI: 10.7150/ijms.6.329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 10/20/2009] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To assess the validation of a novel control selection design by comparing the consistency between the new design and a routine design in a large case-control study that was incorporated into a nationwide mortality survey in China. METHODS A nationwide mortality study was conducted during 1989-1991. Surviving spouses or other relatives of all adults who died during 1986-1988 provided detailed information about their own as well as the deceased person's smoking history. In this study, 130,079 males who died of various smoking-related cancers at age 35 or over were taken as cases, while 103,248 male surviving spouses (same age range with cases) of women who died during the same period and 49,331 males who died from causes other than those related to smoking were used as control group 1 and control group 2, respectively. Consistency in the results when comparing cases with each of the control groups was assessed. RESULTS Consistency in the results was observed in the analyses using different control groups although cancer deaths varied with region and age. Equivalence could be ascertained using a 15% criterion in most cancer deaths which had high death rates in urban areas, but they were uncertain for most cancers in rural areas irrespective of whether the hypothesis testing showed significant differences or not. CONCLUSIONS Sex-matched living spouse control design as an alternative control selection for a case-control study is valid and feasible, and the basic principles of the equivalence study are also supported by epidemiological survey data.
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Affiliation(s)
- Jingmei Jiang
- Department of Epidemiology and Medical Statistics, Peking Union Medical College
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12
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Kahende JW, Loomis BR, Adhikari B, Marshall L. A review of economic evaluations of tobacco control programs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2008; 6:51-68. [PMID: 19440269 PMCID: PMC2672319 DOI: 10.3390/ijerph6010051] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 12/23/2008] [Indexed: 11/16/2022]
Abstract
Each year, an estimated 443,000 people die of smoking-related diseases in the United States. Cigarette smoking results in more than $193 billion in medical costs and productivity losses annually. In an effort to reduce this burden, many states, the federal government, and several national organizations fund tobacco control programs and policies. For this report we reviewed existing literature on economic evaluations of tobacco control interventions. We found that smoking cessation therapies, including nicotine replacement therapy (NRT) and self-help are most commonly studied. There are far fewer studies on other important interventions, such as price and tax increases, media campaigns, smoke free air laws and workplace smoking interventions, quitlines, youth access enforcement, school-based programs, and community-based programs. Although there are obvious gaps in the literature, the existing studies show in almost every case that tobacco control programs and policies are either cost-saving or highly cost-effective.
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Affiliation(s)
- Jennifer W. Kahende
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 4770 Buford Highway, NE., MS-K50, Atlanta, GA 30341, USA; E-mails:
(B. A.);
(L. T. M.)
- * Author to whom correspondence should be addressed; E-Mail:
; Tel.: +1-770-488-5279
| | - Brett R. Loomis
- Research Triangle International, Public Health Policy Research Program, Hobbs Building, Rm 139, 3040 Cornwallis Rd, Research Triangle Park, NC 27709, USA; E-Mail:
| | - Bishwa Adhikari
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 4770 Buford Highway, NE., MS-K50, Atlanta, GA 30341, USA; E-mails:
(B. A.);
(L. T. M.)
| | - LaTisha Marshall
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 4770 Buford Highway, NE., MS-K50, Atlanta, GA 30341, USA; E-mails:
(B. A.);
(L. T. M.)
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Willis G, Lawrence D, Hartman A, Stapleton Kudela M, Levin K, Forsyth B. Translation of a tobacco survey into Spanish and Asian languages: the Tobacco Use Supplement to the Current Population Survey. Nicotine Tob Res 2008; 10:1075-84. [PMID: 18584471 PMCID: PMC3803133 DOI: 10.1080/14622200802087572] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Because of the vital need to attain cross-cultural comparability of estimates of tobacco use across subgroups of the U.S. population that differ in primary language use, the National Cancer Institute (NCI) Tobacco Use Special Cessation Supplement to the Current Population Survey (TUSCS-CPS) was translated into Spanish, Chinese (Mandarin and Cantonese), Korean, Vietnamese, and Khmer (Cambodian). The questionnaire translations were extensively tested using an eight-step process that focused on both translation procedures and empirical pretesting. The resulting translations are available on the Internet at http://riskfactor.cancer.gov/studies/tus-cps/translation/questionnaires.html for tobacco researchers to use in their own surveys, either in full, or as material to be selected as appropriate. This manuscript provides information to guide researchers in accessing and using the translations, and describes the empirical procedures used to develop and pretest them (cognitive interviewing and behavior coding). We also provide recommendations concerning the further development of questionnaire translations.
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Affiliation(s)
- Gordon Willis
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-7344, USA.
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Pérez-Ríos M, Montes A. Methodologies used to estimate tobacco-attributable mortality: a review. BMC Public Health 2008; 8:22. [PMID: 18211696 PMCID: PMC2262075 DOI: 10.1186/1471-2458-8-22] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 01/22/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the most important measures for ascertaining the impact of tobacco on a population is the estimation of the mortality attributable to its use. To measure this, a number of indirect methods of quantification are available, yet there is no consensus as to which furnishes the best information. This study sought to provide a critical overview of the different methods of attribution of mortality due to tobacco consumption. METHOD A search was made in the Medline database until March 2005 in order to obtain papers that addressed the methodology employed for attributing mortality to tobacco use. RESULTS Of the total of 7 methods obtained, the most widely used were the prevalence methods, followed by the approach proposed by Peto et al, with the remainder being used in a minority of studies. CONCLUSION Different methodologies are used to estimate tobacco attributable mortality, but their methodological foundations are quite similar in all. Mainly, they are based on the calculation of proportional attributable fractions. All methods show limitations of one type or another, sometimes common to all methods and sometimes specific.
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Affiliation(s)
- Mónica Pérez-Ríos
- Department of Epidemiology, Directorate-General for Public Health, Galician Regional Health Authority, Santiago de Compostela, Spain.
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15
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Altamura AC, Bobo WV, Meltzer HY. Factors affecting outcome in schizophrenia and their relevance for psychopharmacological treatment. Int Clin Psychopharmacol 2007; 22:249-67. [PMID: 17690594 DOI: 10.1097/yic.0b013e3280de2c7f] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A major focus of current treatment research in schizophrenia is the determinants of long-term outcome, including functional outcome and general medical well being, rather than just specific domains of psychopathology such as positive and negative symptoms, mood symptoms, and cognitive impairment. This focus does not negate the importance of the latter issues but sees them as factors contributing to long-term outcome to variable extents. A long-term treatment focus facilitates a more clinically relevant assessment of benefits versus risks of available treatments. For instance, atypical antipsychotic drugs as a group have clear advantages for several important domains of efficacy that may influence long-term outcome, but are also more expensive over the long term. Use of some agents may also result in deleterious physical health consequences as well as large additional costs over the long term owing to metabolic adverse effects. The present paper focuses on several key issues in schizophrenia which are important determinants of long-term outcome in schizophrenia, or influence choice of antipsychotic drugs, or both, including: (i) duration of untreated psychosis; (ii) impact of relapse on long-term outcome; (iii) limited efficacy for specific domains of psychopathology of current treatments; (iv) mortality owing to suicide; and (v) mortality owing to other causes (e.g. cardiovascular disease).
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Affiliation(s)
- A Carlo Altamura
- Department of Psychiatry, University of Milan, Hospital Luigi Sacco, Via G.B. Grassi 74, 20157 Milan, Italy.
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Smyth B, Hoffman V, Fan J, Hser YI. Years of potential life lost among heroin addicts 33 years after treatment. Prev Med 2007; 44:369-74. [PMID: 17291577 PMCID: PMC2039886 DOI: 10.1016/j.ypmed.2006.10.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Revised: 08/12/2006] [Accepted: 10/16/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine premature mortality in terms of years of potential life lost (YPLL) among a cohort of long-term heroin addicts. METHOD This longitudinal, prospective study followed a cohort of 581 male heroin addicts in California for more than 33 years. In the latest follow-up conducted in 1996/97, 282 subjects (48.5%) were confirmed as deceased by death certificates. YPLL before age 65 years was calculated by causes of death. Ethnic differences in YPLL were assessed among Whites, Hispanics, and African Americans. RESULTS On average, addicts in this cohort lost 18.3 years (SD=10.7) of potential life before age 65. Of the total YPLL for the cohort, 22.3% of the years lost was due to heroin overdose, 14.0% due to chronic liver disease, and 10.2% to accidents. The total YPLL and YPLL by death cause in addict cohort were significantly higher than that of US population. The YPLL among African Americans was significantly lower than that among Whites or Hispanics. CONCLUSION The YPLL among addicts was much higher than that in the national population; within the cohort, premature mortality was higher among Whites and Hispanics compared to African American addicts.
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Affiliation(s)
- Breda Smyth
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Valerie Hoffman
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jing Fan
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Yih-Ing Hser
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California
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Holmes MD, Murin S, Chen WY, Kroenke CH, Spiegelman D, Colditz GA. Smoking and survival after breast cancer diagnosis. Int J Cancer 2007; 120:2672-7. [PMID: 17278091 DOI: 10.1002/ijc.22575] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We examined whether a history of smoking is associated with an increased risk of death from any cause or from breast cancer, among women diagnosed with breast cancer. This was a prospective observational study among 5,056 women from the Nurses' Health Study with Stages I-III invasive breast cancer diagnosed between 1978 and 2002 and for whom we had information on smoking, and who were followed until January 2002 or death, whichever came first. Subjects were classified as current, former or never smokers based upon smoking status at the biennial questionnaire immediately preceding the breast cancer diagnosis. In multivariate-adjusted analyses, compared with never smokers, women who were current smokers had a 43% increased adjusted relative risk (RR) [95% confidence interval (95% CI): 1.24-1.65] of death from any cause. A strong linear gradient was observed with the number of cigarettes per day smoked, p-trend <0.0001; the RR (95% CI) for 1-14, 15-24 and 25 or more cigarettes per day was 1.27 (1.01-1.61), 1.30 (1.08-1.57) and 1.79 (1.47-2.19). In contrast, there was no association with current smoking and breast cancer death; the RR (95% CI) was 1.00 (0.83-1.19). Current and past smokers were more likely than never smokers to die from primary lung cancer, chronic obstructive pulmonary disease and other lung diseases. We conclude that a history of smoking increased mortality following diagnosis with breast cancer, but did not increase mortality from breast cancer.
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Affiliation(s)
- Michelle D Holmes
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Gallus S, Schiaffino A, La Vecchia C, Townsend J, Fernandez E. Price and cigarette consumption in Europe. Tob Control 2006; 15:114-9. [PMID: 16565459 PMCID: PMC2563577 DOI: 10.1136/tc.2005.012468] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To analyse the variation in demand for tobacco according to price of cigarettes across the European region. DESIGN Cross-sectional study. SETTING All the 52 countries of the European region. PARTICIPANTS For each European country, data were collected on annual per adult cigarette consumption (2000), smoking prevalence (most recent), retail price of a pack of local and foreign brand cigarettes (around 2000), the gross domestic product adjusted by purchasing power parities, and the adult population (2000). MAIN OUTCOME MEASURE Price elasticity of demand for cigarettes (that is, the change in cigarette consumption according to a change in tobacco price) across all the European countries, estimated by double-log multiple linear regression. RESULTS Controlling for male to female prevalence ratio, price elasticities for consumption were -0.46 (95% confidence interval (CI) -0.74 to -0.17) and -0.74 (95% CI -1.13 to -0.35) for local and foreign brand, respectively. The inverse relation between cigarette price and consumption was stronger in countries not in the European Union (price elasticity for foreign brand cigarettes of -0.8) as compared to European Union countries (price elasticity of -0.4). CONCLUSIONS The result that, on average, in Europe smoking consumption decreases 5-7% for a 10% increase in the real price of cigarettes strongly supports an inverse association between price and cigarette smoking.
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Affiliation(s)
- S Gallus
- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Tingen MS, Waller JL, Smith TM, Baker RR, Reyes J, Treiber FA. Tobacco prevention in children and cessation in family members. ACTA ACUST UNITED AC 2006; 18:169-79. [PMID: 16573730 DOI: 10.1111/j.1745-7599.2006.00116.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the effects of a theory-driven tobacco prevention program in sixth-grade children with a family tobacco cessation component implemented by school nurses in conjunction with the initiation of a statewide toll-free Quit Line. DATA SOURCES Self-report questionnaires completed by the sixth-grade children and their parents/guardians (N= 1024) representing largely rural southern school systems from disparate areas with high prevalence rates of tobacco use and lung cancer diagnoses. Pre- and posttest measures that evaluated the impact of both student and parent/guardian interventions were obtained over a 10-week period. Paired t-tests were used to examine differences between pre- and posttest scores for all student and parent/guardian variables. Repeated-measures analysis of variance was used to examine the effect of parent/guardian smoking on student pre- and posttest scores. CONCLUSIONS The student program resulted in significant improvements in drug knowledge, refusal skills, attitudes, normative expectations, assertiveness, and anxiety reduction techniques. In addition, the effectiveness of several components of the tobacco prevention program for the children was impacted by the smoking status of their parents/guardians. Drug-use intentions and behaviors were lower at posttest for children from homes of nonsmokers versus children from homes of smokers. Parents/guardians consistently reported that smoking was detrimental to themselves, the public, and their children. Of those parents/guardians who identified themselves as smokers (26%) and received cessation materials, 46.4% indicated that the information motivated them to want to quit. IMPLICATIONS FOR PRACTICE Tobacco use continues to be the leading cause of preventable death in the United States, with greater than 2000 new youth becoming regular smokers each day. School nurses and nurse practitioners are in various pivotal positions to address tobacco and its related health concerns through delivery of effective family interventions that target children for tobacco prevention and parent/guardian smokers for cessation.
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Affiliation(s)
- Martha S Tingen
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Augusta, Georgia, USA.
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Genkinger JM, Platz EA, Hoffman SC, Strickland P, Huang HY, Comstock GW, Helzlsouer KJ. C47T polymorphism in manganese superoxide dismutase (MnSOD), antioxidant intake and survival. Mech Ageing Dev 2006; 127:371-7. [PMID: 16458347 DOI: 10.1016/j.mad.2005.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Revised: 12/20/2005] [Accepted: 12/21/2005] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND OBJECTIVE Manganese superoxide dismutase (MnSOD), an enzyme that catalyzes superoxide radical quenching, is hypothesized to protect against premature aging. A C47T transition in the MnSOD gene may affect the enzyme's distribution to the mitochondrion, a site of high oxidative stress. We examined the association between this polymorphism and survival. METHODS Individuals who donated a blood sample to the CLUE I and II campaigns in 1974 and 1989, respectively, and completed a food frequency questionnaire in 1989 (N=6151) were included in the analysis. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated by Cox proportional hazards models. Mortality follow-up extended from 1989 to 2002. RESULTS MnSOD genotype distributions were 27% CC (wildtype homozygotes), 50% CT (heterozygotes) and 23% TT (variant homozygotes). TT and CT genotypes compared to the CC genotype were not associated with all-cause or cardiovascular disease mortality. A slight, but non-statistically significant higher risk of cancer mortality was observed for the CT (HR=1.13, 95% CI: 0.86-1.49) and TT (HR=1.24, 95% CI: 0.90-1.70) genotypes compared to CC genotype (p-trend=0.19). CONCLUSION We did not observe an association between the C47T polymorphism in the MnSOD gene and survival. These null associations were not modified by fruit and vegetable intake, cigarette smoking status, or body mass index.
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Affiliation(s)
- Jeanine M Genkinger
- Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Building 2, Boston, MA, United States
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Fishman PA, Ebel BE, Garrison MM, Christakis DA, Wiehe SE, Rivara FP. Cigarette tax increase and media campaign cost of reducing smoking-related deaths. Am J Prev Med 2005; 29:19-26. [PMID: 15958247 DOI: 10.1016/j.amepre.2005.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2004] [Revised: 03/02/2005] [Accepted: 03/11/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tobacco use results in 500,000 premature deaths annually. Most smokers begin using tobacco before age 21, so the greatest impact on preventing smoking-related mortality is likely to come from campaigns targeting youths. This study estimates the cost-effectiveness of an anti-smoking media campaign and dollar 1 per pack increase in cigarette taxes on the lifetime decrease in smoking-attributable mortality among the cohort of all 18-year-olds in the United States during the year 2000. METHODS Cost-effectiveness analysis conducted from a societal perspective. RESULTS The combined effects of a media campaign and dollar 1 per pack tax increase will result in a societal savings of between dollar 590,000 per life-year saved, at a 3% discount rate and dollar 1.4 million per life year saved, at a 7% discount rate. CONCLUSIONS A media campaign and $1 per pack cigarette tax increase will reduce overall smoking prevalence, significantly decrease smoking-attributable mortality, and decrease net societal costs.
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Affiliation(s)
- Paul A Fishman
- Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington 98101, USA.
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