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Multicomponent environmental interventions to prevent youth tobacco use

Public Health & Prevention: Population-level policies
Benefit-cost methods last updated December 2023.  Literature review updated June 2016.
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Multicomponent environmental interventions for reducing youth tobacco use target community policies and norms and outlets where youth purchase tobacco (e.g., retail tobacco shops, grocery or convenience stores). Interventions often start with community mobilization, media coverage of youth substance use and potential harm, and merchant education. Interventions were implemented across a range of rural and urban communities, for varying periods of time (approximately 2-3 years). In this analysis we only include interventions with a component targeting illegal retail tobacco sales to minors. We include four studies that isolate effects of community-level intervention. Two compare intervention sites to sites receiving no intervention, and two compare sites with a school-based program only to sites with both school-based and community-level intervention. Most interventions were implemented in the mid-1990’s, paralleling implementation of state and federal tobacco control policies.
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2022). 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 $355 Benefits minus costs $894
Participants $637 Benefit to cost ratio $5.85
Others $99 Chance the program will produce
Indirect ($13) benefits greater than the costs 84%
Total benefits $1,079
Net program cost ($185)
Benefits minus cost $894

^WSIPP’s benefit-cost model does not monetize this outcome.

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. See Estimating Program Effects Using Effect Sizes for additional information.

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
12 2 2882 -0.017 0.028 12 -0.017 0.028 13 -0.051 0.067
12 2 2261 -0.047 0.035 15 -0.047 0.035 18 -0.145 0.001
12 4 123 -0.324 0.153 12 n/a n/a n/a -0.709 0.001
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
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Smoking before end of high school Labor market earnings associated with smoking $258 $608 $0 $0 $866
Health care associated with smoking $96 $27 $99 $48 $271
Mortality associated with smoking $1 $2 $0 $31 $34
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($92) ($92)
Totals $355 $637 $99 ($13) $1,079
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Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $53 2015 Present value of net program costs (in 2022 dollars) ($185)
Comparison costs $0 2015 Cost range (+ or -) 30%
Estimated program costs are based on the SAMHSA NREPP cost report for the Communities Mobilizing for Change on Alcohol intervention. We include costs for a community organizer and their expenses, and also for intensive training through the Youth Leadership Institute (, assuming that the effects found in research evaluations were produced by community organizers with high levels of training and support.
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.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative 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 discounted dollars. 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.

Citations Used in the Meta-Analysis

Altman, D.G., Wheelis, A.Y., McFarlane, M., Lee, H.-R., & Fortmann, S.P. (1999). The relationship between tobacco access and use among adolescents: a four community study. Social Science & Medicine, 48(6), 759-775.

Biglan, A., Henderson, J., Humphrey, D., Yasui, M., Whisman, R., Black, C., James, L. (1995). Mobilising positive reinforcement to reduce youth access to tobacco. Tobacco Control, 4(1), 42-48.

Biglan, A., Ary, D., Koehn, V., Levings, D., Smith, S., Wright, Z., James, L., & Henderson, J. (1996). Mobilizing positive reinforcement in communities to reduce youth access to tobacco. American Journal of Community Psychology, 24(5), 625-638.

Biglan, A., Arvy, D.V., Smolkowski, K., Duncan, T., & Black, C. (2000). A randomized controlled trial of a community intervention to prevent adolescent tobacco use. Tobacco Control, 9, 24-32.

Chen, V., & Forster, J.L. (2006). The long-term effect of local policies to restrict retail sale of tobacco to youth. Nicotine & Tobacco Research, 8(3), 371-377.

Perry, C.L., Komro, K.A., Veblen-Mortenson, S., Bosma, L.M., Farbakhsh, K., Munson, K.A., et al. (2003). A randomized controlled trial of the middle and junior high school D.A.R.E. and D.A.R.E. Plus programs. Archives of Pediatrics & Adolescent Medicine, 157(2), 178-184.