Smoking and drinking while pregnant

Smoking and drinking while pregnant is generally acknowledged to be a bad for the child's health depending, of course, on the extent of it. So how common is it and what are some of the predictors?
Using Growing Up in Ireland data I graph the mothers response to a question which asked about this. About 60% never drank and less than 40% said occasionally. For smoking about 75% never smoked though about 13% smoked daily.
These questions were asked 9 years after the child was born and are probably under-estimates. One is less likely, I think, to overstate one's drinking or smoking.
If one does some simple multivariate (ordered probit) analysis it is striking that there are some very different patterns:
Older mothers are more likely to have consumed alcohol than younger mothers while pregnant but young mothers are more likely to smoke than the older ones. Income also has opposite effects being positively associated with drinking and negatively associated with smoking. The same is true for mothers education. Likewise medical card holders are more (less) likely to smoke (drink). So there seems to be a clear class divide. These effects are simultaneous, remember.
The one factor I found which had a consistent effect (& there are many other possible factors which I didn't look at) was a question that asked the respondent "Would you describe yourself as religious/spiritual?". Those that answered in the higher categories ("very much so" or "extremely") were significantly less likely to have smoked or drank alcohol while pregnant.
It is interesting to speculate whether this has something to do with an association between religiousity and discount rates. It seems there may be positive externalities from religion/spirituality.

Rack off tobacco companies

Australians will ban all colour and branding from cigarette packaging and replace it with pictures of gangrened feet, amongst other things!

Here, we just recently put our swanky cigarette boxes out of view and without much fuss but the Australian plan is generating a lot of opposition, most of which is coming from obvious vested interests.

Tobacco companies' are proven masters when it comes to the dark art of persuasion and have always managed to wriggle their way around advertising restriction policies as they met them; the advertising of Dunhill "aftershave" is a clear example of their smooth cross-product branding acrobatics. This new government policy, which bans the use of colour, brand, and identity, is the ultimate way of curbing their influence. To my mind, blank packaging is defensible and seems fair. In addition the government could provide clear information on the risks associated with smoking to help inform consumers. This would be useful and honest, unlike what is being planned here.

Do the Australian government really know the probability of developing trenchfoot from smoking? Assuming they do, then they must know its not very high (given the few limbless smokers you see or hear about). So what we're dealing with here is actually a message that is inherently disingenuous. That's not good... nor is spreading such a message, with the intension of manipulating behaviour, in a realm that works by bypassing reason! are we really ok with this?

I'm pretty sure this is what used to call propaganda.

The Effect of Smoking in Young Adulthood..

Evidence based on the Vietnam Era Draft Lottery

A thought provoking paper that I overlooked last year but which has recently come to my attention. Using neat causal techniques without strong identifying assumptions this paper suggests that smoking in young adulthood does not lead to large negative health effects later in life. The paper deals convincingly with obvious issues like mortality and other attenuating factors and although it might be reasonable to have some LATE concerns it remains a striking finding.

The Effect of Bans and Taxes on Passive Smoking

This just out looks interesting:

Adda, Jérôme, and Francesca Cornaglia. 2010. "The Effect of Bans and Taxes on Passive Smoking." American Economic Journal: Applied Economics, 2(1): 1–32.

DOI:10.1257/app.2.1.1

Abstract

We evaluate the effect of smoking bans and excise taxes on the exposure to tobacco smoke of nonsmokers, and we show their unintended consequences on children. Smoking bans perversely increase nonsmokers' exposure by displacing smokers to private places where they contaminate nonsmokers. We exploit data on bio-samples of cotinine, time use, and smoking cessation, as well as state and time variation in anti-smoking policies across US states. We find that higher taxes are an efficient way to decrease exposure to tobacco smoke.

Do smoking bans work?

CHANGES IN U.S. HOSPITALIZATION AND MORTALITY RATES FOLLOWING
SMOKING BANS Kanaka D. Shetty et al Working Paper 14790 NBER

This is a really interesting paper, brought to my attention by Ian Irvine. The authors say " In contrast with smaller regional studies, we find that workplace bans are not associated with statistically significant short-term declines in mortality or hospital admissions for myocardial infarction or other diseases. An analysis simulating smaller studies using subsamples reveals that large short-term increases in myocardial infarction incidence following a workplace ban are as common as the large decreases reported in the published literature." They also make the intriguing suggestions that " publication bias could plausibly explain why dramatic short‐term public health improvements were seen in prior studies of smoking bans."

Has any one looked at the Irish case? Daily or weekly data on hospitalization with some break-down by cause might be sufficient.

A snag with Increased taxes on cigarettes

Jim Power’s recent report on behalf of the Irish Cancer Society, ASH and the Irish Heart Foundation, according to media reports, argued for a sharp increase in taxes on cigarettes. See

http://www.irishheart.ie/iopen24/calls-increase-price-cigarettes-n-200.html

This has generated a great deal of comment including some criticism by columnist Noel Whelan pointing out the obvious problem of increased cross-border shopping/smuggling. The argument for such taxes is simple: cigarettes are price responsive so a tax on them, by reducing demand, should lead to better health outcomes and generate some much needed tax revenue. A win-win situation then? Not necessarily since advocates of the tax increase miss an essential point. A little behavioural economics (not to mention common sense) goes a long way here. Leaving side the cross border shopping issue a deeper problem is that while the number of cigarettes smoked may be responsive to price (& hence tax) so too is smokers’ behaviour. In particular there is good evidence that in response to increased excise taxes, smokers will smoke more intensively thereby extracting more nicotine from cigarettes. Evidence from epidemiology suggests that smokers can regulate the amount of nicotine extracted from a given cigarette by varying the number of puffs and the degree and length of inhalation. Smoking a cigarette more intensively, up to the filter, leads an individual to be exposed to more dangerous chemicals. Moreover not all cigarettes are the same and there is also good evidence that smokers respond to increased taxes by switching to brands with higher tar and nicotine yields.

The idea that smokers compensate for higher prices by extracting more nicotine is not simply a theoretical possibility but has been shown in an important study by Adda and Cornaglia in the American Economic Review (2006). When individuals inhale nicotine it is metabolized into cotinine which can be measured in saliva samples. Using US data, they find that in response to tax increases, smokers fully compensate for consuming fewer cigarettes with increased smoking intensity thereby keep nicotine levels constant. While their estimates may be at the pessimistic end of the scale the basic point is uncontroversial: it is not sufficient to simply look at the number of cigarettes smoked. Ian Irvine’s paper ( http://ideas.repec.org/p/ucd/wpaper/200818.html ) has a somewhat different take on this.
Of course if taxes cause individuals to stop smoking then there will be a reduction in nicotine although this will reduce tax revenues not increase them. In short, the prospects for such tax increases to lead to better health outcomes and more tax revenue are far from clear.

Paying People to Quit Smoking Once Again

Another paper (this time an RCT) shows that paying people to quit smoking works.

"The incentive group had significantly higher rates of smoking cessation than did the information-only group 9 or 12 months after enrollment (14.7% vs. 5.0%, P<0.001) and 15 or 18 months after enrollment (9.4% vs. 3.6%, P<0.001)."

Please, Please, Please someone do this in Ireland - I will do your stats for free provided the results are made public!


http://content.nejm.org/cgi/content/short/360/7/699

Effects of the Irish Smoking Ban on Respiratory Health of Bar Workers and Air Quality in Dublin Pubs

On the topic of smoking:


Environmental tobacco smoke (ETS) causes disease in non-smokers. Workplace bans on smoking are interventions to reduce exposure to ETS to try to prevent harmful health effects. The Irish Government on the 29th March 2004 introduced the first national comprehensive legislation banning smoking in all workplaces including bars and restaurants. This study examines the impact of this legislation on air quality in pubs and on respiratory health effects in bar workers in Dublin.

Concentrations of PM2.5 and PM10 particulate matter in 42 pubs were measured and compared before and after the ban. Benzene concentrations were also measured in 26 of the pubs. Eighty one (81) barmen volunteered to have full pulmonary function studies, exhaled breath carbon monoxide (CO) and salivary cotinine levels performed before the ban and repeated one year later after the ban. They also completed questionnaires on exposure to environmental tobacco smoke (ETS) and respiratory symptoms on both occasions.

There was an 83% reduction in PM2.5 and an 80.2% reduction in Benzene concentration in the bars. There was a 79% reduction in exhaled breath CO and an 81% reduction in salivary cotinine. There were statistically significant improvements in measured pulmonary function tests (PFTs) and significant reductions in self reported symptoms and exposure levels in volunteer non-smoking barmen after the ban.

A total workplace smoking ban results in a significant reduction in air pollution in pubs
and an improvement in respiratory health in barmen.

Goodman et al (2007)

NBER - The Mortality Cost to Smokers

This article estimates the mortality cost of smoking based on the first labor market estimates of the value of statistical life by smoking status. Using these values in conjunction with the increase in the mortality risk over the life cycle due to smoking, the value of statistical life by age and gender, and information on the number of packs smoked over the life cycle, produces an estimate of the private mortality cost of smoking of $222 per pack for men and $94 per pack for women in 2006 dollars, based on a 3 percent discount rate.

http://www.nber.org/papers/w13599.pdf

Predicting Health Behaviors with an Experimental Measure of Risk Preference

Lisa R. Anderson (Department of Economics, College of William and Mary)
Jennifer M. Mellor (Department of Economics, College of William and Mary)

http://d.repec.org/n?u=RePEc:cwm:wpaper:59&r=cbe

We conduct a large-scale economics experiment paired with a survey to examine the association between individual risk preferences and health-related behaviors among adults aged 18 to 87 years. Risk preferences are measured by the Holt and Laury (2002) lottery choice experiment. Controlling for race, sex, and age, we find that risk preference is significantly associated with cigarette smoking, being overweight or obese, seat belt non-use, and driving over the speed limit. In additional specifications, we find that risk preference is significantly associated with heavy episodic drinking, and is a significant predictor of the number of risky behaviors.