ObjectiveTo assess the return on investment (ROI) of the Florida tobacco control programme, the Bureau of Tobacco Free Florida (BTFF), in terms of healthcare expenditure savings and mortality cost saved as a result of reduced mortality due to the programme from 1999 to 2015.MethodsWe use a synthetic control method to estimate the impact of the BTFF on smoking-attributable mortality, years of life lost (YLL), healthcare expenditures, and the economic value of premature mortality due to smoking in Florida from 1999 through 2015. We calculated an ROI for healthcare expenditures and for the value of life years saved.ResultsFrom 1999 to 2015, adult smoking prevalence in Florida averaged 0.98 percentage points lower than prevalence in the synthetic control states (19.6% vs 20.6%). The ROI over the period from 1999 to 2015 was 9.61 for healthcare expenditures and 112.44 for premature mortality. These ROIs suggest that for every US$1 of expenditure by BTFF, smoking-attributable healthcare expenditures decreased by almost US$11 and reductions in the economic costs associated with YLL due to smoking-attributable mortality totaled approximately US$113.ConclusionsOur results suggest the BTFF resulted in fewer YLL, substantial healthcare cost savings and substantial savings in terms of mortality costs. The positive ROIs for healthcare expenditures and premature mortality suggest that the BTFF is a good investment of public funds.

What is already known about this topic?Statewide media campaigns are an evidence-based component of comprehensive tobacco control programs. However, because of budget limitations, few state tobacco control programs can devote resources to both create and consistently air media campaigns.What is added by this report?From 2011 through 2018, the Bureau of Tobacco Free Florida aired hardhitting advertisements from successful national and state campaigns as part of their Tobacco Free Florida campaign. The study found that exposure to the Tobacco Free Florida campaign influenced the rate of quit attempts among adult smokers in Florida.What are the implications for public health practice?Statewide media campaigns can use existing effective advertising materials to affect population-level quit attempts. Abstract ConclusionThe Tobacco Free Florida campaign affected cessation-related behaviors in Florida over an 8-year period. Evidence-based state tobacco education campaigns can accelerate progress toward the goal of reducing adult smoking.

Objectives. States that are legalizing cannabis for adult use are increasingly focused on equity, with the goal of repairing some of the harm caused by the War on Drugs. This study explains and describes the emphasis states are placing on equity and assesses whether public education can be used to increase public support for equity-focused cannabis policies. Methods. We conducted an online survey of 893 New Jersey adults in August and September of 2021, just as state’s Cannabis Regulatory Commission was publishing the first set of regulations for the legal sale and use of cannabis for adults age 21 and older. The study included an experimental design, in which half of respondents viewed an educational message about equity-focused cannabis policies before answering survey questions, and the other half did not. Results. Few participants (24.9%) were familiar with the concept of equity in cannabis policy, and a substantial proportion—from about 20% to 35%—provided a “neutral” or “don’t know” response when asked about support for specific policies. Exposure to an educational message was associated with greater perceived importance of equity in cannabis policy (p < 0.05) and greater support for equity-focused policies. Specifically, participants who saw an educational message had greater agreement that New Jersey should provide priority licensing (p < 0.01) and grants (p < 0.001) to people who have been arrested for cannabis, and who now want to participate in the legal cannabis industry. Conclusions. Cannabis regulators, public health professionals, and people working to advance racial justice may be able to advance state equity goals and remedy some of the harm from the War on Drugs by expanding public education campaigns to include equity messages.

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