A ‘smoke-free generation’ in Canada? New analysis says it would result in vast health gains, healthcare cost savings
University of Ottawa
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Dr. Doug Coyle of the University of Ottawa suggests that if the Canadian government were to implement a “smoke-free generation” policy there would be massive health benefits. His study estimates that the policy would result in $2.3 billion less in health care costs and lead to 476,814 more quality-adjusted life years for Canadians over a 50-year timespan.
view moreCredit: Faculty of Medicine, University of Ottawa
Smoking stubbornly remains a leading cause of disease, disability and death in Canada, even as prevalence rates have fallen significantly over the last 50 years. So what new smoking cessation initiative can save lives and billions of dollars in health-care costs?
A highly compelling analysis by a uOttawa Faculty of Medicine health economist explores the long-term impacts of one bold smoking restriction proposal: a lifetime ban on tobacco products to individuals born after a specific date.
This “smoke-free generation” concept is aimed at forging a generation of individuals who would never be able to legally purchase tobacco or nicotine vaping products. It proposes that preventing young people from taking up smoking is key since roughly 80 percent of people take up smoking by age 18, and nearly all smokers start by age 26. It’s a policy measure that was seriously debated in New Zealand and has been recommended by smoking cessation experts in Canada.
Dr. Doug Coyle suggests that if the Canadian government were to implement a “smoke-free generation” policy there would be massive health benefits. His study estimates that the policy would result in $2.3 billion less in health care costs and lead to 476,814 more quality-adjusted life years for Canadians over a 50-year timespan.
The analysis assumed a perpetual ban on cigarette sales to anyone born after 2009 if imposed on Jan. 1, 2025.
The research forecasting the long-term impacts of a SFG policy was featured today in the January edition of Health Promotion and Chronic Disease Prevention in Canada, a publication of the Public Health Agency of Canada.
One of the peer-reviewed journal's reviewers described Dr. Coyle’s analysis as a “very important piece of work which could influence policy.”
An expert at researching health economics and applying analyses to health policy, Dr. Coyle says the study’s “biggest finding is that introducing a SFG policy would lead to substantive health gains with significant health care cost savings.”
“Current legislation is ineffective as most long-term smokers initiate smoking prior to the legal age for smoking. Thus, a SFG policy avoids the vast health losses occurring due to uptake of smoking earlier than legally allowed,” he says.
The published analysis took an existing model relating to smoking cessation and augmented it to assess the impacts of an SFG policy on quality-adjusted life years (QALYs), life expectancy, health care costs, smoking-related taxes, and Canadian tobacco industry gross domestic product. The policy’s overall impact for the entire Canadian population was assessed for time periods up to 90 years.
While the study found that there would be significant health care cost saving and more quality-adjusted life years for Canadians, it also found the policy would also result in $7.4 billion less in smoking-related taxes and a $3.1 billion reduction in tobacco industry GDP. However, the study suggests that the combined value of health benefits gained and health care costs averted would surpass the hit of lower tax revenues and reduced GDP.
“Although health care cost savings are lower than the combination of lost tax revenues and the decline in the GDP from the Canadian tobacco industry, the value of the health benefits realized outweigh the negative offsets,” the study concludes.
Dr. Coyle says that since taxes on tobacco smoking are regressive and impact poorer populations more proportionally than wealthier ones, the government could replace the lost tax with a “more progressive tax substitute" that "would be more fair and equitable.”
Dr. Coyle’s decades of work have influenced the practice and methods of health economics and directly influenced policy in Canada and the UK. He’s a Professor Emeritus of the uOttawa Faculty of Medicine’s School of Epidemiology and Public Health (SEPH). He served as SEPH’s interim director from 2016-18 and was previously director of the graduate program in epidemiology.
Journal
Health Promotion and Chronic Disease Prevention in Canada
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Original quantitative research – Implementing a smoke-free generation policy for Canada: estimates of the long-term impacts
Article Publication Date
13-Jan-2025
U.S. soldiers 10 times more likely to use addictive nicotine pouches, study finds
University of Virginia Health System
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Melissa Little, PhD, led the study examining nicotine pouch use among U.S. soldiers.
view moreCredit: University of Virginia
American soldiers are 10 times more likely to use nicotine pouches that can cause serious health issues than average American adults, according to a survey of military personnel at Fort Liberty, the largest American military base.
Conducted by researchers at UVA Cancer Center, the Fort Liberty Department of Public Health and the UNC Lineberger Comprehensive Cancer Center, the study analyzed anonymous responses from 1,957 soldiers surveyed in 2022 and 2023. Among survey participants, 23.8% reported using nicotine pouches in the previous 30 days, compared with a 2022 study that found just 2.9 percent of all American adults had reported ever using nicotine pouches.
“Military personnel historically use tobacco and nicotine products at much higher rates than their civilian counterparts,” said Melissa Little, PhD, director of the Center for Nicotine and Tobacco Research at the University of Virginia School of Medicine. “Our results show that these same disparities are continuing with new and emerging products, like nicotine pouches.”
Growing Popularity
Nicotine pouch use grew in popularity during the survey period, as 24.7% of soldiers queried in 2023 reported using nicotine pouches compared with 20.2% in 2022. The highly addictive pouches have been linked to cardiovascular risks, lung and stomach problems, gum ulcers, oral health issues and other concerns, including nicotine’s ability to promote the growth of cancer.
Users were more likely to be younger, male, White, unmarried and users of other tobacco or nicotine products such as cigarettes, smokeless tobacco and vapes. Soldiers ages 30 and older were less likely to use nicotine pouches than soldiers ages 17 to 24. Survey participants with at least a bachelor’s degree were more likely to use nicotine pouches than soldiers with a high school degree or GED.
With approximately 200,000 American soldiers leaving the military each year, the researchers said that continued research into nicotine pouch use is needed to develop ways to reduce nicotine and tobacco consumption as soldiers return to civilian life.
“We are currently working on addressing these high rates of nicotine pouches by developing tailored interventions for military personnel,” Little said. “Given everything that military personnel sacrifice to serve our country, providing them with the tools to lead the healthiest lives possible is the best way we can give back.”
Findings Published
The researchers have published their results in the scientific journal JAMA Network Open. The research team consisted of Little, Kathryn M. Polaskey, Asal Pilehvari, Rebecca A. Krukowski, Kurt M. Ribisl and Teresa D. Pearce. Ribisl disclosed that he has served as a paid expert consultant representing plaintiffs in litigation against e-cigarette and tobacco companies.
The study was supported by grant R01DA043468 from the National Institutes of Health’s National Institute on Drug Abuse and grants P30CA225520 and P30CA044579 from the National Cancer Institute.
To keep up with the latest medical research news from UVA, subscribe to the Making of Medicine blog at http://makingofmedicine.virginia.edu.
Journal
JAMA Network Open
