Using the approach of co-integrating regressions, the researchers modeled the relationship between per capita tobacco control expenditures, per capita cigarette consumption and health care expenditures across the study time frame. They compared those results in California to 38 control states that did not have comprehensive tobacco control programs before 2000.

"We confirmed these results with a wide range of model reliability tests and sensitivity analyses to make sure that the findings we found were not a result of some unobserved third factor," says Lightwood. "For example, including differences between California and the control states on a variety of risk factors did not materially affect the results."

The risk factors included being overweight or obese, hypertension, binge drinking, no regular exercise, demographic factors, cost structure of health care inputs, active physicians per capita, hospital beds per capita, proportion of population receiving Medicaid services, and economic activity.

"The methods in this study can be used to forecast future costs, and will provide important additional means for validating program evaluations that previously did not exist," Lightwood adds.

The study results show that tobacco control programs not only reduce smoking and prevent disease, but also quickly and substantially reduce health care costs, according to Glantz, who also notes that the savings grew over time, reaching 7.3 percent of total health care costs after 15 years. "Large scale tobacco control programs should be an integral part of the medical cost containment that everyone agrees must be part of any health care reform," he emphasizes.


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