Program, policy, and price interventions for tobacco control: quantifying the return on investment of a state tobacco control program.

OBJECTIVES: We examined health effects associated with 3 tobacco control interventions in Washington State: a comprehensive state program, a state policy banning smoking in public places, and price increases. METHODS: We used linear regression models to predict changes in smoking prevalence and specific tobacco-related health conditions associated with the interventions. We estimated dollars saved over 10 years (2000-2009) by the value of hospitalizations prevented, discounting for national trends. RESULTS: Smoking declines in the state exceeded declines in the nation. Of the interventions, the state program had the most consistent and largest effect on trends for heart disease, cerebrovascular disease, respiratory disease, and cancer. Over 10 years, implementation of the program was associated with prevention of nearly 36,000 hospitalizations, at a value of about $1.5 billion. The return on investment for the state program was more than $5 to $1. CONCLUSIONS: The combined program, policy, and price interventions resulted in reductions in smoking and related health effects, while saving money. Public health and other leaders should continue to invest in tobacco control, including comprehensive programs.

Promoting tobacco cessation via the workplace: opportunities for improvement.

INTRODUCTION: Little research exists on the prevalence of evidence-based tobacco cessation practices in workplaces, employer promotion of state-sponsored quitlines and predictors of these practices. METHODS: Cross-sectional analysis of the 2008 Healthy Worksite Survey, a telephone survey administered to Washington employers with 50 or more employees (n=693). The objectives were to describe workplaces' implementation of evidence-based tobacco cessation practices and identify key predictors of implementation in order to highlight opportunities for interventions. RESULTS: Among these employers, 38.6% promoted quitting tobacco, and 33.8% offered insurance coverage for cessation medications and counselling, 27.5% referred no-smoking violators to cessation services, and 5.7% included the state-sponsored quitline in health promotion messages. Larger workplaces and workplaces with a wellness staff, committee or coordinator had greater insurance coverage for tobacco cessation, communications promoting tobacco cessation, and promotion of the state-sponsored quitline (p<0.01). Workplaces with a wellness staff, committee or coordinator referred more violators of no-smoking policies to cessation services (p<0.01). CONCLUSIONS: In Washington State workplaces do little to promote tobacco cessation by their employees. The lack of tobacco cessation promoting practices at small businesses, restaurants and bars, and businesses without wellness personnel indicates an opportunity for finding and reaching current smokers at businesses with limited resources. By adopting inexpensive prevention efforts, such as promoting the state-sponsored tobacco cessation quitline, employers can help employees quit smoking and, thereby, assist in improving employee health and lower medical costs.