UCSF Study Finds $18 Billion Tobacco Toll in California, 2009

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Smoking took an $18.1 billion toll in California in 2009—$487 for each resident—and was responsible for more than one in seven deaths in the state, more than from AIDS, influenza, diabetes, or many other causes, according to the first comprehensive analysis in more than a decade on the financial and health impacts of tobacco.

While the number of smokers in California declined from a decade ago, and fewer cigarettes were smoked on a daily basis, nearly 4 million people still smoked, including an estimated 146,000 adolescents, reported the new University of California San Francisco (UCSF) study.1

Snapshot of State’s Tobacco Use

The study, a snapshot of tobacco use throughout the state, was based on data from 2009, the most recent available when the study began. Similar statewide studies were conducted by the same investigators in 1999 and 1989.

“Studying the economic impact of smoking helps us to better understand how tobacco use affects the entire state and allows us to track changes that have occurred over time,” said Principal Investigator Wendy Max, PhD, Professor of Health Economics at the UCSF School of Nursing and Director of the UCSF Institute for Health & Aging.

 “We found that while the California Tobacco Control Program has led to reductions in tobacco use in the state over the last decade, smoking is still far too prevalent and results in far too many deaths and high health-care costs,” she said.   

Cigarette smoking is a leading cause of preventable death in the United States, triggering substantial health-care costs and lost productivity from illness and premature death. The toll extends to nonsmokers exposed to secondhand smoke who also are known to suffer ill health effects and increased mortality.

In the new report, the UCSF researchers profiled the state’s 58 counties with total costs, costs per resident and per smoker, expenditures for each type of health care, smoking prevalence, and mortality measures.

Tobacco Control Policies

“County-level estimates of the costs of smoking help to identify geographic disparities in the economic burden of tobacco use. These data are useful for local governments and policymakers to develop more effective tobacco control policies at the local level,” said coauthor Hai-Yen Sung, PhD, Professor of Health Economics at the UCSF School of Nursing and the UCSF Institute for Health & Aging.

 The report found that the state’s tobacco control efforts are resulting in fewer smoking-attributable deaths, reduced real costs of smoking, and lower smoking prevalence rates compared to a decade ago. Nonetheless, costs remain high and the wide variation in smoking costs across the counties suggests that many geographic areas would benefit from targeted efforts to reduce smoking. ■

 Disclosure: The project was supported by a grant from the Tobacco-Related Disease Research Program of the University of California’s Office of the President.


1. Max W, Sung HY, Shi Y, et al: The Cost of Smoking in California, 2009. Institute for Health & Aging, School of Nursing University of California, San Francisco. October 2014.