Effect of the California Tobacco Control Program on Personal Health Care Expenditures

Background: Large state tobacco control programs have been shown to reduce smoking and would be expected to affect health care costs. We investigate the effect of California's large-scale tobacco control program on aggregate personal health care expenditures in the state. Methods and Findings: Cointegrating regressions were used to predict (1) the difference in per capita cigarette consumption between California and 38 control states as a function of the difference in cumulative expenditures of the California and control state tobacco control programs, and (2) the relationship between the difference in cigarette consumption and the difference in per capita personal health expenditures between the control states and California between 1980 and 2004. Between 1989 (when it started) and 2004, the California program was associated with $86 billion (2004 US dollars) (95% confidence interval [CI] $28 billion to $151 billion) lower health care expenditures than would have been expected without the program. This reduction grew over time, reaching 7.3% (95% CI 2.7%–12.1%) of total health care expenditures in 2004. Conclusions: A strong tobacco control program is not only associated with reduced smoking, but also with reductions in health care expenditures. Stanton Glantz and colleagues find that the California state tobacco control program is associated not only with reduced smoking, but with reductions in health care costs as well. Background: According to the World Health Organization (WHO), tobacco causes 1 in 10 adult deaths worldwide and is the leading preventable cause of death in the world. In 2005, tobacco caused 5.4 million deaths, which amounts to one death every 6 seconds. It is estimated that by 2030, annual deaths from tobacco use will be 8 million worldwide. Eighty percent of these deaths will occur in the developing world. Why Was This Study Done?: The success of large public health programs, especially those that counter the tactics of powerful industries such as the tobacco industry, require funding. The justification of public spending on these initiatives should be evidence driven. While the success of the CTCP in reducing smoking was known, it was not yet clear whether the program had reduced health care costs. The researchers investigated the effect of the CTCP on personal health care expenditures in the state. Their findings can provide useful information for the development of other tobacco control initiatives. What Did the Researchers Do and Find?: Using the statistical approach of cointegrating regressions, the researchers modeled the relationships between per capita tobacco control expenditures, per capita cigarette consumption, and health care expenditures. They analyzed data from 1980 and 2004 on smoking, health care expenditures, and exposure to a tobacco control educational program in California and compared them to a group of 38 control states. Control states were those without comprehensive tobacco control programs prior to 2000 or cigarette tax increases of $0.50 or more per pack over the study period. This comparison allowed the researchers to assess the effect of the CTCP on total personal health care spending. What Do These Findings Mean?: The CTCP has been successful in reducing smoking in California in comparison to other states, and has reduced personal health care expenditures. These cost reductions were substantial, rapid, and grew over time. The researchers contend that the CTCP's focus on social norm change among adults, not primarily on youth prevention, is responsible for such rapid and large reductions in disease and the associated health care costs. They state that a program focused on primary prevention of smoking among adolescents would take decades to have any impact on tobacco-induced diseases, which rarely manifest among adolescents or even young adults. These researcher's findings support the establishment of strong tobacco control programs in other settings: they not only reduce smoking, prevent disease, and save lives, but also represent an important way to curb rapidly increasing health care expenditures in the short term. Additional Information.: Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0050178.