The cost-effectiveness of intensive national school-based anti-tobacco education: results from the tobacco policy model

OBJECTIVES

School-based anti-tobacco education using the "social influences" model is known to reduce smoking among youth by 5-56%. Program effectiveness, however, dissipates in 1-4 years. Consequently, opinion leaders have questioned whether a more intensive national educational effort would be economically efficient. To address this question, we evaluated the cost-effectiveness of enhanced nationwide school-based anti-tobacco education relative to the status quo.

METHODS

To estimate cost-effectiveness, we created the Tobacco Policy Model, a system dynamics computer simulation model. The model relies on secondary data and is designed to calculate the expected costs and public health gains of any tobacco policy or intervention over any time frame.

RESULTS

Over 50 years, cost-effectiveness is estimated to lie between $4,900 and $340,000 per quality-adjusted life-year (QALY), depending on the degree and longevity of program effectiveness. Assuming a 30% effectiveness that dissipates in 4 years, cost-effectiveness is $20,000/QALY. Sensitivity analysis reveals that cost-effectiveness varies with cost, survival, and quality-of-life estimates but cost-effectiveness ratios generally remain favorable.

CONCLUSIONS

Although not cost saving, a much more intensive school-based anti-tobacco educational effort would be an economically efficient investment for the nation.

Public health impact of changes in smoking behavior: results from the Tobacco Policy Model

OBJECTIVES

The relative magnitude of the public health gains from preventing smoking initiation versus encouraging cessation or avoiding relapse in different ages and genders is estimated and compared.

METHODS

Health gains are defined as the predicted increase in Quality-Adjusted Life-Years (QALYs) to the US population during a century. To estimate QALYs, we developed the Tobacco Policy Model. The model simulates a 10% reduction in the annual probability of initiation versus a 10% increase in cessation versus a 10% reduction in relapse in males and females in six age groups: 10 to 19, 20 to 29, 30 to 39, 40 to 49, 50 to 59 and 60 to 69.

RESULTS

Among youth and young adults, reducing initiation yields far more QALYs than encouraging cessation or averting relapse. In middle-aged adults, cessation yields the most QALYs, followed by averting relapse and reducing initiation. In the oldest age group, averting relapse yields the most QALYs followed by cessation and reducing initiation. In general, increasing cessation and reducing relapse is more beneficial in males than in females whereas reducing initiation is more beneficial in females.

CONCLUSIONS

The relative value of preventing initiation, encouraging cessation, and averting relapse differs by age and gender. Reducing initiation in youth is likely to offer the largest public health impact during the next century.

The link between smoking and impotence: two decades of evidence

BACKGROUND

Anti-tobacco advertisements now feature the risk of impotence as a reason to avoid or cease tobacco use. The scientific evidence, however, is mixed. To shed light on the controversy, we compiled 2 decades of published data on the link between smoking and impotence.

METHODS

We searched MEDLINE from 1980 to the present for studies that reported smoking prevalence among impotent male subjects. For each study we recorded the age of subjects, their state of residence, the percentage that were current smokers, and the time period over which study data were collected. For comparison purposes, we estimated age-, state-, and year-specific smoking rates in the general male population using the Behavioral Risk Factors Surveillance System. We performed a meta-analysis using a random effects model.

RESULTS

Among the 1008 journal articles examined, we identified 19 studies that reported the smoking habits of 3819 impotent men. Of these 19 studies, 16 indicated a smoking prevalence exceeding that of the general population. The 6 largest studies all revealed a higher prevalence of smoking among impotent men. Meta-analysis reveals that 40% of impotent men were current smokers compared with 28% of men in the general population. CONCLUSIONSBased on almost 2 decades of evidence, tobacco use is an important risk factor for impotence. Anti-tobacco advertisements featuring impotence as a reason to avoid or cease tobacco use are well grounded in scientific fact.