smoking waste money essay

• Smoking - the financial cost

Actions for this page

• If you need added incentive to quit smoking, think about how much of your weekly income is going up in smoke every week.
• At today’s prices, if you smoke one pack of cigarettes per day for 10 years, you’ll spend over $140,000 – enough for a deposit on a house.

On this page

After one day of not smoking, after 2 days of not smoking, after one week of not smoking, after one month of not smoking, after 3 to 6 months of not smoking, after one year of not smoking, other cost-saving benefits of quitting, future benefits of not smoking, where to get help.

Smoking costs money as well as affecting your health . Cigarettes are expensive and quitting can save you money now, as well as saving on future health costs.

If you need an added incentive to quit, think about how much of your weekly income is going up in smoke. One packet of 20 cigarettes costs around $39 and the price keeps rising. What could you do for yourself and your family with that extra money? More than you think. At today's prices, if you smoke one pack of cigarettes each day for 10 years, you'll spend over $140,000 - easily enough to buy a new car (or 2) or put a deposit on a house.

After one day of not smoking, you've got an extra $39 in your pocket. You could treat yourself to a cafe lunch or buy some phone credit.

The health benefits of not smoking for one day include:

• Most of the nicotine is cleared from your body.
• Your heart rate slows to a normal rate and your blood pressure is more stable.
• Your finger tips are warmer.

After 2 days of not smoking, you've saved $78 . You could take a friend to the movies, go to the footy or cricket, or treat yourself to a meal at a restaurant.

The health benefits of not smoking for 2 days include:

• Your skin, hair and breath smell fresher.
• Less carbon monoxide from smoke in your system means you're breathing more easily.

After one week of not smoking, you've got an extra $270 in your pocket. You could have a massage and a facial, take the family to dinner, go to a gig, or buy some new clothes.

The health benefits of not smoking for one week include:

• You have higher blood levels of protective antioxidants, such as vitamin C.
• Your sense of smell and taste may improve.

After one month of not smoking, you've saved $1,200. You could go away for a weekend, cover your petrol costs for a few months, or buy a new TV.

The health benefits of not smoking for one month include:

• Your heart is working more efficiently.
• Exercising is easier.
• Your immune system is starting to recover and your body is better at protecting cuts and wounds from infection.

After 3 months of not smoking, you've saved $3,500. This is enough for a new computer and your internet costs for a year. After 6 months, you've got nearly $7,000 to spend. You could take your family for a holiday to Queensland.

The health benefits of not smoking for 3 to 6 months include:

• The small hair-like structures that clean your lungs , called cilia, are working better.
• You're likely to cough and wheeze less, and cough up less phlegm.
• Blood flow to your fingers and toes improves.
• You may feel less stressed or in a better mood than when you were smoking.

After one year of not smoking, you've saved over $14,000. You could buy some new furniture or pay a lump sum off your mortgage.

The health benefits of not smoking for one year are that your lungs have continued to improve. Your small airways are healthier and your lung function is better than if you had kept smoking.

If you quit smoking, you'll save money in many other ways, including:

• You're less likely to suffer from colds , the flu or other lung infections, which means fewer trips to the doctor, less money spent on medications and fewer sick days.
• You won't need so many visits to the dentist to have your teeth professionally cleaned.
• You won't have to spend as much time and money on maintaining the house. For example, smoking inside your home discolours paint and wallpaper.
• You'll cut down on your cleaning bills because clothes, furniture upholstery and the interior of your car no longer smell of cigarette smoke.
• The risk of fire in your home is lower.

The health and financial benefits of quitting continue as the years go by and include:

• Your chances of conceiving a baby improve. Smoking can cause fertility problems, such as impotence in men and a lower chance of conceiving in women . Women who smoke during pregnancy are more likely to have a miscarriage .
• Over time, your sense of smell will continue to slowly improve.
• Within 5 years, your risk of stroke is substantially reduced. You've also saved $70,000.
• After 10 to 15 years, your risk of developing lung cancer is half that of a person who continues to smoke. You've also saved over $140,000.
• After 20 years, your risk of coronary heart disease and stroke is nearly the same as a person who has never smoked. You've also saved over $280,000.
• Quitting smoking benefits men and women of all ages and improves health in general. Remember that the rate and extent of recovery can vary from person to person.
• Your GP (doctor)
• Your pharmacist
• Call Quitline External Link on 13 78 48 or visit the Quit website External Link .
• Health benefits of quitting External Link , Quit.
• Tobacco in Australia: Facts and issues External Link , 2020, Greenhalgh EM, Scollo MM, and Winstanley MH [editors]. Cancer Council Victoria.
• Harte CB, Meston CM 2014, ' Effects of smoking cessation on heart rate variability among long-term male smokers External Link ', International Journal of Behavioral Medicine, vol. 21, no. 2, pp. 302-9.
• Smoking cessation: a report of the Surgeon General External Link , 2020, Centers for Disease Control and Prevention.
• Thun MJ, Carter BD, Feskanich D, et al. 2013, '50-year trends in smoking-related mortality in the United States' External Link , The New England Journal of Medicine, vol. 368, no. 4, pp. 351-64.
• Ding N, Sang Y, Chen J, et al. 2019, 'Cigarette smoking, smoking cessation, and long-term risk of 3 major atherosclerotic diseases' External Link , J Am Coll Cardiol, vol. 74, no. 4, pp. 498-507.
• Mons U, Muezzinler A, Gellert C, et al. 2015, 'Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium' External Link , BMJ, vol. 350, no. h1551.

This page has been produced in consultation with and approved by:

Give feedback about this page

More information, related information.

• Victoria’s tobacco and e-cigarette laws
• E-cigarettes and vaping
• Smoking - effects on your body
• Smoking kills

From other websites

• External Link Quit

Content disclaimer

Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional. The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances. The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website.

Essay on Smoking

500 words essay on  smoking.

One of the most common problems we are facing in today’s world which is killing people is smoking. A lot of people pick up this habit because of stress , personal issues and more. In fact, some even begin showing it off. When someone smokes a cigarette, they not only hurt themselves but everyone around them. It has many ill-effects on the human body which we will go through in the essay on smoking.

Ill-Effects of Smoking

Tobacco can have a disastrous impact on our health. Nonetheless, people consume it daily for a long period of time till it’s too late. Nearly one billion people in the whole world smoke. It is a shocking figure as that 1 billion puts millions of people at risk along with themselves.

Cigarettes have a major impact on the lungs. Around a third of all cancer cases happen due to smoking. For instance, it can affect breathing and causes shortness of breath and coughing. Further, it also increases the risk of respiratory tract infection which ultimately reduces the quality of life.

In addition to these serious health consequences, smoking impacts the well-being of a person as well. It alters the sense of smell and taste. Further, it also reduces the ability to perform physical exercises.

It also hampers your physical appearances like giving yellow teeth and aged skin. You also get a greater risk of depression or anxiety . Smoking also affects our relationship with our family, friends and colleagues.

Most importantly, it is also an expensive habit. In other words, it entails heavy financial costs. Even though some people don’t have money to get by, they waste it on cigarettes because of their addiction.

How to Quit Smoking?

There are many ways through which one can quit smoking. The first one is preparing for the day when you will quit. It is not easy to quit a habit abruptly, so set a date to give yourself time to prepare mentally.

Further, you can also use NRTs for your nicotine dependence. They can reduce your craving and withdrawal symptoms. NRTs like skin patches, chewing gums, lozenges, nasal spray and inhalers can help greatly.

Moreover, you can also consider non-nicotine medications. They require a prescription so it is essential to talk to your doctor to get access to it. Most importantly, seek behavioural support. To tackle your dependence on nicotine, it is essential to get counselling services, self-materials or more to get through this phase.

One can also try alternative therapies if they want to try them. There is no harm in trying as long as you are determined to quit smoking. For instance, filters, smoking deterrents, e-cigarettes, acupuncture, cold laser therapy, yoga and more can work for some people.

Always remember that you cannot quit smoking instantly as it will be bad for you as well. Try cutting down on it and then slowly and steadily give it up altogether.

Get the huge list of more than 500 Essay Topics and Ideas

Conclusion of the Essay on Smoking

Thus, if anyone is a slave to cigarettes, it is essential for them to understand that it is never too late to stop smoking. With the help and a good action plan, anyone can quit it for good. Moreover, the benefits will be evident within a few days of quitting.

FAQ of Essay on Smoking

Question 1: What are the effects of smoking?

Answer 1: Smoking has major effects like cancer, heart disease, stroke, lung diseases, diabetes, and more. It also increases the risk for tuberculosis, certain eye diseases, and problems with the immune system .

Question 2: Why should we avoid smoking?

Answer 2: We must avoid smoking as it can lengthen your life expectancy. Moreover, by not smoking, you decrease your risk of disease which includes lung cancer, throat cancer, heart disease, high blood pressure, and more.

Customize your course in 30 seconds

Which class are you in.

• Travelling Essay
• Picnic Essay
• Our Country Essay
• My Parents Essay
• Essay on Favourite Personality
• Essay on Memorable Day of My Life
• Essay on Knowledge is Power
• Essay on Gurpurab
• Essay on My Favourite Season
• Essay on Types of Sports

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Download the App

Stanford Journal of Public Health

The Economic Burden of Smoking

Ildemaro Gonzalez

Smoking leads to approximately half a million American deaths every year, and the economic cost of direct medical care and net loss of productivity compounds to a total of $289 to $332 billion per year 2 . The $151 billion loss of productivity is due to the premature deaths of smokers, who have an average life expectancy that is at least 10 years shorter than nonsmokers 3 . Because of these early deaths, millions of working adults die and are no longer able to productively contribute to society and the economy; this is a loss of productivity and a loss of money that otherwise would be circulating and increasing the American economy. At the current smoking rates 1 out of every 13 children, or 5.6 million children alive today, will die prematurely due to smoking 4 . One critical problem with smoking is that it not only hurts the smokers, but it can also threaten the health of nonsmokers who are exposed to secondhand smoke.

Secondhand smoke exposure should not be taken lightly. Smoking is a remarkably destructive action that negatively impacts smokers and their entire communities. Every year nearly 42,000 Americans die from secondhand smoke3. This number is slightly greater even than the number of Americans who die of breast cancer each year, which totals to around 40,000 5 . Secondhand smoke alone accounts for $5.6 billion of productivity loss annually3. The issue of secondhand smoke is of particular concern in public or subsidized housing because the negative externalities of smoking are amplified in these small, high-density communities. Residents in these types of housing are especially susceptible to secondhand smoking exposure through ventilation systems and open windows. If smoking was prohibited in public and subsidized housing $53 million per year would be saved from smoking-related fire damage, and $134 million would be saved from the increased cost of maintenance and cleaning in housing units that permit smoking. The total amount saved in secondhand smoke-related health care would amount to $310 million annually if smoking were banned in public and subsidized housing 6 . These benefits would trickle down to the children in these types of housing since children exposed to secondhand smoke are twice as likely to develop asthma, and also more likely to partake in smoking as well 7 .

Individual smokers can also substantially benefit economically if they stop smoking. A pack of cigarettes ranges from $4.96 to $14.50 in the Unites States; at just one pack per day, a smoker could save $1,765 to $5,162 per year if they quit. After just 15 years an ex-smoker would have saved $26,486 to $77,430, and that does not even take into account other cost saving benefits of quitting smoking. The risk of fires in the house is lower, and the ex-smoker’s immune system and overall health would improve dramatically, saving potentially thousands of dollars of health costs. Not to mention the fact that smokers pay higher insurance, lose money on the resale of their cars and homes, and have to spend extra money on dry cleaning and teeth cleaning.

Smoking tobacco creates a monetary vacuum that sucks away a considerable amount of Americans’ money. The average retail price of a pack of cigarettes in the U.S. is $5.51, but the price of that pack of cigarette on the economy and society amounts to $18.057. The most detrimental aspect of smoking is the loss of productivity due to premature death. The $132 billion spent on smoking-related health costs is money that is at least transferred to the healthcare system and doctors who will spend it elsewhere, allowing the money to continue to cycle through the economy, but the $151 billion lost annually though lost productivity is money that will not be created and will not be able to circulate throughout the economy 2 . Minimizing smoking rates would save hundreds of thousands of lives, improve overall health, and allow Americans and the economy to save a considerable amount of money that would otherwise be burn a hole right through their wallets.

References:

1. Centers for Disease Control and Prevention. Trends in current cigarette smoking among high school students and adults, United States, 1965-2011. http://www.cdc.gov/tobacco/data_statistics/tables/trends/cig_smoking. Accessed November 2, 2014.

2. American Cancer Society. How does tobacco use affect the economy? http://www.cancer.org/cancer/cancercauses/tobaccocancer/questionsaboutsmokingtobaccoandhealth/questions-about-smoking-tobacco-and-health-tob-and-economy. Accessed November 2, 2014.

3. Centers for Disease Control and Prevention. Tobacco-related mortality. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm. Accessed November 2, 2014.

4. U.S. Department of Human Services. Surgeon General report says 5.6 million U.S. children will die prematurely unless current smoking rates drop. http://www.hhs.gov/news/press/2014pres/01/20140117a.html. Accessed November 2, 2014.

5. National Cancer Institute. SEER stat fact sheets: Breast cancer. http://seer.cancer.gov/statfacts/html/breast.html. Accessed November 2, 2014.

6. Centers for Disease Control and Prevention. Almost $500 million could be saved annually by making subsidized housing smoke-free. http://www.cdc.gov/media/releases/2014/p1002-smoke-free-housing.html. Accessed November 2, 2014.

7. American Lung Association. Smoking cessation: The economic benefits. http://www.lung.org/stop-smoking/tobacco-control-advocacy/reports-resources/cessation-economic-benefits/states/united-states.html. Accessed November 2, 2014.

Image Link:

https://www.flickr.com/photos/haleyscottxoxo/5638809514/in/photolist-9AhnBG-aJhzdR-iXmBmw-67cc3T-oxxRMJ-aFbHit-gvhAZQ-8K1CG7-8K1CFd-8K1CJo-8JXAjH-8JXA8P-8JXAgD-8JXAnZ-8K1CHs-8JXAig-8JXAai-8nhg4q-jKbkpV-8DU9yG-8aeMki-bAYCv8-mjog8g-Aqqdy-xYEPq-jVpnWw-7LjCBA-9faJti-6quaMn-7FPW4e-7uaUMN-9YV7xr-2cvfEs-658gAh-bQmLu-jAxKsV-5s51JU-5vx31T-6Zn2Mk-4T4p4X-4tGT59-eb8faW-isQt7y-bQbEG6-79CUmC-gtLn3s-5dqPTC-8YTQkY-a726NA-2RNawq

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Tob Use Insights

The Economic Impact of Smoking and of Reducing Smoking Prevalence: Review of Evidence

Victor u ekpu.

1 Adam Smith Business School (Economics Division), University of Glasgow, Glasgow, UK.

Abraham K Brown

2 Nottingham Business School (Marketing Division), Nottingham Trent University, Nottingham, UK.

Associated Data

Supplementary file 1..

Search strategy for PubMed [modified for NIHR (CDR)].

Supplementary File 2.

Summary of results from selected economic studies by types of intervention.

Tobacco smoking is the cause of many preventable diseases and premature deaths in the UK and around the world. It poses enormous health- and non-health-related costs to the affected individuals, employers, and the society at large. The World Health Organization (WHO) estimates that, globally, smoking causes over US$500 billion in economic damage each year.

This paper examines global and UK evidence on the economic impact of smoking prevalence and evaluates the effectiveness and cost effectiveness of smoking cessation measures.

STUDY SELECTION

Search methods.

We used two major health care/economic research databases, namely PubMed and the National Institute for Health Research (NIHR) database that contains the British National Health Service (NHS) Economic Evaluation Database; Cochrane Library of systematic reviews in health care and health policy; and other health-care-related bibliographic sources. We also performed hand searching of relevant articles, health reports, and white papers issued by government bodies, international health organizations, and health intervention campaign agencies.

Selection criteria

The paper includes cost-effectiveness studies from medical journals, health reports, and white papers published between 1992 and July 2014, but included only eight relevant studies before 1992. Most of the papers reviewed reported outcomes on smoking prevalence, as well as the direct and indirect costs of smoking and the costs and benefits of smoking cessation interventions. We excluded papers that merely described the effectiveness of an intervention without including economic or cost considerations. We also excluded papers that combine smoking cessation with the reduction in the risk of other diseases.

Data collection and analysis

The included studies were assessed against criteria indicated in the Cochrane Reviewers Handbook version 5.0.0.

Outcomes assessed in the review

Primary outcomes of the selected studies are smoking prevalence, direct and indirect costs of smoking, and the costs and benefits of smoking cessation interventions (eg, “cost per quitter”, “cost per life year saved”, “cost per quality-adjusted life year gained,” “present value” or “net benefits” from smoking cessation, and “cost savings” from personal health care expenditure).

MAIN RESULTS

The main findings of this study are as follows:

• The costs of smoking can be classified into direct, indirect, and intangible costs. About 15% of the aggregate health care expenditure in high-income countries can be attributed to smoking. In the US, the proportion of health care expenditure attributable to smoking ranges between 6% and 18% across different states. In the UK, the direct costs of smoking to the NHS have been estimated at between £2.7 billion and £5.2 billion, which is equivalent to around 5% of the total NHS budget each year. The economic burden of smoking estimated in terms of GDP reveals that smoking accounts for approximately 0.7% of China’s GDP and approximately 1% of US GDP. As part of the indirect (non-health-related) costs of smoking, the total productivity losses caused by smoking each year in the US have been estimated at US$151 billion.
• The costs of smoking notwithstanding, it produces some potential economic benefits. The economic activities generated from the production and consumption of tobacco provides economic stimulus. It also produces huge tax revenues for most governments, especially in high-income countries, as well as employment in the tobacco industry. Income from the tobacco industry accounts for up to 7.4% of centrally collected government revenue in China. Smoking also yields cost savings in pension payments from the premature death of smokers.
• Smoking cessation measures could range from pharmacological treatment interventions to policy-based measures, community-based interventions, telecoms, media, and technology (TMT)-based interventions, school-based interventions, and workplace interventions.
• The cost per life year saved from the use of pharmacological treatment interventions ranged between US$128 and US$1,450 and up to US$4,400 per quality-adjusted life years (QALYs) saved. The use of pharmacotherapies such as varenicline, NRT, and Bupropion, when combined with GP counseling or other behavioral treatment interventions (such as proactive telephone counseling and Web-based delivery), is both clinically effective and cost effective to primary health care providers.
• Price-based policy measures such as increase in tobacco taxes are unarguably the most effective means of reducing the consumption of tobacco. A 10% tax-induced cigarette price increase anywhere in the world reduces smoking prevalence by between 4% and 8%. Net public benefits from tobacco tax, however, remain positive only when tax rates are between 42.9% and 91.1%. The cost effectiveness ratio of implementing non-price-based smoking cessation legislations (such as smoking restrictions in work places, public places, bans on tobacco advertisement, and raising the legal age of smokers) range from US$2 to US$112 per life year gained (LYG) while reducing smoking prevalence by up to 30%–82% in the long term (over a 50-year period).
• Smoking cessation classes are known to be most effective among community-based measures, as they could lead to a quit rate of up to 35%, but they usually incur higher costs than other measures such as self-help quit-smoking kits. On average, community pharmacist-based smoking cessation programs yield cost savings to the health system of between US$500 and US$614 per LYG.
• Advertising media, telecommunications, and other technology-based interventions (such as TV, radio, print, telephone, the Internet, PC, and other electronic media) usually have positive synergistic effects in reducing smoking prevalence especially when combined to deliver smoking cessation messages and counseling support. However, the outcomes on the cost effectiveness of TMT-based measures have been inconsistent, and this made it difficult to attribute results to specific media. The differences in reported cost effectiveness may be partly attributed to varying methodological approaches including varying parametric inputs, differences in national contexts, differences in advertising campaigns tested on different media, and disparate levels of resourcing between campaigns. Due to its universal reach and low implementation costs, online campaign appears to be substantially more cost effective than other media, though it may not be as effective in reducing smoking prevalence.
• School-based smoking prevalence programs tend to reduce short-term smoking prevalence by between 30% and 70%. Total intervention costs could range from US$16,400 to US$580,000 depending on the scale and scope of intervention. The cost effectiveness of school-based programs show that one could expect a saving of approximately between US$2,000 and US$20,000 per QALY saved due to averted smoking after 2–4 years of follow-up.
• Workplace-based interventions could represent a sound economic investment to both employers and the society at large, achieving a benefit–cost ratio of up to 8.75 and generating 12-month employer cost savings of between $150 and $540 per nonsmoking employee. Implementing smoke-free workplaces would also produce myriads of new quitters and reduce the amount of cigarette consumption, leading to cost savings in direct medical costs to primary health care providers. Workplace interventions are, however, likely to yield far greater economic benefits over the long term, as reduced prevalence will lead to a healthier and more productive workforce.

CONCLUSIONS

We conclude that the direct costs and externalities to society of smoking far outweigh any benefits that might be accruable at least when considered from the perspective of socially desirable outcomes (ie, in terms of a healthy population and a productive workforce). There are enormous differences in the application and economic measurement of smoking cessation measures across various types of interventions, methodologies, countries, economic settings, and health care systems, and these may have affected the comparability of the results of the studies reviewed. However, on the balance of probabilities, most of the cessation measures reviewed have not only proved effective but also cost effective in delivering the much desired cost savings and net gains to individuals and primary health care providers.

It is a known fact that both active and passive smoking are damaging to human health and have associated economic costs. Cigarette smoking is the cause of many preventable diseases, a leads to premature deaths, and accounts for a significant proportion of many health inequalities. The World Health Organization (WHO) currently estimates that each year smoking accounts for about ~6 million deaths worldwide and causes about half a trillion dollars in economic damage annually. 1 This number of smoking-attributable deaths is expected to rise to 7 million by 2020 and to more than 8 million a year by 2030 if the current rate of smoking continues unabated. 2 According to recent statistics from the Action on Smoking and Health, 3 smoking causes ~80% of deaths from lung cancer, ~80% of deaths from bronchitis and emphysema, and ~17% of deaths from heart disease. More than one quarter of all cancer deaths can be attributed to smoking. These include cancer of the lung, mouth, lip, throat, bladder, kidney, pancreas, stomach, liver, and cervix. It is also estimated that globally 600,000 deaths a year are caused by second-hand smoke, and most of these deaths occur among women and children.

The US center for Disease Control and Prevention also reported that cigarette smoking is the proximate cause of over 440,000 premature deaths annually, of which 50,000 is attributable to second-hand smoke. 4 – 6 Recent statistics from the British National Health Service (NHS) Health and Social Care Information Centre 7 shows that smoking accounts for about 100,000 deaths a year in the UK (79,100 in England, 13,000 in Scotland, 5,600 in Wales, and 2,300 in Northern Ireland). This compares with similar studies for UK in 2009, which showed that there were 109,164 deaths due to smoking (19% of all deaths in the UK), of which 27% deaths in men and 11% deaths in women can be traced to smoking. 8 These figures no doubt show that addiction to cigarette smoking poses a lot of health risk and could be loosely described as a death sentence in disguise . Reducing the prevalence of this menace is thus a worthy cause for health care professionals, the government, and society at large.

This paper reviews the major studies on the economics of tobacco smoking and the economic impact of reducing its prevalence. The paper examines the following research questions:

• What are the economic costs and benefits of smoking?
• How effective and cost effective are smoking cessation measures in terms of delivering cost savings and net gains to individuals and primary health care providers?

The economic impact of smoking is twofold: the costs of tobacco use itself, and the costs of reducing its prevalence among smokers. Beyond the face value of cigarette purchases, the costs of tobacco use have more far-reaching health and economic implications on private individuals, families, employers, and taxpayers. The costs of smoking have thus been classified as direct, indirect, and intangible. The direct costs of smoking include the cost of illness due to smoking on affected patients, and the health care expenditure involved in the treatment of smoking-related illnesses (eg, cost of drugs and administrative services). In the UK, direct costs of smoking arise from GP consultations, prescriptions for drugs, and various costs related to treating diseases attributable to smoking. 7 Direct costs could also include the resources used up by other agencies and charitable organizations. 9 The World Bank estimates that about 15% of the aggregate health care expenditure in high-income countries can be attributed to smoking. 10 , 11 In the UK, the direct costs of smoking to the NHS have been estimated at between £2.7 billion and £5.2 billion, which is equivalent to around 5% of the total NHS budget each year. 3 , 7 , 8 , 12 – 14 Smoking also poses considerable indirect costs to society and the nonsmoking public, eg, costs of second-hand smoking, costs to employers in the form of loss of productivity and absenteeism of smokers owing to smoking-related illnesses. 15 In addition, smoking-induced fires, sickness/invalidity benefits, litter, etc are all negative externalities of smoking to society. The direct and indirect costs of smoking can be measured b and hence are tangible costs, whereas there are some costs that cannot be easily quantified, such as loss of life, and the burden of pain and suffering caused by smoking-induced illness. 16 , 17 These unquantifiable costs are often referred to as the intangible costs of smoking.

Just as there are costs emanating from smoking, there are also benefits associated with reducing the incidence or prevalence of smoking. Benefits here refer to the losses that could be avoided by the individuals who quit smoking, such as cost savings from smoking in terms of reduced morbidity and mortality, reductions in the costs of illness, and the marginal risk of disease. 18 Other benefits of reducing smoking prevalence are longevity and improvement in the quality of life of quitters and passive smokers, improved workplace productivity, reduced costs of cleaning up the environment after smoking, reduction in fires caused by smoking, and the resulting damage or destruction, as well as a healthier population, among other benefits. There is a growing body of literature suggesting that smoking cessation interventions, coupled with regulations and legislations, are effective ways to reduce smoking prevalence. 16 , 17 , 19 , 20 Furthermore, there is evidence to suggest that smoking cessation interventions are among the most cost-effective and economically reasonable ways of appropriating health care resources. 5 , 9 – 11 , 21 – 27

This study attempts to review the existing evidence on the economic, health-related, and non-health-related impact of reducing smoking prevalence. First, we summarize the search methods and selection procedure used to conduct the systematic review, and then we examine the quality assessment method used in evaluating the study quality. The paper utilizes two main approaches used by medical researchers for economic evaluation c : cost-effectiveness analysis (CEA) and cost–benefit analysis (CBA). These are discussed in detail in Section “Measures of Evaluating Economic Impact”. The aim of this paper is to identify evidence on the effectiveness and cost effectiveness of smoking cessation interventions and also to identify data that may be of use in the economic modeling of the cost savings and net benefits derivable from investing in smoking cessation programs in the UK. Two specific pieces of work are presented in this review. The Section “Global Evidence on the Economics of Smoking” examines the evidence globally on the costs and benefits attributable to smoking, and then reviews the literature on the effectiveness and cost effectiveness of smoking cessation programs across countries. These will be examined under six broad headings: 1) pharmacological treatment interventions, 2) policy-based interventions, 3) community based interventions, 4) telecoms, media, and technology (TMT)-based interventions, 5) school-based interventions, and 6) workplace- or employer-based interventions. The second major segment of this review (“The Economic Impact of Smoking and Smoking-cessation Interventions in UK”) examines the economic impact of smoking in the UK. The rationale for narrowing down to UK is to assess how these various types of interventions are applied in a single country case study. Here, the costs and benefits of smoking in the UK are examined, as well as the effectiveness and cost effectiveness of UK-specific smoking cessation intervention programs. The Section “Discussion” discusses the main findings of the review by comparing results across types of intervention, across countries, and across measurement outcomes, and in some cases, providing the range of costs or cost savings for each intervention by combining costs from multiple sources. The section also discusses some of the known limitations of the study.

Research Methods

Search methods and selection criteria: overview.

A systematic review produced several studies, out of which a total of 99 literature sources on the economics of smoking and of reducing smoking prevalence were used for the review. We captured major economic studies on the health and economic impact of smoking and cost effectiveness of tobacco policies published between 1992 and 2014, but included only eight relevant studies before 1992. We also performed hand-searching of relevant articles, which produced additional 52 papers, including useful non-economic studies, and health reports and white papers issued by government bodies, international health organizations and health intervention campaign agencies that are usually not included in the electronic databases. This brings the total number of studies included in the review to 151. Of this number, 123 were strictly peer-reviewed medical journals, while 28 were useful government (public health) reports and white papers. This paper benefits strongly from the inclusion and synthesis of high-level evidence from mostly recent studies (eg, 2005–2014), with the implication that newer and better methods, indicators, or measures have been reported in order to aid economic modeling.

Study outcomes

Primary outcomes of the selected studies are smoking prevalence, direct and indirect costs of smoking, and the costs and benefits of smoking cessation interventions (eg “cost per quitter”, “cost per quality of life year gained”, “cost per life saved”, “present value” or “net benefits” from smoking cessation, and “cost savings” from personal health care expenditure).

Identification of studies

Two main electronic databases were searched. These are PUBMED (January 1992 to July 2014) and CRD (NIHS) (January 1992 to July 2014). The reason for the selection of these databases is that they are both very comprehensive databases containing health care-related studies. For example, PUBMED contains more than 23 million citations for biomedical literature from MEDLINE. The CRD database also contains the NHS Economic Evaluation Database, the Cochrane Library of Systematic Reviews in health care and health policy, and other health care-related bibliographic sources. To identify relevant studies for this review, we used a detailed search strategy for each database. These were based on the search strategy developed for PUBMED but revised appropriately for each database to take account of differences such as vocabulary and syntax rules. Key terms used were “economic” or “costs”, or “cost effectiveness” and “smoking”, or “tobacco” for the international evidence section, while the search strategy for the UK segment of the study included “UK” to the list of key words (see Supplementary File 1 ). Other keywords used were “tobacco control”, “smoking reduction”, and “smoking cessation”. We also performed hand searches on other databases such as EconLit, Science Direct, JSTOR, Cochrane Library, and Google Scholar using the same keywords, and this produced most of the papers already contained in PUBMED/MEDLINE and CRD. Unpublished reports, abstracts, brief and preliminary reports were considered for inclusion on the same basis as published reports. There was no restriction based on language or date.

Selection of studies

The authors read all titles and/or abstracts resulting from the search process, and any irrelevant studies were removed. Full copies of the remaining potentially relevant studies were obtained and assessed independently by the authors to ensure that these clearly met all inclusion criteria. Those that were clearly irrelevant or had insufficient information to make a decision were excluded, or the authors were contacted for further information to aid the decision process. Decisions were based on inclusion criteria, ie, types of studies, types of participants, interventions, and outcome measures used. Variations in authors’ opinion were resolved through discussion and consensus.

Under the review of international (non-UK) evidence in Section “Global evidence on the economics of smoking”, we assessed and summarized 36 papers on the costs and benefits of smoking as well as 65 papers on the effectiveness and cost effectiveness of smoking cessation interventions across countries. Though a substantial part of the evidence on the economics of smoking were drawn from the United States, we tried as much as possible to reflect pockets of evidence from other countries around the world, especially from China, the largest producer and consumer of tobacco products, as well as from Australia, Hong Kong, Korea, Thailand, Taiwan, Sweden, France, Belgium, Denmark, India, Turkey, Netherlands, and Canada. 26 , 28 – 42 These countries appear to be known to have carried out comprehensive tobacco control policies. This study reviewed only relevant papers on the effectiveness and cost effectiveness of smoking cessation under six headings: pharmacological interventions (8), policy-based interventions (19), community-based interventions, (10), TMT-based interventions (12), school-based interventions (5) and workplace- or employer-based interventions (7).

With regard to the UK, in Section “The economic impact of smoking and smoking cessation interventions in UK”, this study reviewed 33 papers, 19 on the costs and benefits of smoking in UK and 14 studies on the effectiveness and cost effectiveness of UK-specific smoking cessation interventions. Cost estimates are mostly expressed in US dollars for international evidence (except where stated otherwise) and in British pounds for UK evidence.

Data extraction and management

Data were extracted from published sources using a standard data recording form. Studies that reported primary outcomes were extracted and reviewed. At the first level of screening, we excluded papers that merely described the effectiveness of an intervention without including economic or cost considerations. We also excluded studies that combined smoking cessation with the reduction in the risk of other diseases such as lung cancer, myocardial infarction, chronic obstructive pulmonary disease (COPD), stroke, obesity, diabetes, coronary heart disease, etc. At the second level of screening, we excluded papers in which study design, methods, or outcomes did not appear to be consistent with those of the review as well as publications that appeared more than once in both databases. Figure 1 illustrates the study selection process more clearly.

Flowchart of study selection process.

Risk of bias

The risk of bias in studies was assessed via the criteria described in version 5.0.0 of Cochrane Reviewers Handbook . 43 This is based on the evaluation of six specific methodological domains (ie, sequence generation, allocation concealment, blinding, incomplete outcome data, selective outcome reporting, and other issues). Generally, the six domains are used by answering a prespecified question about the adequacy of each study in relation to each domain, such that a judgment of “Yes” indicates low risk of bias, “No” indicates high risk of bias, and “Unclear” indicates unclear or unknown risk of bias.

For this review, the following domains were used: sequence generation, allocation concealment (avoidance of selection bias), incomplete outcome data, and selective outcome reporting. Blinding was not possible because of the nature of some of the studies/intervention used.

Measures of evaluating economic impact

We now discuss two methods commonly used by medical researchers for economic evaluation: cost effective analysis (CEA) and cost-benefit analysis (CBA).

Cost effectiveness analysis

CEA is a measure of cost savings. It tends to link the cost of an intervention to the health improvements or gains caused by that intervention. Measures of health improvements include cases avoided (CA), hospital days avoided (HDA), deaths averted (DA), and life-years saved (LYS). 5 Other measures include cost per quitter (CPQ) enrolled in community-based cessation programs such as a self-help program, a smoking cessation class, an incentive-based cessation contest, 44 or in a quitline program. 45 The cost effectiveness of a cessation program may not only be looked at in absolute terms but also in relative or comparative terms to other intervention programs because each program may have different dimensions of cost effectiveness. Cost effectiveness is usually measured in ratios. A higher cost effectiveness ratio means that a program is less cost effective than another intervention program. However, Altman et al 44 put forward an argument that the fact that an intervention program yields a high cost effectiveness ratio does not necessarily imply that it is a less desirable outcome. It may well mean that even the most cost-effective program only impacts on a small fraction of the population in need, so that a wiser decision would be to implement as many cost-effective programs that satisfy the needs of more diverse groups of citizens.

Cost–benefit analysis

CBA is an economic technique that is used in evaluating the economic soundness or feasibility of an intervention program. CBA measures both the costs and monetary benefits derivable from an intervention, discounted at their present value. Discounting helps to make divergent outcomes of costs and benefits comparable irrespective of the date at which they occur. According to Phillips and Prowle, 22 there are three basic stages involved when conducting a CBA: (1) the costs incurred in the intervention program must be identified, measured, and assessed; (2) the benefits associated with the intervention also has to be identified, measured, and assessed in which case any input–output misalignments or time-dependent outcomes (eg, of a reduction in smoking prevalence) will have to be adjusted; (3) the costs and adjusted benefits are now combined to arrive at a measure of the net present value of outcomes, ie, the difference between the present value of benefits and the present value of costs. If benefits exceed costs, then the intervention is economically viable, and has a positive net benefit. Otherwise, it has a negative net benefit. Another way of looking at this is to estimate the benefit–cost ratio, that is, the present value of benefits divided by the present value of costs. The higher the benefit–cost ratio, the more desirable is the outcome of the intervention. It should be noted that many health researchers find it difficult to attach monetary values to health outcomes, and hence find the technique less useful than CEA and CUA. 5

Global Evidence on the Economics of Smoking

According to the Campaign for Tobacco-Free Kids, 46 the top five cigarette-consuming countries are China, Russia, United States, Japan, and Indonesia. China consumes more than 35% of the world’s cigarettes, with 53% of males smoking. Philip Morris International, British American Tobacco, Japan Tobacco International, and Imperial Tobacco are the world’s four largest multinational tobacco companies. The largest state tobacco monopoly is the China National Tobacco Corporation, which has the largest share of the global market among all companies. Based on WHO estimates, tobacco use costs the world an estimated $500 billion each year in health care expenditures, productivity losses, fire damage, and other costs. In the US alone, smoking causes more than $193 billion each year in health-related costs, including medical costs and the cost of lost productivity caused by smoking. 5 , 47 New figures from the Campaign for Tobacco-Free Kids show that the social cost of smoking in the US could be estimated at about US$321 billion (ie both smoking-caused health costs of US$170 billion and associated productivity losses of US$151 billion). 59 (See Fig. 2 ). This section examines the economic costs and benefits of smoking in some detail, citing examples from countries where tobacco is in high demand and use.

Smoking-attributable expenditure in the United States (USD billion).

Note: Campaign for Tobacco-Free Kids. 50

Smoking-attributable costs and benefits

As shown earlier, the costs of smoking can be classified into health-related costs and non-health-related costs.

Health-related costs

The health care costs associated with tobacco-related illnesses are extremely high. In the United States, total annual public and private health care expenditures caused by smoking amount to approximately US$170 billion. 59 Measured as a proportion of the gross domestic product (GDP), smoking costs in the US are approximately 1% of the GDP. Many studies have estimated the health-related costs of smoking. These costs include medical expenditure on drugs and administration, smoking-attributable morbidity and mortality, medical costs attributable to passive smoking, maternal smoking, and children smoking. Other direct costs include sickness/invalidity benefits attributable to tobacco abuse. A study by Yang et al 48 reveals three ways in which smoking-attributable expenditures could be measured—average expenditure per inpatient hospitalization (or admission), average expenditure per outpatient visit, and self-medication expenditures. Some other indicators of health care expenditure include smoking-induced emergency and general practitioner visits for adults and children, and use of nursing homes and home-based care. 49

Annual federal and state government smoking-caused Medicaid payments are estimated at US$39.6 billion (federal share: US$22.5 billion; states’ share: US$17.1 billion) (see Fig. 2 ). State-level estimates from USA revealed that the direct costs of smoking in California in 1999 were US$8.6 billion, with nearly half of this amount (47%) going to hospital care, 24% for ambulatory care, 15% for nursing home care, 13% for prescriptions, and 1% for domestic health care services. 4 Fresh statistics from Campaign for Tobacco-Free Kids 50 on state tobacco-related costs and revenues has revealed that smoking-related medical expenditures in US varied dramatically across states, with a low of US$22.4 million in Wyoming to a high of US$3.31 billion in New York. Another report by Armour et al 51 showed that the proportion of health care expenditure attributable to smoking ranged between 6% and 18% across the different states.

The National Drug Strategy in Australia estimated the total social costs of smoking in Australia between 2004 and 2005 at about AUD$31.4 billion, representing 56.2% of total costs of drug abuse in Australia. 16 Of these costs, AUD$12.02 billion or 38.2% was classified as tangible costs, while AUD$19.45 billion or 61.8% was intangible costs. Yang et al 48 estimated the economic burden of smoking for 2008 in China at US$28.9 billion, representing 0.7% of China’s GDP and 3% of national health care expenditures. This figure also averaged US$127.30 per smoker. According to the study, mortality costs contributed the most to smoking-attributable costs in China, followed by outpatient expenditures. Results also show that, as a result of high prevalence rate, a whopping 93% of total economic cost of smoking in China was borne by men. Results from Hong Kong reveal that annual health-related cost of smoking in 1998 was US$688 million. 49 The same study shows that about 5,596 deaths in Hong Kong among adults 35 years of age and above in 1998 was attributable to active smoking, while passive smoking accounted for 1,324 deaths. This brings to a total of 6,920 tobacco-related deaths out of 32,847 deaths. In what seems very surprising, passive smoking accounted for 23% of total smoking-related health care costs in Hong Kong, implying a growing risk of the prevalence of passive smoking. In Taiwan, the total smoking-attributable expenditures (SAEs) totaled US$397.6 million, representing 6.8% of the total medical expenditures for people aged 35 years and over. 52 The mean annual medical expenditure per smoker was US$70 more than that of each nonsmoker.

Although the health risks associated with passive smoking d have been well documented in the literature, little is known about the economic costs. Regular exposure to second-hand smoke (SHS) among nonsmokers both at home and in the workplace could be economically costly in as much as it poses enormous health hazards. Following a recent research conducted by Plescia et al 53 on SHS exposure in North Carolina, the total annual cost of treatment for conditions related to such exposure was estimated to be US$293.3 million in 2009. Though the majority of the SHS victims were children, the most common cases were traceable to cardiovascular conditions. In a similar study in Minnesota by Waters et al, 54 the total annual cost of treatment for conditions associated with SHS was estimated to be US$228.7 million in 2008 dollars—equivalent to US$44.58 per Minnesota resident. Just as passive smoking poses huge health care costs, smoking during pregnancy, otherwise called “maternal smoking”, also has some related cost implications. It is associated with considerably higher child health expenditures as well as increase in overall medical costs. 55 For example, the annual direct medical expenditure for early childhood respiratory illness attributable to maternal smoking totaled US$661 million for all children under the age of six. 56 Further evidence reveals that smoking-attributable neonatal costs in the US represent almost US$367 million in 1996 dollars. 57 Though these costs vary considerably from state to state, they can easily be avoided by implementing temporary cessation programs aimed at pregnant women.

The foregoing statistics indicate that smoking everywhere is very costly in many respects and takes a huge toll on public finances. For most countries, smoking-attributable costs represent the largest single expenditure in total health care costs, with wider implications for the economy.

Non-health-related costs

Besides the health care costs of smoking, there are other costs that the abuse of tobacco imposes on society, and these costs need not be treated as less important. Tobacco-related illnesses and premature mortality impose high productivity costs to the economy because of sick workers and those who die prematurely during their working years. Lost economic opportunities in highly populated developing countries are likely to be particularly severe as tobacco use is high and growing in those areas. 58 Countries that are net importers of tobacco leaf and tobacco products lose millions of dollars a year in foreign exchanges. Fire damage and the related costs are significant. In 2000, about 300,000 or 10% of all fire deaths worldwide were caused by smoking, and the estimated total cost of fires caused by smoking was US$27 billion. 59 Tobacco production and use also damage the environment and divert agricultural land that could be used to grow food.

The economic loss to employers in the form of workplace absenteeism and the resulting lost productivity of their smoking employees is particularly alarming. In specific terms, employers suffer loss of revenue from the days off work and earnings lost from work owing to smoking-induced illness and premature death of its smoking employees during productive years. It is reported that US smokers are absent from work approximately 6.5 days more per year than nonsmokers. They make about six visits more to the health care centers per year than their nonsmoking counterparts, while dependents of smokers visit health care centers four times more than nonsmokers. 23 , 56 Recent US statistics show that the total cost of productivity losses caused by smoking each year amounts to US$151 billion. 47 , 59 This estimate only includes costs from productive work lives shortened by smoking-caused death, and does not include costs from smoking-caused disability during work lives, smoking-caused sick days, or smoking-caused productivity declines when at work, all of which amount to huge economic losses to the US. In California alone, the annual value of lost productivity owing to smoking-related illness between 2000 and 2004 averaged US$8.54 billion (US$6.87 billion for Florida; US$6.79 billion for Texas, and US$6.05 billion for New York), showing that these US states and many others have lost huge productive hours and potential revenue owing to smoking-induced health problems. These results suggest that, if adequate measures are taken by primary health authorities and employers to promote smoking cessation, there will be huge cost savings from smoking-related illnesses and premature deaths.

Absenteeism and premature deaths represent only a fraction of the aggregate indirect burden of smoking to employers. It may well be that even at work smoking-induced illness could retard the performance of smoking employees and translate into lost time and earnings, which may not be easily quantified. Arguing in this light, Thompson and Forbes 60 noted that productivity losses emanating from smoking for the most part arise from short-term absenteeism or from performance at less than full efficiency due to respiratory problems or other smoking-induced illnesses. However, one cannot overlook the impact of other qualitative factors that lead to absenteeism and reduced productivity such as other health indicators (alcohol, weight, exercise, etc), job characteristics (occupation type, income, employment status, hours worked), and demographic characteristics (age, sex, ethnicity, marital status, education, place of work, etc). Evidence from Bush and Wooden 61 revealed that, even after controlling for these factors, smoking was still highly correlated with work-place absenteeism. In fact, in their 1994 paper on the impact of smoking and alcohol on workplace absence, Bush and Wooden concluded that, after controlling for the effect of other variables, employees on smoking status were found to be 1.4 times more likely to be absent, and ex-smokers were found to be 1.3 times more likely to be absent than nonsmokers. Their results also showed that the probabilities of smoking-induced absenteeism differed considerably by sex. For male smokers, the probability of workplace absence surpassed that of male non-smokers by 1.7 times, while for female smokers the probability of absence fell slightly to 1.2 times more than those females who have never smoked.

Apart from smoking-attributable absenteeism, cigarette smoking and its associated activities can also be economically costly when they are the cause of fires. In the study conducted by Collins and Lapsley, 17 the total cost of smoking-attributable fires in New South Wales, Australia, in 2006/2007 was estimated at AUD$51.4 million, with tangible costs representing over three-quarters of the total cost. In USA, smoking-induced fires lead to the death of 2,300 civilians (men, women, and children inclusive) per year, with additional 5,000 injuries per year. 23 , 56 Besides the health care costs of treating injured or burn victims, direct property damaged from fires induced by tobacco has been valued at US$552 million per year. Other costs to employers of workers who smoke include health care claims and benefits not related to health care. 23 There are also some hidden costs that are economically significant to society but often omitted in most studies for the lack of satisfactory data, eg, costs of paramedical and ambulance services, damage caused by smoking-induced forest fires, toxic effects from tobacco consumption, especially amongst children, as well as accidents and other property loss caused by cigarette smoking apart from fires.

Economic benefits of smoking

The cost of smoking notwithstanding, the tobacco industry poses a great deal of benefits, especially to the economy, consumers, and producers. It is therefore imperative to examine the positive economic effects of smoking and, hence, the impact or consequences on these of reducing smoking prevalence. Following previous studies by Thompson and Forbes, 60 Woodfield, 62 and Cohen and Barton, 56 among others, the major benefits of smoking are in economic stimulation, namely income generated from production and consumption, tax yields, employment, and early death of smokers. Taxes on cigarettes have always contributed to government treasury. In 2009, President Barrack Obama signed an act that raised the US federal tax rate on cigarettes from 39 cents to US$1.01 per pack. The 156% tax increase was estimated to earn the US government about US$33 billion in tax over a 4½-year period. There are, however, economic consequences of raising taxes (see “The economics of policy-based interventions” Section).

The World Bank estimates that tobacco farming employs about 33 million people worldwide, and about 15 million of those workers reside in China alone. 63 In China, over 4 million households rely on tobacco for their livelihood, as tobacco farmers, cigarette industry retailers, or employees. 32 In fact, China is the largest producer and consumer of tobacco worldwide. All cigarettes are produced by the Chinese government’s tobacco monopoly company, which produces more than 1.7 trillion cigarettes annually. In 2003, the company generated almost US$2 billion in profits and taxes, while income from tobacco represented about 7.4% of centrally collected government revenue. In terms of consumption, China boasts of a smoking population of 350 million active smokers and 460 million passive smokers. In 2010, about 52.9% of Chinese men and 2.4% of women were current smokers. 48 Given that China is the most populous country in the world, this proportion of smokers translates into enormous earning potential.

Apart from the income benefits of tobacco smoking, another source of benefit, especially to the government, of smoking is the substantial cost savings in pension payments from premature death of smokers. This is a highly debated issue in the literature, because it is premised on the thinking that a shorter life expectancy implies a reduced expenditure on pensions. Thus, attempts to promote this will be deemed socially undesirable and hence cannot be incorporated into social policy design. 60 , 62

Clearly, from the above, therefore, if tobacco farming is to be phased out, many households, investors, and the government itself will suffer huge economic losses. Hence there is a need to strike a balance between the costs and benefits of smoking. But this is easier said than done, especially as the health implications of smoking far outweigh any associated economic returns from the perspective of a socially desirable outcome.

Effectiveness and cost effectiveness of smoking cessation interventions

Because the health hazards attributable to smoking are very significant, the risks of illness or disease are reduced following smoking-cessation interventions. 19 According to a UK General Household Survey in 1998, about 27% of adults (aged 16 years and above) were smokers, and of this figure about 70% wanted to quit smoking. Data from a similar survey conducted in 1994 by the US health authorities indicated that 46.4% of smokers had made serious attempts to stop in the year preceding the survey, but only 5.7% of smokers managed to abstain from smoking after a period of 1 month or more, and only 2.5% of smokers are able to achieve permanent abstinence each year. The reason for this is smoking is an addiction and can hardly be stopped on the basis of will power alone. Evidence from Feenstra et al 11 shows that only ~3%–7% of smokers who attempt to stop smoking on will power are still abstinent after 1 year. In order to enhance quit rates, there must be some deliberate measures to incentivize cessation. There are different forms of smoking cessation interventions, and they range from pharmacological treatment interventions to policy-based interventions, community-based cessation programs, TMT-based interventions, school-based interventions, and workplace- or employer-based interventions.

The aim of this section is to identify and evaluate cross-country evidence on the effectiveness and cost effectiveness of smoking cessation interventions. The idea of carrying out economic evaluations is to identify which interventions utilize the least resources or have greater cost savings, while being most effective in reducing both the number of smokers and the health- and non-health-related risks associated with smoking. By comparing the costs and outcomes of different alternative interventions, economic evaluations help health care professionals and policy makers in deciding the most efficient use of scarce resources. 24 In estimating the effectiveness of cessation interventions, two major indicators are necessary: the number of long-term quitters and the health gains from smoking cessation, measured according to the age and sex of the quitters. 19 In estimating the cost effectiveness of smoking cessation interventions, emphasis is placed on the impact of such interventions on direct cost reductions with respect to smoking-related morbidity and mortality rates as well as the effect on long-term medical expenditure.

Pharmacological treatment interventions

There are several pharmacological agents that are commonly used to aid smokers in their quest to quit smoking. However, we will concentrate on the three major types: nicotine replacement therapy (NRT), bupropion sustained release (SR), and varenicline. These treatment interventions are widely available on prescription, and in the case of NRT as an over-the-counter medication. They are licensed as first-line treatments for use as smoking-cessation aids in the US and the EU, and are widely recommended in many national guidelines. 64

The aim of NRT is to temporarily replace much of the nicotine from cigarettes to reduce motivation to smoke and the physiological and psychological withdrawal symptoms often experienced during a quit attempt, thus easing the transition from cigarette smoking to complete abstinence. It is available in various forms and dosages, including transdermal patches (ie, absorbed slowly through the skin), as chewing gum, oral and nasal sprays, lozenges, sublingual tablets, and inhalers. NRT, in all its commercially available forms, has been found to help people who make a quit attempt to increase their chances of successfully stopping smoking. NRT increase the rate of quitting by as much as 50%–70% regardless of setting. 65

Bupropion was developed as a non-tricyclic antidepressant, and is sometimes preferred by smokers who do not wish to use a nicotine-based treatment, or who have already failed to quit using NRT. The usual dose for smoking cessation is 150 mg once a day for 3 days, increasing to 150 mg twice a day, continued for 7–12 weeks. 64 The quit attempt is generally initiated a week after starting pharmacotherapy. Some studies have shown that bupropion doses up to 300 mg per day does have significant effect in a dose–response fashion on smoking cessation, but does not seem to affect long-term cessation rates (see 66 ).

Varenicline is a selective nicotinic receptor partial agonist, licensed as a prescription-only treatment for smoking cessation in USA in 2006 and in Europe in 2006/2007. The standard regimen is 1 mg twice a day for 12 weeks, with the first week titrated to reduce side effects, and quit date set for the second week. Varenicline has helped ~50% more people to quit than nicotine patch and “other” NRT (tablets, sprays, lozenges, and inhalers) and ~70% more people than nicotine gum. 64 This means that for every 10 people who quit with NRT patch or with “other” NRT, about 15 could be expected to quit with varenicline, and for every 10 who quit with NRT gum, about 17 could be expected to quit with varenicline.

NRT, bupropion, and varenicline all improve the chances of quitting, with low risk of harms, and in some cases, using a combination of these pharmacological treatments could be seen to be even more clinically effective. However, as noted earlier, to justify the investment in any intervention, its effectiveness must be evaluated alongside its cost effectiveness. The cost effectiveness of pharmacological interventions is thus as important as their clinical effectiveness. A review of economic studies on these pharmacological treatment interventions (see Supplementary File 2 ) showed that varenicline and bupropion (with or without behavioral interventions) are more cost effective than NRT measures such as nicotine gum, patch, lozenge, and inhaler. A recent study by the Canadian Agency for Drugs and Technologies 33 found that, if providers’ willingness to pay (WTP) was greater than US$10,000 per QALY gained, then varenicline was the optimal treatment of choice compared to NRT and bupropion.

Several studies have also found that the use of NRT and/or bupropion SR along with GP counseling is both clinical and cost effective in primary health care. For example, Stapleton et al 67 showed that contingent prescriptions could yield additional life years at a cost between £398 (US$724) and £758 (US$1,380) in 1998 UK pounds compared to brief counseling alone. In a similar estimation of the cost effectiveness of treating nicotine dependence (including NRT and counseling), Croghan et al 68 found the aggregate 1-year smoking rate to be 22% with a cost of $9,231 per net life year gained. This cost compares favorably with other medical services that rely only on GP counseling however brief or intensive. Although NRT products can be purchased over the counter, many people have suggested that free NRT treatments yield more positive results in terms of number of quitters than other cessation interventions. For example, Ong and Glantz 69 found that in Minnesota, a free NRT program would generate 18,500 quitters at a cost of US$4,440 per quality of life adjusted years (QALY) compared to implementing a smoke-free workplace policy, which would generate 10,400 quitters at US$506 per QALY.

Nielsen and Fiore 70 conducted a CBA of bupropion SR and nicotine transdermal patch (NTP) to see which of the two, or whether a combination of both, was more cost effective for smoking cessation. The results revealed that bupropion is more cost beneficial than either NTP or bupropion and NTP together, producing a net benefit in the first post-quit year of up to £338 per employee who attempts to quit compared with US $26 for NTP only, US$178 for the two combined, and US$258 for placebo, another pharmaceutical therapeutic that was used in the clinical trials. Thus, according to this study, bupropion is able to offer the most substantial monetary benefits than any other pharmacological treatment. In a more recent study by Bolin et al, 31 the cost effectiveness of varenicline was compared with nicotine patches for smoking cessation in four European countries (Belgium, France, Sweden, and UK). Surprisingly, the results showed that the use of varenicline for smoking cessation was associated with reduced smoking-related morbidity and mortality more than was the case using NRT. The number of morbidities avoided per 1,000 smokers who made attempts to quit ranged from 9.7 in Belgium to 6.5 in UK. The number of QALY gained, per 1000 smokers, was 23 in Belgium, 19.5 in France, 29.9 in Sweden, and 23.7 in UK. The results of the base-case simulations revealed that, with the exception of France, varenicline treatment appeared to be more cost effective and cost saving than NRT. Thus, funding varenicline as a smoking cessation aid is an economically justifiable use of health care resources in these countries.

The economics of policy-based interventions

This subsection takes a look at the global evidence on the economic consequences of policy-based measures that aid smoking cessation. These include price-based measures (eg, increase in tobacco taxes, limitations on tobacco crop subsidies) and non-price measures (eg, no smoking regulations at work and in public places, restriction on sales to minors, and bans on promotion and advertising, etc). Legislative bans could either ban smoking completely (comprehensive) or restrict it to designated areas (partial). Both price-based measures and legislation-based smoking bans or restrictions have been found to yield both health and economic gains, including (1) reduction in smoking prevalence though reductions in the demand for and consumption of cigarettes, (2) significant reductions in the incidence of smoking-related diseases and deaths, (3) reduction in smoking-related medical costs, and (4) large gains in cumulative life years and QALYs. 23 , 36 , 37 , 71 – 79

Increase in tobacco taxes

The most widely used measure to reduce the demand for tobacco is increase in taxes. This puts an upward pressure on tobacco prices, and higher tobacco prices tend to significantly reduce the consumption of tobacco. 74 , 77 According to a World Bank report, 63 when taxes are raised on tobacco, consumption decreases especially in young people; a 10% cigarette price increase results in a 7% decrease in smoking by young people and 4% by the general public. It has also been hypothesized that a price increase of 10% would reduce smoking by 4% in high-income countries and by about 8% in low-and middle-income countries. 23 , 71 In other words, the price elasticity of demand for tobacco is higher in low- and middle-income countries and among populations of young or teenage smokers who are the most responsive to price changes. Smokers in high-income countries are, however, less responsive to price changes. According to Atkinson and Townsend, 80 low price sensitivity means that the revenue argument against tax increases is rather unconvincing. As long as prices do not respond proportionately to tax increases (ie, price elasticity of less than 1), the revenue from tobacco will surely increase when taxes go up since “a fall in consumption is more than offset by the extra tax paid by those who continue to smoke” (pp. 492). Thus, according to Atkinson and Townsend, so long as the reduction in tobacco consumption is attributable to increased duty, the amount of corporate revenue from tobacco is likely to remain unaffected. The World Bank has recommended that “Governments increase tobacco tax to about 65% of retail price”. 63 Increasing tobacco prices also increases the chances of cigarette theft, smuggling, and counterfeiting. The Mackinac Center on Public Policy estimates that profits made illegally from smuggling cigarettes to the US could amount to be between US$10 billion and US$17 billion. 81 Over the years, tobacco tax increases have brought about increases in revenue for the government, even when the incidence of smuggling and tax evasion are discounted. Currently, in most high-income countries where tobacco control policies are very comprehensive, tobacco taxes represent between two-thirds and four-fifths of the retail price of cigarettes, whereas in low- and middle-income countries, they are generally below 50% of the total price.

Apart from the decline in tobacco consumption via increased prices, raising cigarette taxes also poses some potential health and cost-saving benefits. Reduced tobacco consumption leads to a reduction in health care costs as former smokers and their children do not require as much medical care or treatment as they used to. 23 There is also another argument that says that huge tobacco taxes are equitable in the sense that it makes the tobacco industry pay more for the huge economic burden placed by its products to the health care system as well as the negative externalities of same to society. The income generated from tobacco taxes can also be used to finance community education and advertising against tobacco. In China, the largest producer and consumer of tobacco, a recent tobacco tax adjustment has just been implemented and, if this tax increase passes through to retail prices, it is expected to reduce the number of smokers by 630,000 saving 210,000 lives, at a price elasticity of −0.15. 32 Following the same model, a tax increase of 1RMB (or US$0.13) per pack of cigarettes is expected to increase the revenue accruable to the Chinese government by 129 billion RMB (US$17.2 billion), reduce consumption by 3.0 billion packs of cigarettes, reduce the number of smokers by 3.42 million, and save 1.14 million lives. These figures indicate that tobacco tax increase in China can be construed as the most cost-effective measure of smoking cessation.

In summary, tobacco tax increases reduces tobacco consumption via higher cigarette prices, raises government revenue, saves more lives, preserves employment, and reduces tobacco farming. However, whether or not tax increases lead to loss of revenue in the tobacco industry is still a subject of debate, as smuggling and tax evasion help to minimize any losses arising from taxation.

Smoking restrictions in the work place and in public places

It is in recognition of the dangers of passive smoking that many governments institute no smoking restrictions in public places (eg, bars, restaurants, public buses, trains, airports, government buildings, and other public facilities) and private workplaces. Governments are now increasingly sensitive to the need to protect its citizens from the externalities caused by environmental tobacco smoke. Evidence from the US and Canada suggests that smoke-free air policies are associated with a significant reduction in cigarette consumption. 23 , 71 , 82 In a report issued by the United States Environmental Protection Agency, the costs and benefits of a proposed national smoke-free environment act were modeled to identify its net benefits. The proposed policy was meant to curtail significantly smoking in public places entered by more than 10 people per week. The costs considered were costs of implementing and enforcing the restriction, costs of building and maintaining smoking lounges, among other costs. The benefits included savings from smoking-related medical expenditures, heart diseases averted, the value of lives saved, costs averted by a reduction in smoking-induced fires, and gains in productivity. 83 The net present value to society was estimated to fall between US$42 and US$78 billion, and this range was obtained by considering high and low estimates of costs and benefits. In another study by the Stephens et al, 82 they analyzed the relationship between cigarette prices and no-smoking bylaws to the prevalence of smoking in Canada. Results from a comparison of price and policy differences among Canadian provinces showed that the tendency of being a smoker falls with rising cigarette prices and with widespread no-smoking regulations, even after controlling for age, sex, education, and marital status of respondents. They thus concluded that no smoking regulations should be accompanied by an increase in cigarette prices to be more effective. If either were used in isolation, the outcomes will likely produce a lesser impact than the two measures used together.

Bans on tobacco advertisement

Tobacco remains the second most heavily advertised product in the United States besides the automobile industry. 23 Over the years, it has been widely advocated that bans be placed totally on cigarette advertisements and promotional activities. In many countries, this bill has been a subject of controversy or debate. There are those who argue that a partial ban on advertisement has little or no effect on cigarette consumption. 71 , 80 This is because, most adverts, particularly the tobacco-industry-related ones only reveal the brands smoked instead of the quantity smoked. In this sense, therefore, it is difficult to measure the impact of increased or reduced advertising on tobacco consumption. In addition, companies affected by such legislation could seek to utilize alternative forms of media. In an econometric study on high-income countries, Saffer and Chaloupka 84 noted that comprehensive bans on tobacco advertising tend to reduce consumption.

Community-based intervention programs

Smoking cessation programs also come in the form of community-based interventions to educate, inform, and assist smokers in their quitting attempts. According to Secker-Walker et al, 85 a community intervention is defined as “a co-ordinated, multi-dimensional programme aimed at changing adult smoking behaviour, involving several segments of the community and conducted in a defined geographical area, such as a town, city, country, or other administrative district” (pp. 3). These programs could range from community pharmacy-based interventions to group-based counseling, incentive-based smoking cessation contests, use of self-help quit smoking kit, and, in some cases, mass media campaigns directed at certain communities within a defined geographical area. The aim of this section is to identify and assess global evidence on the effectiveness and cost effectiveness of such interventions.

Nine studies on community-based interventions were reviewed, including studies by Altman et al, 44 Secker-Walker et al, 86 Stephens et al, 82 Secker-Walker et al, 87 , 88 Lightwood et al, 89 Hurley and Matthews, 26 , 30 and Simpson and Nonnemaker. 90 Altman et al, as far back as 1987, studied the cost effectiveness and cost distribution of three community-based smoking cessation programs designed for use in the two education communities of the Stanford Five City Project. These programs included (1) smoking cessation class (eight 1-hour training sessions offered to ~8–25 participants where several quitting techniques were taught); (2) incentive-based smoking cessation contest (a 6-week community smoking cessation prize contest where entrants were assessed and rewarded on the basis of their smoking status and habits); and (3) self-help quit smoking kit (included tips on smoking replacement habits, social support available, public commitment, and record keeping and goal setting, among other tips aimed at providing specific actions to aid individual smoking cessation). Results revealed that the self-help quit had the lowest total cost (US$26,190), lowest quit rate (21%), lowest time requirement for participants, and was the most cost effective (with a CER of $50). However, the smoking cessation class was the most effective, requiring the most time from participants, with a quit rate of 35%, but incurring the highest total costs (US$261,589) and was also least cost effective (US$276). The smoking cessation contest was in-between the other two programs, with a total cost of US$82,925, a quit rate of 22%, and a CER of US$151.

A community pharmacy also provides an excellent setting in which to provide a smoking cessation program, as the pharmacy would have regular contact with residents of the area. Thavorn and Chaiyakunapruk 30 evaluated the incremental cost effectiveness of a community-pharmacist-based smoking cessation (CPSC) in Thailand. They found that the CPSC program yielded cost savings and life year gains to the health system. A series of sensitivity analyses, however, demonstrated that both cost savings and life year gains were sensitive to variations in discount rate and long-term smoking quit rate associated with the intervention (see Supplementary File 2 for more details on the results).

Lightwood et al 89 also examined the effect of California’s Tobacco Control Program (CTCP) on aggregate personal health expenditures in the state. The CTCP, which was established in 1989, offered a comprehensive approach to smoking cessation by altering the existing social norms and values among tobacco users. The campaign featured an aggressive media campaign with three themes, namely the tobacco industry lies, nicotine is addictive, and second-hand smoke kills. It also included a radical public policy change, especially in the area of promoting smoke free environments. The findings of the study revealed that, between 1989 and 2004, the California program led to a reduction in personal health care expenditures to the tune of US$86 billion (in 2004 dollars), which would have been expected without the program. Using 95% confidence interval, the cost savings ranged between $28 billion and US$151 billion.

Hurley and Matthews 26 also presented evidence on the cost effectiveness of Australia’s National Tobacco Campaign (NTC), an intensive mass media antismoking campaign, which was launched in 1997. Using a quit benefits model (QBM), the study predicted that the NTC avoided more than 32,000 cases of COPD, 11,000 cases of acute myocardial infarction, 10,000 cases of lung cancer, and 2,500 cases of stroke. The model also predicted the prevention of about 55,000 deaths, 323,000 life-years gain, and 407,000 QALYs, as well as a health care cost savings of AUD$740.6 million. Thus, the NTC was both effective and cost saving.

The above studies as well as other community-based interventions all reveal that a strong and aggressive tobacco control program do not only reduce the number of smokers and its resulting health benefits but also reduce substantially the health care expenditure associated with smoking prevalence. It is worth noting that the benefits of these initiatives may not have been well established quantitatively in the sense that most of these studies reflect potential uncertainty in the estimates and data used as well as differences in the parameters estimated. In some cases, data sufficient to establish definite causality are also lacking. However, on the balance, the community-based cessation initiatives examined appear to yield substantial net benefits.

Telecoms, media, and technology-based interventions

TMT-based interventions refer to electronic and mass media-related means aimed at offering support to effect changes in smoking behavior in adults and young adolescents. Examples include telephone counseling offered through “quitlines” or “helplines”; radio, TV, and print media; and computer and Internet-based intervention programs. A summary of the results of related TMT-based cost effectiveness studies can be found in Supplementary File 2 .

Telephone counselling, quitlines and text messaging

Telephone services can provide information and support for smokers. Counseling may be provided proactively or offered reactively to callers to smoking cessation helplines. 91 Support can be given in individual counseling sessions or in a group therapy where clients can share problems and derive support from one another. Counseling may be helpful in planning a quit attempt and could assist in preventing relapse during the initial period of abstinence. Although intensive face-to-face intervention increases quit rates, there are difficulties in delivering it to large numbers. Telephone counseling may be a way of providing individual counseling more affordably.

Tomson et al 45 examined the cost effectiveness of the Swedish quitline, a free-of-charge service offered to the smoking population in Sweden to aid cessation. About 31% of the study population (354 callers) reported abstinence after 1 year of the implementation of the scheme, leading to an accumulated number of life year saved of 2,400. The cost per quitter ranged between US$311 and US$401. In comparison with other smoking cessation interventions, the study concluded that the Swedish quitline was cost effective. A more recent study by Rasmussen 40 assessed the cost effectiveness of the Danish smoking cessation telephone service “quitline”. The study was based on the number of quitline callers in 2005. A total 511 ex-smokers were estimated to have gained 2172 life years based on prolonged abstinence over 12 months. Discounting life years (LYs) at 3% per annum, the costs per LYS are €213 for ex-smokers with continued abstinence and €137 for ex-smokers with point prevalence abstinence. The sensitivity analysis for a worst case scenario indicates that the costs per LYS are €1199. The author concluded that the Danish reactive telephone counseling to aid smoking cessation appears to be cost effective in comparison with other Danish smoking cessation interventions.

Farrelly et al 92 took a rather different dimension to the study of quitlines by assessing the relative effectiveness and cost effectiveness of television, radio, and print advertisements in generating calls to the New York smokers’ quitline. The results showed that there was a positive and statistically significant association between the call volume and expenditures for television ( P < 0.01) and radio ( P < 0.001) advertisements and a slightly significant effect for expenditures on newspaper advertisement ( P < 0.065). Though television advertising had the largest effect on call volume, differences in advertising costs for different media implied that call volume on the quit-line was least responsive to increases in expenditure on television advertising (0.1%) per US$1000 increase compared to the other mass media: radio (5.7%) and newspaper (2.8%). While it was difficult to determine the optimal mix of expenditures, the bottom line is that all three mass media effectively raised the number of callers to the New York quitline.

Another telecom-based intervention measure is the use of mobile phone text messaging facilities to aid smoking cessation. A study by Guerriero et al 93 used a cohort simulation model to determine the cost effectiveness of smoking cessation support delivered by mobile phone text messaging in the UK, called “Txt2stop”. The cost effectiveness was measured in terms of cost per quitter, cost per life year gained, and cost per QALY gained. The cost of text-based support per 1,000 enrolled smokers was £16,120, which, given an estimated 58 additional quitters at 6 months, equates to £278 per quitter. However, when the future NHS costs saved (as a result of reduced smoking) are included, text-based support would be cost saving. It is estimated that 18 LYs are gained per 1,000 smokers (0.3 LYs per quitter) receiving text-based support, and 29 QALYs are gained (0.5 QALYs per quitter). The deterministic sensitivity analysis indicated that changes in individual model parameters did not alter the conclusion that this is a cost-effective intervention. Similarly, the probabilistic sensitivity analysis indicated a >90% chance that the intervention will be cost saving.

Mass-media-led interventions

Mass media interventions consist of the dissemination through television, radio, print media, and billboards of cessation-related messages, informing smokers and motivating them to quit. Mass media campaigns can be effective in keeping tobacco control on the social and political agenda, in reinforcing community action, and in triggering other interventions. Campaigns are designed either directly to change individuals’ smoking behavior (the risk factor model) or to catalyze other forces of social change (the social diffusion model), which may then lead to change in the social norms about smoking. 94 Social diffusion campaigns, such as those run in Australia, Canada, UK, Thailand, and in some US states, are designed to de-normalize smoking, thus counteracting the tobacco industry’s message that smoking is desirable and harmless.

While many studies have revealed that mass media interventions are effective in reducing smoking prevalence among adults, not many studies have commented on the cost effectiveness of such campaigns. Villanti et al 95 evaluated the cost effectiveness of the American Legacy Foundation’s national “EX” campaign, which ran on radio and TV in 2008 and was designed to promote smoking cessation among adult smokers. The incremental societal cost of EX, in 2009 dollars, was US$166 million. Data from eight designated media market areas studied indicate that, in a hypothetical nationwide cohort of 2,012,000 adult smokers ages 18–49, EX resulted in 52,979 additional quit attempts and 4,238 additional quits and saved 4,450 QALYs. Incremental cost-utility estimates comparing EX to the status quo—that is, the situation that would have existed in eight markets with no campaign and no change in cessation behavior—ranged from a cost of US$37,355 to US$81,301 per QALY, which suggests that the campaign was cost effective. These findings are consistent with previous evidence that national mass media campaigns for smoking cessation in the US can lower smoking prevalence in a cost-effective manner. However, in a study on the cost effectiveness of online, radio, and print tobacco control advertisements targeting 25–39-year-old males in Australia, Clayforth et al 42 found that online advertising could be more cost effective than other non-television advertising media such as radio and press in reaching and affecting target audiences, implying that online campaigns may be a highly cost-effective channel for low-budget tobacco control media campaigns (see Supplementary File 2 for details).

Computer- and internet-based programs

Personal computers, the Internet, and other electronic aids, which are now an indispensable part of daily life for many people around the world, also offer additional means of effecting changes to smoking behavior. These electronic-based measures have been found to be effective and cost effective in reducing smoking prevalence among adults (see 35 , 96 , 97 ). For example, computer-tailored programs that entail the adaption of the content of an intervention to participants’ individual characteristics using computer programs have been found to be both effective and economically efficient. 41 Most often, a questionnaire is used as a screening instrument, in which case answers provided by the smokers on the questions are accumulated into a large data file and are subsequently matched with relevant feedback messages that are ultimately combined into a tailored feedback letter. Tailored interventions are more effective in attracting and keeping a smoker’s attention, resulting in better processing of information. Civljak et al 97 found that Internet programs that were interactive and tailored to individual responses led to higher quit rates than usual care or written self-help at 6 months or longer. There are two types of computer-tailored programs: single computer-tailored programs and multiple computer-tailored programs. A single-tailored feedback message is successful in increasing cessation rates, but dynamically tailored feedback provided on multiple occasions can even be more effective. Due to the automatic generation of the tailored feedback and the fact that computer-tailored interventions are increasingly delivered online, the integration of an internet-based computer-tailored program in the general practice setting might limit the burden on health professionals and patients, reduce facility and administrative costs, and could potentially be time and cost saving. 41 However, the Internet may offer additional benefits when combined with usual pharmacological interventions, such as NRT, varenicline, or other pharmacotherapy.

School-based interventions

Though the majority of smoking-related deaths occur in people aged 35 years or older, the onset of tobacco use occurs primarily in early adolescence, which makes adolescents a special target for smoking prevention projects. Schools have been identified as an ideal site to deliver tobacco prevention programs since they capture the majority of youth across a large age range, including the ages when most young people initiate smoking. The main perceived advantages of school-based intervention programs are that almost all children can be reached through schools, and a focus on education fits naturally with the daily activities of schools. 98 Researchers often employ five types of school-based intervention programs, each based on a different theoretical orientation: (1) information-only curricula, ie, interventions that provide information to oppose tobacco use (also called normative education). These educational programs provide content and activities that seek to correct inaccurate perceptions regarding high prevalence of tobacco use; (2) social competence curricula, a group of interventions that aim to help adolescents refuse offers to smoke by improving their general social competence—including training on life skills such as self-control, self-esteem, decision making, and cognitive skills for resisting interpersonal and media influences; (3) social influence curricula, educational programs that seek to inform youths about the effects of outside influences such as advertising on their behavior, teach them that smoking is not the norm, and give them the skills to refuse cigarettes; (4) combined social competence and social influences curricula, methods that draw on both social competence and social influence approaches, and (5) multimodal programs, which combine curricular approaches with wider initiatives within and beyond the school, including programs for parents, schools, communities, and initiatives to change school policies about tobacco, or state policies about the taxation, sale, availability, and use of tobacco.

Although numerous school-based smoking prevention trials have found short-term decreases in smoking prevalence by up to 30%–70%, there is little or no evidence on the long-term effectiveness of school-based smoking prevention programs. 98 – 100 Tengs et al 101 have reported that the effectiveness of anti-tobacco education programs using the “social influences” model tends to dissipate in 1–4 years, raising questions about the long-term economic efficiency of such initiatives. Using a system-dynamics computer simulation model based on secondary data, the authors evaluated the cost effectiveness of an enhanced nationwide school-based anti-tobacco education and found that over 50 years, cost effectiveness is estimated to lie between US$4,900 and US$340,000 per QALY, depending on the degree and longevity of program effectiveness. Assuming a 30% effectiveness that dissipates in 4 years, cost effectiveness is US$20,000/QALY. A similar study on the cost effectiveness of a school-based tobacco use prevention program in the US, known as Toward No Tobacco Use (TNT), showed that the program was highly effective as the government could expect to save US$13,316 per LY saved and a saving of US8,482 per QALY saved. However, a peer-led intervention, known as ASSIST, aimed at reduced smoking among adolescents in England and Wales, was only valued to yield a modest cost saving, with an incremental cost per student not smoking after 2 years of follow-up at £1,500 (CI = £669–£9,947). Other cost-effectiveness studies on school-based smoking cessation programs are summarized in Supplementary File 2 . From all of these studies, an issue that remains unresolved is the extent to which reductions in adolescent smoking lead to lower smoking prevalence and/or earlier smoking cessation in adulthood.

Workplace interventions

There has been growing interest within the business community regarding interventions against smoking in the workplace. Smoking interventions in the workplace particularly have numerous advantages. First, a large number of people can be contacted, canvassed, and enrolled in programs with relative ease, sometimes with the aid of extensive onsite occupational health facilities. 102 Second, worksites have the potential for higher participation rate than non-workplace environments. Third, worksites have the potential to provide sustained peer group support and positive peer pressure for quitting and staying tobacco-free. Fourth, it provides a particular opportunity to target young men, who traditionally have low general practitioner consultation rates and are thus less likely to benefit from opportunistic health promotion activity in primary care. Fifth, in some workplaces, occupational health staff may be on hand to give professional support. Finally, the employee need not travel to attend cessation programs; hence the workplace provides convenience benefits to the employee. 103 , 104 It is worthy of note that many of these assumptions are based on a model of workplace that is rapidly changing. With many generation-Y employees who change jobs frequently or work from multiple locations, the net benefits from workplace cessations could be expected to become marginal in the long run.

Workplace smoking interventions can take numerous forms, including pharmacological interventions, behavioral interventions, or a combination of both. It could target individuals or specific employee groups. The main strategies include smoking prohibition, incentives, competitions, individual and group counseling, self-help materials, pharmacological therapy, and social and environmental support.

Many health economics researchers have found empirical evidence to support the general belief that smoking intervention programs help a firm’s bottom line by reducing health care costs, absenteeism, and its attendant productivity losses and other employer-related costs. 105 However, there are serious challenges to the reliability and validity of their findings, as some critics of this literature have cited systematic biases affecting the credibility of some of these studies. These biases often manifest themselves in underestimation of costs and overestimation of benefits. Other researchers who have carried out behavioral workplace interventions have found a strong consistency in the correlation between smoking interventions and reduced cigarette consumption and decreased exposure to environmental tobacco smoke. 106 Smedslund et al 103 also compared the cost effectiveness of behavioral workplace interventions compared to pharmacological interventions and found that controlled smoking cessation trials at the worksite showed initial effectiveness, but the effect seemed to decrease over time and was not present beyond 12 months. Jackson et al, 107 however, showed that pharmacological interventions at the workplace seemed to generate 12-month employer cost savings per nonsmoking employee of between $150 and $540. The authors however found that varenicline was more cost beneficial than placebo because it had higher quit rates. Warner et al 105 also found that smoking cessation is a very sound economic investment for the firm, and is particularly profitable when long-term benefits are included, with an eventual benefit–cost ratio of 8.75. Other studies by Ong and Glantz 108 also showed that the first year effect of making all workplaces in the US smoke-free would produce about 1.3 million new quitters and prevent over 950 million cigarette packs from being smoked annually, worth about US$2.3 billion in pretax sales to the tobacco industry. In addition to preventing the risk of smoking-induced diseases such as myocardial infarctions and strokes, smoke-free work places could result in nearly US$49 million in savings in direct medical costs after 1 year. At steady state, more than US$224 million would be saved in direct medical costs annually (see Supplementary File 2 for summary of results).

Overall, this section has examined evidence across countries on the economic impact of smoking and the effectiveness and cost effectiveness of reducing smoking prevalence through intervention programs. It has examined the health-and non-health-related costs and benefits of smoking as well as the effectiveness and cost effectiveness of pharmacological, policy-based, community-based, TMT-based, school-based and workplace- or employer-based smoking cessation interventions carried out through the years by different countries or state public health agencies. Key statistics and examples were drawn from United States, China, Australia, Canada, Hong Kong, Belgium, Taiwan, India, France, and Sweden. Next, this study narrows down by reviewing the economics of smoking in United Kingdom.

The Economic Impact of Smoking and Smoking Cessation Interventions in UK

The costs and benefits of smoking in uk.

Smoking has also been responsible for over 100,000 deaths per annum over the last decade in UK. The number of deaths attributable to smoking in 2005 was estimated at 109,164. 8 The financial and health burden of smoking in UK is enormous. Previous studies have estimated the direct costs of treating smoking-related diseases by the NHS to range somewhere between £1.4 and £1.7 billion every year. 10 , 56 , 109 , 110 A more recent study conducted by Callum et al 12 showed that smoking-attributable costs to the NHS in 2006 was estimated at £2.7 billion. This includes smoking attributable hospital admissions (£1 billion), outpatient attendances (£190 million), general practitioner (GP) consultations (£530 million), practice nurse consultations (£50 million), and GP prescriptions (£900 million). Allender et al 8 estimates the costs of smoking-induced ill health to the NHS to be £5.2 billion in 2005–2006, representing about 5.5% of the total NHS budget that year e (see also 7 ). The cost of smoking in UK is thus increasing every year. The estimates provided by the above studies, however, are conservative cost estimates because they do not include the indirect costs of passive smoking and productivity losses due to smoking-related morbidity and premature mortality. The costs of informal care, smoking-related fires, cleaning costs, and sickness absence payments were also excluded from these estimates.

Cohen and Barton 56 show that approximately 50 million working days f are lost in UK annually due to smoking, valued at £1.71 billion. The British Medical Association 112 estimates that each year in UK, at least 1,000 deaths are attributable to passive smoking and more than 17,000 children under the age of five are admitted to hospital because of the ill effects of second-hand smoke. Parrott and Godfrey 10 have estimated that each year in UK the cost of treating childhood illnesses related to smoking is about £410 million. The same study estimates the damage caused by smoking-related fires to be around £151 million each year in England and Wales. If all these indirect costs estimates are included to the NHS figures, the financial burden of smoking in UK will skyrocket. A more recent report by the Policy Exchange in 2010 attempts to sum up the total estimated costs to society of smoking in UK and puts the figure at £13.74 billion. This includes £2.7 billion cost to the NHS but also the loss in productivity from smoking breaks (£2.9 billion), and increased absenteeism (£2.5 billion). Other costs include cleaning up cigarette butts (£342 million), the cost of fires (£507 million), the loss of economic output from the death of smokers (£4.1 billion), and passive smokers (£713 million).

The study by Allender et al 8 shows the percentage attributable to smoking of total NHS costs for smoking-related conditions in 2005–2006 by countries in UK (see Table 1 ). In England, the cost of smoking is £4.3 billion and this represents about 85% of the total smoking attributable costs in UK. For Wales, Scotland, and Northern Ireland, smoking-attributable cost was £234.2 million, £409.4 million and £127.9 million, respectively. Following the analysis made by this study, the smoking-attributable fraction (SAF) in UK was estimated at 23%. The SAF represents the costs attributable to smoking for smoking-related conditions, as a proportion of total NHS expenditure for those conditions. The smoking-related conditions considered included cardiovascular diseases, COPD, other respiratory conditions, lung/bronchus/trachea cancer, mouth and oral cancer and peptic ulcer disease.

Percentage of NHS costs attributable to smoking in 2005–2006 by countries in UK. 8

In spite of the costs of smoking in UK, there are potential economic benefits that smoking brings to the economy. Just like in other countries, tobacco is a major revenue earner for the government. Thus, a reduction in the prevalence of smoking will bring about significant loss to the Exchequer. According to the HM Revenue and Customs 112 Tobacco Bulletin and Factsheets, the treasury earned £9.5 billion in revenue from tobacco duties in the financial year 2011–2012 (excluding VAT). This amounts to 2% of the total government revenue. Including VAT at an estimated £2.6 billion, total tobacco revenue was £12.1 billion. 113 The price of a pack of 20 premium brand cigarettes currently costs around £7.98, of which £6.17 (or 77%) is tax. 114 The economic benefits of smoking from taxation alone thus appear to be noticeably higher than the direct costs of smoking in UK. A CBA of the effects of increasing tobacco taxation commissioned by ASH (in 115 ) found that a tobacco price increase of 5% would result in net benefits to the economy as a whole of around £10.2 billion over 50 years. The economic benefits in the first 5 years would be around £270 million per year on average.

Apart from government taxation, tobacco companies make huge profits from sale of tobacco products. In 2012, British American Tobacco, which is the world’s second largest tobacco company, produced 694 billion cigarettes worldwide (down from 705 billion in 2011) and reported an operating profit of £5.14 billion, an increase of 15% on 2011. 116 The two major UK tobacco companies—Imperial Tobacco and Gallaher (the latter now owned by JTI)—control around 85% of the UK market.

The economic benefits of smoking in UK could also be seen in terms of employment in the tobacco and dependent industries. According to the National Statistics from Tobacco Manufacturers Association, 117 approximately 5,700 people are employed in tobacco manufacturing in UK. It has been argued that a reduction of smoking might not necessarily imply an overall increase in unemployment. It may well boost employment and output. 56 , 118 , 119 The argument is that, though there will be loss of job in the tobacco industry following smoking cessation, money not expended on tobacco will then be spent elsewhere, thereby increasing the demand for other goods and services, and hence generating employment for some other sectors. The extent, to which this happens, however, depends on the spending patterns of the former smokers. McNicoll and Boyle 118 estimated that a total cessation of cigarette purchases in Glasgow will bring about net benefits to the Scottish economy. They estimated that for every £1 million reduction in cigarette expenditure, there would be a net increase in Scottish output of £1.1 million and a net increase of Scottish employment of 64 jobs. In a similar study by Buck et al, 119 a 40% reduction in smoking—a target set by the 1992 UK Policy document—will have estimated effects of increasing jobs in the UK by 150,000. As noted earlier, a smoking population also has the benefit of achieving savings in pension payments from the premature death of smokers. Manning et al 120 have estimated that every pack of cigarettes smoked reduces the life expectancy by 137 minutes and pension costs by $1.82.

The effectiveness and cost effectiveness of UK-specific smoking cessation programs

This section takes a look at the effectiveness and cost effectiveness of smoking cessation interventions that are specific to the UK and identifies where there are any cost savings or net benefits to the health care system arising from a reduction in smoking prevalence. It reviews high-quality evidence on the economics of smoking cessation programs implemented in the different parts of UK. In 1998, the UK government for the first time took a comprehensive approach to the reduction of smoking prevalence in England when it published a policy paper (called a White Paper), Smoking Kills. This program was aimed at reducing smoking among children and adolescents, and help adult smokers, particularly the disadvantaged ones (including pregnant women) to quit smoking. The strategy involved ban on tobacco advertising, further increases in tobacco prices g , measures to reduce smoking in workplaces and in public places, measures to restrict the sale of tobacco to minors h , and also, for the first time in the history of NHS, the commitment of huge resources to smoking cessation treatment services. Smoking Kills has been able to reduce the average prevalence of smoking in adults (16 years+) in England from 27% before the implementation period to 21% in 2008. 121

NHS smoking cessation treatment services

The White Paper, Smoking kills , sets out guidelines for the provision of specialist smoking cessation services. The United Kingdom was the first country to introduce a national smoking cessation treatment program funded through public taxes. 122 Since then, other countries have implemented similar treatment services, eg, Japan and Taiwan. Since 2000, many smokers have received behavioral support through counseling or special training sessions to aid smoking cessation. In England and other parts of UK, smokers can purchase NRT products from local pharmacies and shops. A report from the National Institute for Clinical Excellence (NICE) 123 in March 2002 showed that NRT and bupropion are some of the most cost-effective treatments of all pharmacological interventions. Their cost effectiveness has been estimated by NICE in terms of cost per life year gained (LYG); NHS treatment services produce a cost of about £3000 per LYG and about £2000 when adjusted using UK discount rates (estimates cited in Ref. 124 , pp. 5). Stapleton 125 reveals that calculations based on the reported performance of the NHS specialist smoking cessation services suggest they are highly cost effective, generating a cost of less than £800 per life-year saved. The same study reveals that during April 2000 and March 2001, about 126,800 smokers made an attempt to quit smoking while attending cessation services. Of these, 48% were abstinent at the end of 4 weeks. The total costs (including treatment and administrative costs) were £21.4 million or £209 when expressed per patient treated.

According to a more recent report for 2005, an estimated 2 million smokers in UK used NRT products (and to a much lesser extent bupropion) to aid in stopping smoking. 122 The effectiveness of these treatment services has also been estimated at ~2%–3% abstinence rates. In all, about 90,000 smokers (out of an estimated 12 million smokers in UK) stopped smoking permanently in 2005, implying that about 0.75% of smokers became ex-smokers due to smoking cessation treatments.

Two very recent studies have also examined the cost effectiveness of NRT, bupropion, and varenicle for preventing or reducing relapse to smoking by abstinent smokers following smoking cessation. 27 , 126 Their findings revealed that, like other interventions, relapse prevention interventions (RPIs) are also likely to be highly cost and clinically effective. When compared to no intervention, using bupropion for relapse prevention resulted in an incremental QALY increase of 0.07 with a concurrent NHS cost saving of £68; NRT and varenicline both caused incremental QALY increases of 0.04 at costs of £12 and £90, respectively. Extensive sensitivity analyses from both studies demonstrated that cost-effectiveness ratios were more sensitive to variations in RPI effectiveness than cost. In addition, even after varying key model parameters, the cost effectiveness of NRT and bupropion generally remained. Cost effectiveness ratios only exceeded the UK NICE benchmark of £20,000 per QALY when drug treatment effects were projected to last for only 1 year.

In summary, NHS treatment services and relapse prevention intervention services have been both clinically and cost effective, generating substantial health and cost savings that are acceptable to health care providers.

Community pharmacy-based smoking cessation

Crealey et al 127 have looked at the cost effectiveness of a community pharmacy-based smoking cessation program in Northern Ireland. Data from a pilot study conducted in two community pharmacies in Belfast were used as the basis of the current study, which examined the costs and effects associated with a formal counseling program for smoking cessation by community pharmacists across Northern Ireland. The Pharmacists Action on Smoking (PAS) model was the only active intervention used in the study. Findings indicate that the cost per life year saved when using the PAS program ranges from £196.76 to £351.45 in men and from £181.35 to £772.12 for women (1997 values), depending on age. This compares favorably with other disease prevention medical interventions such as screening for hypertension or hypercholesterolemia. More recently, Boyd and Briggs 128 examined the cost effectiveness of pharmacy-based versus group behavioral support in smoking cessation services in Glasgow. This study was based on the premise that smokers attending group-based support for smoking cessation are significantly more likely to be successful than those attending pharmacy-based support. The study was conducted using a combination of observational study data and information from the NHS Greater Glasgow and Clyde smoking cessation services. Findings revealed that incremental cost per 4-week quitter for pharmacy-based support was found to be approximately £772 and £1612 for group support, dismissing the earlier hypothesis. Furthermore, estimated incremental cost per QALY for pharmacy-based service is £4400 and £5400 for group support service. The study, however, concludes that both group support and pharmacy-based support for smoking cessation are highly cost effective.

Action Heart promotion program

Action Heart is a cost-effective, community-based heart promotion project, which was implemented between 1991 and 1995 in Wath and Swinton, England. Baxter et al 129 carried out a prospective comparative study to establish whether this community-based coronary heart disease health promotion intervention, undertaken over 4 years, was associated with a reduction in the prevalence in adults of risk factors associated with heart disease, including smoking, as well as to estimate the cost effectiveness of this intervention. Smoking prevalence before and after the intervention was assessed using a questionnaire mailed to residents in both the intervention and control areas. Smoking decreased in the intervention area and increased in the control area between 1991 and 1995. Results showed that the intervention achieved a smoking abstinence rate of 6.9%, while 8.7% more of the sample population consumed low-fat milk between the intervention and control area in the 4-year period. The differences between the areas rose from 4.2% to 9.2%. Total project cost (including allowances for community project officer and worker, consumables and other overheads, other NHS staff, school expenditure, etc) was £110,000. The estimated cost per life year gained was £31.

Heart beat wales (HBW)

Phillips and Prowle 22 also appraised the economics of a no-smoking intervention program named Heart Beat Wales (HBW) carried out between 1985 and 1988. Health benefits were estimated as intermediate and final outcomes. Intermediate outcomes were the reduction in the number of smokers and the amount of tobacco consumed. The final outcomes were presented in the terms of reduced morbidity and mortality in three disease groups—coronary heart disease (CHD), lung cancer, and chronic bronchitis. The program costs included direct cash costs and staff costs. Total cost in year 1 was £72,000, in year 2 £82,000, in year 3 £150,000, and in year 4 £205,000. Results show a net present value of benefits to NHS of £4,134,000. The “economic” appraisal has a present value of benefits of £43,503,000. The estimated cost of a working life year saved is £5.78. The net present value of benefits from reductions in smoking is significantly greater than costs in terms of both the NHS and the economy as a whole in Wales. In addition, the net costs per life year saved reveals that the program generates additional working life years at relatively low cost.

No smoking day

More than two decades after the launch of the “No Smoking Day” (NSD) in UK, Owen and Youdan 130 and Kotz et al 131 evaluated the impact and relevance of this national awareness day. Launched in 1984, the campaign seeks to create an enabling environment for smokers to quit smoking. When the campaign began, smoking prevalence in the UK was more than 33% of adults; in 2003 it dropped to 25%. The campaign expenditure ranges somewhere between £470,000 and £550,000 annually. Results show that follow-up after 1 week indicates awareness of NSD is lower in 2004 than in 1986, 2 years after it was launched. However, awareness is still high at 70% for all smokers. Interestingly, the decline in participation from 18% of aware smokers in 1994 to 7% in 2001 was reversed in 2005 when about 19% either gave up or reduced their smoking on NSD. In 2004, NSD awareness had reached 78% of the smoking population. When compared to the 8.5 million smokers in England, the campaign can be deemed to be effective in reaching its target audience. In addition, media coverage has increased regardless of the fact that the campaign expenditure has remained relatively constant and calls to national smokers’ helpline on NSD are typically four times those received on a normal day. The cost of NSD per smoker was £0.088. The discounted life years gained per smoker in the modal age group 35–44 years was 0.00107, resulting in an incremental cost–effectiveness ratio (ICER) of £82.24 (95% CI 49.7–231.6). Thus, the campaign emerges as an extremely effective and cost-effective public health intervention in aiding smoking cessation.

HEBS’s mass media-led intervention

Ratcliffe et al 132 evaluated the costs and outcomes of a mass media-led antismoking campaign in Scotland, which was conducted by the Health Education Board for Scotland (HEBS). The campaign had three elements or features, namely 1) mass media advertising, including television, outdoor posters, and press; 2) Smokeline , a free telephone quitline to aid smoking cessation; and 3) You can stop smoking , a practical handbook aimed at guiding smokers to renounce smoking. At the end of a 12-month period, about 9.88% of individuals in the follow-up sample reported they have renounced smoking since 6 months after the campaign. The costs of the campaign (including the youth campaign costs) ranged from £1,486,101 to £1,546,420. In terms of costs per quitter, estimates ranged from £189 to £369. The costs per life year saved attributable to the campaign ranged from £304 to £656. Another mass media campaign based on behavior change theory and operating through both traditional and new media, known as Stoptober , was launched in England during late 2012. Brown et al 133 found that Stoptober was both effective and cost effective, as it generated up to 350,000 quit attempts and saved 10,400 discounted life years (DLY) at less than £415 per DLY in the modal age group.

This section has reviewed the economic impact of smoking and reducing its prevalence in UK. Though smoking is beneficial to the UK both in terms of tax revenue and employment, the health- and non-health-related costs of smoking to the NHS and the society far outweigh any benefits that might be accruable at least from a socially desirable perspective. Most smoking cessation interventions implemented in the UK have also been highly effective, reducing the number of smokers and any health risks associated with smoking.

This study reviews major studies on the economics of tobacco smoking and the economic impact of reducing its prevalence both globally and in UK. The findings from the review reveal that tobacco smoking is the cause of many preventable diseases and premature deaths in UK and around the world. It poses enormous health- and non-health-related costs to the affected individuals, employers, and the society at large. The WHO estimates that, globally, smoking causes over US$500 billion in economic damage each year. In the UK, the total estimated costs of smoking to society could be put at £13.74 billion. In the US, a much larger economy by population and GDP, the social cost of smoking is more than 8 times that of UK—US$193 billion (or ~£114 billion) according to estimates from Kahende et al, 5 though this figure is even larger when we consider latest estimates from the Campaign for Tobacco-Free Kids, which puts the social cost of smoking at US$321 billion. 59 About 15% of the aggregate health care expenditure in high-income countries can be attributed to smoking. In the US, the proportion of health care expenditure attributable to smoking ranges between 6% and 18% across different states. In the UK, the direct costs of smoking to the NHS have been estimated at between £2.7 billion and £5.2 billion, which is equivalent to around 5% of the total NHS budget each year. The economic burden of smoking estimated in terms of GDP reveals that smoking accounts for approximately 0.7% of China’s GDP and approximately 1% of US GDP. As part of the indirect (non-health-related) costs of smoking, the total productivity losses caused by smoking each year in the US have been estimated at US$151 billion. Smoking is therefore considerably expensive to countries where its prevalence is high, particularly high-income countries. The costs notwithstanding, smoking has some potential economic benefits to most economies. The economic activities generated from the production and consumption of tobacco provides economic stimulus. It also produces huge tax revenues for most governments, especially in high-income countries, as well as employment in the tobacco industry. Income from the tobacco industry accounts for up to 7.4% of centrally collected government revenue in China. Smoking also yields cost savings in pension payments from the premature death of smokers.

Several measures have been undertaken by most countries (including UK) over the years in order to reduce the prevalence of smoking in adults, children, and pregnant women. These measures range from pharmacological treatment interventions (such as the use of NRT, bupropion, and varenicle) to policy-based measures (tax increases, smoking restrictions, bans on tobacco advertising, etc), community-based interventions (such as smoking cessation contests, classroom education, self-help quit kit, etc), TMT-based measures (such as quitlines, mass media led interventions, internet- and computer-based measures), school-based measures, and workplace interventions. We now discuss some of the findings from the review by comparing results across types of intervention, implementation countries, and measurement outcomes, where possible.

Comparing the effectiveness and cost effectiveness of various interventions

From the review of pharmacological and medical treatment interventions for smoking cessation across countries, it was found that cost per life year saved ranged between US$128 and US$1,450 and up to US$4,400 per QALY saved. Comparing various types of pharmacological interventions, existing studies showed that varenicline (with or without behavioral interventions) seemed to be the most cost-effective therapy, followed by bupropion and NRT. However, the results have a high risk of bias because the manufacturer of varenicline funded most of the studies comparing varenicline with bupropion or NRT. In the UK, it was found that the use of NRT and/or bupropion combined with GP counseling was both clinically effective and cost effective to primary health care providers.

Some studies reveal that pharmacological treatments tend to yield more positive results in terms of number of quitters than other cessation interventions (eg, NRT programs could yield as much as 18,500 quitters at a cost of US$4,440 per QALY compared to implementing a smoke-free workplace policy, which would generate 10,400 quitters at US$506 per QALY). The use of pharmacotherapies such as varenicline when combined with other behavioral treatment interventions (such as proactive telephone counseling and Web-based delivery, or both) is cost effective when measured from both cost per LY and cost per QALY, with costs per additional 6-month nonsmoker and per additional life time quitter ranging from US$1,278 to US$1,617 and from US$2,601 to US$3,291, respectively.

With respect to policy-based measures, increase in tobacco taxes is unarguably the most effective means of reducing the consumption of tobacco and hence the health care costs associated with treating smoking-caused diseases. Findings show that a 10% tax-induced cigarette price increase anywhere in the world reduces smoking prevalence by between 4% and 8%. Apart from reducing the number of smokers and saving lives, increasing tobacco taxes also raise government revenue accruable from tobacco manufacturers and retailers. Thus, as cigarette taxes increase, government tax revenues continue to rise even as smoking prevalence falls. In fact, net public benefits from tobacco tax remain positive only when tax rates are between 42.9% and 91.1%. However, increase in tobacco taxes increases the risk of reduction in employment in tobacco companies and the incidence of cigarette smuggling and tax evasion, further dwindling the net benefits from tax increases. Non-price-based measures (such as smoking restrictions in work places, public places, bans on tobacco advertisement, and raising the legal age of smokers) have also proven to be both effective and cost saving. The health and economic benefits of such measures include reduction in smoking prevalence, reduction in second hand smoke, savings from smoking-related medical expenditures, heart diseases averted, costs averted by a reduction in smoking-induced fires, and gains in productivity. Findings show that the cost–effectiveness ratio of implementing non-price-based smoking cessation legislations range from US$2 to US$112 per LYG, while reducing smoking prevalence by up to 30%–82% in the long term (over 50-year period).

From the perspective of the public health system, community-based intervention programs yield cost savings and life year gains. There are, however, differences in the effectiveness and cost effectiveness of different types of community-based interventions. Smoking cessation classes are known to be most effective among community-based measures since they require more time commitment from participants. They could lead to a quit rate of up to 35%, but they usually incur higher costs. On the other hand, self-help quit smoking kits usually require the lowest time commitment from participants and are usually the most cost effective. Community pharmacies also provide opportunities for regular contact with residents of a local community. On average, community pharmacist-based smoking cessation programs yield cost savings to the health system of between US$500 and US$614 per LYG. Knowledge of the health and economic gains of different community-based measures is highly desirable when health policy decision makers plan the allocation of resources for smoking cessation at the community level. One classic example of an effective community-based campaign is the UK’s “No Smoking Day”. After almost three decades of its launch, the campaign has achieved a 78% awareness rate. It has also reduced smoking prevalence by 14%. With the cost of NSD per smoker at £0.088 and ICER of £82.24, NSD emerges as an extremely cost-effective public health intervention.

Since many people are ambivalent about smoking, it has been widely held that advertising media, telecommunications, and other technology-based interventions usually have positive synergistic effects. In fact, as many studies show, an integrated approach involving a combination of multiple media to deliver a message produces greater effects than relying on one medium alone. However, the outcomes on the effectiveness and cost effectiveness of TMT-based measures have been inconsistent. For example, Farrelly et al 92 examined the effects of expenditure on TV, radio, and print advertising and concluded that, while TV advertising produced the greatest yielded proportionally higher increases in the call rate. Clayforth et al 42 found that online-only advertising campaigns can be substantially more cost effective than other non-television advertising media such as radio, and print media, including when an integrated approach is used. Chen et al 34 , 35 also found that making some form of electronic support available to smokers actively seeking to quit (eg, PC, internet, and other electronic aids) is highly likely to be cost effective. This is true whether the electronic intervention is delivered alongside brief advice or more intensive counseling.

The differences in reported cost effectiveness may be partly attributed to varying methodological approaches, including different inputs used to determine model parameters, especially the different dependent variables tested (eg, calls to a quitline versus intention to quit; visits to a quit website versus online registration to smoking cessation services), disparate levels of resourcing between campaigns, differences in national contexts, and differences in advertising campaigns tested on different media. For example, radio is limited to sound, while traditional print media is confined to static pictures. Further, it is difficult to isolate the effects of individual media due to the tendency for campaigns to typically involve the simultaneous use of different media to optimize results. In such circumstances, it is difficult to attribute results to specific media. Some studies have, however, shown that under a wide variety of conditions, the use of personalized smoking cessation service advice, when combined with telephone counseling, mobile phone messages, or other personalized computer-based intervention measures, is both beneficial for health and cost saving to a health system.

In evaluating the effectiveness of school-based intervention programs aimed at preventing smoking in children and adolescents, many studies have conducted analysis of peer-led programs, analysis of social influences, social competences, gender effects, class competitions, and booster sessions, among other measures. Thomas et al 98 found that all these theoretical approaches were very effective in aiding smoking cessation particularly in the number of youths that were prevented from starting smoking. Numerous smoking prevalence trials have found short-term decreases in smoking prevalence of between 30% and 70%. As with other intervention programs, determining that a program is effective may not be sufficient to justify its implementation since the resources to fund school-based smoking prevention programs are limited. Because of limited financial resources, most school-based smoking cessation programs are usually carried out in multiple schools, most times covering thousands of students across communities or regions within the countries of implementation (eg, TNT in USA; ASSIST in England and Wales; MYTRI in India; SFC in Germany). Total intervention costs could range from US$16,400 to US$580,000 depending on the scale and scope of intervention, and these costs usually cover personnel expenses, costs of materials, travel expenses, and program administration costs. Most studies evaluating the cost effectiveness of school-based programs show that one could expect a saving of approximately between US$2,000 and US$20,000 per QALY saved due to averted smoking after 2–4 years of follow-up.

Finally, from the economic evaluation of smoking cessation activities at the workplace, it is evident that employer-based interventions could be beneficial to both employers and the society at large. For example, Warner et al 105 found that smoking cessation is a very sound economic investment for the firm, and is particularly profitable when long-term benefits are included, with an eventual benefit–cost ratio of 8.75. Jackson et al 107 also showed that pharmacological interventions at the workplace seemed to generate 12-month employer cost savings per nonsmoking employee of between $150 and $540. Other studies by Ong and Glantz 108 also showed that the first-year effect of making all workplaces in the US smoke-free would produce about 1.3 million new quitters and prevent over 950 million cigarette packs from being smoked annually, worth about US$2.3 billion in pretax sales to the tobacco industry. In addition to preventing the risk of smoking-induced diseases such as myocardial infarctions and strokes, smoke-free work places could result in nearly US$49 million in savings in direct medical costs after 1 year. At steady state, more than US$224 million would be saved in direct medical costs annually.

From a review of these and other economic studies, it can be safely deduced that the economic benefits of employer-based smoking cessation measures are likely to be far more greater than the costs involved, particularly on a long-range basis, since reduced worksite smoking prevalence translates into reduced absenteeism, increased productivity, lower health insurance costs, higher cost savings, and higher overall benefit–cost ratio in the long run. Moreover, the economic advantages of workplace anti-tobacco policies seem to be more visible when smoking at the workplace is completely prohibited and no smoking areas are set.

Limitations of the study

Only a few studies examining the long-term effect of smoking cessation interventions were found. Evidence of long-term health and economic benefits of many cessation interventions such as clinical and workplace interventions remains uncertain. A series of sensitivity analyses from many of the studies also show that both cost savings and life year gains are sensitive to variations in the discount rates and the long-term smoking quit rate associated with the intervention. Thus, there is a high risk of uncertainty in some of the cost estimates provided in this study. Another source of error in comparative analysis is the differences in basis for cost comparisons across countries and the impact of inflation on cost estimates. For example, there are significant differences across countries in terms of basic demographic and socioeconomic characteristics, life expectancy of population, and advancements in health care systems. Thus, calculation of life years saved and medical costs of smoking-related diseases are likely to differ significantly across countries. Also, the inflation rates in developing/emerging countries like India, Thailand, Taiwan, and China are likely to be higher than those in developed countries such as USA, UK, Canada, and Australia where inflation rates are known to be somewhat lower. Hence, some studies may overstate the real cost estimates if not properly discounted (ie, adjusted) for inflation, thus making comparisons across time and countries difficult. Finally, it is worth noting that the results of many studies reviewed may not have been well established quantitatively in the sense that most of these studies reflect potential uncertainty in the estimates and data used and, in some cases, data sufficient to establish definite causality are lacking.

Conclusions

Though tobacco smoking may be economically beneficial, its direct costs and externalities to society far outweigh any benefits that might be accruable at least when considered from the perspective of socially desirable outcomes (eg, a healthy population and a vibrant workforce). There are enormous differences in the application and economic measurement of smoking cessation measures across various types of interventions, methodologies, countries, economic settings, and health care systems, and these may have affected the comparability of the results of the studies reviewed. However, on the balance of probabilities, most of the cessation measures reviewed have not only proved effective but also cost effective in delivering the much-desired cost savings and net gains to individuals and primary health care providers.

Supplementary Data

a Cigarette smoking is a major contributor to chronic obstructive pulmonary disease, peripheral and cerebrovasular disease, coronary artery disease (CAD), cancer of the lung or pharynx, larynx, oesophagus, pancreas, bladder, kidney and cervix, peptic ulcer disease, and nonmalignant diseases of the mouth, 134 , 135 among other smoking-induced illnesses.

b For example, evidence from Kahende et al 5 show that in the US, the medical costs (part of direct costs) and productivity losses (part of indirect costs) caused by cigarette smoking can be estimated to be worth US$193 billion annually.

c Other approaches that are not considered in this analysis include Cost Analysis (CA) and Cost Utility Analysis (CUA)—see Kahende et al 5 ).

d Passive smoking has some causal relationships with coronary heart disease, heart attacks, and chronic respiratory symptoms. For children and infants, SHS exposure can also lead to low birth weight, sudden infant death syndrome (SIDS), childhood respiratory illness and Asthma, amongst others. In US, about 53,000 deaths of nonsmokers can be attributed to passive smoking ( 56 :s39).

e The cost of smoking to the NHS Wales has been estimated to be £386 million in 2007/2008, which is equivalent to £129 per head and 7% of total health care expenditure in Wales. 136

f In England and Wales, more than 34 million days are lost through sickness absence resulting from smoking-related ill-health, while in Scotland the cost of productivity loss is ~£400–£450 million. In addition, smoking-induced fires cost about £4 million per annum in Scotland. 10 , 137

g One major issue associated with tax increases is that of smuggling and tax evasion. In the UK, it is estimated that approximately 40% of cigarettes do not have UK duty paid on them. The average cost of such cigarettes is almost half the price of legitimate ones. Taxation policies therefore need to be accompanied by a radical law enforcement mechanism in order to reduce this problem. 122

h Like in many countries, the UK government forbid children under the age of 16 from purchasing tobacco products. However, the effectiveness of this restriction has been called to question as children are able to obtain cigarettes from their older friends, siblings, or vending machines.

ACADEMIC EDITOR: Zubair Kabir, Editor in Chief

FUNDING: Authors disclose no funding sources.

COMPETING INTERESTS: Authors disclose no potential conflicts of interest.

Paper subject to independent expert blind peer review by minimum of two reviewers. All editorial decisions made by independent academic editor. Upon submission manuscript was subject to anti-plagiarism scanning. Prior to publication all authors have given signed confirmation of agreement to article publication and compliance with all applicable ethical and legal requirements, including the accuracy of author and contributor information, disclosure of competing interests and funding sources, compliance with ethical requirements relating to human and animal study participants, and compliance with any copyright requirements of third parties. This journal is a member of the Committee on Publication Ethics (COPE).

Author Contributions

Conceived and designed the experiments: VE and AB. Analyzed the data: VE. Wrote the first draft of the manuscript: VE. Contributed to the writing of the manuscript: AB. Agree with manuscript results and conclusions: VE and AB. Jointly developed the structure and arguments for the paper: VE and AB. Made critical revisions and approved final version: VE and AB. All authors reviewed and approved of the final manuscript.

Money and smoking

By any measure, regular smoking can cost a lot. For example, smoking 20 cigarettes a day over the course of a year would, in 2018, cost a smoker in the UK about £3000, depending on the brand. In practice the amount people we spoke to spent on cigarettes varied – and it was much cheaper if people smoked ‘roll-ups’ or ‘rollies’, loose tobacco rolled in papers. For some money they spent on cigarettes was important in the decision to cut down or stop, while others thought they would always have prioritised spending money on cigarettes.

Smoking more and smoking less

As we discussed in ‘Friends, parents and first cigarettes’ younger teenagers rarely bought their first few cigarettes – those whose parents smoked often stole them to smoke alone or share with friends. Many who smoked as teenagers or as students started buying cigarettes regularly when they started a part time or full time job. As their disposable income increased some people changed to a more expensive brand, or smoked branded cigarettes rather than roll-ups. Haseen said that when he had some ‘money in his pocket’ during his time in India, he became brand-conscious and smoked an imported brand.

When Keith first started work, he could afford to smoke more. Even when he had a young family and was worse off, he still smoked.

Age at interview 59

Gender Male

View profile

It certainly increased and certainly since I had more disposable income and went out when I was a little older 17, 18. I had two years after school, after doing A’ levels when I didn’t take on further education. I earned quite a lot, relatively a lot of money then, so it was great, so a lot of disposal income and I smoked more or less you know, straight through that time really. I could afford to do so. So I suppose that enabled me to do it looking back. Yes.

And when would you smoke mainly when you were sort of in your late teens?

Late teens. I think socially again. The two years I had I could smoke during work, it was possible to smoke during work in those days, and in public places and I had all sorts of jobs. All sorts of, I worked in labouring and, and delivering bread and lorry driving, or lorry drivers mates really. All sorts of, I needed time away from institutions really. And I was very well paid for doing it. I was relatively well off, so smoked most of the time I think.

And would the amount you earned affect the amount you smoked?

Well if I hadn’t have got the money, I wouldn’t have been able to smoke as many I did, yes, that’s, that’s certainly been a factor. Although when I was first married and bringing up my family, we were pretty hard up then to start with and I still carried on smoking. Probably not as much but still carried on smoking.

And did you

So it was quite sorry to interrupt.

But it just goes to show what a powerful. It’s totally illogical isn’t it, to smoke is totally illogical? But it’s such a powerful force that it overcomes all of the internal blocks and checks that you have. And you end up rationalising something illogical to yourself and you know that it doesn’t make sense.

Sign up to access embed codes.

Chris’s family had little money when she was growing up, so only when she earned her own money could she afford to smoke more.

Age at interview 65

Gender Female

Money was very scarce. My Mum and Dad, they worked hard, and we didn’t have a lot of money, sort of, you know, you’d pinch one out of the packet and hope they don’t notice. And then perhaps two or three a week if you’re lucky. But that was about it, and you sort of started work and you buy it, you start buying them. And that’s you’re hooked then.

So when did you start work?

Well I was 14 when I started work. I left school when I was 14 and I was a telephonist. So yes, I did. So, but it was sort of in the summer holidays before I actually left school, that we mustn’t, well when he got me smoking and we used do it regularly me and my brother [laughs], share a cigarette.

So it was mainly with your brother, rather than?

Yes mainly with my brother. I had a younger brother then, but we wouldn’t let him do it, because he was too young. We thought we were the oldest. So

And tell me about smoking when you started working?

I didn’t earn a lot of money when I first started working. Obviously I used to give my Mum half of it. It was about £4.50 a week. But then, I just sort of buy, mainly when I went out, you know, wed go out with friends and I’d buy a packet of cigarettes. Probably only ten, you know, but that was it. Then you get mixing with people that are smoking already and it just escalates from there. The more you earn, the more cigarettes you buy. It’s as simple as that. You know, to us smoking what 20, 30 a day. And that was it.

When Laura was at school, she had two part-time jobs and this helped her to afford to smoke 20 cigarettes a day.

Age at interview 32

I was smoking every day. There was quite a lot of down time at school, well there probably wasn’t, but I had a lot of down time at school. I wasn’t a skiver but perhaps I wasn’t in all the lessons. I’m not too sure. But yes, there was a place where you would walk to that was in the village where the school was and everyone would congregate there.

So yes, it was, and I had a job then as well so I could afford to smoke. It wasn’t an issue. I’d got two jobs part time. So, that was probably the main thing, having the cash to spend on it. That helps [laughs].

And was it something you sort of did very consciously, you know, as you sort of smoked more and more, were you noticing that or how would you describe it?

I didn’t. No, it wasn’t deliberate and I didn’t really notice it until I was buying a ten packet a day, which was my normal for quite a long time. I can’t remember when that happened, but I can remember then having, for a while to go and. I’d buy ten, they’d go, then buy another ten and then thinking it would be easier to buy twenty and when I realised that, I thought, oh my God, I’m smoking twenty a day. That’s a lot. But it didn’t stop me.

And I got, because I was a poor student at the end of the day. I was still at school full time, but I did have these two jobs. And once I got a car my car was always full of cigarette packets and if I ever ran out of cigarettes I could rummage around opening them all and I’d always find some. So I wasn’t that careful about finishing the packets either. I just. And I was go to person if anyone wanted cigarettes and I had them. So yes. I don’t know. It’s just the money again I guess [laughs].

Over the course of her ‘smoking career’ Sue went from smoking expensive French cigarettes to rollies (hand-rolled tobacco). People who had started smoking in the UK in the 1950s or 1960s talked about how cheap cigarettes used to be compared to now, and Gareth recalled buying them individually in sweet shops as a whole packet cost too much. People like Carol, Rukmini or Haseen, who didn’t grow up in the UK, remembered how much cheaper cigarettes were in South Africa and India. Tobacco is still more heavily taxed in the UK than most other countries and many smokers stock up on duty free cigarettes when they can. As a teenager Anna bought cheap tobacco in Germany that she sold on to friends at boarding school. Jules and Angela talked about spending their pocket money on cigarettes, and quite a lot of Miles’s student grant used to go on cigarettes.

When she was buying a pack every day Cassie didn’t notice how much she was spending on cigarettes, but now she realises how much money she has wasted on cigarettes.

Age at interview 22

But you know, I get very angry when other people ask me for my cigarettes, because I think buy your own they’re mine. You know. So I think maybe that’s the psychological thing, the need to keep hold of them so that I can carry on smoking, and I think, if I had like £5 left and that’ all I had till the next month or until next year, I would spend it on cigarettes rather than anything else. And if someone gave me the choice between food and cigarettes, may be not now, but before, I would have chosen cigarettes. Which is quite drastic.

And how’s it been with money and cigarettes?

Fine. Cigarettes do eat up your money very quickly. But I think, you know, because you’re buying them, if you, if you smoke a pack of 20 cigarettes. I don’t what the average price is – £6? Then you’re buying them every day if you’re quite a heavy smoker, so you don’t really notice your money going down, and you get so used to it, you don’t notice your money going down, but as, as I’m trying to quit, every time I do go buy it, you know, I don’t want to buy it because of the price now. I’m really bothered about the money I’m spending. It’s such a waste and I could, could spend it on something else. But before when I was regularly smoking all the time and not concerned about quitting the money didn’t even bother me. You know, as long as it’s there, it’s there to spend. So it so much seemed worthwhile.

Living in a University hostel in New Delhi, Rukmini used to spend about a third of her limited income on cigarettes.

Age at interview 35

It was something that everybody else was smoking around me and I guess, you know, it was also economically very cheap to smoke those cigarettes to smoking anything else, because we were students and living on very little.

So how much would cigarettes take up of your income?

I didn’t have an income. I was living on stuff. I was living on money sent to me from home, and I was doing a bit of tuition there, therefore I wouldn’t really call that income. I don’t know. It was about, I would say it was ten to twelve pounds a month which was a substantial amount of what I used to spend in a month at that particular point of time. I wouldn’t say it was everything. I think a third of what I had. You know, but it was about 1200 rupees which was about yes, roughly about £10 – £10-12. But yes. Which I know is nothing as compared to, you know, how much you can smoke here for £10-12 is nothing, but it was quite a substantial amount for me at that particular point of time.

And did that feel like a decision to spend that? Did it?

It never felt like it was a decision, it just was something that everybody else around me did and I just did it, you know, and I didn’t really, there wasn’t like a conscious decision, but I thought that I will spend only this much, I wouldn’t spend that much. Just that, you know, people just smoked cigarettes. If you didn’t have money to buy cigarettes, you smoked cigarettes from somebody else. And you just smoked.

I think with that kind of communal living you know, it was pretty shared. So if you didn’t have many to buy cigarettes your friends would give you cigarettes you know.

Sue smoked at the time her daughter was at university and money was tight. Her friends would always give her cigarettes when she was short.

Age at interview 48

I thought its bad and horrible it smells isn’t it. So it’s crazy. It does make you sound really as though you know you’re a bit nuts. Do you know what I mean. So why did I do?

So what seems strange about it now when you look back?

What seems strange?

You know, you said you feel it was a bit nuts.

Well like I said before, I knew it was bad, smelling horrible, and it cost me money which I didn’t really have. It’s only recently that I’ve actually got to a stage in my life where I don’t have to worry about, you know, if the car goes wrong and things like that. Whereas at that time, if anything went wrong it was a major issue for me. With both children at university, we were getting some help with that but, you know, I was still supporting them and yes, wasting money on cigarettes wasn’t clever.

But I had a lot of really nice friends who we would supply me [laughs]. You know, with all the people that I went out with, they would just go, It doesn’t matter you know. The funny thing was they’d moan about some people. They’d moan about men, because blokes don’t make men scroungers, but with women it was oh you can have one, is fine.

Val wondered how she ever afforded to spend £15 a day on cigarettes, and now she couldn’t manage to smoke on a pension. Carol said that it didn’t matter how much money she had, she always made sure she had cigarette money. However she remembered feeling shocked when she calculated how much money she spent in a year on cigarettes. One thing people did mention was the social aspect of sharing cigarettes. When cigarettes were cheap, and smoking was widespread, it was considered good manners to offer a pack of cigarettes around a group. Some people like Sue remembered that people used to ask to have her expensive French cigarettes all the time. Others like Rukmini, Laura and Abdul had fond memories of sharing cigarettes amongst friends, even when they couldn’t afford them. Cassie and others pointed out that it was now inappropriate to ask for a cigarette from someone else.

NHS stop smoking services are provided free but people who preferred to use private treatment (for example hypnotherapy) were sometimes very conscious that the investment in treatment needed to pay off.

Is saving money a reason to quit?

Whilst some people prioritised the money they spent on cigarettes above many other things, others, when they realised the expense, or had other expenses such as having a family, resented how much it cost. At a population level, there are clear links between increases in the tax on cigarettes and the number of people who give up (or do not start)

One reason why Andy started to think about giving up smoking was that it cost too much.

Age at interview 31

It was the time I thought to myself, oh do you know what, it’s time I just boot this in, in the head. I don’t want to do this anymore.

I mean there were other reasons as well. I mean I think I knew deep down it was getting to the point where it was actually getting too expensive. I think it was getting to the point where they were just about to go to £5 a pack. And I think at some point I sat down and calculated how much it was costing me a month and I looked at how much I was, because I was struggling a little bit at the time with money, and I was thinking, God if I packed in smoking, I’d have x’ amount of money extra a month so I could, those nights I had to stay in, I’d be able to go out. Or you know, you know, the old, the old chestnut, you know, if you give up smoking put the money aside and get yourself something nice. I thought, you know, I could save up and get, I don’t know, an iPod or something like that, back then. And, then I looked at it, and I thought God almighty how much is this costing me, and that coupled with the fact that I wasn’t really enjoying it any more. I was just going through the process of doing it, I think was enough to, to, you know, for me just to kick it in the head.

Rukmini couldn’t afford cigarettes when she moved to the UK, and price rises in the 90s made people like Jules think twice about smoking. Sue and Munir said that, although money was important, they stopped smoking for other reasons.

Although he had saved money towards a deposit for a house, Andrew didn’t think that in his experience money alone was a good enough reason to quit smoking.

Blodwen helped people with alcohol problems become aware of what they were spending. Calculating how much she spent on cigarettes gave her an incentive to quit. [TEXT ONLY]

Age at interview 55

And then of course, you know, the cost. Because, it’s strange, you know, I’ve thought about this, and like with work with the alcohol, and you know, people keeping diaries and stuff like this and you add the cost column and that’s the one that makes the biggest difference of all. That people realise, my God. Did I spend that much on cigarettes? Did I spend that much on drink? And then of course, you know, it gives you that bit of an oomph then to, to sort of, you know, continue as, as you have been really. But yes. So I’m not much of case history to be honest with you.

Well tell me about that, when did you notice at the time? Did you only notice it afterwards? How did it work?

I noticed it at the time, yes, I have, you know, I definitely am able to save and, and I’m a lot more sort of conscious of it now, you know, IWhat I noticed initially was how much more money I had in my purse at the end of the week, whereas you know, maybe it would have gone on cigarettes. I’d think oh I’ve still got that twenty pounds. It’s in my purse. So of course, you know, you think oh yes, you know, so that can go towards a holiday, that can go towards some new clothes or, or whatever isn’t it? So yes, that was the real incentive for me.

Roger was diagnosed with a serious lung condition and also didn’t want to give his money to tobacco companies any more.

Age at interview 66

Well people have said to me, Oh, how much I bet you’ve saved a fortune, haven’t you? Well, for me, from what I’ve said obviously, saving money was the least of my concerns. That didn’t have a part to play in it at all. There was a, there was a social conscience reason if you like as well, because I suddenly realised, when I found out I’d got chronic obstructive pulmonary disease, even though it was only low grade if you like, I suddenly realised that every time I went into the tobacconist, I was giving him money. He was making money out of me making myself ill. But that’s beside the point, what was more important to me was, that there are huge multinational, global tobacco corporations who are making money out of us smokers. Because they’d been banned from advertising in Britain and in Western countries, they’re now centring their attention on China and some of the developing countries, where there aren’t restrictions on advertising to the same degree. And I just thought to myself, why am I giving these bastards my money when, if I die, it’s an irrelevance to them,’ because theres another generation coming along and theres always foreigners who they can get hooked on the habit anyway. And they can still make their millions, and I thought enough, you’ve had enough of my money. I don’t want to give you any more,’ and that was another factor. It wasn’t because ooh I’d have quids in the bank,’ it was because I didn’t want to give these murdering bastards any more of my money. And think of that when you smoke your cigarettes.

Despite smoking for many years Sue had always been concerned that she was putting money into the pockets of the tobacco companies who she sees as ‘very cynical organisations. Because for years they’ve tried to buy expert opinion that says that smoking’s not harmful.’

After you’ve quit

Some people didn’t notice much difference in the amount of money they had after they’d quit, but others had ingenious strategies for saving the money they would have spent on cigarettes and using it in other ways. Khan could spend the money on clothes, his family or other things he enjoyed, Munir noticed that he had more cash in his wallet at the end of the week. Peter had an app on his phone called ‘Since iQuit’ which showed him how much money he had saved as time passed.

To motivate herself, Sarah made a money box to save all the money she would have spent on cigarettes in order to spend it on something special in the future.

Age at interview 33

But to prevent, I guess whilst exploring my own ambivalence, I got creative. I’m a little bit of a creative person and I made a paper mache money box out there and that money box, and I will be checking it’s still there when you leave [laughs], that money box doesn’t take coins. It only takes notes, because I couldn’t buy a packet of cigarettes with a coin. And every other day I put a note in there, and that to me is okay. Once it’s in there I can’t get it out. So I can’t delve in to go and buy some cigarettes. So I’m committing my cigarette money to its destination once it’s in there because I can’t get it out and, and I think that making that was a hands on process for me. It was a really fun creative process for me, and I made it with a reason. I was still smoking when I was making that, but I was making that with a purpose and as I made it the purpose grew and I actually then became quite excited about stopping smoking. Rather than being ambivalent I was quite excited about how I was going to use my money box. Which sounds completely crazy now. But how I was going to use my money box and what I was going to do with, you know, at the end of it.

What are your thoughts?

What I’m going to do at the end of it. Do you know what I don’t really know now. Oh theres loads of things I want to do. Theres loads of things I want to do. I want to get my bathroom tiled. I want to do this and I want to do that. But right now, I, it’s funny when I was doing it, it was things like I wanted to go to New York for my birthday. But I think the other flip side is, you know, with my Mum not being very well, actually the littlest things in life have been so much so. You know, right now, actually I don’t want to go across the other side of the world, even if it is for a weekend. I want to be nearby to home. So, you know, I guess it’s just, I want to buy my Mum a big bunch of flowers when I want, instead of buying a packet of cigarettes. And whatever it may be, I want to be able to, to share stuff. You know, to, to, to not have to say no to an opportunity because I can’t afford it. And to know that I can, even if I have to smash my money box [laughs].

Raf couldn’t afford to smoke once he had more family responsibilities, and now he has quit he has saved around £60 a week.

Age at interview 40

And but eventually, as time went by, when I suppose, it’s a case of when more responsibilities kick in, that’s when you actually start feeling it in your wallet. How much of a dent it’s actually making.

So what were the responsibilities that kicked in?

Just family, family responsibilities, you know, like having to pay your own way at home and that kind of thing, and then when I got married and as times gone by, obviously responsibilities they just increase. They never decrease and it’s just been getting harder and harder and harder as times been going by. And I mean no matter how much money you’re actually earning, you still do feel what’s going out of your pocket, and especially to things like cigarettes and what have you.

So have you noticed the difference in the last nine weeks at all?

Yes. I’m saving on average I’d say about £60 a week. And whereas before, that £60 a week, no matter what I’d need it for, it’d go on cigarettes. Whereas now obviously I can put that money elsewhere, and get something for the kids, or whatever else I need to go out and buy, I’ve got that spare money there, sat there waiting to be used. Whereas before it would just be cigarettes only.

And are you keeping it sort of separate or does it just get absorbed?

No, not separate as such. But it’s just the fact that knowing that I’ve got that extra money there, I can actually go out and whatever else I need to get, I can comfortably go out and get it. Whereas before, no matter how urgently I needed something, I wouldn’t buy it for the sake of that money being spent on the cigarettes.

Laura stopped drinking red wine at the same time she quit smoking, and used the money she had saved to pay for a gym membership and to get her teeth whitened.

When I quit smoking and drinking red wine and coffee and all the other bad things, and I’d split up with my boyfriend and I was going to the gym and life was great and I just thought I was saving so much money and I could go to the gym and I can buy the best membership I want and I can afford it because I don’t smoke, what else can I do. And I thought, yes, I’m going to get my teeth sorted out because they were a horrible colour from all of that terrible stuff I was drinking and smoking and I spent about £300 getting them whitened at the dentist. And it was brilliant. It was such a He told me the price and I thought what? And then I thought I’d spend much more than that on cigarettes I can do that. That’s fine. And I got it done and it’s lasting through and that was a really nice permanent physical thing to do to myself to say I’m not going to smoke any because I’ve just spent £300 getting my teeth cleaned. I’m not, I’m not going to ruin that with a cigarette. That was quite a good final seal the deal kind of thing for me. I liked it.

Looking back, Val realised that she had probably worked until age 66 because she ‘couldn’t afford the lifestyle that I had on a pension. But thinking back, I think it was probably because the money I needed for smoking, not bills’.

(Also see ‘ Complementary approaches to quitting’ )

Changing culture, public health campaigns and the smoking ban

The ban on smoking in public places came into effect in Scotland in 2006 and in the rest of the UK in 2007 (the Republic...

Help from pharmacists, GPs, and Nicotine Replacement Therapies

Although many people decide to try to quit smoking by themselves others seek help from a pharmacist or their GP. Here we discuss the help...

Home — Essay Samples — Nursing & Health — Smoking — Cause And Effect Of Smoking

Cause and Effect of Smoking

• Categories: Smoking Smoking Ban

About this sample

Words: 788 |

Published: Jun 13, 2024

Words: 788 | Pages: 2 | 4 min read

Table of contents

The lure of smoking: root causes, impact on health: the grim reality, social and economic ramifications.

Cite this Essay

Let us write you an essay from scratch

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Get high-quality help

Prof Ernest (PhD)

Verified writer

• Expert in: Nursing & Health Law, Crime & Punishment

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

2 pages / 712 words

3 pages / 1160 words

2 pages / 783 words

2 pages / 826 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Smoking

Smoking is a prevalent practice in many societies, with approximately 1 billion people engaging in this habit. The act of smoking involves burning substances, such as tobacco or cannabis, and inhaling the resulting smoke into [...]

Vaping, once hailed as a safer alternative to traditional smoking, has now come under scrutiny due to its potential health risks and widespread usage among young people. This essay explores the various dangers associated with [...]

Good afternoon, ladies and gentlemen. Today, I would like to talk to you about the dangers of smoking and the impact it has on individuals and society as a whole. Smoking is a prevalent habit that has been around for centuries, [...]

Smoking has numerous health effects, both short-term and long-term. Some of the short-term effects include bad breath, yellow teeth, and decreased sense of taste and smell. The long-term effects, however, are much more severe. [...]

For years there has been conflicting research whether smoking should be banned or not and it is a significant issue today. Many people have given up smoking while others still continue to smoke. Smoking is the inhalation and [...]

Stop smoking it can cost you your life! What is smoking? How can something small cause so much harm to the world? Smoking is an addictive drug that can cause death or cancer it has caused, More than 10 times as many U.S. [...]

Related Topics

By clicking “Send”, you agree to our Terms of service and Privacy statement . We will occasionally send you account related emails.

Where do you want us to send this sample?

By clicking “Continue”, you agree to our terms of service and privacy policy.

Be careful. This essay is not unique

This essay was donated by a student and is likely to have been used and submitted before

Download this Sample

Free samples may contain mistakes and not unique parts

Sorry, we could not paraphrase this essay. Our professional writers can rewrite it and get you a unique paper.

Please check your inbox.

We can write you a custom essay that will follow your exact instructions and meet the deadlines. Let's fix your grades together!

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

Persuasive Essay Writing

Persuasive Essay About Smoking

Craft an Engaging Persuasive Essay About Smoking: Examples & Tips

Published on: Jan 25, 2023

Last updated on: Jul 23, 2024

People also read

How to Write a Persuasive Essay: A Step-by-Step Guide

Easy and Unique Persuasive Essay Topics with Tips

The Basics of Crafting an Outstanding Persuasive Essay Outline

Ace Your Next Essay With These Persuasive Essay Examples!

Persuasive Essay About Gun Control - Best Examples for Students

Top Examples of Persuasive Essay about Covid-19

Learn How To Write An Impressive Persuasive Essay About Business

Learn How to Craft a Compelling Persuasive Essay About Abortion With Examples!

Make Your Point: Tips and Examples for Writing a Persuasive Essay About Online Education

Learn How To Craft a Powerful Persuasive Essay About Bullying

Learn How to Write a Persuasive Essay About Social Media With Examples

Craft an Effective Argument: Examples of Persuasive Essay About Death Penalty

Share this article

Are you stuck on your persuasive essay about smoking? If so, don’t worry – it doesn’t have to be an uphill battle. 

What if we told you that learning to craft a compelling argument to persuade your reader was just a piece of cake? 

In this blog post, we'll provide tips and examples on writing an engaging persuasive essay on the dangers of smoking…all without breaking a sweat! 

So grab a cup of coffee, get comfortable, and let's get started!

On This Page On This Page -->

Persuasive Essay-Defined 

A persuasive essay is a form of academic writing that presents an argument in favor of a particular position, opinion, or viewpoint. 

It is usually written to convince the audience to take a certain action or adopt a specific viewpoint. 

The primary purpose of this type of essay is to provide evidence and arguments that support the writer's opinion.

In persuasive writing, the writer will often use facts, logic, and emotion to convince the reader that their stance is correct. 

The writer can persuade the reader to consider or agree with their point of view by presenting a well-researched and logically structured argument. 

The goal of a persuasive essay is not to sway the reader's opinion. It is to rather inform and educate them on a particular topic or issue. 

Check this free downloadable example of a persuasive essay about smoking!

Simple Persuasive essay about smoking

Read our extensive guide on persuasive essays to learn more about crafting a masterpiece every time. 

Persuasive Essay Examples About Smoking 

Are you a student looking for some useful tips to write an effective persuasive essay about the dangers of smoking? 

Look no further! Here are several great examples of persuasive essays that masterfully tackle the subject and persuade readers creatively.

Persuasive speech on the smoking outline

Persuasive essay about smoking should be banned

Persuasive essay about smoking pdf

Persuasive essay about smoking cannot relieve stress

Persuasive essay about smoking in public places

Speech about smoking is dangerous

For more examples about persuasive essays, check out our blog on persuasive essay examples .

Paper Due? Why Suffer? That's our Job!

Argumentative Essay About Smoking Examples

Our examples can help you find the points that work best for your style and argument. 

Argumentative essay about smoking introduction

Argumentative essay about smoking pdf

Argumentative essay about smoking in public places

10 Tips for Writing a Persuasive Essay About Smoking 

Here are a few tips and tricks to make your persuasive essay about smoking stand out: 

1. Do Your Research

 Before you start writing, make sure to do thorough research on the topic of smoking and its effects. 

Look for primary and secondary sources that provide valuable information about the issue.

2. Create an Outline

An outline is essential when organizing your thoughts and ideas into a cohesive structure. This can help you organize your arguments and counterarguments.

Read our blog about creating a persuasive essay outline to master your next essay.

3. Clearly Define the Issue

 Make sure your writing identifies the problem of smoking and why it should be stopped.

4. Highlight Consequences

 Show readers the possible negative impacts of smoking, like cancer, respiratory issues, and addiction.

5. Identity Solutions 

Provide viable solutions to the problem, such as cessation programs, cigarette alternatives, and lifestyle changes.

6. Be Research-Oriented  

Research facts about smoking and provide sources for those facts that can be used to support your argument.

7. Aim For the Emotions

Use powerful language and vivid imagery to draw readers in and make them feel like you do about smoking.

8. Use Personal Stories 

Share personal stories or anecdotes of people who have successfully quit smoking and those negatively impacted by it.

9. Include an Action Plan

Offer step-by-step instructions on how to quit smoking, and provide resources for assistance effectively.

10. Reference Experts 

Incorporate quotes and opinions from medical professionals, researchers, or other experts in the field.

These tips can help you write an effective persuasive essay about smoking and its negative effects on the body, mind, and society. 

When your next writing assignment has you feeling stuck, don't forget that essay examples about smoking are always available to break through writer's block.

And if you need help getting started, our expert essay writer at CollegeEssay.org is more than happy to assist. 

Just give us your details, and our persuasive essay writer will start working on crafting a masterpiece. 

We provide top-notch essay writing service online to help you get the grades you deserve and boost your career.

Try our AI writing tool today to save time and effort!

Frequently Asked Questions

What would be a good thesis statement for smoking.

A good thesis statement for smoking could be: "Smoking has serious health risks that outweigh any perceived benefits, and its use should be strongly discouraged."

What are good topics for persuasive essays?

Good topics for persuasive essays include the effects of smoking on health, the dangers of second-hand smoke, the economic implications of tobacco taxes, and ways to reduce teenage smoking. 

These topics can be explored differently to provide a unique and engaging argument.

Cathy A. (Marketing, Literature)

For more than five years now, Cathy has been one of our most hardworking authors on the platform. With a Masters degree in mass communication, she knows the ins and outs of professional writing. Clients often leave her glowing reviews for being an amazing writer who takes her work very seriously.

Paper Due? Why Suffer? That’s our Job!

Keep reading

Legal & Policies

• Privacy Policy
• Cookies Policy
• Terms of Use
• Refunds & Cancellations
• Our Writers
• Success Stories
• Our Guarantees
• Affiliate Program
• Referral Program
• AI Essay Writer

Disclaimer: All client orders are completed by our team of highly qualified human writers. The essays and papers provided by us are not to be used for submission but rather as learning models only.

• Paper writing help
• Buy an Essay
• Pay for essay
• Buy Research Paper
• Write My Research Paper
• Research Paper Help
• Custom Research Paper
• Custom Dissertation
• Dissertation Help
• Buy Dissertation
• Dissertation Writer
• Write my Dissertation
• How it works

How To Write A Smoking Essay That Will Blow Your Classmates out of the Water

A smoking essay might not be your first choice, but it is a common enough topic, whether it is assigned by a professor or left to your choice. Today we’ll take you through the paces of creating a compelling piece, share fresh ideas for writing teen smoking essays, and tackle the specifics of the essential parts of any paper, including an introduction and a conclusion.

Why Choose a Smoking Essay?

If you are free to select any topic, why would you open this can of worms? There are several compelling arguments in favor, such as:

• A smoking essay can fit any type of writing assignment. You can craft an argumentative essay about smoking, a persuasive piece, or even a narration about someone’s struggle with quitting. It’s a rare case of a one-size-fits-all topic.
• There is an endless number of  environmental essay topics ideas . From the reasons and history of smoking to health and economic impact, as well as psychological and physiological factors that make quitting so challenging.
• A staggering number of reliable sources are available online. You won’t have to dig deep to find medical or economic research, there are thousands of papers published in peer-reviewed journals, ready and waiting for you to use them. 

Essential Considerations for Your Essay on Smoking

Whether you are writing a teenage smoking essay or a study of health-related issues, you need to stay objective and avoid including any judgment into your assignment. Even if you are firmly against smoking, do not let emotions direct your writing. You should also keep your language tolerant and free of offensive remarks or generalizations.

The rule of thumb is to keep your piece academic. It is an essay about smoking cigarettes you have to submit to your professor, not a blog post to share with friends.

How to Generate Endless Smoking Essay Topic Ideas

At first, it might seem that every theme has been covered by countless generations of your predecessors. However, there are ways to add a new spin to the dullest of topics. We’ll share a unique approach to generating new ideas and take the teenage smoking essay as an example. To make it fresh and exciting, you can:

• Add a historic twist to your topic. For instance, research the teenage smoking statistics through the years and theorize the factors that influence the numbers.
• Compare the data across the globe. You can select the best scale for your paper, comparing smoking rates in the neighboring cities, states, or countries.
• Look at the question from an unexpected perspective. For instance, research how the adoption of social media influenced smoking or whether music preferences can be related to this habit.

The latter approach on our list will generate endless ideas for writing teen smoking essays. Select the one that fits your interests or is the easiest to research, depending on the time and effort you are willing to put into essay writing .

How To Write An Essay About Smoking Cigarettes

A smoking essay follows the same rules as an academic paper on any other topic. You start with an introduction, fill the body paragraphs with individual points, and wrap up using a conclusion. The filling of your “essay sandwich” will depend on the topic, but we can tell for sure what your opening and closing paragraphs should be like.

Smoking Essay Introduction

Whether you are working on an argumentative essay about smoking or a persuasive paper, your introduction is nothing but a vessel for a thesis statement. It is the core of your essay, and its absence is the first strike against you. Properly constructed thesis sums up your point of view on the economic research topics and lists the critical points you are about to highlight. If you allude to the opposing views in your thesis statement, the professor is sure to add extra points to your grade.

The first sentence is crucial for your essay, as it sets the tone and makes the first impression. Make it surprising, exciting, powerful with facts, statistics, or vivid images, and it will become a hook to lure the reader in deeper. 

Round up the introduction with a transition to your first body passage and the point it will make. Otherwise, your essay might seem disjointed and patchy. Alternatively, you can use the first couple of sentences of the body paragraph as a transition.

Smoking Essay Conclusion

Any argumentative and persuasive essay on smoking must include a short conclusion. In the final passage, return to your thesis statement and repeat it in other words, highlighting the points you have made throughout the body paragraphs. You can also add final thoughts or even a personal opinion at the end to round up your assignment.

Think of the conclusion as a mirror reflection of your introduction. Start with a transition from the last body paragraph, follow it with a retelling of your thesis statement, and complete the passage with a powerful parting thought that will stay with the reader. After all, everyone remembers the first and last points most vividly, and your opening and closing sentences are likely to have a significant influence on the final grade.

Bonus Tips on How to Write a Persuasive Essay About Smoking

With the most challenging parts of the smoking essay out of the way, here are a couple of parting tips to ensure your paper gets the highest grade possible:

• Do not rely on samples you find online to guide your writing. You can never tell what grade a random essay about smoking cigarettes received. Unless you use winning submissions from essay competitions, you might copy faulty techniques and data into your paper and get a reduced grade.
• Do not forget to include references after the conclusion and cite the sources throughout the paper. Otherwise, you might get accused of academic dishonesty and ruin your academic record. Ask your professor about the appropriate citation style if you are not sure whether you should use APA, MLA, or Chicago.
• Do not submit your smoking essay without editing and proofreading first. The best thing you can do is leave the piece alone for a day or two and come back to it with fresh eyes and mind to check for redundancies, illogical argumentation, and irrelevant examples. Professional editing software, such as Grammarly, will help with most typos and glaring errors. Still, it is up to you to go through the paper a couple of times before submission to ensure it is as close to perfection as it can get.
• Do not be shy about getting help with writing smoking essays if you are out of time. Professional writers can take over any step of the writing process, from generating ideas to the final round of proofreading. Contact our agents or skip straight to the order form if you need our help to complete this assignment.

We hope our advice and ideas for writing teen smoking essays help you get out of the slump and produce a flawless piece of writing worthy of an A. For extra assistance with choosing the topic, outlining, writing, and editing, reach out to our support managers .

• Undergraduate
• High School
• Architecture
• American History
• Asian History
• Antique Literature
• American Literature
• Asian Literature
• Classic English Literature
• World Literature
• Creative Writing
• Linguistics
• Criminal Justice
• Legal Issues
• Anthropology
• Archaeology
• Political Science
• World Affairs
• African-American Studies
• East European Studies
• Latin-American Studies
• Native-American Studies
• West European Studies
• Family and Consumer Science
• Social Issues
• Women and Gender Studies
• Social Work
• Natural Sciences
• Pharmacology
• Earth science
• Agriculture
• Agricultural Studies
• Computer Science
• IT Management
• Mathematics
• Investments
• Engineering and Technology
• Engineering
• Aeronautics
• Medicine and Health
• Alternative Medicine
• Communications and Media
• Advertising
• Communication Strategies
• Public Relations
• Educational Theories
• Teacher's Career
• Chicago/Turabian
• Company Analysis
• Education Theories
• Shakespeare
• Canadian Studies
• Food Safety
• Relation of Global Warming and Extreme Weather Condition
• Movie Review
• Admission Essay
• Annotated Bibliography
• Application Essay
• Article Critique
• Article Review
• Article Writing
• Book Review
• Business Plan
• Business Proposal
• Capstone Project
• Cover Letter
• Creative Essay
• Dissertation
• Dissertation - Abstract
• Dissertation - Conclusion
• Dissertation - Discussion
• Dissertation - Hypothesis
• Dissertation - Introduction
• Dissertation - Literature
• Dissertation - Methodology
• Dissertation - Results
• GCSE Coursework
• Grant Proposal
• Marketing Plan
• Multiple Choice Quiz
• Personal Statement
• Power Point Presentation
• Power Point Presentation With Speaker Notes
• Questionnaire
• Reaction Paper
• Research Paper

Research Proposal

• SWOT analysis
• Thesis Paper
• Online Quiz
• Literature Review
• Movie Analysis
• Statistics problem
• Math Problem
• All papers examples
• How It Works
• Money Back Policy
• Terms of Use
• Privacy Policy
• We Are Hiring

Cause and Effects of Smoking Cigarettes, Essay Example

Pages: 3

Words: 914

Hire a Writer for Custom Essay

Use 10% Off Discount: "custom10" in 1 Click 👇

You are free to use it as an inspiration or a source for your own work.

Smoking cigarettes has historically been a leisurely and highly popular social activity that a litany of people turn to as a way to assuage daily stress, lose weight, and feel socially accepted in a constantly evolving social world. Tobacco, the main ingredient in cigarettes, has high levels of nicotine, which is a highly addictive ingredient that makes it hard for people to quit smoking if nicotine is ingested on a quotidian basis (Woolbright, 1994, p. 337). According to the CDC (2014), cigarette smoking causes over 480,000 deaths annually in the United States alone, which translates into one out of every five people extirpating due to the ingestion of tobacco. A preventable cause of death, cigarette smoking kills more persons than accidents caused due motor vehicle accidents, alcohol consumption, illegal drug use, deaths involving firearms, and the HIV/AIDS virus altogether (Center For Disease Control and Prevention, 2014). Women who smoke tobacco disproportionately suffer from even more health problems as it directly harms not only their reproductive health but also their mortality and morbidity rates of their progeny or future children (American Lung Association, n.d.). People should not smoke because it not only spawns negative health effects but also because it is not economically useful. If people stopped smoking, many lives would be both indirectly and directly saved from premature and preventative deaths as a result.

Doctors and other medical experts pinpoint the various health hazards caused by smoking, especially to the statistics pertaining to the nexus between smoking cigarettes and premature death, in order to convince people to quit smoking. In the past five decades, the risk of premature death in both female and male smokers has profoundly increased (Centers for Disease Control and Prevention, 2014). According to the CDC (2014), smoking cigarettes causes a handful of diseases because it adversely impacts almost all bodily organs and detracts from the general health of enthusiastic smokers. The risk of developing coronary heart disease (COPD), various cardiovascular maladies, and stroke–the leading cause of death in the United States alone–increases two to four times as much due to the damage it spawns to blood vessels because tobacco narrows and thickens them. These ramifications cause rapid heartbeat, which results in higher blood pressure levels which renders smokers vulnerable to blood clots. If blood clots prevent blood from reaching the heart, people put themselves  at risk for heart attack due to the fact that the heart does not get enough oxygen and thus kills the heart muscle. In addition, blood clots can also cause a stroke because they can hinder blood flow to the brain. Shockingly, quitting smoking even after just one year drastically enhances an individual’s risk of incurring poor cardiovascular health. Moreover, smoking is directly connected to various respiratory diseases due to the fact that it harms both airways and alveoli, or the minute air vacs, that are in the lungs. Chronic Obstructive Pulmonary Disease (COPD), emphysema, and bronchitis are common forms of lung disease that chronic smokers often develop. In addition, medical experts correlate cigarette smoking with a litany of cancers, which have been pinpointed as the primary cause of lung cancer in individuals who smoke for a protracted period of time. Smoking cigarettes can also spawn various other types of cancer, including cancer in the stomach, liver, kidneys, bladders, pancreas, and oropharynx. Smoking not only puts smokers at risk for these often fatal types of cancer but also to those around smokes as a result of second-hand smoking. Second-hand smoke, according to the CDC (2014), causes an estimated 34,000 deaths per year in non-smokers because they too develop various cardiovascular diseases while an estimated 8,000 persons prematurely dying as a result of stroke (CDC, 2014). They also are put at risk for developing lung cancer by approximately thirty percent, and their risk for heart attack is also amplified. Physicians estimate that if nobody smoked cigarettes around the world, an estimated one out of every three deaths caused by cancer would not manifest (1).

More poignantly, smoking cigarettes negatively impacts women’s reproductive health, and children who are exposed to cigarette smoke suffer from often fatal effects. Many studies have analyzed and outlined the negative ramifications of maternal smoking on both the mother and the baby and/or infant ( Hofhuis, de Jongste, & Merkus, 2003 & Woolbright, 1994). Many states require documentation on birth certificates of maternal tobacco consumption (Woolbright, 1994). Despite the Surgeon General’s stern warning that maternal smoking has been linked to fetal injury, premature birth, and/or low birth rate, 15-37% of pregnant women still smoke cigarettes while pregnant (Hofhuis, de Jongste, & Merkus, 2003). Mothers who smoke also frequently participate in other high-risk behaviors that also negatively impacts the health of their progeny. Additionally, factors including marital and socio-economic status in addition education level affect the outcome of pregnancies due to increased vulnerability to cigarette smoking (Woolbright, 1994, p. 330). Low birth weight is the main impact of maternal smoking, although the existing literature pinpoints infant death and premature birth as major ramifications of it as well. Infant exposure to tobacco after they are born puts him or her at risk of premature death if they develop respiratory diseases in addition to Sudden Infant Death Syndrome (Woolbright, 1994). Hofhuis, de Jongste, and Merkus (2003) assessed how smoking cigarettes during pregnancy in addition to passive smoking thereafter affects both the mortality and morbidity rates in children. Statistics show that other obstetric complications directly linked to smoking, including spontaneous abortions, premature rupture of membranes, ectopic pregnancies, and complications related to the placenta. Smoking also stunts the lung growth that fetuses need in utero, which results in the child suffering from weakened lungs after birth while also exponentially increases the child’s chance of suffering from asthma and a vast array of other crippling  respiratory diseases. In addition, it stunts brain development and detracts from the child’s mental acuity.

Health Effects of Cigarette Smoking. (2014, February 6).  Centers for Disease Control and Prevention . Retrieved November 21, 2015 from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_ cig_smoking/

American Lung Association. (n.d.). Women and tobacco use.  American Lung Association . Retrieved November 21, 2015 from http://www.lung.org/stop- smoking/about-smoking/facts- figures/women-and-tobacco-use.html

Ault, R. W., Jr., R. E., Jackson, J. D., Saba, R. S., & Saurman, D. S. (1991). Smoking and Absenteeism. Applied Economics ,  23 , 743-754.

Hodgson TA. Cigarette Smoking and Lifetime Medical Expenditures.  Millbank Q  1992, 70, 81-125.

Hofhuis, W., de Jongste, J. C., & Merkus, P. J. (2003). Adverse Health Effects of Prenatal and Postnatal Tobacco Smoke Exposure on Children.  Arch Dis Child ,  88 , 1086-1090.

Woolbright, L. A. (1994). The effects of maternal smoking on infant health. Population Research and Policy Review ,  13 (3), 327-339.

Stuck with your Essay?

Get in touch with one of our experts for instant help!

Are ADHD Medications Overprescribed in Children? Research Proposal Example

The Vow, Essay Example

Time is precious

don’t waste it!

Plagiarism-free guarantee

Privacy guarantee

Secure checkout

Money back guarantee

Related Essay Samples & Examples

Voting as a civic responsibility, essay example.

Pages: 1

Words: 287

Utilitarianism and Its Applications, Essay Example

Words: 356

The Age-Related Changes of the Older Person, Essay Example

Pages: 2

Words: 448

The Problems ESOL Teachers Face, Essay Example

Pages: 8

Words: 2293

Should English Be the Primary Language? Essay Example

Pages: 4

Words: 999

The Term “Social Construction of Reality”, Essay Example

Words: 371

235 Smoking Essay Topics & Examples

Looking for smoking essay topics? Being one of the most serious psychological and social issues, smoking is definitely worth writing about.

🏆 Best Smoking Essay Examples & Topic Ideas

🥇 good titles for smoking essay, 👍 best titles for research paper about smoking, ⭐ simple & easy health essay titles, 💡 interesting topics to write about health, ❓ essay questions about smoking.

In your essay about smoking, you might want to focus on its causes and effects or discuss why smoking is a dangerous habit. Other options are to talk about smoking prevention or to concentrate on the reasons why it is so difficult to stop smoking. Here we’ve gathered a range of catchy titles for research papers about smoking together with smoking essay examples. Get inspired with us!

Smoking is a well-known source of harm yet popular regardless, and so smoking essays should cover various aspects of the topic to identify the reasons behind the trend.

You will want to discuss the causes and effects of smoking and how they contributed to the persistent refusal of large parts of the population to abandon the habit, even if they are aware of the dangers of cigarettes. You should provide examples of how one may become addicted to tobacco and give the rationales for smokers.

You should also discuss the various consequences of cigarette use, such as lung cancer, and identify their relationship with the habit. By discussing both sides of the issue, you will be able to write an excellent essay.

Reasons why one may begin smoking, are among the most prominent smoking essay topics. It is not easy to begin to enjoy the habit, as the act of smoke inhalation can be difficult to control due to a lack of experience and unfamiliarity with the concept.

As such, people have to be convinced that the habit deserves consideration by various ideas or influences. The notion that “smoking is cool” among teenagers can contribute to the adoption of the trait, as can peer pressure.

If you can find polls and statistics on the primary factors that lead people to tweet, they will be helpful to your point. Factual data will identify the importance of each cause clearly, although you should be careful about bias.

The harmful effects of tobacco have been researched considerably more, with a large body of medical studies investigating the issue available to anyone.

Lung cancer is the foremost issue in the public mind because of the general worry associated with the condition and its often incurable nature, but smoking can lead to other severe illnesses.

Heart conditions remain a prominent consideration due to their lethal effects, and strokes or asthma deserve significant consideration, as well. Overall, smoking has few to no beneficial health effects but puts the user at risk of a variety of concerns.

As such, people should eventually quit once their health declines, but their refusal to do so deserves a separate investigation and can provide many interesting smoking essay titles.

One of the most prominent reasons why a person would continue smoking despite all the evidence of its dangers and the informational campaigns carried out to inform consumers is nicotine addiction.

The substance is capable of causing dependency, a trait that has led to numerous discussions of the lawfulness of the current state of cigarettes.

It is also among the most dangerous aspects of smoking, a fact you should mention.

Lastly, you can discuss the topics of alternatives to smoking in your smoking essay bodies, such as e-cigarettes, hookahs, and vapes, all of which still contain nicotine and can, therefore, lead to considerable harm. You may also want to discuss safe cigarette avoidance options and their issues.

Here are some additional tips for your essay:

• Dependency is not the sole factor in cigarette consumption, and many make the choice that you should respect consciously.
• Cite the latest medical research titles, as some past claims have been debunked and are no longer valid.
• Mortality is not the sole indicator of the issues associated with smoking, and you should take chronic conditions into consideration.

Find smoking essay samples and other useful paper samples on IvyPanda, where we have a collection of professionally written materials!

• How Smoking Is Harmful to Your Health The primary purpose of the present speech is to inform the audience about the detrimental effects of smoking. The first system of the human body that suffers from cigarettes is the cardiovascular system.
• Conclusion of Smoking Should Be Banned on College Campuses Essay However, it is hard to impose such a ban in some colleges because of the mixed reactions that are held by different stakeholders about the issue of smoking, and the existing campus policies which give […]
• Should Smoking Be Banned in Public Places? Besides, smoking is an environmental hazard as much of the content in the cigarette contains chemicals and hydrocarbons that are considered to be dangerous to both life and environment.
• Advertisements on the Effect of Smoking Do not Smoke” the campaign was meant to discourage the act of smoking among the youngsters, and to encourage them to think beyond and see the repercussions of smoking.
• Smoking: Problems and Solutions To solve the problem, I would impose laws that restrict adults from smoking in the presence of children. In recognition of the problems that tobacco causes in the country, The Canadian government has taken steps […]
• Smoking Cigarette Should Be Banned Ban on tobacco smoking has resulted to a decline in the number of smokers as the world is sensitized on the consequences incurred on 31st May.
• Quitting Smoking: Strategies and Consequences Thus, for the world to realize a common positive improvement in population health, people must know the consequences of smoking not only for the smoker but also the society. The first step towards quitting smoking […]
• Should Cigarettes Be Banned? Essay Banning cigarette smoking would be of great benefit to the young people. Banning of cigarette smoking would therefore reduce stress levels in people.
• Hookah Smoking and Its Risks The third component of a hookah is the hose. This is located at the bottom of the hookah and acts as a base.
• Causes and Effects of Smoking Some people continue smoking as a result of the psychological addiction that is associated with nicotine that is present in cigarettes.
• Peer Pressure and Smoking Influence on Teenagers The study results indicate that teenagers understand the health and social implications of smoking, but peer pressure contributes to the activity’s uptake.
• Smoking Cessation Programs Through the Wheel of Community Organizing The first step of the wheel is to listen to the community’s members and trying to understand their needs. After the organizer and the person receiving treatment make the connection, they need to understand how […]
• Smoking and Its Effects on Human Body The investigators explain the effects of smoking on the breath as follows: the rapid pulse rate of smokers decreases the stroke volume during rest since the venous return is not affected and the ventricles lose […]
• Teenage Smoking and Solution to This Problem Overall, the attempts made by anti-smoking campaigners hardly yield any results, because they mostly focus on harmfulness of tobacco smoking and the publics’ awareness of the problem, itself, but they do not eradicate the underlying […]
• On Why One Should Stop Smoking Thesis and preview: today I am privileged to have your audience and I intend to talk to you about the effects of smoking, and also I propose to give a talk on how to solve […]
• Ban of Tobacco Smoking in Jamaica The first part of the paper will address effects of tobacco smoking on personal health and the economy. Cognizant of its international obligation and the aforementioned health effects of tobacco smoke, Jamaica enacted a law […]
• Aspects of Anti-Smoking Advertising Thus, it is safe to say that the authors’ main and intended audience is the creators of anti-smoking public health advertisements.
• “Thank You For Smoking” by Jason Reitman Film Analysis Despite the fact that by the end of the film the character changes his job, his nature remains the same: he believes himself to be born to talk and convince people.
• Health Care Costs for Smokers Higher Tobacco taxes Some of the smokers have the same viewpoint that the current level of taxes imposed on the tobacco is high, 68%, and most of them, 59%, are in agreement for the increase […]
• Smoking and Its Negative Effects on Human Beings Therefore, people need to be made aware of dental and other health problems they are likely to experience as a result of smoking.
• Smoking Among Teenagers as Highlighted in Articles The use of tobacco through smoking is a trend among adolescents and teenagers with the number of young people who involve themselves in smoking is growing each day.
• Smoking: Effects, Reasons and Solutions This presentation provides harmful health effects of smoking, reasons for smoking, and solutions to smoking. Combination therapy that engages the drug Zyban, the concurrent using of NRT and counseling of smokers under smoking cessation program […]
• Social Marketing: The Truth Anti-Smoking Campaign The agreement of November 1998 between 46 states, five territories of the United States, the District of Columbia, and representatives of the tobacco industry gave start to the introduction of the Truth campaign.
• The Change of my Smoking Behavior With the above understanding of my social class and peer friends, I was able to create a plan to avoid them in the instances that they were smoking.
• Cigarette Smoking in Public Places Those who argue against the idea of banning the smoking are of the opinion that some of them opt to smoke due to the stress that they acquire at their work places.
• Public Health Education: Anti-smoking Project The workshop initiative aimed to achieve the following objectives: To assess the issues related to smoking and tobacco use. To enhance the health advantages of clean air spaces.
• Virginia Slims’ Impact on Female Smokers’ Number Considering this, through the investigation of Philip Morris’ mission which it pursued during the launch of the Virginia Slims campaign in 1968-1970 and the main regulatory actions undertaken by the Congress during this period, the […]
• Health Promotion for Smokers The purpose of this paper is to show the negative health complications that stem from tobacco use, more specifically coronary heart disease, and how the health belief model can help healthcare professionals emphasize the importance […]
• Gender-Based Assessment of Cigarette Smoking Harm Thus, the following hypothesis is tested: Women are more likely than men to believe that smoking is more harmful to health.
• Hazards of Smoking and Benefits of Cessation Prabhat Jha is the author of the article “The Hazards of Smoking and the Benefits of Cessation,” published in a not-for-profit scientific journal, eLife, in 2020.
• The Impact of Warning Labels on Cigarette Smoking The regulations requiring tobacco companies to include warning labels are founded on the need to reduce nicotine intake, limit cigarette dependence, and mitigate the adverse effects associated with addiction to smoking.
• Psilocybin as a Smoking Addiction Remedy Additionally, the biotech company hopes to seek approval from FDA for psilocybin-based therapy treatment as a cigarette smoking addiction long-term remedy.
• Investing Savings from Quitting Smoking: A Financial Analysis The progression of interest is approximately $50 per year, and if we assume n equal to 45 using the formula of the first n-terms of the arithmetic progression, then it comes out to about 105 […]
• Smoking as a Community Issue: The Influence of Smoking A review of the literature shows the use of tobacco declined between 1980 and 2012, but the number of people using tobacco in the world is increasing because of the rise in the global population.
• Smoking Public Education Campaign Assessment The major influence of the real cost campaign was to prevent the initiation of smoking among the youth and prevent the prevalence of lifelong smokers.
• Quitting Smoking and Related Health Benefits The regeneration of the lungs will begin: the process will touch the cells called acini, from which the mucous membrane is built. Therefore, quitting the habit of smoking a person can radically change his life […]
• Smoking and Stress Among Veterans The topic is significant to explore because of the misconception that smoking can alleviate the emotional burden of stress and anxiety when in reality, it has an exacerbating effect on emotional stress.
• Smoking as a Predictor of Underachievement By comparing two groups smoking and non-smoking adolescents through a parametric t-test, it is possible to examine this assumption and draw conclusions based on the resulting p-value.
• Smoking and the Pandemic in West Virginia In this case, the use of the income variable is an additional facet of the hypothesis described, allowing us to evaluate whether there is any divergence in trends between the rich and the poor.
• Anti-Smoking Policy in Australia and the US The anti-smoking policy is to discourage people from smoking through various means and promotion of a healthy lifestyle, as well as to prevent the spread of the desire to smoke.
• Smoking Prevalence in Bankstown, Australia The secondary objective of the project was to gather and analyze a sufficient amount of auxiliary scholarly sources on smoking cessation initiatives and smoking prevalence in Australia.
• Drug Addiction in Teenagers: Smoking and Other Lifestyles In the first part of this assignment, the health problem of drug addiction was considered among teens and the most vulnerable group was established.
• Anti-Smoking Communication Campaign’s Analysis Defining the target audience for an anti-smoking campaign is complicated by the different layers of adherence to the issue of the general audience of young adults.
• Smoking Cessation Project Implementation In addition, the review will include the strengths and weaknesses of the evidence presented in the literature while identifying gaps and limitations.
• Smoking Cessation and Health Promotion Plan Patients addicted to tobacco are one of the major concerns of up-to-date medicine as constant nicotine intake leads to various disorders and worsens the health state and life quality of the users.
• Maternal and Infant Health: Smoking Prevention Strategies It is known that many women know the dangers of smoking when pregnant and they always try to quit smoking to protect the lives of themselves and the child.
• A Peer Intervention Program to Reduce Smoking Rates Among LGBTQ Therefore, the presumed results of the project are its introduction into the health care system, which will promote a healthy lifestyle and diminish the level of smoking among LGBTQ people in the SESLHD.
• Smoking: Benefits or Harms? Hundreds of smokers every day are looking for a way to get rid of the noose, which is a yoke around the neck, a cigarette.
• The Culture of Smoking Changed in Poland In the 1980-90s, Poland faced the challenge of being a country with the highest rates of smoking, associated lung cancer, and premature mortality in the world.
• The Stop Smoking Movement Analysis The paper discusses the ideology, objective, characteristics, context, special techniques, organization culture, target audience, media strategies, audience reaction, counter-propaganda and the effectiveness of the “Stop Smoking” Movement.”The Stop Smoking” campaign is a prevalent example of […]
• Health Promotion Plan: Smokers in Mississippi The main strategies of the training session are to reduce the number of smokers in Mississippi, conduct a training program on the dangers of smoking and work with tobacco producers.
• Smoking Health Problem Assessment The effects of smoking correlate starkly with the symptoms and diseases in the nursing practice, working as evidence of the smoking’s impact on human health.
• Integration of Smoking Cessation Into Daily Nursing Practice Generally, smoking cessation refers to a process structured to help a person to discontinue inhaling smoked substances. It can also be referred to as quitting smoking.
• E-Cigarettes and Smoking Cessation Many people argue that e-cigarettes do not produce secondhand smoke. They believe that the e-fluids contained in such cigarettes produce vapor and not smoke.
• Introducing Smoking Cessation Program: 5 A’s Intervention Plan The second problem arises in an attempt to solve the issue of the lack of counseling in the unit by referring patients to the outpatient counseling center post-hospital discharge to continue the cessation program.
• Outdoor Smoking Ban in Public Areas of the Community These statistics have contributed to the widespread efforts to educate the public regarding the need to quit smoking. However, most of the chronic smokers ignore the ramifications of the habit despite the deterioration of their […]
• Nicotine Replacement Therapy for Adult Smokers With a Psychiatric Disorder The qualitative research methodology underlines the issue of the lack of relevant findings in the field of nicotine replacement therapy in people and the necessity of treatment, especially in the early stages of implementation.
• Smoking and Drinking: Age Factor in the US As smoking and drinking behavior were both strongly related to age, it could be the case that the observed relationship is due to the fact that older pupils were more likely to smoke and drink […]
• Smoking Cessation Clinic Analysis The main aim of this project is to establish a smoking cessation clinic that will guide smoker through the process of quitting smoking.
• Cigarette Smoking Among Teenagers in the Baltimore Community, Maryland The paper uses the Baltimore community in Maryland as the area to focus the event of creating awareness of cigarette smoking among the teens of this community.
• Advocating for Smoking Cessation: Health Professional Role Health professionals can contribute significantly to tobacco control in Australia and the health of the community by providing opportunities for smoking patients to quit smoking.
• Lifestyle Management While Quitting Smoking Realistically, not all of the set goals can be achieved; this is due to laxity in implementing them and the associated difficulty in letting go of the past lifestyle.
• Smoking in the Actuality The current use of aggressive marketing and advertising strategies has continued to support the smoking of e-cigarettes. The study has also indicated that “the use of such e-cigarettes may contribute to the normalization of smoking”.
• Analysis of the Family Smoking Prevention and Tobacco Control Act The law ensures that the FDA has the power to tackle issues of interest to the public such as the use of tobacco by minors.
• “50-Year Trends in Smoking-Related Mortality in the United States” by Thun et al. Thun is affiliated with the American Cancer Society, but his research interests cover several areas. Carter is affiliated with the American Cancer Society, Epidemiology Research Program.
• Pulmonology: Emphysema Caused by Smoking The further development of emphysema in CH can lead to such complications caused by described pathological processes as pneumothorax that is associated with the air surrounding the lungs.
• Smoking and Lung Cancer Among African Americans Primarily, the research paper provides insight on the significance of the issue to the African Americans and the community health nurses.
• Health Promotion and Smoking Cessation I will also complete a wide range of activities in an attempt to support the agency’s goals. As well, new studies will be conducted in order to support the proposed programs.
• Maternal Mental Health and Prenatal Smoking It was important to determine the variables that may lead to postpartum relapse or a relapse during the period of pregnancy. It is important to note that the findings are also consistent with the popular […]
• Nursing Interventions for Smoking Cessation For instance, the authors are able to recognize the need to classify the level of intensity in respect to the intervention that is employed by nurses towards smoking cessation.
• Smoking and Cancer in the United States In this research study, data on tobacco smoking and cancer prevalence in the United States was used to determine whether cancer in the United States is related to tobacco smoking tobacco.
• Marketing Plan: Creating a Smoking Cessation Program for Newton Healthcare Center The fourth objective is to integrate a smoking cessation program that covers the diagnosis of smoking, counseling of smokers, and patient care system to help the smokers quit their smoking habits. The comprehensive healthcare needs […]
• Risks of Smoking Cigarettes Among Preteens Despite the good news that the number of preteen smokers has been significantly reducing since the 1990s, there is still much to be done as the effects of smoking are increasingly building an unhealthy population […]
• Healthy People Program: Smoking Issue in Wisconsin That is why to respond to the program’s effective realization, it is important to discuss the particular features of the target population in the definite community of Wisconsin; to focus on the community-based response to […]
• Health Campaign: Smoking in the USA and How to Reduce It That is why, the government is oriented to complete such objectives associated with the tobacco use within the nation as the reduction of tobacco use by adults and adolescents, reduction of initiation of tobacco use […]
• Smoking Differentials Across Social Classes The author inferred her affirmations from the participant’s words and therefore came to the right conclusion; that low income workers had the least justification for smoking and therefore took on a passive approach to their […]
• Cigarette Smoking Side Effects Nicotine is a highly venomous and addictive substance absorbed through the mucous membrane in the mouth as well as alveoli in the lungs.
• Long-Term Effects of Smoking The difference between passive smoking and active smoking lies in the fact that, the former involves the exposure of people to environmental tobacco smoke while the latter involves people who smoke directly.
• Smoking Cessation Program Evaluation in Dubai The most important program of this campaign is the Quit and Win campaign, which is a unique idea, launched by the DHCC and is in the form of an open contest.
• Preterm Birth and Maternal Smoking in Pregnancy The major finding of the discussed research is that both preterm birth and maternal smoking during pregnancy contribute, although independently, to the aortic narrowing of adolescents.
• Enforcement of Michigan’s Non-Smoking Law This paper is aimed at identifying a plan and strategy for the enforcement of the Michigan non-smoking law that has recently been signed by the governor of this state.
• Smoking Cessation for Patients With Cardio Disorders It highlights the key role of nurses in the success of such programs and the importance of their awareness and initiative in determining prognosis.
• Legalizing Electronic Vaping as the Means of Curbing the Rates of Smoking However, due to significantly less harmful effects that vaping produces on health and physical development, I can be considered a legitimate solution to reducing the levels of smoking, which is why it needs to be […]
• Inequality and Discrimination: Impact on LGBTQ+ High School Students Consequently, the inequality and discrimination against LGBTQ + students in high school harm their mental, emotional, and physical health due to the high level of stress and abuse of various substances that it causes.
• Self-Efficacy and Smoking Urges in Homeless Individuals Pinsker et al.point out that the levels of self-efficacy and the severity of smoking urges change significantly during the smoking cessation treatment.
• “Cigarette Smoking: An Overview” by Ellen Bailey and Nancy Sprague The authors of the article mentioned above have presented a fair argument about the effects of cigarette smoking and debate on banning the production and use of tobacco in America.
• “The Smoking Plant” Project: Artist Statement It is the case when the art is used to pass the important message to the observer. The live cigarette may symbolize the smokers while the plant is used to denote those who do not […]
• Dangers of Smoking While Pregnant In this respect, T-test results show that mean birthweight of baby of the non-smoking mother is 3647 grams, while the birthweight of smoking mother is 3373 grams. Results show that gestation value and smoking habit […]
• The Cultural Differences of the Tobacco Smoking The Middle East culture is connected to the hookah, the Native American cultures use pipes, and the Canadian culture is linked to cigarettes.
• Ban on Smoking in Enclosed Public Places in Scotland The theory of externality explains the benefit or cost incurred by a third party who was not a party to the reasoning behind the benefit or cost. This will also lead to offer of a […]
• How Smoking Cigarettes Effects Your Health Cigarette smoking largely aggravates the condition of the heart and the lung. In addition, the presence of nicotine makes the blood to be sticky and thick leading to damage to the lining of the blood […]
• Alcohol and Smoking Abuse: Negative Physical and Mental Effects The following is a range of effects of heavy alcohol intake as shown by Lacoste, they include: Neuropsychiatric or neurological impairment, cardiovascular, disease, liver disease, and neoplasm that is malevolent.
• Smoking Prohibition: Local Issues, Personal Views This is due to the weakening of blood vessels in the penis. For example, death rate due to smoking is higher in Kentucky than in other parts of the country.
• Ban Smoking in Cars Out of this need, several regulations have been put in place to ensure children’s safety in vehicles is guaranteed; thus, protection from second-hand smoke is an obvious measure that is directed towards the overall safety […]
• Smoking: Causes and Effects Considering the peculiarities of a habit and of a disease, smoking can be considered as a habit rather than a disease.
• Smoking and Its Effect on the Brain Since the output of the brain is behavior and thoughts, dysfunction of the brain may result in highly complex behavioral symptoms. The work of neurons is to transmit information and coordinate messengers in the brain […]
• Smoking Causes and Plausible Arguments In writing on the cause and effect of smoking we will examine the issue from the point of view of temporal precedence, covariation of the cause and effect and the explanations in regard to no […]
• Summary of “Smokers Get a Raw Deal” by Stanley Scott Lafayette explains that people who make laws and influence other people to exercise these laws are obviously at the top of the ladder and should be able to understand the difference between the harm sugar […]
• Smoking Qualitative Research: Critical Analysis Qualitative research allows researchers to explore a wide array of dimensions of the social world, including the texture and weave of everyday life, the understandings, experiences and imaginings of our research participants, the way that […]
• Motivational Interviewing as a Smoking Cessation Intervention for Patients With Cancer The dependent variable is the cessation of smoking in 3 months of the interventions. The study is based on the author’s belief that cessation of smoking influences cancer-treated patients by improving the efficacy of treatment.
• Factors Affecting the Success in Quitting Smoking of Smokers in West Perth, WA Australia Causing a wide array of diseases, health smoking is the second cause of death in the world. In Australia, the problem of smoking is extremely burning due to the high rates of diseases and deaths […]
• Media Effects on Teen Smoking But that is not how an adult human brain works, let alone the young and impressionable minds of teenagers, usually the ads targeted at the youth always play upon elements that are familiar and appealing […]
• Partnership in Working About Smoking and Tobacco Use The study related to smoking and tobacco use, which is one of the problematic areas in terms of the health of the population.
• Causes and Effects of Smoking in Public The research has further indicated that the carcinogens are in higher concentrations in the second hand smoke rather than in the mainstream smoke which makes it more harmful for people to smoke publicly.
• Quitting Smoking: Motivation and Brain As these are some of the observed motivations for smoking, quitting smoking is actually very easy in the sense that you just have to set your mind on quitting smoking.
• Health Effects of Tobacco Smoking in Hispanic Men The Health Effects of Tobacco Smoking can be attributed to active tobacco smoking rather than inhalation of tobacco smoke from environment and passive smoking.
• Smoking in Adolescents: A New Threat to the Society Of the newer concerns about the risks of smoking and the increase in its prevalence, the most disturbing is the increase in the incidences of smoking among the adolescents around the world.
• Smoking and Youth Culture in Germany The report also assailed the Federal Government for siding the interest of the cigarette industry instead of the health of the citizens.
• New Jersey Legislation on Smoking The advantages and disadvantages of the legislation were discussed in this case because of the complexity of the topic at hand as well as the potential effects of the solution on the sphere of public […]
• Environmental Health: Tabaco Smoking and an Increased Concentration of Carbon Monoxide The small size of the town, which is around 225000 people, is one of the reasons for high statistics in diseases of heart rate.
• Advanced Pharmacology: Birth Control for Smokers The rationale for IUD is the possibility to control birth without the partner’s participation and the necessity to visit a doctor just once for the device to be implanted.
• Legislation Reform of Public Smoking Therefore, the benefit of the bill is that the health hazard will be decreased using banning smoking in public parks and beaches.
• Smoking Bans: Protecting the Public and the Children of Smokers The purpose of the article is to show why smoking bans aim at protecting the public and the children of smokers.
• Clinical Effects of Cigarette Smoking Smoking is a practice that should be avoided or controlled rigorously since it is a risk factor for diseases such as cancer, affects the health outcomes of direct and passive cigarette users, children, and pregnant […]
• Public Health and Smoking Prevention Smoking among adults over 18 years old is a public health issue that requires intervention due to statistical evidence of its effects over the past decades.
• Smoking Should Be Banned Internationally The questions refer to the knowledge concerning the consequences of smoking and the opinions on smoking bans. 80 % of respondents agree that smoking is among the leading causes of death and 63, 3 % […]
• Microeconomics: Cigarette Taxes and Public Smoking Ban The problem of passive smoking will be minimized when the number of smokers decreases. It is agreeable that the meager incomes of such families will be used to purchase cigarettes.
• Tobacco Debates in “Thank You for Smoking” The advantage of Nick’s strategy is that it offers the consumer a role model to follow: if smoking is considered to be ‘cool’, more people, especially young ones, will try to become ‘cool’ using cigarettes.
• Alcohol and Smoking Impact on Cancer Risk The research question is to determine the quantity of the impact that different levels of alcohol ingestion combined with smoking behavioral patterns make on men and women in terms of the risks of cancer.
• Indoor Smoking Restriction Effects at the Workplace Regrettably, they have neglected research on the effect of the legislation on the employees and employers. In this research, the target population will be the employees and employers of various companies.
• Hypnotherapy Session for Smoking Cessation When I reached the age of sixty, I realized that I no longer wanted to be a smoker who was unable to take control of one’s lifestyle.
• Smoking Experience and Hidden Dangers When my best college friend Jane started smoking, my eyes opened on the complex nature of the problem and on the multiple negative effects of smoking both on the smoker and on the surrounding society.
• South Illinois University’s Smoking Ban Benefits The purpose of this letter is to assess the possible benefits of the plan and provide an analysis of the costs and consequences of the smoking ban introduction.
• Smoking Cessation in Patients With COPD The strategy of assessing these papers to determine their usefulness in EBP should include these characteristics, the overall quality of the findings, and their applicability in a particular situation. The following article is a study […]
• Smoking Bans: Preventive Measures There have been several public smoking bans that have proved to be promising since the issue of smoking prohibits smoking in all public places. This means it is a way of reducing the exposure to […]
• Ban Smoking Near the Child: Issues of Morality The decision to ban smoking near the child on father’s request is one of the demonstrative examples. The father’s appeal to the Supreme Court of California with the requirement to prohibit his ex-wife from smoking […]
• The Smoking Ban: Arguments Comparison The first argument against banning smoking employs the idea that smoking in specially designated areas cannot do harm to the health of non-smokers as the latter are supposed to avoid these areas.
• Smoking Cessation and Patient Education in Nursing Pack-years are the concept that is used to determine the health risks of a smoking patient. The most important step in the management plan is to determine a date when the man should quit smoking.
• Philip Morris Company’s Smoking Prevention Activity Philip Morris admits the existence of scientific proof that smoking leads to lung cancer in addition to other severe illnesses even after years of disputing such findings from health professionals.
• Tobacco Smoking and Its Dangers Sufficient evidence also indicates that smoking is correlated with alcohol use and that it is capable of affecting one’s mental state to the point of heightening the risks of development of disorders.
• Cigarette Smoking and Parkinson’s Disease Risk Therefore, given the knowledge that cigarette smoking protects against the disease, it is necessary to determine the validity of these observations by finding the precise relationship between nicotine and PD.
• Tuberculosis Statistics Among Cigarette Smokers The proposal outlines the statistical applications of one-way ANOVA, the study participants, the variables, study methods, expected results and biases, and the practical significance of the expected results.
• Smoking Habit, Its Causes and Effects Smoking is one of the factors that are considered the leading causes of several health problems in the current society. Smoking is a habit that may be easy to start, but getting out of this […]
• Smoking Ban and UK’s Beer Industry However, there is an intricate type of relationship between the UK beer sector, the smoking ban, and the authorities that one can only understand by going through the study in detail The history of smoking […]
• Smokers’ Campaign: Finding a Home for Ciggy Butts When carrying out the campaign, it is important to know what the situation on the ground is to be able to address the root cause of the problem facing the population.
• Mobile Applications to Quit Smoking A critical insight that can be gleaned from the said report is that one of the major factors linked to failure is the fact that smokers were unable to quit the habit on their own […]
• Behavior Modification Technique: Smoking Cessation Some of its advantages include: its mode of application is in a way similar to the act of smoking and it has very few side effects.
• Effects of Thought Suppression on Smoking Behavior In the article under analysis called I suppress, Therefore I smoke: Effects of Thought Suppression on Smoking Behavior, the authors dedicate their study to the evaluation of human behavior as well as the influence of […]
• Smoking Cessation Methods These methods are a part of NRT or nicotine replacement therapy, they work according to the principle of providing the smoker with small portions of nicotine to minimize the addiction gradually and at the same […]
• Understanding Advertising: Second-Hand Smoking The image of the boy caught by the smoke is in the center of the picture, and it is in contrast with the deep black background.
• People Should Quit Smoking Other counseling strategies such as telephone calls and social support also serves the ultimate goal of providing a modern approach in which counseling can be tailored to suit the counseling needs of an individual smoker. […]
• Importance of Quitting Smoking As such, quitting smoking is important since it helps relief the worry and the fear associated with possibility of developing cancer among other smoking-related illnesses. It is therefore important to quit smoking if the problems […]
• Anti-Smoking Campaign in Canada This is not the first attempt that the federal government of Canada intends to make in reducing the prevalence of smoking in the country.
• Electronic Cigarettes: Could They Help University Students Give Smoking Up? Electronic Cigarettes An electronic cigarette is an electronic device that simulates the act of smoking by producing a mist which gives the physical sensation and often the flavor and the nicotine just as the analog […]
• Psychosocial Smoking Rehabilitation According to Getsios and Marton most of the economic models that evaluate the effects of smoke quitting rehabilitation consider the influence of a single quit attempt.
• Tips From Former Smokers (Campaign) Over the years, the campaigns have led to both the increase and the decrease of smoking all over the world. The second type of anti-smoking campaign employed was the use of celebrities to encourage people […]
• Combating Smoking: Taxation Policies vs. Education Policies This is a considerable provision in the realms of health; hence, the efforts created by the government to curb this trend should be supported fully. In this regard, there is need to reduce the mentioned […]
• The Program to Quit Smoking The second stage of the evaluation proves revealed the benefits of the program for the hospital in terms of discount rates for employees, age categories involved in the program. This process consists in selection of […]
• Smoking Culture in Society Smoking culture refers to the practice of smoking tobacco by people in the society for the sheer satisfaction and delight it offers.
• Possible Smoking Policies in Florida Majority also think that went it comes to workplaces hotels and bars it would be more appropriate to provide specific smoking zones as opposed to total bans The implications of the policy adopted therefore affect […]
• Smoking Ban in the State of Florida These are the Total Ban Policy, the Partial Ban policy and the Liberated Smoking policy. The policy is authoritarian and ignores the interests of the smokers.
• Core Functions of Public Health in the Context of Smoking and Heart Disease In the relation to our problem, heart attacks and smoking, it is important to gather the information devoted to the number of people who suffered from heart attacks and indicate the percentage rate of those […]
• Smoking: Pathophysiological Effects In addition to the effects of smoking on the various body organs including the heart and lungs, smoking has also been shown to have adverse effects on the brain resulting to a compromise of the […]
• Putting Out the Fires: Will Higher Taxes Reduce the Onset of Youth Smoking? According to the article under consideration, increase in price of cigarettes can positively or negatively affect the rate of smoking among the youth.
• Smoking Bans in US The issue of whether to ban smoking indoors by the governments of various countries is popular as they try to take a step towards curbing the harmful effects of smoking.
• Smoking as Activity Enhancer: Schizophrenia and Gender Once learning the effects which nicotine has on people’s health and the relation between gender and schizophrenia, one can possibly find the ways to prevent the latter and to protect the people in the high-risk […]
• Medical Coverage for Smoking Related Diseases However, one of the most oblivious reasons is that it is a deterrent to this behavior, which is harmful to the life of the smoker.
• Exposure to mass media proliferate smoking The chronological array of events in the study with actual days of research and findings, prints out reality and easily enable the readers to connect the subjects of the study with the actual events that […]
• The Realm of reality: Smoking In a nutshell, it can be argued that the definition of a man or a woman is different and not the same as in earlier days.
• Ethical Problem of Smoking Since the job is urgent and therefore needed in a few days time, I would request her to work on the job with the promise that I will communicate her complaints to Frank and Alice […]
• The Rate of Smoking Among HIV Positive Cases.
• Studying the Government’s Anti-Smoking Measures
• Smoking Should Be Banned In the United States
• Effectiveness of Cognitive Behavioral Theory on Smoking Cessation
• Effectiveness of the Cognitive Behavioral Therapy for Smoking Cessation
• Wayco Company’s Non-smoking Policy
• Adverse Aspects of Smoking
• Negative Impacts of Smoking on Individuals and Society
• Cannabis Smoking in Canada
• Smoking Ban in the United States of America
• Dangers of Smoking Campaign
• Smoking Ban in New York
• Smoking and Adolescents
• Trends in Smoking Prevalence by Race/Ethnicity
• Business Ethics: Smoking Issue
• Should Smoking Tobacco Be Classified As an Illegal Drug?
• Where Does the Path to Smoking Addiction Start?
• Public Health Communication: Quit Smoking
• Are Estimated Peer Effects on Smoking Robust?
• Are There Safe Smoking and Tobacco Options?
• What Are the Health Risks of Smoking?
• Does Cigarette Smoking Affect Body Weight?
• Does Cigarette Smuggling Prop Up Smoking Rates?
• What Foods Help You Quit Smoking?
• How Can People Relax Without Smoking?
• Does Education Affect Smoking Behaviors?
• Is Vaping Worse Than Smoking?
• Do Movies Affect Teen Smoking?
• What Is Worse: Drinking or Smoking?
• Does Smoking Affect Breathing Capacity?
• Does Smoking Cause Lung Cancer?
• Does Having More Children Increase the Likelihood of Parental Smoking?
• Does Smoking Cigarettes Relieve Stress?
• Does Time Preference Affect Smoking Behavior?
• How Does Smoking Affect Cardiovascular Endurance?
• How Hypnosis Can Help You Quit Smoking?
• How Does Smoking Affect Brain?
• How Nicotine Affects Your Quit Smoking Victory?
• How Does Secondhand Smoking Affect Us?
• Why Is Smoking Addictive?
• How Smoking Bans Are Bad for Business?
• Why Smoking Should Not Be Permitted in Restaurants?
• Why Public Smoking Should Be Banned?
• Why Has Cigarette Smoking Become So Prominent Within the American Culture?
• What Makes Smoking and Computers Similar?
• Does Smoking Affect Schooling?
• What Effects Can Cigarette Smoking Have on the Respiratory System?
• What Are the Most Prevalent Dangers of Smoking and Drinking?
• Social Security Paper Topics
• Drugs Titles
• Cannabis Essay Titles
• Global Issues Essay Topics
• Cardiovascular Diseases Titles
• Marijuana Ideas
• NHS Research Ideas
• Hypertension Topics
• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2024, February 29). 235 Smoking Essay Topics & Examples. https://ivypanda.com/essays/topic/smoking-essay-examples/

"235 Smoking Essay Topics & Examples." IvyPanda , 29 Feb. 2024, ivypanda.com/essays/topic/smoking-essay-examples/.

IvyPanda . (2024) '235 Smoking Essay Topics & Examples'. 29 February.

IvyPanda . 2024. "235 Smoking Essay Topics & Examples." February 29, 2024. https://ivypanda.com/essays/topic/smoking-essay-examples/.

1. IvyPanda . "235 Smoking Essay Topics & Examples." February 29, 2024. https://ivypanda.com/essays/topic/smoking-essay-examples/.

Bibliography

IvyPanda . "235 Smoking Essay Topics & Examples." February 29, 2024. https://ivypanda.com/essays/topic/smoking-essay-examples/.

Essay on Smoking Cigarettes

Students are often asked to write an essay on Smoking Cigarettes in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Smoking Cigarettes

Harmful habit.

Smoking cigarettes is a dangerous habit that can lead to many health issues. The chemicals in cigarettes damage the lungs and heart, and they can also cause cancer.

Effects on the Lungs

Smoking cigarettes paralyzes the tiny hairs in the lungs that help to keep them clean. This makes it easier for tar and other harmful substances to build up in the lungs, which can lead to lung disease and cancer.

Effects on the Heart

Smoking cigarettes increases the risk of heart disease and stroke. The chemicals in cigarettes damage the blood vessels and make them more likely to form clots. Smoking also raises blood pressure and cholesterol levels, which are both risk factors for heart disease.

Effects on Cancer

Smoking cigarettes is the leading cause of preventable cancer deaths. The chemicals in cigarettes can damage DNA and cause cells to grow out of control. Smoking cigarettes increases the risk of cancer of the lungs, mouth, throat, esophagus, stomach, pancreas, kidney, and bladder.

250 Words Essay on Smoking Cigarettes

Smoking cigarettes: a harmful habit.

Smoking cigarettes is the leading cause of preventable cancer deaths. Cigarettes contain chemicals that can damage the DNA in your cells, which can lead to cancer. The chemicals in cigarettes can also cause inflammation, which is a risk factor for cancer.

Heart Disease

Smoking cigarettes increases your risk of heart disease. The chemicals in cigarettes can damage the blood vessels in your heart, which can lead to a heart attack or stroke. Smoking cigarettes can also raise your blood pressure and cholesterol levels, which are also risk factors for heart disease.

Other Health Problems

Smoking cigarettes can cause a variety of other health problems, including:

Quitting Smoking

If you smoke cigarettes, quitting is the best thing you can do for your health. Quitting smoking can reduce your risk of cancer, heart disease, and other health problems. It can also improve your appearance, energy levels, and overall quality of life.

Smoking cigarettes is a harmful habit that can have serious consequences for your health. If you smoke, quitting is the best thing you can do for your health. There are many resources available to help you quit smoking.

500 Words Essay on Smoking Cigarettes

What are cigarettes.

Cigarettes are small, cylindrical objects made of tobacco leaves that are rolled in paper. They are lit at one end and smoked, with the smoke being inhaled into the lungs.

Why Do People Smoke?

There are many reasons why people start smoking cigarettes. Some people think it looks cool, while others believe it helps them to relax or concentrate. Still others may smoke because they are addicted to nicotine, a chemical found in tobacco that can make people feel good.

The Dangers of Smoking

Smoking cigarettes is a very dangerous habit. It can cause a number of health problems, including lung cancer, heart disease, and stroke. Smoking can also increase the risk of developing other diseases, such as COPD, emphysema, and bronchitis.

The Effects of Smoking on the Body

When you smoke a cigarette, the nicotine in the tobacco quickly enters your bloodstream. This can cause your heart rate and blood pressure to increase, and it can also make you feel lightheaded or dizzy. Smoking can also damage your lungs and other organs, and it can lead to a number of health problems.

Smoking cigarettes is a harmful habit that can lead to a number of health problems. If you smoke, the best thing you can do for your health is to quit. There are many resources available to help you quit, so there is no reason to continue smoking.

If you’re looking for more, here are essays on other interesting topics:

Apart from these, you can look at all the essays by clicking here .

Leave a Reply Cancel reply

Save my name, email, and website in this browser for the next time I comment.