Taking a Hit
The Incidence of the Healthcare Costs of Smoking
Benjamin Cowan & Benjamin Schwab
Journal of Health Economics, forthcoming
Abstract:
Smokers earn less than non-smokers, but much is still unknown about the source(s) of the smoker's wage gap. We build on the work of Bhattacharya and Bundorf (2009), who provide evidence that obese workers receive lower wages on account of their higher expected healthcare costs. Similarly, we find that smokers who hold employer-sponsored health insurance (ESI) receive significantly lower wages than their non-smoking peers, while smokers who are not insured through their employer endure no such wage penalty. Our results have two implications: first, the incidence of smokers' elevated medical costs appears to be borne by smokers themselves in the form of lower wages. Second, differences in healthcare costs between smokers and non-smokers are a significant source of the smoker's wage gap.
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Paul Heaton
Journal of Public Economics, forthcoming
Abstract:
Many jurisdictions have considered relaxing Sunday alcohol sales restrictions, yet such restrictions' effects on public health remain poorly understood. This paper analyzes the effects of legalization of Sunday packaged liquor sales on crime, focusing on the phased introduction of such sales in Virginia beginning in 2004. Differences-in-differences and triple-differences estimates indicate the liberalization increased minor crime by 5% and alcohol-involved serious crime by 10%. The law change did not affect domestic crime or induce significant geographic or inter-temporal crime displacement. The costs of this additional crime are comparable to the state's revenues from increased liquor sales.
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Nan Jiang & Pamela Ling
American Journal of Public Health, forthcoming
Objectives: We investigated tobacco companies' knowledge about concurrent use of tobacco and alcohol, their marketing strategies linking cigarettes with alcohol, and the benefits tobacco companies sought from these marketing activities.
Methods: We performed systematic searches on previously secret tobacco industry documents, and we summarized the themes and contexts of relevant search results.
Results: Tobacco company research confirmed the association between tobacco use and alcohol use. Tobacco companies explored promotional strategies linking cigarettes and alcohol, such as jointly sponsoring special events with alcohol companies to lower the cost of sponsorships, increase consumer appeal, reinforce brand identity, and generate increased cigarette sales. They also pursued promotions that tied cigarette sales to alcohol purchases, and cigarette promotional events frequently featured alcohol discounts or encouraged alcohol use.
Conclusions: Tobacco companies' numerous marketing strategies linking cigarettes with alcohol may have reinforced the use of both substances. Because using tobacco and alcohol together makes it harder to quit smoking, policies prohibiting tobacco sales and promotion in establishments where alcohol is served and sold might mitigate this effect. Smoking cessation programs should address the effect that alcohol consumption has on tobacco use.
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Alcohol Use and Popularity: Social Payoffs From Conforming to Peers' Behavior
Ana Balsa et al.
Journal of Research on Adolescence, September 2011, Pages 559-568
Abstract:
Although many economic analyses of adolescents have examined the costs of risky behaviors, few have investigated the gains that young people derive from such actions, particularly in terms of social payoffs for complying with peer behavior. This paper studies the relationship between adolescents' use of alcohol (relative to that of their peers) and popularity at school. We use data from the National Longitudinal Study of Adolescent Health, a rich and nationally representative survey with detailed information on social networks. Our findings suggest that adolescents are socially rewarded for conforming to their peers' alcohol use and penalized (to a lesser degree) for increasing their consumption above that of their peers. Male adolescents are rewarded for keeping up with their peers' drinking and for getting drunk. Female adolescents are rewarded for drinking per se, but not necessarily for keeping up with their peers. The results offer new information on peer influence and have implications for substance abuse interventions at school and in the community.
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Elisabeth Gentry et al.
American Journal of Public Health, forthcoming
Objectives: We investigated the frequency of alcohol ads at all 113 subway and streetcar stations in Boston and the patterns of community exposure stratified by race, socioeconomic status, and age.
Methods: We assessed the extent of alcohol advertising at each station in May 2009. We measured gross impressions and gross rating points (GRPs) for the entire Greater Boston population and for Boston public school student commuters. We compared the frequency of alcohol advertising between neighborhoods with differing demographics.
Results: For the Greater Boston population, alcohol advertising at subway stations generated 109 GRPs on a typical day. For Boston public school students in grades 5 to 12, alcohol advertising at stations generated 134 GRPs. Advertising at stations in low-poverty neighborhoods generated 14.1 GRPs and at stations in high-poverty areas, 63.6 GRPs.
Conclusions: Alcohol ads reach the equivalent of every adult in the Greater Boston region and the equivalent of every 5th- to 12th-grade public school student each day. More alcohol ads were displayed in stations in neighborhoods with high poverty rates than in stations in neighborhoods with low poverty rates.
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Differential prevalence of alcohol use among 2-year and 4-year college students
Cayley Velazquez et al.
Addictive Behaviors, forthcoming
Purpose: To determine whether alcohol use behaviors and alcohol-related consequences differed among students attending two-year versus four-year colleges.
Methods: Participants (N = 13,700) from 7 two-year and 11 four-year colleges completed the 2010 College Student Health Survey. Alcohol use behaviors included past year alcohol use, past month alcohol use, and binge drinking over the past two weeks. Alcohol-related factors included average calculated blood alcohol level and average number of alcohol-related consequences. Cross-sectional mixed-effects regression analyses were conducted to determine if the prevalence of alcohol-related behaviors and consequences differed among two-year and four-year colleges.
Results: Students attending four-year colleges, particularly males, were more likely to report past year alcohol use, past month alcohol use, and binge drinking, as well as a higher average blood alcohol content and a greater number of alcohol-related consequences than their two-year counterparts (p < 0.05). Among female students there were fewer differences between two-year and four-year college students. Many differences remained after adjusting for socio-demographic factors (e.g., age, race/ethnicity), however, with the addition of living situation as a covariate, several of the differences among males were no longer significant.
Conclusions: Significant differences in alcohol-related behaviors and consequences exist among students attending two-year versus four-year colleges. While the prevalence of alcohol-related behaviors and consequences was lower among two-year college students, they are not a population to be over-looked. The prevalence of alcohol use remains high among both two-year and four-year college students, making it important for researchers to design appropriate interventions for all students regardless of the type of institution being attended.
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Causes of the Decline in Cigarette Smoking Among African American Youths From the 1970s to the 1990s
Tyree Oredein & Jonathan Foulds
American Journal of Public Health, forthcoming
Abstract:
Adult cigarette smoking prevalence trends among African Americans (AAs) and Whites are similar. However, during the decline in youth smoking that occurred between the mid-1970s and the early 1990s, the drop in smoking rates among AA adolescents was more than double that among Whites. We examined the evidence for potential explanations for this phenomenon. On the basis of our findings, we propose that racial differences in parental attitudes, religious ties, negative perceptions and experiences of the health effects of smoking, worsening poverty, increased use of food stamps, and price sensitivity were major factors contributing to the more rapid decrease in and continued lower rates of smoking among AA youths.
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Tailgating as a unique context for parental modeling on college student alcohol use
Caitlin Abar, Rob Turrisi & Beau Abar
Journal of Adolescence, October 2011, Pages 1103-1106
Abstract:
Little attention has been directed toward potential differential effects of the various contexts in which parents model alcohol use. The present study examined college football tailgating as a potential context in which parental modeling may be more or less risky. 290 college freshmen were assessed for perceptions of their parents' drinking and tailgating behaviors, individual alcohol use and consequences. Hierarchical multiple regressions were performed and results revealed that parental tailgating accounted for a significant increase in the variance explained in each of the student drinking measures. Parental drunkenness at tailgates predicted college student drinking and negative consequences, over and above the influence of typical parental heavy episodic drinking. The specific context in which students perceive their parents as drinking heavily may impact their own drinking. Tailgating at sporting events appears to be one such context where students perceive alcohol behaviors which they later model.
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Margaret Weden & Jeremy Miles
American Journal of Public Health, forthcoming
Objectives: We assessed intergenerational transmission of smoking in mother-child dyads.
Methods: We identified classes of youth smoking trajectories using mixture latent trajectory analyses with data from the Children and Young Adults of the National Longitudinal Survey of Youth (n=6349). We regressed class membership on prenatal and postnatal exposure to maternal smoking, including social and behavioral variables, to control for selection.
Results: Youth smoking trajectories entailed early-onset persistent smoking, early-onset experimental discontinued smoking, late-onset persistent smoking, and nonsmoking. The likelihood of early onset versus late onset and early onset versus nonsmoking were significantly higher among youths exposed prenatally and postnatally versus either postnatally alone or unexposed. Controlling for selection, the increased likelihood of early onset versus nonsmoking remained significant for each exposure group versus unexposed, as did early onset versus late onset and late onset versus nonsmoking for youths exposed prenatally and postnatally versus unexposed. Experimental smoking was notable among youths whose mothers smoked but quit before the child's birth.
Conclusions: Both physiological and social role-modeling mechanisms of intergenerational transmission are evident. Prioritization of tobacco control for pregnant women, mothers, and youths remains a critical, interrelated objective.
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Drinking at college parties: Examining the influence of student host-status and party-location
Cynthia Buettner, Atika Khurana & Natasha Slesnick
Addictive Behaviors, forthcoming
Abstract:
The present research focuses on the party related drinking behaviors of college students and explores the differences in these behaviors based on students' host status (i.e. party host vs. party attendee). Furthermore, we examine if the differences in party hosts and attendees' drinking behaviors vary as a function of the party location (on-campus vs. off-campus). Multiple regression analyses were conducted using data from 3,796 undergraduates at a Midwestern University. Findings revealed a significant interaction between host status and party location, such that student party hosts reported significantly greater drink consumption and related consequences as compared to party attendees, only when the party was organized off-campus. For parties organized on-campus, student hosts reported lower drink consumption as compared to attendees. College-based preventive interventions should target students likely to host off-campus parties due to their high risk for involvement in heavy drinking.
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Secondhand Tobacco Smoke: A Source of Lead Exposure in US Children and Adolescents
Andria Apostolou et al.
American Journal of Public Health, forthcoming
Objectives: We evaluated the relationship between secondhand tobacco smoke (SHS) exposure and blood lead levels in US children and adolescents.
Methods: We analyzed data from 6830 participants aged 3-19 years in the National Health and Nutrition Examination Survey (1999-2004) who were not active smokers and for whom SHS exposure information and blood lead measurements were available.
Results: After multivariable adjustment, participants in the highest quartile of serum cotinine (≥0.44 µg/L) had 28% (95% confidence interval=21%, 36%) higher blood lead levels than had those in the lowest quartile (<0.03 µg/L). Similarly, blood lead levels were 14% and 24% higher in children who lived with 1 or with 2 or more smokers, respectively, than they were in children living with no smokers. Among participants for whom lead dust information was available, the associations between SHS and blood lead levels were similar before and after adjustment for lead dust concentrations.
Conclusions: SHS may contribute to increased blood lead levels in US children. Lead dust does not appear to mediate this association, suggesting inhalation as a major pathway of exposure. Eliminating SHS exposure could reduce lead exposure in children.
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Driving Under the Influence of Our Fathers
Randi Hjalmarsson & Matthew Lindquist
B.E. Journal of Economic Analysis & Policy, November 2010
Abstract:
This paper uses data from the Stockholm Birth Cohort Study to document intergenerational associations in drunk driving between fathers and their children. The proportion of sons with a record of drunk driving is 2.3 times larger for sons whose fathers have a conviction for drunk driving than for sons whose fathers have not been convicted. For daughters, the proportion is 7.8 times larger. The average number of convictions is twice as large for sons whose fathers have a conviction for drunk driving than for sons whose fathers have not been convicted. For daughters, the average number of convictions is 15.3 times larger. We argue that these intergenerational associations in drunk driving have important implications for treatment strategies and public policy.
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Lasting effects of alcohol: Subliminal alcohol cues, impairment expectancies, and math performance
Guido van Koningsbruggen & Wolfgang Stroebe
European Journal of Social Psychology, forthcoming
Abstract:
Many people believe that drinking alcohol reduces cognitive performance, and prior research has shown such expectancy-related impairment even when people merely thought that the (non-alcoholic) drink they consumed contained alcohol. This study tested whether subliminal priming with alcohol-related cues would similarly result in expectancy-consistent cognitive performance decrements. Additionally, the moderating role of alcohol use was examined. After assessing participants' baseline math performance, participants were primed with alcohol-related or neutral words and then completed a post-treatment math task. Whereas impairment expectancies had no influence on math performance in control participants, expectancies predicted math performance for participants primed with alcohol-related words. As hypothesized, expectancy-consistent impairment in performance was only observed among high alcohol users. The current findings suggest that, in the presence of alcohol-related cues in the environment, some people may perform less on cognitive tasks even in the absence of actual or assumed alcohol consumption and without being aware of it.
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E. Regidor et al.
Journal of Epidemiology & Community Health, August 2011, Pages 702-708
Objective: Given the limited evidence available about the effects of clean indoor air laws on smoking behaviour in the general population, the impact of national smoke-free workplace, bar and restaurant legislation, implemented on 1 January 2006, on smoking prevalence in Spain was assessed in this study.
Methods: Population-based trend analysis using estimates for 27 periods from the beginning of 2000 to the end of 2008-three periods per year. To calculate the period per cent change in smoking prevalence, the permutation test for joinpoint regression to detect significant changes was used.
Results: In men and women aged 15-24 years, the prevalence of smoking declined between the first period in 2000 and the third period in 2008, whereas in women aged 45-64 years, it increased by 1.7% per period. A declining trend was detected up to the first period in 2006 in men and women aged 25-44 years and in men aged 45-64 years, but between the beginning of 2006 and the end of 2008 the prevalence of smoking increased by 1.2%, 0.7% and 2.0% per period in men aged 25-44 years, in women aged 25-44 years and in men aged 45-64 years, respectively.
Conclusions: 3 years after a national smoke-free law was implemented, the trend in smoking prevalence in some population groups was unchanged; however, in others, the declining trend of previous years was reversed. The similarity of these findings to those observed in other countries suggests that clean indoor air laws, although effective in reducing exposure to second-hand smoke, may not achieve the secondary objective of reducing the prevalence of smoking in the population.
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Estimates of Peer Effects in Adolescent Smoking across Twenty Six European Countries
Duncan McVicar
Social Science & Medicine, forthcoming
Abstract:
Although it is widely believed that one of the key factors influencing whether an adolescent smokes or not is the smoking behavior of his or her peers, empirical evidence on the magnitude of such peer effects, and even on their existence, is mixed. This existing evidence comes from a range of studies using a variety of country-specific data sources and a variety of identification strategies. This paper exploits a rich source of individual level, school-based, survey data on adolescent substance use across countries - the 2007 European Schools Survey Project on Alcohol and Other Drugs - to provide estimates of peer effects between classmates in adolescent smoking for 75,000 individuals across 26 European countries, using the same methods in each case. The results suggest statistically significant peer effects in almost all cases. These peer effects estimates are large: on average across countries, the probability that a ‘typical' adolescent smokes increases by between .31 and .38 percentage points for a one percentage point increase in the proportion of classmates that smoke. Further, estimated peer effects in adolescent smoking are stronger intra-gender than inter-gender. They also vary across countries: in Belgium, for example, a one percentage point increase in reference group smoking is associated with a .16 to .27 percentage point increase in own smoking probability; in the Netherlands the corresponding increase is between .42 and .59 percentage points.
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Fabrice Etilé & Andrew Jones
Journal of Health Economics, July 2011, Pages 811-831
Abstract:
Post-war expansion of education in France transformed the distribution of schooling for the cohorts born between the 1940s and the 1970s. However, throughout this expansion the proportion with the highest levels of qualifications remained stable, providing a natural control group. We evaluate the impact of schooling on smoking, for the beneficiaries of the post-war expansion, by comparing changes in their outcomes across birth cohorts with changes within the control group. We uncover robust evidence that educational expansion contributed to a decline in smoking prevalence of 2.9 points of percentage for men and 3.2 points for women at the turn of the 21st century. Our results also suggest that the persistence of the schooling-smoking gradient is better explained by differences in the education-related opportunity costs of smoking than by differences in information about smoking dangers.
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Meghan Richards & Kirsten Oinonen
Journal of Adolescence, October 2011, Pages 1065-1076
Abstract:
A cross-sectional retrospective design was employed to examine the relationship between age at menarche (AAM) and alcohol use patterns from middle childhood (age 7) to early adulthood in 265 University-aged women. Earlier menarche was associated with: (a) earlier ages at first drink and first intoxication, (b) greater use between ages 9 and 14 (i.e., frequency, amount, vomiting), and (c) binge drinking between ages 11 and 14. In contrast, late menarche was associated with greater current use in the adult women (i.e., frequency, amount, hangovers). Early timing of first intoxication relative to menarche (FIRM) strongly predicted higher current drinking. These findings suggest: (a) a link between AAM and alcohol use as early as age 9, (b) opposite relationships between AAM and alcohol use during two distinct developmental periods separated by a period of use unassociated with AAM, and (c) that the impact of early FIRM on adult consumption deserves further study.
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Reid Hester, Harold Delaney & William Campbell
Psychology of Addictive Behaviors, forthcoming
Abstract:
To evaluate the effectiveness of a computer-delivered intervention (CDI) to reduce heavy drinking and alcohol-related problems in college students in two randomized clinical trials. In Experiment 1, we randomized 144 students to either the CDI or an assessment-only control group with follow-ups at 1 and 12 months. In Experiment 2, we randomized 82 students to either the CDI or a delayed-assessment control group with follow-up at 1 month. In Experiment 1, participants in both groups significantly reduced their drinking at both follow-ups. Compared to the control group, the CDI group reduced their drinking significantly more at 1 and 12 months on three drinking measures at α < .05. Using a more conservative, Bonferroni-adjusted criterion yielded one significant difference in a measure of heavier drinking at the 1 month follow-up. The mean between-groups effect sizes were d = .34 and .36 at 1 and 12 months, respectively. Experiment 2. Compared to the delayed assessment control group, the CDI group significantly reduced (by the Bonferroni-adjusted criterion) their drinking on all consumption measures. These results support the effectiveness of the CDI with heavy drinking college students when used in a clinical setting. In addition, the significant reductions in typical drinking in the control group in Experiment 1 and not in Experiment 2 combined with comparable baseline characteristics suggests that the control group in Experiment 1 demonstrated assessment reactivity.
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Quid Pro Quo: Tobacco Companies and the Black Press
Phyra McCandless, Valerie Yerger & Ruth Malone
American Journal of Public Health, forthcoming
Objectives: We explored the relationship between tobacco companies and the Black press, which plays an important role in conveying information and opinions to Black communities.
Methods: In this archival case study, we analyzed data from internal tobacco industry documents and archives of the National Newspaper Publishers Association (NNPA), the trade association of the Black press.
Results: In exchange for advertising dollars and other support, the tobacco industry expected and received support from Black newspapers for tobacco industry policy positions. Beginning in the 1990s, resistance from within the Black community and reduced advertising budgets created counterpressures. The tobacco industry, however, continued to sustain NNPA support.
Conclusions: The quid pro quo between tobacco companies and the Black press violated journalistic standards and represented an unequal trade. Although numerous factors explain today's tobacco-related health disparities, the Black press's service to tobacco companies is problematic because of the trust that the community placed in such media. Understanding the relationship between the tobacco industry and the NNPA provides insight into strategies that the tobacco industry may use in other communities and countries.
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Marc Mooney et al.
Drug and Alcohol Dependence, 1 August 2011, Pages 74-77
Background: While the majority of pathological gamblers are current cigarette smokers (CS), some have quit smoking (former smokers, FS) while others never smoked (never smokers, NS). The reasons for elevated smoking rates in pathological gambling are not known, but gamblers may use nicotine as a putative cognitive enhancer. This study evaluated impulsivity and cognitive flexibility in a sample of pathological gamblers with differing smoking status.
Methods: Fifty-five subjects with pathological gambling (CS, n = 34; FS, n = 10; NS, n = 11) underwent cognitive assessments using the Stop-Signal (SST) and Intradimensional/Extra-dimensional (ID/ED) set-shift tasks.
Results: CS reported less severe gambling problems than either FS or NS on the Yale Brown Obsessive Compulsive Scale modified for Pathological Gambling, and CS was associated with significantly fewer directional errors on the SST task, compared to NS. In addition, in CS, higher daily cigarette consumption was associated with fewer total errors on the ID/ED task.
Conclusions: The potential role of nicotine as a cognitive enhancer was supported by objective tests of impulsivity and cognitive flexibility. Human laboratory studies using nicotine challenges in pathological gambling will shed further light on this relationship.
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Association of BDNF and COMT genotypes with cognitive processing of anti-smoking PSAs
Mary Falcone et al.
Genes, Brain and Behavior, forthcoming
Abstract:
Anti-smoking public service announcements (PSAs) often use persuasive arguments to attempt to influence attitudes about smoking. The persuasiveness of a PSA has previously been associated with factors that influence the cognitive processing of its message. Genetic factors that influence cognitive processing might thus affect individuals' responses to the persuasive arguments presented in PSAs. In the current study, we examined polymorphisms in the genes encoding brain-derived neurotrophic factor (BDNF Val66Met) and catechol-O-methyltransferase (COMT Val158Met), which affect cognitive processing in the prefrontal cortex, to identify genetic factors associated with self-reported outcomes of message processing, perceived effectiveness, and quitting intentions among smokers viewing PSAs. 120 smokers viewed sets of 4 PSAs which varied with respect to features of argument strength and message sensation value. We observed significant associations of BDNF genotype with central processing, narrative processing, perceived effectiveness of the anti-smoking PSAs, and participant quitting intentions; the BDNF Met allele was associated with lower scores on all these measures. Central processing acted as a mediator of the association of genotype with quitting intentions and perceived effectiveness. There was a significant interaction of COMT genotype by argument strength in the model of narrative processing, such that individuals homozygous for the COMT Val allele reported higher narrative processing in the high argument strength condition, but not in the low argument strength condition. To our knowledge, this is the first study to identify genetic factors associated with cognitive processing of anti-smoking public service announcements.