California tobacco control program cuts healthcare expenditure by $134 billion in 19 years

BMJ 2013; 346 doi: (Published 18 February 2013) Cite this as: BMJ 2013;346:f1098
  1. Bob Roehr
  1. 1Washington, DC

The tobacco control program in California has reduced expenditures for tobacco related healthcare by an estimated $134 (£87; €100) billion in its first 19 years, according to an analysis published in PLoS ONE.1

The analysis estimates that 6.8 billion fewer packs of cigarettes, worth $28.5 billion, were sold in the state because of the program up to the end of the fiscal year in 2008.

Smoking prevalence was 3.46 percentage points lower than it would have been without the program, while cigarette consumption per smoker fell by 96.3 packs per year. Per capita healthcare expenditures were $411 lower than what would have occurred had the program not been implemented, according to the model.

“These healthcare savings began to appear almost immediately after the program started and have grown over time, reaching more than $25 billion a year in 2008,” said lead author James Lightwood, a researcher at the University of California, San Francisco.

The incidence of people who smoke and the amount that they smoke are both important factors, say the authors. “About one third of the smoking related cost is due to smoking prevalence and the rest due to consumption per smoker.”

“The effects of reduced passive smoke due to lower prevalence and consumption may be more important than previously thought,” they said, citing a previous study of reduced hospital admissions for coronary events associated with exposure to cigarette smoke.2

Californians voted to create the tobacco control program in 1988, and it began the following year. The public education campaign emphasizes three themes: that the tobacco industry lies, nicotine is addictive, and secondhand smoke kills.

Other policy changes that have influenced patterns of smoking include an increase in the state sales tax on cigarettes and a ban on smoking in public places such as bars and restaurants.


Cite this as: BMJ 2013;346:f1098