Reducing Noncommunicable Disease Risk Factors in Adolescents

Every year, 40 million people around the world die of noncommunicable diseases (NCDs), including heart and respiratory ailments, diabetes, and cancer—and two-thirds of premature NCD deaths among adults can be traced back to behaviors initiated during youth and adolescence (that is, between the ages of 10 and 19). Specifically, researchers have long known that smoking and obesity in this age group contribute to an increased risk of developing NCDs—and that encouraging adolescents not to smoke and to avoid unhealthy foods can have a major impact on health later in life.

How much of an impact? Right now, that is too ambitious a question to answer in practice, but it is possible to extrapolate from the available data and make an educated guess. This is exactly what we have done in “The Investment Case for Reducing Noncommunicable Disease Risk Factors in Adolescents,” a research brief authored by a team of RTI public health and NCD experts.

In our brief, we looked at the current implementation levels for various tobacco use and obesity interventions worldwide and assessed how closing the gap between current and maximum implementation could affect the risk of premature death among today’s adolescents. We then quantified the economic consequences of not fully implementing these interventions—the global “cost of inaction.”

Discouraging Adolescents from Taking up Smoking

Although the problem is less acute in the United States—where tobacco use has long been identified as a public health threat—smoking still accounts for more than 7 million NCD deaths per year worldwide, according to the World Health Organization (WHO). And the studies are unequivocal: 90 percent of adult smokers start smoking by the time they turn 18, and 50 percent of adolescent smokers continue to smoke for another 15 or 20 years. On the positive side, though, adolescents who quit smoking for at least a year have a two-thirds chance of never smoking again.

Poring through the data, we identified the two most effective ways to deter adolescents from smoking: steep excise taxes (WHO recommends that at least 75 percent of the cost of a tobacco product should be attributable to taxes) and point-of-sale (POS) advertising bans. We determined that if every country imposed the WHO-recommended excise tax, the resulting 10 percent increase in average prices would lead to a 5.6 percent decline in adolescent smoking. By the same token, widespread implementation of POS advertising bans would cause 27 percent fewer adolescents to take up smoking in the first place.

Steering Adolescents Away from Unhealthy Food Choices

There were 124 million obese children and adolescents worldwide in 2016, compared to 11 million in 1975—and the most rapid rise has been in low- and middle-income countries. Unlike smoking, obesity can be attributed to various causes, which have to be teased out with a certain amount of nuance. As a result, public health action has not kept pace with the global increase in unhealthy diets and physical inactivity.

We identified two interventions that have a proven impact on adolescent obesity:  taxes on sugar-sweetened beverages (SSBs)—which some countries are starting to implement, with encouraging results—and school-based physical- and nutrition- education programs.  Based on the available results, we determined that a 20 percent excise tax on SSBs would lead to a 10 percent increase in price and a 10 percent reduction of consumption by adolescents. School-based nutrition and physical education programs, meanwhile, would lead to a reduction in body-mass index and, subsequently, a reduction in obesity rates in the target population.

The Long-Term NCD Implications of Adolescent Risk Factor Intervention

The four interventions we analyzed—excise taxes and POS bans for smoking, and excise taxes and education programs for obesity—could have a huge impact on NCD mortality if implemented on a global level. It should be noted that tobacco and SSB consumption vary significantly across countries—for example, Caribbean countries consume almost 10 times as many SSBs as countries in East and Southeast Asia. Hence, when choosing among promising interventions, countries with limited resources should consider their populations’ behavior patterns. If SSB consumption is relatively low, it would make sense to devote more resources to anti-smoking efforts and in-school programs. Also, cash-strapped countries with high SSB consumption rates might favor revenue-raising excise taxes over more-expensive school-based interventions.But the bottom line remains the same: given an all-out effort, we can potentially prevent 20 million global NCD deaths over the next 50 years for a net economic benefit of $300 billion—$6 billion per year in the United States alone.