How to Make People Quit Smoking (Ep. 161)

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(Photo: Fried Dough)

(Photo: Fried Dough)

Our latest Freakonomics Radio episode is called “How to Make People Quit Smoking.” (You can subscribe to the podcast at iTunes, get the RSS feed, or listen via the media player above. You can also read the transcript, which includes credits for the music you’ll hear in the episode.) The gist: the war on cigarettes has been fairly successful in some places. But 1 billion humans still smoke — so what comes next?

In the U.S., roughly 70 percent of smokers say they want to quit. But when they try, some 90 percent of them fail. So what does get people to smoke less? Something must be working: the smoking rate in the U.S. has fallen by more than half.

Kenneth Warner, an economist at the University of Michigan School of Public Health, has been doing tobacco-policy research since the 1970’s. One of the most powerful smoking deterrents, he says, is making cigarettes more expensive.

WARNER: The effects of tax and price are more well studied than any other area of tobacco control. We have a lot of data about that. What we know is that if you increase the price by 10% you will decrease total cigarette consumption by 3 to 4%.

The Vanderbilt economist Kip Viscusi agrees, calling price a “powerful tool” that doesn’t wear out. From a report called “The Economics of Tobacco Taxation,” by Frank J. Chaloupka, here is a good picture showing the relationship between price and cigarette sales:

Screen Shot 2014-04-02 at 10.34.03 AM

Frank Chaloupka

And yet one out of five Americans still smokes. Worldwide, there are about 1 billion smokers, with the highest rates in Asia.

So besides price and tax controls, what makes people quit smoking? In the podcast, you’ll hear from Jeffrey Harris, a physician and economist at M.I.T. who has studied tobacco control in Uruguay, which he calls “a pioneer” in smoking cessation. In his most recent paper on the topic — “Tobacco Control Campaign in Uruguay: Impact on Smoking Cessation during Pregnancy” (abstract; PDF) — he discusses the effect of cigarette packaging that includes graphic, grotesque imagery:

Courtesy of Jeffrey Harris

You’ll also hear about the upside of smoking — or at least of getting nicotine in your system. Paul Newhouse, an M.D. who runs the Center for Cognitive Medicine at Vanderbilt, is doing research to learn if nicotine (divorced from smoking, ideally) has strong medicinal efficacy:

NEWHOUSE: It appears to activate a class of what we call receptors, [which are] important for regulating a whole variety of brain functions. And so we think that nicotinic receptors are important for things like attention, for behavioral strategies, for what we call executive functioning, which is the ability to make decisions and evaluate information, we think it’s important for memory, and so that has led us to thinking about what particular disorders might be helped by stimulating nicotinic receptors with nicotine or with something else.

Among the disorders that Newhouse and others in his field think may benefit from nicotine therapy: schizophrenia, Parkinson’s disease, Alzheimer’s disease, anxiety, depression, and many others. If nicotine does indeed work as theorized, that may explain why so many people have such a hard time quitting smoking: they are self-medicating.

You’ll also hear about an early tobacco-control policy from the Ottoman Empire in the early 1600s. Trust us, you wouldn’t have wanted to be a smoker then.


Serbin Zlat

Peer pressure was the culprit in my case, or sheer stupidity (And it was also "Seattle-pressure" that made me quit, too, because smokers are simply despised in Seattle. A smoker is a third-class citizen in Seattle). For the next 21 years I smoked, one pack a day for 18 of those 21. Then at 33 I became a father. One colleague, a heavy smoker, got throat cancer. My father-in-law had lost one lung (lung cancer) many years earlier due to smoking. My father, another 3 packs a day smoker, got some lung disease that took his breath away and now he can't lift 3 pounds and make 5 steps (he quit the day doctor showed him a picture of his lungs.) Another thing that helped me tremendously was “The Economist's Guide to Parenting" by Freakonomics :). One thing that stuck with me was that off all the things that you'll try to steer your children toward, the chance that a smoker's child will become a smoker grows by 75%, and that is something no parents want to steer their children toward. That really stayed with me, and remembering that my childhood was engulfed in smoke, that pushed me over the edge. Then I started preparing myself mentally for quitting. I didn't set a date. I didn't even know if I would try (I believed I was too weak to even attempt and that I would surely fail, which frightened me deeply.) But I knew I would "think" about it. So I thought about it, more or less every day for a year, preparing myself for the big day. In hope to increase my chances I got a prescription for Chantix. I have no clue if they helped one bit, but I continued to take them for the whole 4-month treatment. The thing that was crucial in my case, and without which I wouldn't have made it was pure will, and what gave me that will was a year of mental preparation. Quitting is difficult, for some more for others less. I smoked for 21 years, and I quit on the very first attempt (I've been tobacco-free for 2 and a half years) simply because I made up my mind.

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Joey

Great show - i'm a fan who religiously waits for your podcast here in the Philippines.

This episode got me thinking and made me formulate a question. In the show the idea of nicotine as medication for cure mental illness was presented; also presented was the idea that nowadays the it's the lower income segments, and the population that only completes some form of high-school education that tended to smoke the most. I'd just like to ask if there has been any study made correlating mental health and poverty? --- hope you can make a show out of this.

Alan Brody

This is an excellent program and unusually brave for asking the question: do smokers get anything out of it?

The public health position has generally been "no" - that it's a trick of advertising by an immoral industry. While tobacco companies have certainly pushed the envelope, smoking has taken off in many places where there is little or no advertising at all - Italy and pre-capitalist China being two examples.

As the author of "Cigarette Seduction", which explores the tobacco industry's research, I can show that smoking, bad as it is, fills some deep human needs and the self medication is both mental and spiritual. Depression is big issue since smokers today are 3 times more likely to be depressed than the general population. But we also know that wealthier or more sophisticated ex-smokers have turned to ADD medication, and anxiety pills as well as anti-depressants in place of smoking.

Doing a little Freakonics myself, I have found the decline of smoking in the the general population from around 42% to around 24% almost exactly mirrors the increased use by the adult population of prescription psychoactives from around 24% to 42%.

In other words, people don't really quit smoking so much find outer solutions for their issues.

When it comes to teenagers, the great lure of smoking has always been the early induction into adulthood - in other words, initiation. Their alternatives to smoking run the gamut of excessive drinking to prescription and illegal drugs.

So, to respond to the first past of the program, yes teenage usage is down - but are there any studies showing what teens are doing instead?

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Allen

Are we talking cause or correlation? If price is a cause, North Dakota's smoking rate should be significantly higher than Minnesota's. IIRC MN's tax is 6-7 times higher than ND's. Yet North Dakota's smoking rate is barely higher than Minnesota's.

Maybe the regions where there is the most social pressure against smoking tend to be the ones where the cost of cigarettes is highest?

KMW

As an economics instructor, I was happy about the market dynamics and the price influence on smoking habits discussed in the podcast. One thing that bothered me, though, was the misuse of economics terminology by Kip Viscusi of Vanderbilt (and subsequent misuse in these comments). When the price of a product increases DEMAND for the product does not decrease - quantity demanded does. I realize it's a small distinction and probably only matters to those of us who teach this material, but if I require community college students to learn the proper use of this term I wish Freakonomics could use it properly, too. This is actually a podcast I would assign to my principles of micro students if not for this issue.

Martin Miljkovic

Hi what was the link for that free book?
It was something like audiobooks/freak ?

AmyInNH

Tax rate versus smoking rate, not necessarily the reason for decline. Likely more to do with the C Everett Coop non-stop ads on TV, which correlate to the downward motion in the graph, in the late 1970s/early 1980s.

Alda Fritz

I no longer see it as important! If you want to exclude the habit, should be excluded from every person, and not a particular one

Alda Firtz

Well, i think they should be told that how much smoking wastes their money on annual basis and they could have saved well over $6000+ a year if they quit smoking and spend that money in something useful or a family vacation.