Dazed and confused

Kevin Lewis

May 28, 2015

Smoking and (Not) Voting: The Negative Relationship Between a Health-Risk Behavior and Political Participation in Colorado

Karen Albright et al.
Nicotine & Tobacco Research, forthcoming

Introduction: Considerable evidence suggests that cigarette smokers are an increasingly marginalized population, involved in fewer organizations and activities and with less interpersonal trust than their nonsmoking counterparts. However, only two previous studies, both among Swedish populations, have investigated smokers' attitudes toward political systems and institutions. The current, cross-sectional study examines smoking in relation to voting, a direct behavioral measure of civic and political engagement that at least partly reflects trust in formal political institutions.

Methods: Secondary analyses were conducted of interview data from 11,626 respondents in the Colorado Tobacco Attitudes and Behaviors Survey. Data were collected via telephone between October 2005 and mid-April 2006 and included respondents' reported voting behavior in the 2004 national election; the participation rate was 89.7%. Balanced multiple logistic regression was used to examine associations between smoking and voting while controlling for other covariates known to be associated with both variables.

Results: In the final model, daily smokers were less than half as likely as nonsmokers to report having voted in the election.

Conclusions: The results suggest possible consonance with previous work linking smoking with political mistrust. Possible causal mechanisms are discussed. This study is the first to link a health-risk behavior with electoral participation, and provides initial evidence that smoking is negatively associated with political participation. Future research should investigate how public health might enhance tobacco control efforts by taking nonvoting behavior into consideration, or creatively combining smoking cessation interventions with voter registration and other civic engagement work, particularly among socioeconomically disadvantaged populations.


"Fighting a Hurricane": Tobacco Industry Efforts to Counter the Perceived Threat of Islam

Mark Petticrew et al.
American Journal of Public Health, June 2015, Pages 1086-1093

Islamic countries are of key importance to transnational tobacco companies as growing markets with increasing smoking rates. We analyzed internal tobacco industry documents to assess the industry's response to rising concerns about tobacco use within Islamic countries. The tobacco industry perceived Islam as a significant threat to its expansion into these emerging markets. To counter these concerns, the industry framed antismoking views in Islamic countries as fundamentalist and fanatical and attempted to recruit Islamic consultants to portray smoking as acceptable. Tobacco industry lawyers also helped develop theological arguments in favor of smoking.


Optimal Drug Policy in Low-Income Neighborhoods

Edward Coulson, Ping Wang & Sheng-Wen Chang
Journal of Public Economic Theory, forthcoming

The control of drug activity currently favors supply-side policies: drug suppliers in the U.S. face a higher arrest rate and longer sentences than demanders. We construct a simple model of drug activity with search and entry frictions in labor and drug markets. Our calibration analysis suggests a strong "dealer replacement effect." As a result, given a variety of community objectives, it is beneficial to lower supplier arrests and raise the demand arrest rate from current values. A 10% shift from supply-side to demand-side arrests can reduce the population of potential drug dealers by 22-25000 and raise aggregate local income by $380-400 million, at 2002 prices.


Alcohol Mixed With Energy Drink Use Among U.S. 12th-Grade Students: Prevalence, Correlates, and Associations With Unsafe Driving

Meghan Martz, Megan Patrick & John Schulenberg
Journal of Adolescent Health, May 2015, Pages 557-563

Purpose: The consumption of alcohol mixed with energy drinks (AmED) is a risky drinking behavior, most commonly studied using college samples. We know little about rates of AmED use and its associations with other risk behaviors, including unsafe driving, among high school students. This study examined the prevalence and correlates of AmED use among high school seniors in the United States.

Methods: Nationally representative analytic samples included 6,498 12th-grade students who completed Monitoring the Future surveys in 2012 and 2013. Focal measures included AmED use, sociodemographic characteristics, academic and social factors, other substance use, and unsafe driving (i.e., tickets/warnings and accidents) after alcohol consumption.

Results: Approximately one in four students (24.8%) reported AmED use during the past 12 months. Rates of AmED use were highest among males and white students. Using multivariable logistic regression models controlling for sociodemographic characteristics, results indicate that students who cut class, spent more evenings out for fun and recreation, and reported binge drinking, marijuana use, and illicit drug use had a greater likelihood of AmED use. AmED use was also associated with greater odds of alcohol-related unsafe driving, even after controlling for sociodemographic, academic, and social factors and other substance use.

Conclusions: AmED use among 12th-grade students is common and associated with certain sociodemographic, academic, social, and substance use factors. AmED use is also related to alcohol-related unsafe driving, which is a serious public health concern.


Alcohol Consumption, Deterrence and Crime in New York City

Hope Corman & Naci Mocan
Journal of Labor Research, June 2015, Pages 103-128

This paper investigates the relationship between alcohol consumption, deterrence, and crime for New York City. We use monthly time-series data from 1983 to 2001 to analyze the impacts of variations in both alcohol consumption and deterrence on seven "index" crimes. We tackle the endogeneity of arrests and the police force by exploiting the temporal independence of crime and deterrence in these high-frequency data, and we address the endogeneity of alcohol by using instrumental variables where alcohol sales are instrumented with city and state alcohol taxes and minimum drinking age. We find that alcohol consumption is positively related to assault, rape, and larceny crimes but not murder, robbery, burglary, or motor vehicle theft. We find strong deterrence for all crimes except assault and rape. Generally, deterrence effects are stronger than alcohol effects.


The impact of restaurant smoking bans on dining out expenditures: Evidence from panel data

Dohyung Kim & Baríş Yörük
Journal of Urban Economics, forthcoming

Many state and local governments in the United States have laws that prohibit smoking in restaurants to protect people from the harmful effects of secondhand tobacco smoke. The opponents of these laws have long argued that these laws may harm the restaurant industry by repelling customers who smoke on a regular basis. In this paper, using data from the confidential version of the Panel Study of Income Dynamics (PSID), we estimate the impact of restaurant smoking bans on dining out expenditures of smoking and nonsmoking households. We identify the impact of these bans by exploiting the substantial variation in the implementation of these bans across different cities, counties, and states. Our results indicate that although restaurant smoking bans are associated with a 15.1 percent decrease in dining out expenditures of smoking households, they increase the dining out expenditures of nonsmoking households by 8.6 percent. Since the majority of the U.S. population does not smoke, the aggregate impact of restaurant smoking bans on dining out expenditures is slightly positive but statistically insignificant. These results imply that restaurant smoking bans do not harm the restaurant industry.


The Unintended Consequences of Countermarketing Strategies: How Particular Antismoking Measures May Shift Consumers to More Dangerous Cigarettes

Yanwen Wang, Michael Lewis & Vishal Singh
Marketing Science, forthcoming

Countermarketing, or efforts to reduce consumption of certain products, has become common in categories such as tobacco, junk food, fossil fuels, and furs. Countermarketing has a particularly long history in the tobacco industry. Efforts to reduce smoking have included excise taxes that increase the cost of consumption, smoke-free restrictions that make consumption less convenient, and antismoking advertising campaigns that highlight the dangers of tobacco use. This article presents an analysis of the relative effectiveness of these different strategies. We find that cigarette excise taxes are the most effective tool for reducing overall cigarette sales, followed by antismoking advertising. Smoke-free restrictions are not found to have a significant effect on cigarette sales. We also investigate how these various policy tools induce product substitution. This issue is of considerable importance because some countermarketing techniques may potentially shift consumers to more dangerous, higher nicotine and tar cigarettes. Specifically, we find that excise taxes levied on a per pack basis rather than based on nicotine levels often shift consumers to more dangerous products.


Estimating the Price Elasticity of Demand for Different Levels of Alcohol Consumption among Young Adults

Vinish Shrestha
American Journal of Health Economics, Spring 2015, Pages 224-254

Understanding the effect of higher alcohol prices on alcohol demand according to one's level of alcohol consumption is crucial while evaluating the effectiveness of using alcohol taxes as an alcohol-control medium. In this study, I estimate the differential responses to alcohol prices on alcohol demand for young adults by asking whether heavy drinkers are more responsive to higher alcohol prices than light and moderate drinkers. To conduct the analysis, I use the data from the National Longitudinal Survey of Youth (NLSY97) for the years 1997 to 2008. To answer the research question on hand, I implement three different econometric methods: (1) pooled quantile regression; (2) quantile regression for panel data; and (3) finite mixture models. Findings from these methods consistently suggest that heavy drinkers respond to higher alcohol prices by lowering their alcohol intake. Since alcohol-related externalities are likely to be caused by heavy drinkers, the results emphasize the possibility of higher alcohol taxes curbing alcohol-related externalities associated with young adults by lowering the alcohol consumption among the heavy drinkers.


A Behavioral Economic Model of Alcohol Advertising and Price

Henry Saffer, Dhaval Dave & Michael Grossman
Health Economics, forthcoming

This paper presents a new empirical study of the effects of televised alcohol advertising and alcohol price on alcohol consumption. A novel feature of this study is that the empirical work is guided by insights from behavioral economic theory. Unlike the theory used in most prior studies, this theory predicts that restriction on alcohol advertising on TV would be more effective in reducing consumption for individuals with high consumption levels but less effective for individuals with low consumption levels. The estimation work employs data from the National Longitudinal Survey of Youth, and the empirical model is estimated with quantile regressions. The results show that advertising has a small positive effect on consumption and that this effect is relatively larger at high consumption levels. The continuing importance of alcohol taxes is also supported. Education is employed as a proxy for self-regulation, and the results are consistent with this assumption. The key conclusion is that restrictions on alcohol advertising on TV would have a small negative effect on drinking, and this effect would be larger for heavy drinkers.


Violence in Illicit Markets: Unintended Consequences and the Search for Paradoxical Effects of Enforcement

James Prieger & Jonathan Kulick
B.E. Journal of Economic Analysis & Policy, forthcoming

The textbook competitive model of drug markets predicts that greater law enforcement leads to higher black market prices, but also to the unintended consequences of greater revenue and violence. These predictions are not in accord with the paradoxical outcomes evinced by recent history in some drug markets, where enforcement rose even as prices fell. We show that predictions of the textbook model are not unequivocal, and that when bandwagon effects among scofflaws are introduced, the simple predictions are more likely to be reversed. We next show that even simple models of noncompetitive black markets can elicit paradoxical outcomes. Therefore, we argue that instead of searching for assumptions that lead to paradoxical outcomes, which is the direction the literature has taken, it is better for policy analysis to choose appropriate assumptions for the textbook model. We finish with performing such an analysis for the case of banning menthol cigarettes. Under the most plausible assumptions enforcement will indeed spur violence, although the legal availability of electronic cigarettes may mitigate or reverse this conclusion.


Trends and characteristics of heroin overdoses in Wisconsin, 2003-2012

Jon Meiman, Carrie Tomasallo & Leonard Paulozzi
Drug and Alcohol Dependence, forthcoming

Background: Heroin abuse has increased substantially during the past decade in the United States. This study describes trends and demographic shifts of heroin overdoses and heroin-related fatalities in Wisconsin and contrasts these with prescription opioid overdoses.

Methods: This study was cross-sectional using databases of emergency department (ED) visits, hospital admissions, and death certificates in Wisconsin, United States, during 2003-2012. Cases were Wisconsin residents treated for heroin or prescription opioid overdose, and residents who died of heroin-related drug poisoning. Primary measurements were rates over time and by geographic region, and rates and rate ratios for selected demographic characteristics.

Results: During 2003-2012, age-adjusted rates of heroin overdoses treated in EDs increased from 1.0 to 7.9/100,000 persons; hospitalized heroin overdoses increased from 0.7 to 3.5/100,000. Whites accounted for 68% of hospitalized heroin overdoses during 2003-2007 but 80% during 2008-2012. Heroin-related deaths were predominantly among urban residents; however, rural fatalities accounted for zero deaths in 2003 but 31 (17%) deaths in 2012. Among patients aged 18-34 years, those hospitalized with heroin overdose were more often men (73.0% versus 54.9%), uninsured (44.2% versus 29.9%), and urban (84.3% versus 73.2%) than those with prescription opioid overdose. Rates of ED visits for heroin overdose in this age group exceeded rates for prescription opioid overdose in 2012 (26.1/100,000 versus 12.6/100,000 persons, respectively)

Conclusions: An epidemic of heroin abuse is characterized by demographic shifts toward whites and rural residents. Rates of heroin overdose in younger persons now exceed rates of prescription opioid overdose.


Secondhand Smoke Exposure and Other Correlates of Susceptibility to Smoking: A Propensity Score Matching Approach

Russell McIntire et al.
Addictive Behaviors, September 2015, Pages 36-43

Secondhand smoke (SHS) exposure is responsible for numerous diseases of the lungs and other bodily systems among children. In addition to the adverse health effects of SHS exposure, studies show that children exposed to SHS are more likely to smoke in adolescence. Susceptibility to smoking is a measure used to identify adolescent never-smokers who are at risk for onset of smoking. Limited research has been conducted on the influence of SHS on susceptibility to smoking. The purpose of this study was to determine a robust measure of the strength of correlation between SHS exposure and susceptibility to smoking among never-smoking U.S. adolescents. This study used data from the 2009 National Youth Tobacco Survey to identify predictors of susceptibility to smoking in the full (pre-match) sample of U.S. adolescents and a smaller (post-match) sample created by propensity score matching. Results showed a significant association between SHS exposure and susceptibility to smoking among never-smoking U.S. adolescents in the pre-match (OR = 1.47) and post-match (OR = 1.52) samples. The odds ratio increase after matching suggests that the strength of the relationship was underestimated in the pre-match sample. Other significant correlates of susceptibility to smoking identified include: gender, race/ethnicity, personal income, smoke-free home rules, number of friends who smoke, perception of SHS harm, perceived benefits of smoking, and exposure to pro-tobacco media messages. The use of propensity score matching procedures reduced bias in the post-match sample and, in effect, provided a more robust estimate of the influence of SHS exposure on susceptibility to smoking, compared to the pre-match sample estimates.


The interest in eight new psychoactive substances before and after scheduling

Anders Ledberg
Drug and Alcohol Dependence, forthcoming

Background: In recent years the recreational use of new psychoactive substances (NPS) has increased. NPS are considered a threat to public health and the main response to this threat is to make the selling and buying of these substances illegal. In Sweden, during the last five years, 62 new substances have been classified as narcotics but little is known of the effects of making a particular substance illegal. The aim of this work is to study how legal status influences the interest in NPS in Sweden.

Methods: Forty-five thousand posts made in a Swedish Internet discussion forum (Flashback Forum) related to eight NPS (MDPV, Methylone, 4-MEC, 4-HO-MET, MXE, 6-APB, AH-7921, and 3-MMC) were used to derive time-dependent measures of interest in these substances. Intervention analyses were used to investigate the effects of legal status on the forum interest.

Results: For all eight substances the activity on the forum (measured as number of posts per day) showed a drastic decrease around the time of classification. The statistical analysis showed that in seven of eight cases, the drop in activity could be accounted for by the legal status of the substances.

Conclusions: The legal status of the substances was shown to have a substantial effect on the interest in the substances. The novel measure used to trace the interest in particular NPS could be a useful tool to follow trends in substance use in almost real-time.


Impact of a U.S. antismoking national media campaign on beliefs, cognitions and quit intentions

Jennifer Duke et al.
Health Education Research, June 2015, Pages 466-483

In 2012, the Centers for Disease Control and Prevention launched a national tobacco education campaign, Tips From Former Smokers, that consisted of graphic, emotionally evocative, testimonial-style advertisements. This longitudinal study examines changes in beliefs, tobacco-related cognitions and intentions to quit smoking among U.S. adult smokers after a 12-week airing of the campaign (n = 4040 adult smokers pre- and post-campaign). Exposure to the campaign was associated with greater odds of intending to quit within the next 30 days [odds ratio (OR) = 1.28, P < 0.01] and within the next 6 months (OR = 1.12, P < 0.05), and quit intentions were stronger among respondents with greater campaign exposure (OR = 1.12, P < 0.01). Campaign exposure was also associated with significant changes in beliefs about smoking-related risks (ORs = 1.15-2.40) and increased worries about health (b = 0.30, P < 0.001). Based on study change rates applied to U.S. census data, an estimated 566 000 additional U.S. smokers reported their intention to quit smoking within the next 6 months as a result of viewing campaign advertisements. Campaign effects were consistent with the theory of reasoned action and an expanding body of research demonstrating that graphic, emotional advertisements are highly effective for prompting positive cessation-related cognitions and behavioral intentions.


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