title: The Cost of Smoking in California.
abstract: BACKGROUND
  The economic impact of smoking, including healthcare costs and the value of lost productivity due to illness and mortality, was estimated for California for 2009.
  
  
  METHODS
  Smoking-attributable healthcare costs were estimated using a series of econometric models that estimate expenditures for hospital care, ambulatory care, prescriptions, home health care, and nursing home care. Lost productivity due to illness was estimated using an econometric model predicting how smoking status affects the number of days lost from work or other activities. The value of lives lost from premature mortality due to smoking was estimated using an epidemiological approach.
  
  
  RESULTS
  Almost 4 million Californians still smoke, including 146 000 adolescents. The cost of smoking in 2009 totaled $18.1 billion, including $9.8 billion in healthcare costs, $1.4 billion in lost productivity from illness, and $6.8 billion in lost productivity from premature mortality. This amounts to $487 per California resident and $4603 per smoker. Costs were greater for men than for women. Hospital costs comprised 44% of healthcare costs.
  
  
  CONCLUSIONS
  Despite extensive efforts at tobacco control in California, healthcare and lost productivity costs attributable to smoking remain high. Compared to costs for 1999, the total cost was 15% greater in 2009. However, after adjusting for inflation, real costs have fallen by 13% over the past decade, indicating that efforts have been successful in reducing the economic burden of smoking in the state.
authors.affiliation: Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, CA wendy.max@ucsf.edu.
authors.forename: Wendy
authors.initials: W
authors.lastname: Max
authors.affiliation: Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, CA.
authors.forename: Hai-Yen
authors.initials: HY
authors.lastname: Sung
authors.affiliation: Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, CA.
authors.forename: Yanling
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, CA.
authors.forename: Brad
authors.initials: B
authors.lastname: Stark
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000639:trends; D000818:Animals; D002140:California / Q000453:epidemiology; D017281:Cost of Illness; D004526:Efficiency; D005260:Female; D017048:Health Care Costs / Q000639:trends; D005102:Health Expenditures / Q000639:trends; D006699:Home Care Services / Q000191:economics / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011817:Rabbits; D012907:Smoking / Q000009:adverse effects / Q000191:economics* / Q000453:epidemiology; D000066477:Work Performance / Q000191:economics* / Q000639:trends; D055815:Young Adult