Tobacco: The Cost-effectiveness of Current Smoke-free Policies

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1. Introduction

Tobacco use constitutes a global epidemic that results in 5 million deaths each year (World Health Organization, 2008). If current trends in tobacco use continue, the number of tobacco-related deaths is expected to rise to 8 million deaths annually by 2030 – with 80 percent of these deaths taking place in low and middle-income countries (LMICs) (Mathers & Loncar, 2006).

Currently, about 10 percent of the world’s smokers live in India (World Health Organization, 2008). The 2009-2010 Global Adult Tobacco Survey, a nationally representative household survey, found that 34.6% of adults over the age of 15 in India currently use tobacco (International Institute for Population Sciences (IIPS), 2010). The prevalence of tobacco smoking in Gujarat, India, including those using smokeless as well as smoked tobacco is estimated to be 19.8% among males and 1.5% among females(International Institute for Population Sciences (IIPS), 2010). Most smokers in India consume bidis, small cigarettes containing, on average, 25 percent less tobacco than the average cigarette (Jha et al., 2008). Despite the smaller amount of tobacco in bidis, they can produce more nicotine, carbon monoxide, and tar than the average manufactured cigarette because of the way smokers puff on them (Mackay J et al., 2006). One recent nationally representative case-control study found that about 70% of smoking-related deaths in India take place during productive years of life between 30-69 years of age (Jha et al., 2008). In addition, the study projected that smoking will kill one million people each year starting in 2010 (Jha et al., 2008).

Since 2005, the World Health Organization (WHO)'s Framework Convention on Tobacco Control (FCTC) offers a ...

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... or sub-national setting. In the past several years, low and middle-income countries have seen an increased number of smoke-free policies (World Health Organization, 2009). However, some of these policies do not meet the FCTC’s recommendations or are poorly enforced at the sub-national level (World Health Organization, 2009). Therefore, it is important to examine the cost-effectiveness of current smoke-free policies to provide decision makers with the evidence needed to strengthen existing policies to meet FCTC requirements. Additionally, given the exceptions in India’s current smoke-free legislation and the high levels of exposure to secondhand smoke found in recent data, there is a particular need for transparent cost-effectiveness analysis of smoke-free legislation in India(International Institute for Population Sciences (IIPS), 2010; Trostle et al., 1999).

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