Gaining a comprehensive understanding of the cost and consequences of smoking commands a high policy priority. The proposed study will take advantage of several existing data bases to estimate the private cost to families and social cost of smoking to those age 25+, including the near elderly and the elderly. Individual contributions to private health insurance, Medicare, Medicaid, Social Security, private pensions, disability insurance, sick leave and other transfer programs will be compared according to smoking status of family members. Our econometric analysis will account for endogeneity of the smoking decision and for factors other than smoking plausibly affecting health services use. A simulation of how age structure and underlying primary causes of death would change under varied societal smoking cessation rates will performed by extending an existing smoking intervention model developed by a study investigator. Several data bases will be used: 1994 National Health interview Survey for persons 25-50; Health and Retirement Study for persons 51-64; Asset and Health Dynamics of the Oldest Old and National Long-Term Care Survey merged with Medicare claims for those 65+. These data will be used to document contributions and outlays from public and private programs by smoking status and to estimate cost of smoking-related diseases, e.g., lung cancer. Survival analysis based on the American Cancer Society's Center Prevention Study data set will be used for the analysis of age structure and mortality and to estimate the lifetime cost of smoking. We will examine implications of our empirical analysis for tort claims brought against tobacco companies and the evolution of legal theories underlying tobacco tort litigation in a law review article.
