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School-based tobacco prevention programs

Public Health & Prevention: School-based
Benefit-cost methods last updated December 2018.  Literature review updated December 2014.
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School-based tobacco prevention programs have curricula specifically designed for tobacco prevention and cessation. These programs aim to increase students’ peer pressure resistance skills, instruct about the health and social consequences of tobacco use, and often teach students to decipher pro-tobacco media messaging. Two name-brand programs included in this meta-analysis were Project Towards No Tobacco Use and Project SHOUT (Students Helping Others Understand Tobacco). Both programs are targeted toward middle school students and are delivered in 12-18 classroom sessions.
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2017). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $995 Benefits minus costs $3,754
Participants $1,520 Benefit to cost ratio $58.88
Others $1,069 Chance the program will produce
Indirect $235 benefits greater than the costs 99 %
Total benefits $3,818
Net program cost ($65)
Benefits minus cost $3,754
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Labor market earnings associated with high school graduation $713 $1,569 $717 $0 $2,999
Health care associated with smoking $389 $110 $401 $194 $1,094
Costs of higher education ($110) ($167) ($50) ($55) ($381)
Mortality associated with smoking $3 $7 $0 $128 $139
Adjustment for deadweight cost of program $0 $0 $0 ($32) ($32)
Totals $995 $1,520 $1,069 $235 $3,818
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $63 2014 Present value of net program costs (in 2017 dollars) ($65)
Comparison costs $0 2014 Cost range (+ or -) 10 %
Although these programs often spread delivery over two school years, with a set of core sessions in the first year and a set of “booster” sessions in the second, our costs assume all sessions are delivered in a single year. We constructed a per-student cost by first computing estimates for Project TNT and Project SHOUT, based on components reported by the National Registry of Evidence-based Programs and Practices (TNT: and Sociometrics (SHOUT: We then computed a simple average of the cost of the two programs. Costs include materials, training, and teacher time for program delivery.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Treatment age No. of effect sizes Treatment N Adjusted effect sizes(ES) and standard errors(SE) used in the benefit - cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Smoking in high school 12 2 2536 -0.171 0.076 14 -0.171 0.076 18 -0.171 0.025

Citations Used in the Meta-Analysis

Dent, C.W., Sussman, S., Stacy, A.W., Craig, S., Burton, D., & Flay, B.R. (1995). Two-year behavior outcomes of Project Towards No Tobacco Use. Journal of Consulting and Clinical Psychology, 63(4), 676-677.

Elder, J.P., Wildey, M., de Moor, C., Sallis, J.F., Eckhardt, L., Edwards, C., . . . Woodruff, S.I. (1993). The long-term prevention of tobacco use among junior high school students: Classroom and telephone interventions. American Journal of Public Health, 83(9), 1239-1244.