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.


Seems like the eCigarette is a step in the right direction.

Back before the US annexed the Philippines in 1898, the Spanish who ruled it had a system in place to keep the use of opium--which was legal--reasonably low through high prices, though their system was indirect and much more flexible: they gave a state-sanctioned monopoly on optium-selling to the ethnic Chinese who lived there. The Chinese had an interest in keeping their prices high, but not so high that it encouraged smuggling (as we are starting to see with cigarettes in certain parts of the US now). The Chinese had an interest in protecting this balance, and because they weren't a government bureaucracy they could adjust their policies faster and more easily.

American Progressives, then and now, had a distaste for letting people use drugs freely, especially if it interfered with the progressives' own globalist aspirations. So back then you had Bishop Charles Brent coming in and nagging Teddy Roosevelt to force W.H. Taft, who was governing the Philippines, to impose a ban on opium. This led to the Opium Exclusion Act and the Harrison Act--all championed by Progressives. Today you have bans on cigarettes and fast food--also championed by Progressives. Oh, and you have left-wingers like Eric Holder and Joe Biden, both heavy hitters in the war on drugs. (Go and look at the introduction of any major anti-drug law before 1950, and many of them since, and you'll see "D"s all over them.)

If you don't know the history, it's puzzling that conservatives today seem more opposed to drug legalization on average than liberals do, but this mystery falls away once you realize that conservatives didn't become that way until after WWII when the Republican Party was infiltrated by neoconservatives, who had no strong views on strictly domestic issues and saw everything in terms of its globalist implications and potential. The neocons, therefore, picked up the inherently globalist baton of drug prohibition from the Progressives, just as the Progressives produced the hippies. Perfect timing.

Cigarettes, meanwhile, were always there right along with drugs and alcohol: hated by Progressives, especially the northern industrialists who believed of cigarettes what Richard Nixon believed of marijuana. They also believed that tobacco and hemp were threats to their industrial might: lucrative crops that those Evil Southerners and rural folk might grow rich from.




I disagree with your Alex Jonesian take on history. When I hear about left-wing globalists who hate X, I tend to tune it out. Let's be serious here.

Gene H

Agreed taxes and/or the price can make a big dent in the problem if you assume the Demand curve slopes downward (which it does).

However, wasn't it Malcolm Gladwell who suggested the (or a) real cause of the persistence of smoking is peer pressure at young ages (13 or so)? The seems to be a "non-price" variable that shifts the demand curve to the right rather than move along with it.

We may be moving up and to the right on the demand curve with a price increase but at the same time it is shifting to the right, keeping a fairly steady equilibrium at 20% or so.

Sorry for the simplistic example. Helps me put a visual to it. :)



Yes, the demand curve slopes downward, but the change in smoking rates from the increase in tax/price depends on the elasticity of the demand curve, and will not necessarily be a big dent.


While listening to myself, I kept questioning the results these guys have found.
For instance, you say (by you I mean "they") cigarettes price increases people quitting. But how do we know they aren't simply getting their cigarettes on the black market instead? Perhaps because of the price increase they've switched to other drugs or alcohol. Perhaps the latter increased in consumption due to cigarettes increase.

I feel like it's hard to say for sure. I grew up in a family of smokers, my mom and brother and have seen all these things happening (price increase, pictures on the box) as well as in my friends circle. Quite frankly, I don't feel like it's doing a great job at deterring smokers.

Just my 2 cents. However. I like the Uruguayn idea of one pack per manufacturer.

Enter your name...

I know middle-aged adults who have cut back and/or tried to quit because of the price increases. The tobacco industry has certainly noticed that net price increases cut demand. (Also, that they cut demand most for the cheapest brands, because when cheap is $7 and expensive is $8, people actually buy a little more of the expensive ones and a lot less of the cheapest.)

The biggest change is in the people (teens) who never start smoking in the first place. If a pack of cigarettes costs $7 (or especially if you have to buy a whole carton at a time, so you actually have to come up $70 at once), then price-sensitive teens don't start. They decide that they'd rather have a new T-shirt or two trips out for fast food. If you count how many 16 year olds are smoking in year 1, raise the price in year 2, and then count how many 16 year olds are smoking afterwards, you find that fewer of them have started after the prices went up.



Part II: Electronic Cigarettes?


I got a rush this morning listening to the episode on my commute in Montevideo, Uruguay. It's nice to have our tiny country mentioned for something nice other than football (i.e. soccer).
Great episode!


Why is there an assumption that people need to be "made to quit smoking"?

Where is the moral question here?

If someone takes part in a peaceful activity (pregnant mothers excluded), and another intervenes to stop the activity, the second person has initiated force and has committed an immoral act.

Let people live their lives and give them the human decency to make their own choices and receive the benefits or suffer the consequences of those choices.


"....another intervenes to stop the activity, the second person has initiated force and has committed an immoral act."

Why is there an assumption that this ^^^ is an immoral act?

On a separate know - what you suggest would be fine were it not for the fact that Medicare covers a lot of the healthcare costs for these people. Why should I, a non-smoker, have my taxes go to paying for someone else's decision to be unhealthy?

THAT seems immoral to me



I am putting forth that anyone who initiates force in an adult voluntary relationship is committing an immoral act. If you are willing to argue against that, I'd be open to hearing that argument.

Setting an arbitrary rule based on a subjective preference for another human is an act of force. "Making someone stop smoking" seems to fit this description.

On your second point, I agree wholeheartedly that you should not have to fund another person's bad behavior. I would offer another argument which is that the REAL initiation of force in this case is TAXATION. The State has taken your private property by force which is immoral.

If you feel that taxation is voluntary (which it is not), then you agree to funding Medicare as it stands.

Tim R

I thought the statement that "one out of five deaths was totally avoidable" was kind of funny. As if those people, if they had never smoked, would never have died.
Yes, I understand that a person dying a specific way might be avoidable, but really the 'death expense' of smoking would simply be moved to some other cause if smoking were eliminated not eliminated itself.
Everyone dies and has medical expenses associated with disease and dying whether they smoke or not. How much higher are the smoking expenses than those they have forestalled, not how high are they in and of themselves?


Lung cancer can be one of the most painful deaths,surely you want to avoid it ?

angela sanders

I do not think folks that do not quit are motivated by money. I think this study is jumping to many conclusions.

I see it is an addiction. I smoked when a carton costs two bucks, but I knew with my family history; smoking would not end well for me, so I quit for my health in 1980 after 7 years of smoking. I started smoking at 17 - high school cool factor.

Nicole Friedman

I call myself a hard core smoker and an addict. Just like an addict, I don't care what gruesome images are on a pack of cigarettes or how much I pay for a pack. I have been smoking on and off for 60 years. I have been trying to quit smoking since I was 23 years old. I've tried smoking cessations programs(3), nicotine patches, cold turkey. All worked for a few months, and one for 5 years. I want to quit but at this point, I've resigned myself that that's who I am. Also, smoking is not a reflection of my character. Just because a person who exercises and doesn't eat meat make him or her a good person, a person who smokes doesn't make him or her a bad person. Smokers are so demonized, what's the next step? Assemble them all in special camps, or better yet, isolate them on an island?


Recently the Secretary or Defense has mulled the idea of banning the sale of smoke products on ships and bases. Quote, "The cost, health care costs are astounding, well over a billion dollars, just in the Department of Defense, on tobacco-related illness and health care. Now, the dollars are one thing, but the health of your people, I don't know if you put a price tag on that."

Question: If the (or a) concern is to reduce heath care costs, which are consuming a larger and larger percentage of the DOD budget every year, what suggestion would you make to Secretary Hagel in getting service members and their families (all receiving the benefits of the reduced costs of military medicine) to stop smoking ?

Ban the use of the products while in uniform? While on military bases or ships, While living in military housing? Or simply banning the use of as a condition of employment?

Just curious.



Dr.Rakesh Gupta

The worst thing about Smoking is that the non-smokers near you including your children suffer from ill effects of second hand and third hand smoke for no fault of theirs.
There is no safe limit for Tobacco/ Nicotine.
Half of the smokers die because of diseases attributed to use of Tobacco
Raising taxes is a well recognized measure to reduce consumption of Tobacco
E-Cigarettes are even worse as they contain pure Nicotine in chemical form,which is banned under Indian poisons act/Insecticide act.Nicotine is even more addictive than Heroine.

Zach Carhide

So what I think we should do. With all the negative marketing ads showing dead lungs.... Why don't we have marketing showing people saying hey I smoked for x years quit cold turkey you can too... I smoked for 10 years 2 packs a day and quite cold turkey. I was talking to some people about this they where wow you smoking I heard it worse that quieting heroin. Now I have never done heroin but from what I see and movies and what not it looks really hard a lot harder then quieting smoking. I think positive reinforcement along with the Dead pictures will work. FYI. I quite because I the price was getting to high so taxes forced me to quite. Another way to look at this so is if everyone one quit smoking tomorrow what would happen with the lose of Tax money. The state/feds would have to get that taxs from somewhere they are as if not more addicted to the money then the smokers are to smoking.