Health Selection and the Effect of Smoking on Mortality (original) (raw)
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On the identification of the effect of smoking on mortality
Working Paper Series
This paper considers the identification of the effect of tobacco on mortality. If individuals select into smoking according to some unobserved health characteristic, then estimates of the effect of tobacco on health that do not account for this are biased. We show that using information on mortality, morbidity and smoking, it is possible to control for this selection effect and obtain consistent estimates of the effect of smoking on mortality. We implement our method on Swedish data. We show that there is selection into smoking, and considerable dispersion around the average effect, so that health policies that aim at decreasing smoking prevalence and quantities smoked might have less effect in terms of average number of years of life gained than previously estimated. We also empirically show that selection into smoking has increased over the last fifty years with the availability of information on the dangers of smoking, so that future studies comparing smokers and non smokers will spuriously reveal a worsening effect of tobacco on health if they fail to control for selection.
Selection and the effect of prenatal smoking
Health Economics, 2010
There is a debate about the extent to which the effect of prenatal smoking on infant health outcomes is causal. Poor outcomes could be attributable to mother characteristics which are correlated with smoking. I examine the importance of selection on the effect of prenatal smoking by using three British cohorts where the mothers' knowledge about the harms of prenatal smoking varied substantially. I find that the effect of smoking on the probability of a low birth weight birth conditional on gestation is slightly more than twice as large in 2000 compared to 1958, implying that selection could explain as much as 50 percent of the current association between smoking and birth outcomes.
The Contribution of Smoking to Educational Gradients in U.S. Life Expectancy
Journal of health and social behavior, 2015
Researchers have documented widening educational gradients in mortality in the United States since the 1970s. While smoking has been proposed as a key explanation for this trend, no prior study has quantified the contribution of smoking to increasing education gaps in longevity. We estimate the contribution of smoking to educational gradients in life expectancy using data on white men and women ages 50 and older from the National Longitudinal Mortality Study (N = 283,430; 68,644 deaths) and the National Health Interview Survey (N = 584,811; 127,226 deaths) in five periods covering the 1980s to 2006. In each period, smoking makes an important contribution to education gaps in longevity for white men and women. Smoking accounts for half the increase in the gap for white women but does not explain the widening gap for white men in the most recent period. Addressing greater initiation and continued smoking among the less educated may reduce mortality inequalities.
Journal of Epidemiology & Community Health, 2014
Background A large part of the socioeconomic mortality gradient can be statistically accounted for by social patterning of adult health behaviours. However, this statistical explanation does not consider the early life origins of unhealthy behaviours and increased mortality risk. Methods Analysis is based on 2132 members of the MRC National Survey of Health and Development with mortality follow-up and complete data. Smoking behaviour was summarised by pack-years of exposure. Socioeconomic circumstances were measured in childhood (father's social class (age 4), maternal education (age 6)) and age 26 (education attainment, home ownership, head of household social class). We estimated the direct effect of early circumstances, the indirect effect through smoking and the independent direct effect of smoking on inequality in all-cause mortality from age 26 to 66. Results Mortality risk was higher in those with lower socioeconomic position at age 26, with a sex-adjusted HR (relative index of inequality) of 1.97 (95% CI 1.18 to 3.28). Smoking and early life socioeconomic indicators together explained 74% of the socioeconomic gradient in mortality (the gradient). Early life circumstances explained 47% of the gradient, 23.5% directly and 23.0% indirectly through smoking. The explanatory power of smoking behaviour for the gradient was reduced from 50.8% to 28% when early life circumstances were added to the model. Conclusions Early life socioeconomic circumstances contributed importantly to social inequality in adult mortality. Our life-course model focusing on smoking provides evidence that social inequalities in health will persist unless prevention strategies tackle the intergenerational transmission of disadvantage and risk.
Educational attainment and cigarette smoking: a causal association?y
2008
Background Despite abundant evidence that lower education is associated with a higher risk of smoking, whether the association is causal has not been convincingly established. Methods We investigated the association between education and lifetime smoking patterns in a birth cohort established in 1959 and followed through adulthood (n ΒΌ 1311). We controlled for a wide range of potential confounders that
Death by Lung Cancer or by Diabetes? The Unintended Consequences of Quitting Smoking
2010
In this paper we study one potential unintended consequences that the US anti-smoking campaign might have had: an increase in the average weight of the population. To these ends, we use data from the Behavioral Risk Factors Surveillance System, a large series of independent representative cross-sectional surveys. We construct a synthetic panel that allows us to control for unobserved heterogeneity and we exploit the exogenous changes in taxes and regulations to instrument the endogenous decision to give up the habit of smoking. Our estimates, are very close to estimates issued in the '90s by the US Department of Health, and indicate that a 10% decrease in the incidence of smoking leads to an average weight increase of 2.2 to 3 pounds, depending on choice of specification. In addition, we find evidence that the effect overshoots in the short run, although a significant part remains even after two years.
Start Smoking Earlier, Smoke More: Does Education Matter?
2020
Cigarette smoking as one of the major public health issues has been debated for decades, while little is known about its relation to initial smoking age from the perspective of human capital. This study investigates the long-term effects of initial smoking age on cigarette consumption and the role of education on its effects among male smokers in China, using panel data from the China Health and Nutrition Survey (CHNS) for the period from 1993 to 2015. Considering the time-invariant property of initial smoking age, the Mundlak (MK) estimator and instrumental variable (IV) estimation are applied to control for individual heterogeneity and the endogeneity of education in cigarette consumption. Two institutional changes of the Nine Years Compulsory Schooling Law and the Provisions on the Prohibition of Using Child Labor are used as instruments for years of education. The empirical estimations indicate that initial smoking age has a statistically significant and positive impact on cigarette consumption. Smokers who start smoking before 18 years of age smoke approximately 11% of cigarettes (1.8 cigarettes) more per day than smokers who start smoking after 18 years of age. We also find that education has a negative effect cigarette consumption but its interaction with initial smoking age shows a positive effect on cigarette consumption. This suggests that additional education can reduce cigarette consumption, but this effect is counteracted due to the early starting of smoking. The effect of initial smoking age is robust for rural and urban samples, while the interaction effect is only significant for the rural sample. Our results provide compelling evidence for the importance of early smoking prevention and intervention.
Tobacco Control, 2004
cohort, a random survey of individuals conducted by the US Department of Labor using a stratified multistage area sample design. Results: Regression results show lower net worth is associated with smoking, after holding constant a variety of demographic factors. Respondents who were ever heavy smokers are associated with a reduction in net worth of over 8300whilelightsmokersare8300 while light smokers are 8300whilelightsmokersare2000 poorer compared to non-smokers. Beyond this reduction, each adult year of smoking is associated with a decrease in net worth of $410 or almost 4%. Conclusions: While a causal relation cannot be proven, smokers appear to pay for tobacco expenditures out of income that is saved by non-smokers. Hence, reductions in smoking will boost wealth, especially among the poor.
International journal of epidemiology, 2014
13. Imai K, Keele L, Tingley D. A general approach to causal mediation analysis. Psychol Methods 2010;15:309-34. 14. VanderWeele TJ, Vansteelandt S. Odds ratios for mediation analysis for a dichotomous outcome. Am J Epidemiol 2010;172: 1339-48. 15. VanderWeele TJ. Bias formulas for sensitivity analysis for direct and indirect effects. Epidemiology 2010;21:540-51. 16. VanderWeele TJ. Mediation analysis with multiple versions of the mediator.
Moral Hazard Heterogeneity: Genes and Health Insurance Influence Smoking after a Health Shock
SSRN Electronic Journal, 2021
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