Economic Evaluation of the SKY Girls Ghana multimedia youth anti-smoking and girls empowerment program

Background/Objectives

This study has three objectives: (1) to estimate the cost per beneficiary of the SKY Girls program, (2) to estimate the effectiveness of the SKY Girls program on key intermediate variables in the behavioral pathway to smoking uptake, and (3) to approximate the cost-effectiveness of the program based on intermediate outcomes and data from a similar SKY Girls program in Botswana.

Description Of Intervention And/or Methods/Design

Designed and implemented by Good Business and Now Available Africa, SKY Girls Ghana relies on twelve multimedia components to promote self-efficacy and social norm changes in the choice not to smoke. By stripping out the aspirational aspects of smoking, SKY Girls seeks to reduce attitudes associated with positive views of smoking, while increasing broader resilience among young people at risk of using tobacco. Longitudinal household survey data collected pre- and post-program for both boys and girls in Ghana are used to collect information on program exposure and smoking norms, attitudes, self-efficacy and behaviors. The evaluation uses a difference-in-differences, quasi-experimental design comparing exposed girls in Accra with comparison girls in other Ghanaian cities

Results/Lessons Learned

We find that SKY Girls Ghana reached approximately 80% of female youth aged 13 - 16 years in the core program areas of Accra, which translates to an estimated 240,000 youth in Greater Accra and surrounding areas. This was achieved at an overall cost of less than $10 per exposed girl. Instrumental Variables Fixed-Effects regression analyses indicate that the SKY Girls program was effective in improving key intermediate outcomes believe to affect smoking, such as increased social support, decreased pressure to smoke cigarettes and shisha, and improved social norms related to the unacceptability of smoking cigarettes. Translating changes in smoking behaviors into reductions in smoking deaths, we find that SKY Girls is a cost-effective youth smoking prevention intervention, yielding incremental cost-effectiveness ratios of $1,931 / Disability Adjusted Life Year (DALY) averted for the girls sample and $1,298/DALY for all youth.

Discussion/Implications For The Field

These findings provide evidence that the SKY Girls anti-smoking SBC program is a cost-effective behavior change intervention by World Health Organization standards. Based on these findings, we argue that a national scale-up of the program is warranted, and recommend that similar programmatic approaches are tested in other lower middle income African countries.

Abstract submitted by: 

Paul Hutchinson - Tulane University

Charles Stoecker - Tulane University

Larissa Persons - Good Business

Dominique Meekers - Tulane University

Jennifer Mitchell - Good Business