title: The carbon footprint of behavioural support services for smoking cessation.
abstract: OBJECTIVE
  To estimate the carbon footprint of behavioural support services for smoking cessation: text message support, telephone counselling, group counselling and individual counselling.
  
  
  METHODS
  Carbon footprint analysis.
  
  
  METHODS
  Publicly available data on National Health Service Stop Smoking Services and per unit carbon emissions; published effectiveness data from the txt2stop trial and systematic reviews of smoking cessation services.
  
  
  METHODS
  Carbon dioxide equivalents (CO2e) per 1000 smokers, per lifetime quitter, and per quality-adjusted life year gained, and cost-effectiveness, including social cost of carbon, of smoking cessation services.
  
  
  RESULTS
  Emissions per 1000 participants were 8143 kg CO2e for text message support, 8619 kg CO2e for telephone counselling, 16 114 kg CO2e for group counselling and 16 372 kg CO2e for individual counselling. Emissions per intervention lifetime quitter were 636 (95% CI 455 to 958) kg CO2e for text message support, 1051 (95% CI 560 to 2873) kg CO2e for telephone counselling, 1143 (95% CI 695 to 2270) kg CO2e for group counselling and 2823 (95% CI 1688 to 6549) kg CO2e for individual counselling. Text message, telephone and group counselling remained cost-effective when cost-effectiveness analysis was revised to include the environmental and economic cost of damage from carbon emissions.
  
  
  CONCLUSIONS
  All smoking cessation services had low emissions compared to the health gains produced. Text message support had the lowest emissions of the services evaluated. Smoking cessation services have small carbon footprints and were cost-effective after accounting for the societal costs of greenhouse gas emissions.
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Anna Jo Bodurtha
authors.initials: AJ
authors.lastname: Smith
authors.forename: Imogen
authors.initials: I
authors.lastname: Tennison
authors.forename: Ian
authors.initials: I
authors.lastname: Roberts
authors.forename: John
authors.initials: J
authors.lastname: Cairns
authors.forename: Caroline
authors.initials: C
authors.lastname: Free
mesh_terms: D001521:Behavior Therapy; D002245:Carbon Dioxide / Q000032:analysis; D058572:Carbon Footprint; D003362:Cost-Benefit Analysis; D003376:Counseling; D006293:Health Promotion / Q000191:economics / Q000379:methods*; D015277:Hotlines; D006801:Humans; D012907:Smoking / Q000191:economics; D016540:Smoking Cessation / Q000191:economics; D060145:Text Messaging; D014029:Tobacco Use Disorder / Q000191:economics / Q000517:prevention & control
chemical_list: D002245:Carbon Dioxide
keywords: Cessation; Economics; Environment; Health Services; Primary Health Care