University Public Health Professor Assists CDC With Designing Software
to Calculate Costs Related to Smoking
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
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
The data will also be helpful
to economists and others interested in the impact that smoking has on
"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 www.cdc.gov/tobacco/SAMMEC.