NRT promotion can increase incentives to smoke

While I retain my view that smokeless tobacco and nicotine replacement therapies (NRT) are a more healthy way for a nicotine addict to access their nicotine, a crucial difficulty in promoting such products is that they may reduce disincentives to smoke. Thus if the constraints on initiating a smoking habit are the anticipated long-term health costs that stem from an anticipated addiction to nicotine that is costly to reverse, any substance, such as NRT, which reduces the cost of quitting, might increase the incentive to initiate use.

In the past I have made much the same point in relation to drugs such as heroin. Successful low cost treatments for heroin addiction might encourage use which then worsens aggregate public health.

A recent NBER paper by Henry Saffer, Terry Wakefield and Yvonne McElrath, The Effect of Nicotine Replacement Therapy Advertising on Youth Smoking, abstracts its main findings as follows:

NRT advertising could decrease smoking by informing smokers that the product can make quitting easier and thus inducing more smokers to try and quit. However, a moral hazard is created because NRT advertising increases the expectation that cessation is relatively easy. NRT advertising could thus induce youth to smoke, to smoke more and/or to delay quit attempts. Data from Nielsen Media Research (Nielsen) and the Monitoring the Future Surveys (MTF) have been used in the empirical work. The Nielsen data are matched to the MTF data by month, year and market. The availability of lagged advertising data allow for calculation of an advertising stock variable. The Nielsen data also measure exposure to national advertising on a local level which allows for use of national advertising data. An exogenous shock allows for bypassing problems of endogeneity. The results indicate that NRT advertising has no effect on participation but increases smoking by youth who do smoke. The elasticity of smoking with respect to NRT advertising is about .10 and the elasticity of smoking with respect to price is about -1.03. Since average youth smoking is about 5.77 cigarettes per day, an increase of 10 percent in NRT advertising would increase this average to about 5.82 cigarettes per day. It is also estimated that a ban on NRT advertising would be equivalent to a 10 percent increase in cigarette prices.

This is a very interesting argument and suggests the need for caution in endorsing NRT and smokeless tobacco products. Moreover it is difficult to see how the adverse incentive effects discussed here can be negated because their effects operate through the consequences of forward looking behaviour on new smokers. I welcome comments from readers on this one.

Thanks to David Jeffery from Oikos for pointing out the SMH article which led me to the Saffer et al. reference.