This study will develop estimates of the cost of smoking for each of California's 58 counties, including costs of both active smoking and secondhand smoke exposure. Estimates will be made of smoking-attributable healthcare costs, time lost from activities, and the value of lives lost prematurely due to smoking-related illness. A report will be produced that will be the third in a series by these investigators. The study has three specific aims:

•  Specific Aim 1. Direct Costs of Smoking-Related Illness. Annual smoking-attributable healthcare expenditures for each county and for California as a whole will be estimated for the most recent year that the data permit, probably 2009. Estimates will be presented separately by age, gender, and type of service, including hospitalization costs as well as the cost of ambulatory care, prescribed medications, home health care, and nursing home care. Costs due to secondhand smoke exposure will be presented separately.
•  Specific Aim 2. Value of Lost Productivity from Smoking-Related Illness. The value of time lost from regular activities by ill smokers will be estimated for California and its counties. This will include the value of time lost from paid employment and housekeeping services.
•  Specific Aim 3. Losses Resulting from Smoking-Caused Deaths. Estimates of the number of deaths from smoking-related diseases, the number of years people would have lived had they not died from smoking-related illnesses, and the value of lost employment and housekeeping will be estimated for active smokers and those exposed to secondhand smoke.

A user-friendly report will be produced, which will contain three sets of tables:
•  California Tables. This section will include a series of tables presenting the costs for the entire state, including total costs, costs per resident, and costs per smoker. Also included will be data on smoking-attributable deaths by disease and gender.
•  County Tables. This section will include a series of tables which list each county total for costs, smoking prevalence, and the mortality measures. Each will be presented separately for men and women. The presentation will allow for easy comparisons of the impact of smoking on different counties.
•  County Profiles. This section will contain a 2-page spread for each of the counties in the state. The profile will include total costs as well as costs per resident and per smoker, expenditures for each type of healthcare, smoking prevalence, and the mortality measures. The profiles will present detailed information on each county in one place to make it easily accessible by tobacco control advocates, legislators, and public health educators.