In the late 1980s, when smoking was still allowed on some flights, California raised its taxes on cigarettes from 10 to 35 cents a pack, allocating 5 cents to smoke-free programs.
The newly created California Tobacco Control Program has funded anti-tobacco media campaigns and community programs to try to improve public health, but some have questioned whether the efforts are worth the cost.
Now comes the answer: For every dollar California spends fighting smoking, health care costs have fallen by $231.
Over three decades that saw historic lawsuits and an expansion of smoking bans, California’s smoking population has fallen from 21.8% in 1989 to 10% in 2019. Its tobacco control program accounted for 2.7 percentage points, which may seem small but has resulted in significant savings. . Those who didn’t quit ended up cutting an average of 119 packages per year in response to the program, according to the study, which appears March 16. Plus one.
Senior author Stanton Glantz, PhD, and recently retired founding director of the UCSF Center for Tobacco Control Research and Education, summed up the findings this way: “Tobacco control programs save a fortune.”
Over the 30-year history of the program, Californians earned $51.4 billion that they would have spent on cigarettes. Health care savings totaled $816 billion.
The return on investment is enormous. Not only do these programs save lives and make people feel better, but they also save people money.”
Stanton Glantz, PhD, senior author
Formation of tobacco control policy
has done econometrics to track the relationship between three types of spending—state tobacco control, consumer tobacco purchases and health care expenditures—over three decades, lead author James Lightwood, Ph.D., assistant professor of clinical pharmacy at UCSD, and Steve Anderson , a. Financial industry forecasting expert. They developed predictive validation of a model first developed by Lightwood and Glantz using 1989-2008 data and updated estimates of the program effect.
The model has withstood more than 30 years, nearly ten years after the original sample, through changing economic conditions and levels of tobacco control spending in California, according to Lightwood.
“This paper greatly strengthens the case that there is a causal relationship between tobacco control and smoking reduction,” Lightwood said.
The authors said the modeling results could help shape tobacco policy in states considering tobacco control measures and in those where support for existing programs may be wobbly. Anderson said the forecasting methods used in the paper are very similar to those used by large companies to inform key business decisions.
“Any state with a high level of smoking that launches a large, long-term program should get results similar to California,” Lightwood said. “But public policy has unique challenges. The political expediency of short-term thinking makes a lot of tobacco control efforts work.”
California is large and diverse, spanning both rural and urban areas, and its population includes many races and ethnicities across the socioeconomic spectrum.
“California is so large that it can be considered average in many ways relevant to the evaluation of a tobacco control program,” Lightwood said.
The benefits grow over time
In previous research, Lightwood and Glantz showed the short-term cost benefits of cutting back on tobacco—heart attacks, strokes, and a rapid drop in birth weight. The current paper models both the short and long-term effects of state programs, which also reflect declines in slower-onset diseases, such as lung cancer.
“The benefits grow over time as more and more diseases are prevented,” Lightwood said. “If you’re doing a less comprehensive program for four or five years, it’s hard to detect a lot of changes in the face of year-to-year fluctuations and the program is vulnerable. But when the program is large and long-term and comprehensive, like the state of California, we can confidently conclude that there is Great, immediate benefits that grow over time.”
The new findings confirm that tobacco control efforts motivate a reduction in smoking, and that even a seemingly small reduction in smoking, such as the 2.7% attributed to a state tobacco control program, quickly and dramatically reduces healthcare expenditures.
“Tobacco control is one of the most powerful things you can do to contain Medicare costs,” Glantz said.
Lightwood, JM, et al. (2023) Reductions in smoking and health care expenditures associated with the California Tobacco Control Program, from 1989 to 2019: a predictive validation. Plus one. doi.org/10.1371/journal.pone.0263579.