HealthLawProf Blog

Editor: Katharine Van Tassel
Case Western Reserve University School of Law

Monday, July 25, 2005

Stop Smoking! The Good News and the Bad News

The New York Times has several pieces on smoking.  The first article discusses a surefire way to stop smoking among teens and other Americans  -- raise taxes on the cigarettes.  The Times reports,

Sometimes the government and advocacy groups have used straight talk, like Nancy Reagan's "Just Say No" campaign. Other times they have tried to play it cool. They drop an egg into a sizzling frying pan and announce, "This is your brain on drugs," or they print mock advertisements that pretend to market cancer. It all feels like a delicate exercise in adolescent psychology.

Much of this back and forth is unnecessary. There is in fact a surefire way to get teenagers to consume less beer, tobacco and drugs, according to one study after another: raise the cost, in terms of either dollars or potential punishment.

In just about every state that increased beer taxes in recent years, teenage drinking soon dropped. The same happened in the early 1990's when Arizona, Maryland, New Jersey and a handful of other states passed zero-tolerance laws, which suspend the licenses of under-21 drivers who have any trace of alcohol in their blood. In states that waited until the late 90's to adopt zero tolerance, like Colorado, Indiana and South Carolina, the decline generally did not happen until after the law was in place.

Teenagers, it turns out, are highly rational creatures in some ways. Budweisers and Marlboros are discretionary items, and their customers treat them as such. Gasoline consumption, by contrast, changes only marginally when the price of a gallon does.

"When people think about drugs, alcohol, even cigarettes, they think about addiction and this strong desire to consume them. They don't think price has an effect," said Sara Markowitz, an economist at Rutgers University in Newark, who studies public health. "That's just wrong. And it holds among kids even more so than among adults."

Unfortunately, it turns out that decreased smoking has been partially responsible for another public health problem - obesity.  Oops!  The Times reports in a second article, 

The obesity epidemic isn't just a growing health risk; it's also a problem for the economy. The percentage of Americans over 20 who are regarded as obese has more than doubled, to about 30 percent, from about 14 percent in the early 1970's. And the Centers for Disease Control and Prevention says obesity was responsible for 112,000 premature deaths in 2002, and for $75 billion in medical costs in 2003.

But as the United States lost the battle against the bulge, it waged a more successful campaign against another menace to public health: smoking. Because of an aggressive public information campaign, new restrictive laws and huge increases in federal and state taxes, the percentage of the population that smoked fell to 22.5 percent in 2002, from 37 percent in 1970.

Strange as it may sound at first, many economists and health care experts say they believe that the two trends may be related. Experts blame factors ranging from urban sprawl to junk-food-laden diets for the increase in the number of Americans who are obese - defined as having a body mass index of over 30.

But smoking, or the decline of smoking, may also play a role. Nicotine is a stimulant, which means that smokers burn calories faster. And it's an appetite suppressant, which means that smokers eat less. Consider "French Women Don't Get Fat," the best selling book. Some critics said that the real reason chic Parisian women stayed trim while gorging themselves on croissants was that they smoked more than their American counterparts.


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