BOSTON - Would health costs go down if everyone stopped smoking? Does cracking down on underage cigarette sales make teenagers smoke less?
If the answer to both questions seems like "yes," think again.
Two new studies published in today's New England Journal of Medicine support the contrary view.
One looked at the economic impact if every smoker went cold turkey tomorrow. The conclusion: Health-care costs would drop for a while but then rise for the simple reason that nonsmokers live longer.
The other study found that even with strict enforcement of laws against selling cigarettes to minors, teens can get them easily, and they smoke just as much, or more.
An estimated 3,000 children take up cigarettes each day in the U.S. Making cigarettes harder to buy is the cornerstone of a new effort by the Food and Drug Administration to keep them away from teens.
FDA rules that went into effect last February require stores to get photo identification from anyone who looks younger than 27. A federal goal is to have at least 80 percent of stores obey the laws.
Enforcement has received little testing. So a team led by Dr. Nancy Rigotti of Massachusetts General Hospital compared high-school students' access to cigarettes in six Massachusetts towns - three where tobacco-sales laws were beginning to get strict enforcement and three where the laws were not enforced.
"Even when 80 percent of merchants obeyed the law, young people said they had little trouble buying," Rigotti said.
The study was conducted from 1994 to 1996.
The researchers sent 16-year-old girls into stores to buy cigarettes. By the study's end, 18 percent of the stores in towns with enforcement were still selling cigarettes to the decoys, compared with 55 percent in the other towns.
A survey of 17,603 high-school students found enforcement did nothing to control teenage smoking. Before and after enforcement, 15 percent of students said they had bought cigarettes within the past month. After enforcement, the number of daily smokers actually rose slightly.
The other study challenges the often-cited belief that smoking drives up health costs. While smoking clearly is unhealthy, the study found, it may not cost more in the end, because smokers die so much younger.
Jan Barendregt and others from Erasmus University in the Netherlands calculated that at any given age, health-care costs for smokers are as much as 40 percent higher than for nonsmokers. And if everyone quit, health-care costs would plummet for a few years.
However, nonsmokers live an average of about seven years longer than nonsmokers, and medical costs for the elderly are high. So 15 years after everyone quit, total health-care costs would level off.
