Smoking, drinking & public health campaigns

Contrary to industry claims the marketing messages people receive about alcohol (as well as effects of price and taxes) strongly condition drinking behaviour.

For example, Saffer and Dave, in an NBER report, based on an extensive longitudinal study of high school students find that:

‘… a compete ban on all alcohol advertising could reduce adolescent monthly alcohol participation by about 24% and binge participation [5 or more drinks in a session] by about 42%. The past month price-participation elasticity was estimated at about -0.28 and the price-binge participation elasticity was estimated at about -0.51. Both advertising and price policies are shown to have the potential to substantially reduce adolescent alcohol consumption’.

What about cigarette smoking? Here advertising is widely restricted but still there are differences in smoking rates. To what extent can differences in public health campaigns warning of the dangers of smoking explain these differences?

One interesting comparison can be drawn between Americans and Europeans. Cutler and Glaeser in a recent NBER study note that while cigarette prices and anti-smoking regulations are both much higher in Europe than the US, Europeans smoke much more than do Americans. Only 19.1% of adult Americans smoke compared to 34% of Germans. (By the way, Australian smoking levels seem lower than the US with the AIHW Drug Use Survey suggesting only about 18.6% of Australians smoke on a daily basis).

In the 1960s Americans smoked per capita more than any Western European country so the difference in smoking intensities cannot be explained by history.

One source of the difference lies in the higher incomes Americans enjoy – at high enough income levels smoking is an inferior good. This can account for about one fifth of the difference between smoking rates. But the main source of difference vis that Europeans are less likely to think that smoking harms health – this difference in belief accounts for about half the difference between smoking rates.

‘The U.S. has one of the highest rates of believing that smoking is harmful; 91% of Americans report believing that smoking causes cancer. Given the high proportion of Americans that believe in UFOs and the literal truth of the bible, this must represent one of the most remarkable instances of the penetration of scientific results in the country. Beliefs about the cancer-causing role of cigarettes in some European countries, like Finland, Greece, Norway, and Portugal, are almost identical to those in the U.S., but in other places beliefs are far weaker. For example in Germany only 73% of respondents said that they believed that smoking causes cancer’.

As Andrew Leigh (who posted on this) remarks, similar cross-country differences also exist among non-smokers, suggesting that this isn’t merely cognitive dissonance – with smokers having falsely optimistic views of the consequences of their smoking. Cutler and Glaeser put the differences down to ‘soft paternalism’ by US cancer researchers and the US Government. The health warnings on cigarette packets and warnings by the Surgeon General on the dangers of smoking apparently had a large impact in conditioning the belief that smoking causes cancer.

The US traditionally rejects paternalism and one can ask why paternalistic interventions were effective here. American health groups specifically focused on the cancer and heart disease risks of smoking while European groups were less effective in influencing public opinion.