Effective population-based tobacco control interventions include tobacco price increases, high-impact anti-tobacco mass media campaigns, and comprehensive smoke-free policies. The evidence shows that implementing and enforcing these strategies, both individually and as part of a comprehensive tobacco prevention and control effort, can reduce smoking initiation and use among adults and youths. Comprehensive tobacco prevention and control efforts involve the coordinated implementation of population-based interventions to prevent tobacco initiation among youth and young adults, promote quitting among adults and youth, eliminate exposure to secondhand smoke, and identify and eliminate tobacco-related disparities among population groups.[1] Tobacco products include cigarettes, cigars, pipes, hookah, smokeless tobacco, and others. Programs combine and integrate multiple evidence-based strategies, including educational, regulatory, economic, and social strategies at local, state, or national levels.[1] Show Evidence-based interventions that are key components of a comprehensive tobacco prevention and control effort include
 CDC’s EXHALEpdf icon package features evidence-based strategies to improve asthma control and reduce healthcare costs, including information about comprehensive smoke-free policies. What is the public health issue?Tobacco use is the single most preventable cause of disease, disability, and death in the United States. Cigarette smoking harms nearly all organs of the body; it has been linked to heart disease, multiple cancers, lung diseases, among others. Smoking during pregnancy also causes harm to the fetus.[5] In addition to adverse effects on individual- and population-level health, smoking imposes an immense financial burden on society, with over 480,000 premature deaths, over $170 billion in lost productivity costs, and at least $133 billion in direct medical care expenditures in the United States each year.[6] The use of smokeless tobacco, cigars, and pipes can also have deadly consequences, including lung, larynx, esophageal, and oral cancers.[7-9] Moreover, the effects of tobacco use are not limited to the user. Secondhand smoke exposure can cause death and many serious diseases, including lung cancer, heart disease, and stroke among adults and respiratory illness, ear infections, asthma attacks, and sudden infant death syndrome among children and infants.[5] An estimated 1 in 4 nonsmokers (58 million people), including about 2 in 5 children, are exposed to secondhand smoke.[10] What is the evidence of the health impact and cost effectiveness?[1-4]A systematic review of proven population-based tobacco control interventions found that these programs were associated with
States that have made larger investments in comprehensive tobacco control efforts have seen larger declines in cigarettes sales than the United States as a whole, and the prevalence of cigarette smoking among adults and youth has declined faster as spending for tobacco control programs has increased. [11] Comprehensive tobacco control efforts have also contributed to reductions in tobacco-related diseases and deaths, and were effective across diverse racial, ethnic, educational, and socioeconomic groups. The review also found that these programs were cost-effective and that healthcare savings were greater than the cost of the intervention. Additional systematic reviews examining the impact of single interventions that may be implemented individually or included as part of a comprehensive tobacco control program, such as mass-media campaigns, price increases, and smoke-free policies, also found strong evidence of their efficacy and cost-effectiveness. Mass-reach Communications Campaigns
An economic review of the evidence found the benefit-to-cost ratio for mass-reach health communications campaigns ranged from 7:1 to 74:1, with an estimated cost of $213 (2011 dollars) per life year saved.[2] Increasing the price of tobacco products
An economic review of the evidence estimated that healthcare cost savings from a 20 percent price increase for tobacco products ranged from -$0.14 to $90.02 per person per year (2011 dollars) in addition to averted productivity losses.[3] Comprehensive smoke-free policies
An economic review of the evidence estimated that net savings resulting from a nationwide U.S. smoke-free policy would range from $700 to $1,297 per person not currently covered by a smoke-free policy (2011 dollars).[4] It also found that smoke-free policies did not have an adverse economic impact on the business activity of restaurants, bars, or establishments catering to tourists; some studies found a small positive effect of these policies.[4] For questions or additional information, email . Page 2
Interventions Changing the Context
Regulatory, legislative, and other policies that support access to clean needles and syringes allow for the legal sale of needles without prescriptions, and include programs to distribute clean needles and safely dispose of used needles.[1, 2] The purpose of these policies is to reduce the transmission of blood-borne pathogens, including HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV). Policies that authorize the legal sale and exchange of clean needles and syringes are typically enacted at the state level. Sixteen states have passed laws authorizing needle and syringe exchanges.[3] Moving toward this goal, California law supports access to clean needles through the nonprescription sale of syringes and needles.[4] Several states have statutes that remove syringes from lists of illegal drug paraphernalia.[3] In order to reduce potential needle stick injuries among police officers, North Carolina legalized needle possession among people who alert police officers to the presence of needles prior to a search.[5] What is the public health issue?Injection drug use (IDU) is a risk factor for contracting blood-borne pathogens such as HIV and HCV, and sharing syringes provides a direct route of transmission for diseases.[6] It is estimated that in 2013, 3,096 of the estimated 47,352 diagnoses of HIV infection in the United States were attributed to IDU.[7] Among persons who inject drugs (PWID), HCV is approximately 10-fold more transmissible than HIV; 50-90% of HIV-infected PWID are co-infected with HCV. ID use has been shown to be the most common means of HCV transmission in the U.S., and an estimated 33 percent of PWID aged 18-30 years are HCV-infected. Older and former PWID have an estimated prevalence of 70-90% due to the increased risk of continued injection drug use and needle sharing in the 1970’s and 1980’s before risks of bloodborne virus transmission were widely known.[8] The lifetime cost of HIV treatment is estimated to be $379,668 (in 2010 dollars).[9, 10] The initial market prices of HCV treatment ranged from $84,000 to $96,000 in 2014.[11] Since 2014, the cost of HCV medications has fallen to an estimated $40,000 for Medicaid programs. Some payers have negotiated greater reductions in HCV drug costs. HCV treatment can save $14.3 billion in health costs while costing $69.5 billion to implement, raising budgetary issues for Medicaid and other insurance plans. PWID can substantially reduce their risk of acquiring and transmitting HIV, HBV, HCV, and other blood-borne infections by using a sterile needle or syringe for every injection.[11] Research shows that barriers such as prescription requirements and legal restrictions on needle possession and distribution can prevent access to clean needles and syringes.[12] Prevention of HCV among PWID is most effective when needle or syringe exchange programs are combined with other prevention services such as behavior-change counseling and addiction treatment services. HCV treatment provides another option for preventing transmission among PWID. A number of models suggest that even modest increases in HCV treatment of PWID can lead to substantial declines in prevalence and incidence of HCV infection when combined with other services.[13-15] What is the evidence of health impact and cost effectiveness?A systematic review of 15 studies analyzing needle-syringe programs (NSP) found that NSP’s were associated with decreases in the prevalence of HIV and HCV and decreases in the incidence of HIV.[1] For example, a series of three-year longitudinal studies investigating the effect of New York’s legalization of syringe exchange programs between 1990 and 2002 found decreases in:
Another study that examined the effect of New York’s exchange program on the prevalence of HCV infection between 1990 and 2001 found that it was associated with a reduction in prevalence from 80 percent to 59 percent among HIV-negative intravenous drug users (p<0.034).[1, 17] An evaluation examining the District of Columbia’s lift of the Congressional ban on syringe exchange programs, which allowed the D.C. Department of Health to initiate an exchange program, showed a 70 percent decrease in new HIV cases among IDU and a total of 120 HIV cases averted in two years [18]. A cost-effectiveness analysis of a New York City needle syringe exchange estimated that the program would result in a baseline one year savings to the government of $1,300 to $3,000 per client. [19] Another cost-effectiveness analysis estimated that expanding access to clean syringes through an additional annual U.S. investment of $10 million would result in:
1 Net present value in U.S. 2011 dollars For questions or additional information, email .
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Which qualitative research method would be best to find an effective intervention that discourages youths in the community from initiating tobacco use?
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