The economic effect of smoke-free restaurant policies on restaurant business in Massachusetts.

The objective of the study was to determine if local smoke-free restaurant policies in Massachusetts affected restaurant sales. The authors used a pre-/post-quasi-experimental design to compare town-level meals tax data before and after the imposition of local smoke-free restaurant policies. Data for 235 towns (including 32 adopting communities) were entered into a fixed effects regression model to estimate changes in restaurant sales over time. The study failed to find a statistically significant effect of local smoke-free policies on restaurant business. It provides evidence that local smoke-free policies do not cause a large decline in communities' restaurant industries.

Local restaurant smoking policy enactment in Massachusetts.

The objective of this study was to identify differences between communities that enact local restaurant smoking policies in Massachusetts and those that do not. Using data from 314 reporting cities and towns, the authors determined that communities with restaurant smoking policies were typically medium-sized towns and had a lower proportion of blue-collar workers than non-adopting communities. Highly restrictive communities had higher median incomes and educational attainment than non-adopting communities. Since the creation of the Massachusetts Tobacco Control Program, the number and strength of restaurant smoking policies have grown.

Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Agency for Health Care Policy and Research.

CONTEXT: The Agency for Health Care Policy and Research (AHCPR) published the Smoking Cessation: Clinical Practice Guideline in 1996. Based on the results of meta-analyses and expert opinion, the guideline identifies efficacious interventions for primary care clinicians and smoking cessation specialty providers. OBJECTIVE: To determine the cost-effectiveness of clinical recommendations in AHCPR's guideline. DESIGN: The guideline's 15 recommended smoking cessation interventions were analyzed to determine their relative cost-effectiveness. Then, using decision probabilities, the interventions were combined into a global model of the guideline's overall cost-effectiveness. PATIENTS: The analysis assumes that primary care clinicians screen all presenting adults for smoking status and advise and motivate all smokers to quit during the course of a routine office visit or hospitalization. Smoking cessation interventions are provided to 75% of US smokers 18 years and older who are assumed to be willing to make a quit attempt during a year's time. INTERVENTION: Three counseling interventions for primary care clinicians and 2 counseling interventions for smoking cessation specialists were modeled with and without transdermal nicotine and nicotine gum. MAIN OUTCOME MEASURE: Cost (1995 dollars) per life-year or quality-adjusted life-year (QALY) saved, at a discount of 3%. RESULTS: The guideline would cost $6.3 billion to implement in its first year. As a result, society could expect to gain 1.7 million new quitters at an average cost of $3779 per quitter, $2587 per life-year saved, and $1915 for every QALY saved. Costs per QALY saved ranged from $1108 to $4542, with more intensive interventions being more cost-effective. Group intensive cessation counseling exhibited the lowest cost per QALY saved, but only 5% of smokers appear willing to undertake this type of intervention. CONCLUSIONS: Compared with other preventive interventions, smoking cessation is extremely cost-effective. The more intensive the intervention, the lower the cost per QALY saved, which suggests that greater spending on interventions yields more net benefit. While all these clinically delivered interventions seem a reasonable societal investment, those involving more intensive counseling and the nicotine patch as adjuvant therapy are particularly meritorious.

Equity of the Medicaid program to the poor versus taxpayers.

The last 15 years have witnessed explosive growth in State Medicaid programs. This article demonstrates the equalizing impacts of greater spending and recent Federal mandates on the health care coverage of the poor. Large inequalities in generosity still remain, however. Inequalities in taxpayer burdens are also documented, and simulations of alternative Federal sharing algorithms show significant changes that would be required to achieve a more equitable distribution of the program's financial burden.