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April 12, 2002


Emory University Public Health Professor Assists CDC With Designing Software to Calculate Costs Related to Smoking

A Web-based software, Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC), developed by researchers at Emory University and the Centers for Disease Control and Prevention (CDC) will allow users to calculate the direct and indirect costs of cigarette smoking for adults and newborn children, in and across the states.

Collaborators believe the software will be used mostly by public health advocates, but that managed care entities, Medicaid program directors, researchers and the general public will find interest in the results as well. By first estimating the number of current year smoking-attributable deaths, the software can be used to estimate the economic costs associated with the years of productive life lost for adults. It also estimates the direct annual medical expenditures for smoking-related conditions for adults and infants.

The original SAMMEC software was released by the CDC in the 1980s and has been used extensively over the years. This new release of the software is the first web-based version and the first to include a maternal and child health (MCH) SAMMEC component. This component allows users to estimate the number of smoking-attributable infant deaths, years of potential life lost for these infants and neonatal medical expenditures attributable to active maternal smoking.

Public Health professor and health economist Kathleen Adams, Ph.D., from Emory University's Rollins School of Public Health, has worked closely with the Division of Reproductive Health (DRH) and the Office of Smoking and Health (OSH) at the CDC and was key to the development of the MCH-SAMMEC economic cost module. Over the past 5 years she has completed research on the relative risks of maternal smoking for adverse maternal outcomes and in turn, estimated their related health care costs.

In 1999, Dr. Adams co-authored a review article that was published in the journal Medical Care Research and Review. In it, she discussed how national studies of the cost of smoking had generally omitted the short-term costs related to smoking during pregnancy and exposure of young children to environmental tobacco smoke. Her most current research on neonatal costs will be published in the upcoming issue of Health Economics (Vol. 11, No. 3).

"For infants, there are four conditions at birth, associated with maternal smoking, that have been found to affect the relative risk of infant mortality. They are reduced birth weight, Sudden Infant Death Syndrome (SIDS) and two respiratory conditions," Adams says. "Each of these are represented in the software.

"Currently, the MCH SAMMEC module can only estimate smoking attributable expenditures related to neonatal medical conditions (i.e., during the delivery hospital stay), but in the future we hope to extend its capacity to calculate smoking-related costs into an infant's first year of life and early childhood. This would include both the effects of maternal smoking prior to birth, as well as the effects of secondhand exposure after birth. Research shows that new cases of asthma and a worsening of asthmatic conditions and other respiratory conditions are greater among children who are exposed to smoking."

Dr. Adams says the MCH SAMMEC software can help encourage Medicaid program managers to reimburse providers for smoking cessation activities since many of their enrollees are pregnant women and infants. Secondly, the statistics can help managed care professionals learn how to better manage the health status and projected costs of their enrollees.

The data will also be helpful to economists and others interested in the impact that smoking has on the economy.

"Using the Adult SAMMEC, employers can look at smoking in terms of working age populations and find the magnitude of work years that could be lost," Dr. Adams explained. "This is where they would see diseases that affect persons in their 40s and 50s, whose work lives would be cut short by smoking-related disease, disability, and/or death."

Moreover, Adams reiterated, Adult SAMMEC and MCH SAMMEC will assist in the efforts to maintain the health of the general public.

In 1998, the tobacco industry agreed to pay a total of $246 billion to the 50 states to settle lawsuits brought by the state attorneys-general.

Georgia has allocated some of its tobacco settlement dollars to the establishment of the Georgia Cancer Coalition — a partnership that will develop a comprehensive cancer research, prevention and treatment program for the benefit of all Georgians.

"In part, that might have been influenced by the facts and figures that are contained within this software showing that smoking does cost all of us," said Dr. Adams. "Many of the smoking-attributable deaths are cancer-related."

Adams sees the revised SAMMEC software as "very user-friendly." Users can read explanations of how each state's computations are derived and what previous research it is based on.

Emory University is the only educational institution currently involved in the new revisions to the SAMMEC web-based software.

Users can access the SAMMEC software at

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