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CENTURY
Yale University
School of Medicine
SAC-203
Connecticut
Mental Health Center
34 Park Street
New Haven, CT 06519

Phone:
203-974-7591

Fax:
203-974-7606

E-mail:
infocentury@yale.edu

CENTURY/TTURC Press Release

Director: Jody L. Sindelar, Ph.D. jody.sindelar@yale.edu

Investigators:
Tracy Falba, Ph.D. tracy.falba@yale.edu
Susan Busch, Ph.D. susan.busch@yale.edu
Noelia Duchovny, Ph.D. noelia.duchovny@yale.edu
Mireia Jofre-Bonet, Ph.D. mireia.jofre-bonet@yale.edu

Research Team: Our research team has expertise in economics, economic evaluations, and policy analysis. Each individual adds specific expertise in substance abuse, aging, insurance, and analytic methods. We have received Ph.D.s from Stanford University, Harvard University, University of Maryland, and Universitat Pompeu Fabra, Spain.

Transdisciplinary Tobacco Use Research Center (tturc) affiliation: Our work in all areas is strengthened by the input of the Yale tturc project, funded by NIDA and NCI (P.I. Stephanie O'Malley, Ph.D.). We are also affiliated with the national, multi-site tturc.

Overall aims

Policy issues. We conduct empirical, population-based and policy related research related to tobacco use. We focus on smoking cessation and those groups that have more difficulty quitting. Our research has two overarching themes.
First, we are interested in the impact of alcohol use, depression, gender and older age on relevant policy related outcomes such as medical care utilization, propensity to seek cessation treatment, and workplace productivity. We analyze complex interactions among health risks, behavioral, socio-economic and demographic factors. We are able to analyze these interactions because we use data sets with large sample sizes and thus large numbers of smokers.
Second, we aim to measure the economic value of a smoker quitting. This value may come from improved health, reduced health care spending, increased workplace productivity and other factors. In all of our research, we plan to carefully consider these benefits from the perspective of society, the state, firms who employ smokers, as well as the individual smoker.
In both research endeavors, we will provide the empirical basis to promote policy changes to reduce the harms of tobacco.

Communication. Our policy analysis is conducted in collaboration with the RWJF funded Communication Unit at the Yale Medical School and School of Public Health. A key purpose of this Unit is to make findings from these and Yale TTURC studies available to audiences who could use the information. Pem McNerney is the Director (pem.mcnerney@yale.edu).

Education. We are involved in several educational efforts, including training Post-Doctoral students (Noelia Duchovny), PhD students (Melissa Carlson and Angela Bauer Snyder) and MPH students. We have a grant to Yale from the American Legacy Foundation (Susan Busch and Tracy Falba, co-PIs) to support some of our educational goals.

Projects

Smoking and productivity. We examine the impact of smoking, quitting, and quantity/frequency of smoking on workplace productivity. We use several measures of productivity, including: absences, wages, hours worked, and retirement. We also examine how the impact of smoking on productivity interacts with state laws regarding tobacco control. We also analyze how individual decisions about smoking and quitting are affected by both work place and state level controls. Our work is empirically based. We use several large, nationally representative data sets. These include the Tobacco Supplements of the Current Population Survey, the Community Tracking Survey, the Health and Retirement Study, and the National Longitudinal Alcoholism and Epidemiology Survey.
Results from our research will benefit various groups of society. Employers and other institutions may be motivated to offer smoking cessation programs and therefore benefit from reduced absenteeism, greater productivity per hour worked, reduced disability and workmen's compensation expenses, and a more stable work force (e.g. reduced turnover). Governments may improve access to smoking cessation programs resulting in increased GDP and reductions in welfare payments. Workers who smoke and their families would share in these benefits as well.

Cost effectiveness analysis (CEA) of innovative treatment. The purpose of this study is to conduct a cost-effectiveness analysis of the use of both naltrexone and the transdermal nicotine patch (naltrexone plus patch) for smoking cessation treatment, as compared to the patch alone. We will utilize data from the Yale tturc's clinical trial of the efficacy of naltrexone when combined with the patch (Stephanie O'Malley, P.I.). We will have detailed data on numerous aspects of the approximately 400 individuals in the trial. Information includes, smoking, alcohol use, and symptoms of depression, in addition to socio-economic and demographic information.
In addition to using the traditional approach to valuing quits as an outcome, we use a novel approach. We will use contingent valuation surveys to elicit individuals' willingness to pay for alternative smoking cessation programs that vary in both effectiveness rates and side effects (including weight gain). This method will allow us to better understand the market for cessation treatments beyond the status quo. In particular, we can examine the value of hypothetical rates of effectiveness and magnitude of side effects, especially weight gain.

Cessation efforts and health in an older population. In this study, we use large secondary data sets to provide empirical information on the interplay among risk-factors for long-term smokers who have found it hard to quit smoking. Older smokers have demonstrated difficulty quitting, have high risk factors of health problems, are female in a large proportion, and may have symptoms of depression and use alcohol. They are likely to be long-term smokers.
We use a nationally representative longitudinal survey, the Health and Retirement Study (HRS) to examine these long-term smokers. The ability to track health, smoking, and workplace productivity across the waves of data enable us to effectively deal with issues of causality. We have several projects, all aimed at understanding which characteristics play a role in motivating older smokers to quit. One analyzes how health status and changes in health status affects an individual's decision to stop smoking and their success. Another examines whether reductions in smoking promote or discourage future cessation. Another seeks to identify policy mechanisms to affect change in older smokers, whether through medical care providers, Medicare or MCOs, family members, employers, etc.

Tobacco Related Policy Research at the Yale School of Public Health is funded by
the Robert Wood Johnson Foundation