The objective of this study is to estimate the cost of smoking in California for 5 racial/ethnic groups: Whites, African Americans, Hispanics, Asians, and Others (American Indian/Alaska Natives, Pacific Islanders, and multi-racial groups). The proposed research is a follow-up to our recently completed TRDRP-funded study of The Cost of Smoking in California, 2009.  That study provided estimates of smoking by type of cost, gender, and age group for each of California's 58 counties for 2009.  Smoking behaviors and health impacts are known to differ by race/ethnicity.  However, the most recent estimates for California are based on data over a decade old. 

In the last decade there have been changes in the state’s demographic composition as well as in smoking behaviors.  California’s highly diverse population profile continues to evolve. All racial/ethnic groups have increased in number as compared to a decade earlier except for Whites, and Hispanics now represent the largest population group in the state.  Smoking prevalence has declined in California over the past decade, but it has impacted subpopulations differently.  Between 2001 and 2011/12, all racial/ethnic groups showed reduced current smoking prevalence except for Hispanic females.  However, some groups showed greater reductions than others.  Notably, African American men showed only a slight reduction in current smoking.  Smoking prevalence does not tell the whole story; smoking behavior is changing as well. The percent of adult California smokers who are light smokers (<10 cigarettes per day) is now 60% for men and 61% for women, and only 18% of men and 11% of women are heavy smokers (20+ cigarettes per day).  Hispanic men and women had the greatest percentage of light smokers (83% and 82% respectively) in 2011/12.  There has also been a shift from daily to nondaily smoking: nondaily smokers represented 15 percent of CA smokers in 1992 and increased to 28 percent in 2008.  This study will take into account the recent changes in both population and smoking behavior that have occurred.  It will provide estimates of the cost of smoking at the state level by race/ethnicity for the most recent year possible, probably 2014, building on the just completed 2009 study. 

The study objectives will be accomplished by addressing three specific aims:

• Specific Aim 1.  Healthcare cost of smoking.  Healthcare costs attributable to smoking will be estimated by race/ethnicity.  Included are costs for hospitalizations, ambulatory care, medications, home health care, and nursing home care.  Estimates will be disaggregated by age, gender, and type of service.
• Specific Aim 2.  Value of lost productivity from smoking-attributable illness.  The value of lost productivity from illness attributable to smoking will be estimated by race/ethnicity.  Included are the value of time lost from paid labor market employment as well as time lost from unpaid housekeeping services.
• Specific Aim 3.  Value of lost productivity from smoking-attributable mortality.  Three measures of smoking-attributable mortality will be estimated: deaths, years of potential life lost, and the value of lost productivity.  Each measure will be estimated by race/ethnicity.

Understanding the economic impact of smoking on CA’s different racial/ethnic groups is important for policy purposes.  Just as the tobacco industry targets certain groups in their marketing efforts, tobacco control policies also need to focus on the groups with the greatest smoking impacts. Cigarette smoking is the leading cause of preventable death in the US and California.  Smoking-attributable costs in CA for 2009 amounted to $18.1 billion: $9.8 billion in healthcare costs, $1.4 billion in lost productivity from illness, and $6.8 billion in lost productivity from premature death.  Knowing the impact smoking has on different groups in the state will help guide the development of targeted cessation, education, and other programs.