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Community-Based Youth Tobacco Control Interventions

Cost Effectiveness of the Full Court Press Project

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Abstract

Background: We evaluated the impact of a community-based tobacco control project that was implemented in the city of Tucson, Arizona, USA, between 1996 and 2001.

Aim: The project’s goal was to reduce the prevalence of youth smoking through change in social norms at schools and in communities and workplaces. As is often the case, these community-based health promotion interventions were implemented in conjunction with other broader programmes, in this case implemented on the state level.

Method: Taking into account state level interventions as well as changes in sociodemographic and economic environment over the course of the project (e.g. increases in cigarette prices), we measure the net effect of the intervention in terms of the number of people who quit or did not initiate smoking and by the discounted life-years gained. To establish the value of investing into community-based intervention, we calculated the real discounted cost per quit and per life-year gained of $US3789 and $US3942, respectively. These compare favourably with the real cost per quit of $US4270 when implementing the 1996 US Clinical Practice Guideline for smoking cessation but exceed the real cost of $US2923 per discounted life-year gained when following the guideline.

Results: A sensitivity analysis that assumed 5% programme persistence (i.e. 5% of the programme’s impact would last forever in the absence of future funding for the programme), one-third would relapse and that one-third of those who quit may have quit smoking even without the programme, suggested a lower cost per discounted life-year saved of $US3476. The cost effectiveness of this project compares favourably with other tobacco control interventions.

Conclusion: Despite its relatively small target group, this community-based intervention was cost effective.

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Notes

  1. 1We assumed that the general tobacco control programmes targeted the population age 10–64 years of Arizona state or Pima County (depending on whether the programme had state- or county-level coverage) while the FCP targeted only the population age 13–18 years living in Tucson.

  2. 2These estimates are consistent with the findings of Peto et al.[29] but are conservative compared with the most recent estimates for men showing that male nonsmokers live on average 10 years longer than lifetime male smokers.[27]

  3. 3The Centers for Disease Control and Prevention estimates that more than half of adult ever-smokers in the US have quit smoking.[32] Some of those who quit do so on their own but some quit as a response to tobacco control programmes. Since the proportion between these two alternatives is not clear, we assumed that two-thirds of those who quit smoking do so on their own and one-third quit as a result of tobacco control activities.

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Acknowledgements

This manuscript was supported by a Robert Wood Johnson Foundation grant (Sponsor Reference #: 044749) for ‘Evaluation and Dissemination of Full Court Press Study Results’.

The authors have no conflicts of interest that are directly relevant to the content of this study.

We would like to thank our research assistant Yanjun Bao from the University of Illinois, Department of Economics.

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Authors and Affiliations

  1. International Tobacco Surveillance, Epidemiology and Surveillance Research, American Cancer Society - National Home Office, Atlanta, Georgia, USA

    Hana Ross

  2. Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA

    Lisa M. Powell

  3. Survey Research, Statistics & Evaluation Center, American Cancer Society - National Home Office, Atlanta, Georgia, USA

    Joseph E. Bauer

  4. Pacific Institute for Research and Evaluation, Calverton, Maryland, USA

    David T. Levy

  5. Department of Economics, University of Baltimore, Baltimore, Maryland, USA

    David T. Levy

  6. Department of Economics, University of Illinois at Chicago, Chicago, Illinois, USA

    Richard M. Peck

  7. Department of Speech, University of Hawaii at Manoa, Honolulu, Hawaii, USA

    Hye-Ryeon Lee

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  1. Hana Ross
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  2. Lisa M. Powell
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Correspondence to Hana Ross.

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Ross, H., Powell, L.M., Bauer, J.E. et al. Community-Based Youth Tobacco Control Interventions. Appl Health Econ Health Policy 5, 167–176 (2006). https://doi.org/10.2165/00148365-200605030-00003

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