What is the potential cost-effectiveness of enforcing a prohibition on the sale of tobacco to minors?

Prev Med. 2001 Feb;32(2):168-74. doi: 10.1006/pmed.2000.0795.


Background: Enforcement programs to halt the sale of tobacco to youths have been implemented across the United States. The potential cost-effectiveness of enforcement was evaluated under a range of assumptions regarding cost and impact.

Methods: An enforcement model was constructed incorporating quarterly inspections of all tobacco vendors. The cost of discounted years of life saved was calculated using reported values regarding cost and a range of assumptions regarding the impact on youth tobacco use.

Results: Inspecting an estimated 543,000 tobacco outlets would cost up to $190 million annually. Costs range from $44 to $8,200 per year of life saved depending on the discount rate and assumptions regarding cost, and efficacy. To compete in cost-effectiveness with implementing smoking cessation guidelines, enforcement would have to produce a 5% reduction in adolescent smoking at a cost of no more than $250 per vendor.

Conclusion: At this level of cost and effectiveness an enforcement program could save 10 times as many lives as the same amount spent on mammography or screening for colorectal carcinoma. A one-cent per pack cigarette tax could fully fund enforcement. Enforcement of tobacco sales laws deserves further study as one component of a multifaceted approach to tobacco use prevention.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age Factors
  • Commerce / legislation & jurisprudence
  • Commerce / statistics & numerical data
  • Cost-Benefit Analysis
  • Drug and Narcotic Control / economics*
  • Drug and Narcotic Control / legislation & jurisprudence
  • Health Care Costs*
  • Humans
  • Models, Econometric
  • Smoking / economics*
  • Smoking / epidemiology
  • Smoking / legislation & jurisprudence
  • Smoking Cessation / economics
  • Smoking Prevention*
  • United States / epidemiology