Hana Ross (International Tobacco Surveillance, Epidemiology and Surveillance Research, American Cancer Society - National Home Office, Atlanta, Georgia, USA) Lisa M. Powell (University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, Illinois, USA) Joseph E. Bauer (Survey Research, Statistics & Evaluation Center, American Cancer Society - National Home Office, Atlanta, Georgia, USA) David T. Levy (Pacific Institute for Research and Evaluation, Calverton, Maryland, USA, Department of Economics, University of Baltimore, Baltimore, Maryland, USA) Richard M. Peck (Department of Economics, University of Illinois at Chicago, Chicago, Illinois, USA) Hye-Ryeon Lee (Department of Speech, University of Hawaii at Manoa, Honolulu, Hawaii, USA)
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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