Does falling smoking lead to rising obesity?

https://doi.org/10.1016/j.jhealeco.2005.07.005Get rights and content

Abstract

The strong negative correlation over time between smoking rates and obesity have led some to suggest that reduced smoking is increasing weight gain in the U.S. This conclusion is supported by the findings of Chou et al. [Chou, S.-Y., Grossman, M., Saffer, H., 2004. An economic analysis of adult obesity: results from the behavioral risk factor surveillance system. Journal of Health Economics 23, 565–587], who conclude that higher cigarette prices lead to increased body weight. We investigate this issue and find no evidence that reduced smoking leads to weight gain. Using the cigarette tax rather than the cigarette price and controlling for non-linear time effects, we find a negative effect of cigarette taxes on body weight, implying that reduced smoking leads to lower body weights. Yet our results, as well as Chou et al., imply implausibly large effects of smoking on body weight. Thus, we cannot confirm that falling smoking leads in a major way to rising obesity rates in the U.S.

Section snippets

Smoking and weight gain

An extensive medical literature has supported the popular contention that smoking facilitates weight control. In 1990, the U.S. Surgeon General reviewed 15 medical studies involving a total of roughly 20,000 test subjects (U.S. Department of Health and Human Services, 1990). Between 58 and 87% of those who had quit smoking gained weight. On average, quitters gained 4 pounds more than those who continued smoking. Individual weight gains of 20 pounds or more following smoking cessation were found

Data

Our basic data source for this analysis is the Behavioral Risk Factor Surveillance System (BRFSS). The data consists of repeated cross-sections for the years 1984 through 2002, collected via monthly telephone surveys of individuals aged 18 years and older. The BRFSS is a nationally representative survey of the United States and has been conducted by state health departments in coordination with the CDC for the purpose of collecting state-level data pertaining to risky personal health behaviors.

Empirical strategy

We begin our analysis by showing reduced form estimates of the impact of cigarette taxes on measures of body weight. In particular, we estimate regression equations of the form:BMIijt=α+β1RTAXjt+β2Xijt+β3URjt+λj+τt+εijtwhere i is the indexes individuals, j the indexes states, t the indexes years, BMI the body mass index or some other measure of body weight, RTAX the real cigarette tax in state j in year t; X the set of individual-specific covariates (e.g. age), UR the unemployment rate in state

Results

Table 2 presents our initial results from estimating equations such as that shown above. We estimate our model for two different measures of body weight: the level of the BMI (results are similar if we use the logarithm of BMI instead) and an indicator for obesity (BMI > 30). We express the cigarette tax in fractions of a dollar, rather than cents (e.g. 0.4 not 40) for ease of interpretation of the coefficients.

Surprisingly, we find that there is a negative relationship between cigarette taxes

Conclusions

Smoking and obesity are the two largest (at least partially) self-imposed health risks facing Americans today. The notion that there is a tradeoff between these risks, with lower smoking causing more weight gain, is the type of “common knowledge” that has in fact found relatively little support in the literature. We provide such analysis in this paper and are unable to detect any evidence that higher cigarette taxes, which lead to lower smoking, also lead to higher weight. The existing study

Acknowledgements

We are grateful to Shin-Yi Chou, Mike Grossman and Inas Rashad for generously providing the data from their earlier study.

Michael D. Frakes gratefully acknowledges financial support from the National Science Foundation and from Harvard Law School's John M. Olin Center for Law, Economics and Business.

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