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

Am J Public Health. 2012 Feb;102(2):e22-8. doi: 10.2105/AJPH.2011.300506. Epub 2011 Dec 15.


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.

MeSH terms

  • Behavioral Risk Factor Surveillance System
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control
  • Commerce / statistics & numerical data*
  • Health Policy*
  • Humans
  • Prevalence
  • Respiratory Tract Diseases / epidemiology
  • Respiratory Tract Diseases / prevention & control
  • Respiratory Tract Neoplasms / epidemiology
  • Respiratory Tract Neoplasms / prevention & control
  • Smoking / economics*
  • Smoking / legislation & jurisprudence*
  • Smoking Prevention
  • Taxes / statistics & numerical data
  • Tobacco Smoke Pollution / legislation & jurisprudence
  • Washington / epidemiology


  • Tobacco Smoke Pollution