Want to Quit Smoking? Get Your Spouse to Do It First

Smoking is one of our favorite topics on this blog -- from the ethics of not hiring smokers to the use of commitment devices to quit. A new NBER paper (gated) by Kerry Anne McGeary looks at smoking in marriages. It finds that one spouse quitting causes the other to quit, through bargaining:

Previous research studying the correlation in smoking behavior between spouses has discounted the role of bargaining or learning. Using the Health and Retirement Study (HRS), which contains information on smoking cessation and spouse’s preferences, this paper presents an essential investigation of the importance of spousal bargaining or learning on the decision to cease smoking. We find, regardless of gender, when one member of [a] couple ceases smoking this induces the other member to cease smoking through bargaining. Further, we find females demonstrate either altruistic behavior toward a spouse, who has suffered a health shock, or learning from their spouse’s health shock.

Help Wanted. No Smokers Need Apply: A New Marketplace Podcast

Our latest podcast is called "Help Wanted. No Smokers Need Apply."  (You can download/subscribe at iTunes, get the RSS feed, listen via the media player above, or read the transcript.)

In many states (21, to be precise), it is perfectly legal for an employer to not hire someone who smokes. This might seem understandable, given that health insurance is often coupled to employment, and since healthcare risks and costs are increasingly pooled. And so: if employers can exclude smokers, should they also be able to weed out junk-food lovers or motorcyclists -- or perhaps anyone who wants to have a baby?

Is It Unethical to Not Hire Smokers?

That is the question asked in a New England Journal of Medicine column by Harald Schmidt, Kristin Voigt, and Ezekiel J. Emanuel:

Finding employment is becoming increasingly difficult for smokers. Twenty-nine U.S. states have passed legislation prohibiting employers from refusing to hire job candidates because they smoke, but 21 states have no such restrictions. Many health care organizations, such as the Cleveland Clinic and Baylor Health Care System, and some large non–health care employers, including Scotts Miracle-Gro, Union Pacific Railroad, and Alaska Airlines, now have a policy of not hiring smokers — a practice opposed by 65% of Americans, according to a 2012 poll by Harris International.

Cigarettes as Weight Control

We've noted before that the U.S. decline in smoking (among teens as well as adults) has likely contributed to the rise in obesity. In a new working paper (gated), John Cawley and Stephanie von Hinke Kessler Scholder consider the degree to which smoking is a conscious effort to avoid weight gain:

We provide new evidence on the extent to which the demand for cigarettes is derived from the demand for weight control (i.e. weight loss or avoidance of weight gain).  We utilize nationally representative data [the Health Behavior in School-Aged Children (HBSC) and the National Health and Nutrition Examination Surveys (NHANES)] that provide the most direct evidence to date on this question:  individuals are directly asked whether they smoke to control their weight.  We find that, among teenagers who smoke frequently, 46% of girls and 30% of boys are smoking in part to control their weight.  This practice is significantly more common among youths who describe themselves as too fat than those who describe themselves as about the right weight.

The derived demand for cigarettes has important implications for tax policy.  Under reasonable assumptions, the demand for cigarettes is less price elastic among those who smoke for weight control.  Thus, taxes on cigarettes will result in less behavior change (but more revenue collection and less deadweight loss) among those for whom the demand for cigarettes is a derived demand.  Public health efforts to reduce smoking initiation and encourage cessation may wish to design campaigns to alter the derived nature of cigarette demand, especially among adolescent girls.

Cause of Death: Drinking More Acceptable Than Smoking in UK

A new study in the Journal of Clinical Pathology from Ian Proctor, Vijay Sharma, Mohammad KoshZaban and Alison Winstanley, reveals doctor biases towards smoking and smokers. The researchers looked at 2,128 death certificates, and 236 postmortems issued at a large London teaching hospital between 2003 and 2009. They found that while alcohol was listed as a major contributor to 57.4 percent of death certificates, smoking was only listed as a cause of death in .5 percent of cases, and usually a secondary cause at that. Considering that 279 of those deaths included either lung cancer or chronic obstructive pulmonary disease -- that's a bit strange.

This study serves as a bellwether of the western world’s campaign to stop smoking. Cigarette packages in the UK carry punitive phrases such as “smokers die younger,” and “smoking can cause a slow and painful death.” More recently, every cigarette pack has been required to carry a graphic image as well: pictures of black lung, throat cancer, and even a corpse. Scarier messages and pictures are coming to the U.S. too. There’s no doubt that our attitudes towards smoking have changed immensely; so drastically, in fact, that the authors conclude that doctors would rather lie and spare a family the eternal shame of having a loved-one remembered as a smoking bandit:

American Health Fail: What's Making Us Fat? A Decline in Smoking

Americans are fat. The latest obesity estimates reach as high as 30% of the population. The future looks worse. There’s been much hand wringing over the years, with a new television show sprouting up every season imploring the obese to lose weight. But everyone wants to know: why is this happening?

Researchers Charles Baum and Shin-Yi Chou provide a detailed look at the leading indicators of weight, using the National Longitudinal Survey of Youth from 1979 and 1997 to compare the habits, similarities and differences between people of the same age - just a quarter century apart. The results aren't pleasant: the largest effect on our recent weight gain? The decline in cigarette smoking.

Freakonomics Poll: Will New Cigarette Warning Labels Reduce Smoking?

Soon, new warning labels on cigarette packs will have even scarier messages, and photos too. Canada has been doing this for years. Will it reduce smoking?

Here are three quick thoughts.

1) I strongly doubt it will increase the quantity of information about smoking. Folks know it is bad for you already.

2) This does not mean it won’t work. Maybe people try to forget the health risks in that moment of passion (folks know birth control helps prevent pregnancy, but similarly, when faced with impending temptations, magically forget such trivial details). Will these photos remind them at that moment of temptation? Maybe. Or maybe it will increase how often their kids or friends give them grief for it, thus creating some social pressure to stop. Naturally there is a counter-argument, that this may enhance teenage smoking, if “being bad” makes it cooler.

If You Have to Walk Outside to Smoke, Does the Exercise Benefit Counteract the Smoking?

A reader named Aras Gaure, who identifies himself as a trainee with the Royal Norwegian Embassy in Pretoria, South Africa, writes to us:

At my workplace, smoking is prohibited –- as in a substantial number of other indoor workplaces. In order for me to have a smoke, I have to walk about 10 meters, get down 2 flights of stairs (a total of nineteen steps), and then walk 15 meters to the nearest terrace. In one workday, I have about 4-5 cigarettes, which means I cover a distance of about 200-250 meters and between 144 and 180 steps every day with regard to my smoking. Many people obviously smoke more and have to cover an even greater distance in order to have a cigarette. As a result of continuous bans on smoking around the world, people (who don’t quit) in many cases have to go through physical exertion numerous times a day to have a smoke. My question is whether or not this (in any sense or form) can be considered beneficial (especially for people who otherwise wouldn’t get this exercise)?

An interesting question but my sense is that the amount of exercise Aras describes -- or even 5x that amount -- is so minimal that it wouldn't come close to offsetting the downsides of smoking. There are certain reported "health benefits of smoking," including weight loss, but even for someone who likes finding counterintuitive trends, I have a hard time buying Aras's wishful thinking. Am I wrong?

Do Smoking Bans Lead to More Fires?

Death by fire has declined significantly over the past 100 years, but there's one surprising policy that may actually increase the prevalence of fires: smoking restrictions and bans.

On-Screen Smoking Down (But Still High)

From a new CDC report: "To monitor the extent to which tobacco use is shown in popular movies, Thumbs Up! Thumbs Down! (TUTD), a project of Breathe California of Sacramento-Emigrant Trails, counted the occurrences of tobacco use (termed "incidents") shown in U.S. top-grossing movies during 1991-2009. This report summarizes the results of that study, which found that the number of tobacco incidents depicted in the movies during this period peaked in 2005 and then progressively declined."