Cost-Effectiveness Analysis of the Not On Tobacco Program for Adolescent Smoking Cessation

Abstract

Public health researchers and practitioners emphasize the need for effective, adoptable, and available youth smoking cessation interventions. Scarce resources demand that such interventions also be cost effective. This study describes a cost-effectiveness analysis (CEA) of the American Lung Association's Not On Tobacco (N-O-T) national and international teen smoking cessation program. N-O-T has been rigorously evaluated as an effective and adoptable program, and was recently found to be the most frequently-used teen smoking cessation program in the nation. N-O-T studies show intent-to-treat quit rates between 15% and 19%, among the highest reported in the literature. The current CEA resulted from a 2-year state-wide demonstration study in Florida, comparing the effectiveness of N-O-T with a 20-min brief intervention (BI). The CEA utilized a Markov transition model of decision analysis to explain stage progression of smoking cessation among participants from the age of 17 to 25 years. The Markov simulation predicted that out of a cohort of 100 N-O-T students, 10 will quit smoking and remain smoke-free at the age of 25 years and 14 will reduce smoking, resulting in 102.22 life years saved and a total of 20.11 years discounted life years (DLY) saved. Among BI youth, six will quit smoking and nine will reduce, indicating 64.31 life years saved and a total 12.65 DLY saved. The incremental DLY saved is 7.46 years. Results indicate that N-O-T is a very cost-effective option school-based smoking cessation, as cost effective as school-based primary tobacco prevention, and potentially more cost effective than adult tobacco use cessation.

Socioeconomic Disparities in Age of Initiation and Ever Tobacco Smoking: Findings from Romania

“…Comprehensive tobacco control measures focused on denormalizing tobacco smoking behaviour in the community are urgently needed in preventing smoking initiation and reducing ever regular smoking. In Romania, it seems that little attention is paid to these issues and there are many areas for improvement using well-known effective solutions and strategies (30)(31)(32)(33)(34)(35). Achieving high compliance with the Framework Convention on Tobacco Control is essential for curbing tobacco epidemic in Romania (36).…”

Effects of Physical Activity on Teen Smoking Cessation

“…N-O-T was selected as the program of use because it has been demonstrated to be effective and cost-efficient. [17][18][19] The program has been adopted by the American Lung Association and has received several federal designations. 20 Enhancing the potential applicability of our findings, a study found N-O-T to be the most widely used teen smoking intervention in the nation.…”

Evaluation of School-Based Smoking-Cessation Interventions for Self-Described Adolescent Smokers

“…7 NOT is one of the best studied and most widely used interventions in the United States. 8 A review of NOT program results showed overall end-ofprogram (EOP) quit rates of 15% to 19% under controlled conditions and ϳ26% under field conditions. 9 Compared with control subjects, students who received the Kickin' Butts program at 1 public school in Baltimore, Maryland, were significantly more likely to report quitting at the EOP and at the 1-month follow-up assessment.…”