Annals of Health Law
STRATEGY AGAINST SMOKING
which is determined by the severity of the participants’ smoking behavior.
Participants who on average smoke more than forty cigarettes per day
constitute Group A, those who smoke less than forty-one but more than
twenty cigarettes are assigned to Group B, and those who smoke between
five and twenty cigarettes, Group C. Following the smoking status
determination of life insurance companies, the model thereby roughly
distinguishes between heavy, average and light smokers. Due to the higher
level of addiction218 Group A will receive the highest rewards, Group B a
half and Group C a quarter of this. The small lottery reward for Group A
shall amount to $15219, the large amount to $150 or – at the participant’s
choice – specific economic goods of equivalent or slightly higher value.220
In order to more efficiently allocate resources it might be preferable to
reduce the lottery rewards after e.g. five years of smoking abstinence,
assuming that the urge for smoking declines after a long period of non-smoking.
In addition to the lottery, the model for the smoking cessation program
also includes a long-term incentive in the form of a special account with an
increasing credit balance, which shall be structured as described above.221
The initial credit balance shall amount to $750 for Group A, $500 for
Group B, and $250 for Group C members, and the progression shall be the
same. The participants will gain access to the funds after fifteen years of
non-smoking. This period is chosen for several reasons: first, the long-term
health consequences of previous smoking, in particular the risks of cancer
and ischemic heart disease, decline significantly over time – after roughly
fifteen years of cessation they are close to those of a non-smoker,
depending on the intensity and the duration of former smoking behavior.222
218. See supra Part II. B.
219. This again is an estimate that might be appropriate for the United States.
220. See supra Part III. B. Given that the desire to smoke decreases after long periods of
non-smoking, one might think of diminishing the rewards over time as fewer incentives are
221. See supra Part III. B.
222. See, e.g., Ichiro Kawachi et al., Smoking Cessation and Time Course of Decreased
Risks of Coronary Heart Disease in Middle-Aged Women, 154 ARCHIVES OF INTERNAL MED.
169 passim (1994); Gilbert S. Omenn et al., The Temporal Pattern of Reduction of Mortality
Risk After Smoking Cessation, 6 AM. J. PREV. MED. 251 passim (1990); Qing Qiao et al.,
Mortality from All Causes and from Coronary Heart Disease Related to Smoking and
Changes in Smoking During a 35-Year Follow-up of Middle-Aged Finnish Men, 21 EUR.
HEART J. 1621 (2000); U.S. DEP’T OF HEALTH AND HUMAN SERV., THE HEALTH BENEFITS OF
SMOKING CESSATION: A REPORT OF THE SURGEON GENERAL 165, 285-287, 303-304 (1990);
Cf. Peter Boyle, Cancer, Cigarette Smoking and Premature Death in Europe: A Review
Including the Recommendations of European Cancer Experts Consensus Meeting, Helsinki,
October 1996, 17 LUNG CANCER 1, 34-35 (1997); Richard Doll et al., Mortality in Relation
to Smoking: 50 Years’ Observations on Male British Doctors, 328 BRITISH MED. J. 1519
passim (2004); Michael T. Halpern et al., Patterns of Absolute Risk of Lung Cancer