title: Long-term health and medical cost impact of smoking prevention in adolescence.
abstract: OBJECTIVE
  To estimate smoking progression probabilities from adolescence to young adulthood and to estimate long-term health and medical cost impacts of preventing smoking in today's adolescents.
  
  
  METHODS
  Using data from the National Longitudinal Study of Adolescent Health (Add Health), we first estimated smoking progression probabilities from adolescence to young adulthood. Then, using the predicted probabilities, we estimated the number of adolescents who were prevented from becoming adult daily smokers as a result of a hypothetical 1 percentage point reduction in the prevalence of ever smoking in today's adolescents. We further estimated lifetime medical costs saved and quality-adjusted life years (QALYs) gained as a result of preventing adolescents from becoming adult daily smokers. All costs were in 2010 dollars.
  
  
  RESULTS
  Compared with never smokers, those who had tried smoking at baseline had higher probabilities of becoming current or former daily smokers at follow-up regardless of baseline grade or sex. A hypothetical 1 percentage point reduction in the prevalence of ever smoking in 24.5 million students in 7th-12th grades today could prevent 35,962 individuals from becoming a former daily smoker and 44,318 individuals from becoming a current daily smoker at ages 24-32 years. As a result, lifetime medical care costs are estimated to decrease by $1.2 billion and lifetime QALYs is estimated to increase by 98,590.
  
  
  CONCLUSIONS
  Effective smoking prevention programs for adolescents go beyond reducing smoking prevalence in adolescence; they also reduce daily smokers in young adulthood, increase QALYs, and reduce medical costs substantially in later life. This finding indicates the importance of continued investment in effective youth smoking prevention programs.
authors.affiliation: Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: lgw0@cdc.gov.
authors.forename: Li Yan
authors.initials: LY
authors.lastname: Wang
authors.affiliation: Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Michael
mesh_terms: D000293:Adolescent; D000067697:Adolescent Health / Q000191:economics / Q000706:statistics & numerical data*; D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012907:Smoking / Q000191:economics / Q000453:epidemiology*; D000074606:Smoking Prevention; D055815:Young Adult
keywords: Daily smoking in adulthood; Medical costs saved; QALYs gained; Smoking in adolescence; Smoking progression probabilities