Enter information below for your population or use the default entries if data are not available. Click the linked words for explanations about the use and sources of these data, and to view model assumptions for smoking intensity, disease, smoking relapse, and the cost of capital.

Tell Us About Your Population

1.	Enter a population name:
2.	Enter the percent of your population covered by each health plan type: Exclusive (HMO) % Mixed (PPO) % Indemnity (FFS) %
3.	Select the State/region of residence: -- Select your state/region -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississppi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 0 -- Regions -- New England Mid Atlantic South Atlantic South Central East N Central West N Central Mountain Pacific
4.	Enter the number of males and females for each age group. Males ages 18-34: 35-64: 65 and over: Females ages 18-34: 35-64: 65 and over:
5.	Enter the percent of current smokers for each group. Males ages 18-34: % 35-64: % 65 and over: % Females ages 18-34: % 35-64: % 65 and over: %
6.	Review and change the percent of adults, by age, who leave the plan each year. Employers enter the percent of employees who leave the firm each year.   Default Rates     Your Rates  ages 18-34: 17.20% % ages 35-64: 6.70% %          ages 65 and over: 2.40% %
7.	Enter cost per participant for prescription medication and telephone counseling, and enter the expected member copayments.   Cost per participant     Member paid cost Medication: $ $ Telephone Counseling: $ $ Both Telephone and Rx: $ $
8.	Enter other program costs you wish to include: Provider Training and Incentives: $ Other Program Support Costs: $
9.	Select the time period for assessing cumulative costs: --Select a year-- Year 1 Year 2 Year 3 Year 4 Year 5

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