How much can business expect to profit from smoking cessation?

doi:10.1016/0091-7435(83)90245-1

Preventive Medicine

Volume 12, Issue 2, March 1983, Pages 358-381

https://doi.org/10.1016/0091-7435(83)90245-1 Get rights and content

Abstract

The data reviewed in this article, drawn from well-known, published sources, offer an estimate of the annual costs of smoking to the average employer. These costs range from $336 to $601 in January 1980 dollars per average smoking employee. The analysis is largely based on aggregate epidemiological data and, in general, the emphasis is on the underestimating of the costs to business. It reports “averages” true for large populations and, therefore, is not individually predictive. The cost centers dealt with are insurance, medical, and others such as absenteeism, productivity, involuntary smoking, and occupational health risk. Included is a discussion of employer-sponsored smoking cessation programs and the benefits therefrom.

References (94)

E.C. Hammond
Tar and nicotine content of cigarette smoke in relation to death rates
Environ. Res.
(1976)
M. Jacobsen
Smoking and disability in miners
Lancet
(1980)
M.M. Kristein
Economic issues in prevention
Prev. Med.
(1977)
P.N. Lee
Passive smoking
Food Cosmet. Toxicol.
(1982)
M. Mushinski et al.
Impact of new smoking trends on women's occupational health
Prev. Med.
(1978)
J. Peto
Taxes, smoking, health
Lancet
(1976)
J. Truett et al.
A multivariate analysis of the risk of coronary heart disease in Framingham
J. Chronic Dis.
(1967)
American Cancer Society
Cancer Facts and Figures
(1982)
American Cancer Society
Progress in Smoking Cessation
American Cancer Society

American Lung Association of Hennepin County

American Telephone and Telegraph Co.

A.B. Atkinson et al.

Economic aspects of reduced smoking

Lancet

(1977)

A. Berk et al.

The economic cost of illness, fiscal 1975

Med. Care

(1978)

W.J. Blot

Lung cancer after employment in shipyards during W.W.H.

New Engl. J. Med.

(1978)

D. Bennett et al.

Smoking policies and smoking cessation programs of large employers in Massachusetts

Amer. J. Public Health

(1980)

A. Blum

Medicine vs. Madison Avenue

L.I. Boden

The economic impact of environmental disease on health care delivery

J. Occup. Med.

(1976)

L.A. Bjurstron et al.

A program of health disease intervention for public employees

J. Occup. Med.

(1977)

W.S. Cain et al.

Odor Control through Ventilation: Smoking vs. Nonsmoking Occupancy

California GASP Newsletter

(Jan. 1980)

R.A. Carelton et al.

Fire deaths from smoking

New Engl. J. Med.

(1979)

Cancer Letter

(June 8, 1979)

The Charlotte Observer

(March 25, 1979)

B. Cooper et al.

The economic cost of illness revisited

Soc. Sec. Bull.

(1976)

Council on Scientific Affairs

Smoking and health

JAMA

(1980)

M.D. Cowell et al.

Mortality Differences between Smokers and Non-smokers

(Oct. 22, 1979)

R. Doll et al.

Cigarette smoking and bronchial carcinoma

J. Epidemiol. Commun. Health

(1978)

L. Garfinkel

Time trends in lung cancer mortality among non-smokers and a note on passive smoking

J. Natl. Cancer Inst.

(1981)

R.E. Glasgow et al.

Behavioral treatment of smoking behavior

G.B. Gori et al.

Toward less hazardous cigarettes

JAMA

(1978)

G.B. Gori et al.

Macroeconomics of disease prevention and the U.S.

Science

(1978)

S.L. Gortmaker

Parental smoking and risk of childhood asthma

Amer. J. Public Health

(1982)

E.C. Hammond et al.

Asbestos exposure, cigarette smoking and death rates

Ann. N.Y. Acad. Sci.

(1979)

T. Harrup et al.

Clinical methods in smoking cessation

Amer. J. Public Health

(1979)

T. Hirayama

Non-smoking wives of heavy smokers have a higher risk of lung cancer: A study from Japan

Brit. Med. J.

(1981)

S. Heyden et al.

Exposure to cotton dust and respiratory disease

JAMA

(1980)

D. Hoffmann et al.

The less harmful cigarette: Present and future

A. Jonston-Early

Smoking abstinence and small cell lung cancer survival

JAMA

(1980)

J.D. Kark et al.

Cigarette smoking as a risk factor for epidemic A (H.N.) influenza in young men

New. Engl. J. Med.

(1982)

P. Kotin et al.

Smoking in the workplace: A hazard ignored

Amer. J. Public Health

(1980)

J.H. Knowles

C.E. Koop et al.

The health consequences of smoking: Cancer

L. Kozlowksi et al.

What researchers make of what cigarette smokers say: Filtering smokers' hot air

Lancet

(1980)

M.M. Kristein

How Much is Chronic Disease Costing the Typical American Company?

M.M. Kristein

Asbestos workers and lung cancer

Amer. J. Public Health

(1981)

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Tobacco industry sociological programs to influence public beliefs about smoking
2008, Social Science and Medicine
Citation Excerpt :
Until the 1970s, public health arguments about tobacco focused on smokers. By the late 1970s two potent arguments emerged which focused on how smoking affects others (Roper Organization, 1978): smoking imposes financial “social costs” (Kristein, 1983; Luce & Schweitzer, 1977; Weis, 1981) because of smokers' medical care, absenteeism, facilities maintenance, and fire risks and secondhand smoke endangers nonsmokers. Cigarette makers recognized that these arguments were stimulating efforts to regulate smoking and contributing to the decline in social acceptability of smoking worldwide (International Committee on Smoking Issues (ICOSI), 1977; Reynolds, 1978; Social Costs Plan, 1989 (est.)).
The multinational tobacco companies responded to arguments about the social costs of smoking and hazards of secondhand smoke by quietly implementing the Social Costs/Social Values project (1979–1989), which relied upon the knowledge and authoritative power of social scientists to construct an alternate cultural repertoire of smoking. Social scientists created and disseminated non-health based, pro-tobacco arguments without fully acknowledging their relationship with the industry. After the US Surgeon General concluded that nicotine was addictive in 1988, the industry responded by forming “Associates for Research in the Science of Enjoyment” (c.1988–1999), whose members toured the world promoting the health benefits of the use of legal substances, including tobacco, for stress relief and relaxation, without acknowledging the industry's role. In this paper we draw on previously secret tobacco industry documents, now available on the Internet to show how both of these programs utilized academic sociologists, political scientists, anthropologists, psychologists, philosophers and economists, and allowed the industry to develop and widely disseminate friendly research through credible channels. Strategies included creating favorable surveys and opinions, infusing them into the lay press and media through press releases, articles and conferences, publishing, promoting and disseminating books, commissioning and placing favorable book reviews, providing media training for book authors and organizing media tours. These programs allowed the tobacco industry to affect public and academic discourse on the social acceptability of smoking.
Return on investment of different combinations of bupropion SR dose and behavioral treatment for smoking cessation in a health care setting: An employer's perspective
2004, Value in Health
The net benefit (i.e., benefits minus costs) of sustained-release (SR) bupropion for smoking cessation from an employer's perspective has previously been evaluated in clinical trials including frequent, in-person behavioral counseling and manufacturer recommended dosing but not in actual practice settings and lower dosing.
The objective of this research was to determine the return on investment (ROI) and internal rate of return (IRR) from an employer's perspective of two dosing schedules of bupropion SR in combination with behavioral interventions of minimal intensity (tailored mailings, TM) or moderate intensity (proactive telephone calls, PTC) in an actual practice setting.
An open-label, randomized trial with 1-year follow-up was conducted in a large health system (Group Health Cooperative) based in Seattle, WA. Participants included 1524 adult smokers interested in quitting smoking. Participants were randomly assigned to receive 150 mg of bupropion SR daily and PTC (n = 382), 150 mg of bupropion SR daily and TM (n = 381), 300 mg of bupropion SR daily and PTC (n = 383) or 300 mg of bupropion SR daily and TM (n = 378). Sufficient medications for 8 weeks of dosing were provided to patients. The primary outcome measure of the field trial was self-reported point-prevalence 7-day nonsmoking status at 12 months, and the primary outcome measures of the economic analysis were employer net benefit, employer ROI, and the ROI-associated IRR using 2002 dollars.
Using net benefit, the 300-mg/PTC and the 150-mg/PTC treatments were approximately equally preferred. Using ROI or IRR, both the 150-mg/TM and 150-mg/PTC treatments were about equally preferred, with IRR values of 31.7% and 31.4%, respectively. Under a pessimistic scenario regarding effectiveness and costs, 150 mg/PTC became more cost-effective than 150 mg/TM, and employer IRR for 150 mg/PTC was 13%. Under an optimistic scenario IRR exceeded 45% for all treatments.
These results suggest that employers can receive competitive returns on investment from sponsoring smoking cessation programs, that 150 mg of bupropion doses yield better returns than 300-mg doses, and that PTC treatments should be preferred to TM if smoking cessation rates in the targeted employee population are lower than those in the study population.
The economics of smoking and cardiovascular disease
2003, Progress in Cardiovascular Diseases
The direct medical cost of cardiovascular and circulatory diseases was $151 billion in 1995, approximately 17% of all direct medical care costs in the United States. Incidence and prevalence based estimates indicate that smoking is a major contributing factor for cardiovascular disease and associated costs. Statewide smoking control programs and workplace and public area smoking bans are effective in reducing smoking prevalence. Smoking cessation therapies are very cost-effective interventions for the prevention of cardiovascular disease. Incidence based estimates indicate that smoking cessation control expenditures in the United States have been a cost effective method for reducing the direct medical costs of cardiovascular disease in the past, and may be cost saving in the future. The expected cost of producing an additional ex-smoker has been estimated to be approximately $1,000 to $1,500. Most or all of this cost can be recovered in the short run from savings in avoided heart attacks and strokes alone in healthy quitters. Observational studies of the direct medical costs following cessation in those observed to quit show a reduction utilization, but which may occur only after a lag of three to five years.
Evaluation of a workplace anti-smoking program at a company with 640 employees
2002, Archivos de Bronconeumologia
El conocimiento del riesgo que supone para los no fumadores la inhalación de aire contaminado con humo de tabaco ha motivado el desarrollo de intervenciones sobre tabaquismo en el medio laboral, aunque en nuestro entorno son todavía escasas. El objetivo de nuestro estudio es conocer la eficacia de una intervención sobre tabaquismo entre los trabajadores de una empresa, según los cambios existentes en la prevalencia pre y postintervención en el grupo estudiado
Se realizó una encuesta preintervención sobre tabaquismo (prevalencia y actitudes) en una empresa de 640 empleados (el 92% varones y el 8% mujeres); a lo largo de los nueves meses siguientes se desarrolló la intervención dentro de la empresa durante el horario laboral; posterior-mente se repitió la encuesta (postintervención) con el objetivo de evaluar su efectividad basándose en los cambios existentes. Se realizó un estudio de datos apareados en los trabajadores que contestaron ambas encuestas
Contestaron la encuesta preintervención 388 empleados (60%), 357 varones (92%), 31 mujeres (8%); edad media, 48,4 (desviación estándar [DE], 9,36). La prevalencia de tabaquismo fue del 55%, incluyendo fumadores a diario, esporádicos y de otras labores de tabaco; media de cigarrillos/día, 17,86 (DE, 2,45); grado de dependencia a la nicotina (test de Fagerström), media, 3,3 (DE, 2,8) sobre 10. Contestaron la encuesta preintervención 206 empleados (el 32% del total); en los trabajadores que contestaron ambas encuestas (83) mediante estudio de datos apareados se observó una disminución de la prevalencia de fumadores del 4% y del número de cigarrillos/día (17,4 preintervención y 16,4 postintervención); estas diferencias no fueron estadísti-camente significativas
El entorno laboral constituye un medio adecuado, infrautilizado en la actualidad, para realizar intervenciones sobre tabaquismo y contribuir así a mejorar la salud de la población trabajadora
Awareness of the health risks of passive smoking for non-smokers has led to the development of work-place interventions for smokers, although they are still few in our setting. The objective of this study was to evaluate the efficacy of an anti-smoking program among the workers of a company, in function of changes in the pre and post-intervention prevalence of smoking in the study population
A pre-intervention questionnaire on smoking (prevalence and attitudes) was administered at a company with 640 employees (92% men, 8% women). An anti-smoking program was carried out inside the company during working hours over the next nine months. The questionnaire was then repeated (post-intervention) in order to evaluate its efficacy based on changes. For employees who answered both questionnaires, paired variables were analyzed
The pre-intervention questionnaire was answered by 388 employees (60%), 357 men (92%) and 31 women (8%); their mean age was 48.4 years (SD 9.36). The prevalence of smoking was 55%, including daily smokers, sporadic smokers and others. The mean number of cigarettes per day was 17.86 (SD 2.45). The mean level of nicotine dependence measured by the Fagerström test was 3.3 (SD 2.8) out of 10. The post-intervention questionnaire was answered by 206 employees (32%). Among employees who answered both questionnaires (83), analysis of paired data showed a decrease in the prevalence of smoking of 4% and in the number of ci-garettes per day from 17.4 (pre-intervention) to 16.4 (post-intervention). The differences were not statistically significant
Although the workplace is an appropriate setting for anti-smoking interventions that would contribute to improving the health of smokers, such programs are currently underutilized
The addition of social support to a community-based large-group behavioral smoking cessation intervention: Improved cessation rates and gender differences
2002, Addictive Behaviors
Objective: To determine the effects on cessation rates of adding a partner support group component to a large-group community-based behavioral smoking cessation program. Methods: During the past eight smoking cessation programs at the Tom Baker Cancer Centre in Calgary, Alberta, Canada, separate support group sessions were offered for support persons of prospective quitters. Six hundred smokers brought 156 support people with them to the groups. Cessation rates were calculated at 3, 6, and 12 months postquit. Results: Those smokers who had support people attending at least one of the support group sessions had higher cessation rates at 3, 6, and 12 months (56%, 46%, and 43%) compared to those without a support person in attendance (36%, 35%, 32%). This effect was especially strong for men, with 3-, 6-, and 12-month cessation rates for those with support of 58%, 54%, and 56%, compared to 52%, 41%, and 36% in the women with support. For men without a support person, the rates were 34%, 35%, and 33%, compared to 38%, 35%, and 31% in women without support. This indicates that although support was initially effective for women, it had no effect on sustained abstinence. Conclusions: The addition of a support person group to a large-group behavioral smoking cessation program was effective in improving 3-month cessation rates in both men and women, but over 1-year of follow-up support was only associated with greater sustained abstinence in men.
Eight-year follow-up of a community-based large group behavioral smoking cessation intervention
2000, Addictive Behaviors
Objective: To evaluate the effectiveness of a large group community-based behavioral smoking cessation intervention over an 8-year follow-up period and to determine precessation predictors of cessation at each follow-up time. Research Approach: Behavioral intervention followed by three longitudinal follow-up interviews. Setting: Regional Outpatient Cancer Centre. Study Participants: 971 participants in smoking cessation clinics held between 1986 and 1990. Intervention: Eight 90-minute sessions over 4 months utilizing education, self-monitoring, nicotine fading, a group quit date and behavioral modification techniques. Up to 110 smokers participated in each group program. Main Outcome Measures: Cessation rates at 3, 6, and 12 months postquit and at 8-year follow-up. Differences between successful and unsuccessful participants in precessation demographic, smoking history, and smoking behavior variables. Results: At 3 months postquit date, 39.3% of the 971 participants reported that they were not smoking, decreasing to 32.1% at 6 months and 26.0% at 12 months. At the 8-year follow-up, 33.9% of the original sample were contacted, and of those, 47.7% reported that they were currently not smoking. There were nine predictors of cessation at the end of the program (3 months), which were similar to those previously reported in the literature. Similarly, at 6 and 12 months, six factors were associated with not smoking. At the 9-year follow-up the only variable predictive of continued abstinence was being female (p < .05). Conclusions: This program was successful in promoting smoking cessation and maintenance, even with its large-group format. Predictive factors were similar to those previously reported in the literature.

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^☆: Supported in part by NCHSR Grant IR03HS03342-01 and USDHEW Grant 282-78-0168BAD to the American Health Foundation, New York, NY.

^☆☆: Based on a talk prepared for the National Interagency Council on Smoking and Health, January 1981, New York.

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General articleHow much can business expect to profit from smoking cessation?☆,☆☆

Abstract

Environ. Res.

Lancet

Prev. Med.

Food Cosmet. Toxicol.

Prev. Med.

Lancet

J. Chronic Dis.

Cancer Facts and Figures

Progress in Smoking Cessation

Economic aspects of reduced smoking

Lancet

The economic cost of illness, fiscal 1975

Med. Care

Lung cancer after employment in shipyards during W.W.H.

New Engl. J. Med.

Smoking policies and smoking cessation programs of large employers in Massachusetts

Amer. J. Public Health

Medicine vs. Madison Avenue

The economic impact of environmental disease on health care delivery

J. Occup. Med.

A program of health disease intervention for public employees

J. Occup. Med.

Odor Control through Ventilation: Smoking vs. Nonsmoking Occupancy

California GASP Newsletter

Fire deaths from smoking

New Engl. J. Med.

Cancer Letter

The Charlotte Observer

The economic cost of illness revisited

Soc. Sec. Bull.

Smoking and health

JAMA

Mortality Differences between Smokers and Non-smokers

Cigarette smoking and bronchial carcinoma

J. Epidemiol. Commun. Health

Time trends in lung cancer mortality among non-smokers and a note on passive smoking

J. Natl. Cancer Inst.

Behavioral treatment of smoking behavior

Toward less hazardous cigarettes

JAMA

Macroeconomics of disease prevention and the U.S.

Science

Parental smoking and risk of childhood asthma

Amer. J. Public Health

Asbestos exposure, cigarette smoking and death rates

Ann. N.Y. Acad. Sci.

Clinical methods in smoking cessation

Amer. J. Public Health

Non-smoking wives of heavy smokers have a higher risk of lung cancer: A study from Japan

Brit. Med. J.

Exposure to cotton dust and respiratory disease

JAMA

The less harmful cigarette: Present and future

Smoking abstinence and small cell lung cancer survival

JAMA

Cigarette smoking as a risk factor for epidemic A (H.N.) influenza in young men

New. Engl. J. Med.

Smoking in the workplace: A hazard ignored

Amer. J. Public Health

The health consequences of smoking: Cancer

What researchers make of what cigarette smokers say: Filtering smokers' hot air

Lancet

How Much is Chronic Disease Costing the Typical American Company?

Asbestos workers and lung cancer

Amer. J. Public Health

General article
How much can business expect to profit from smoking cessation?☆,☆☆