Three essays on the economics of smoking
Each year, more than 9,000 people die from diseases attributable to smoking in Switzerland. This corresponds to 15% of the total number of deaths per year. According to the OECD/WHO report on the Swiss health system, tobacco use is the leading risk factor for disease, as it accounted for 11.2% of total disability-adjusted life years (DALYs) lost in the country in 2002. Intuitively, as human beings, our primary reaction would be to consider these numbers per se as justifications for intervention in the tobacco market, with a substantial reduction in tobacco consumption as the objective. Yet, is any intervention justified in the economic sense? If yes, what is the optimal level of intervention, and what measures are the most effective and, as we must deal with limited resources, cost-effective? Many of these questions remain unresolved. The economic approach benefits from sophisticated analytical instruments, both theoretical and empirical, that have the virtue of providing fairly objective insights into the decision to smoke. <br>This dissertation focuses on the influence of tobacco policies on smoking behavior, on the perception of smoking risks of young individuals, and on the valuation of smoking cessation treatments. It is divided into two main parts. In the first part, I discuss the rationale of analyzing smoking decisions from an economic perspective, based on the specificities of the product. I then briefly present the main models of smoking decisions, and I review the recent literature on the “best-practice” interventions aimed at reducing tobacco use, i.e., price increases, information, advertising bans, smoking bans, and cessation support. The second part consists of three empirical essays related to smoking decisions. The first essay sheds light on the ability of tobacco control expenditures to influence individual smoking decisions. In 2007, in Switzerland, approximately 20 million francs, or 2.6 francs per capita, were spent on non-price policy interventions aimed at reducing tobacco use in the population. While I provide evidence that these resources were effective in increasing the number of quitters, it seems likely that they did not have any significant influence on smoking onset. Besides price increases, tobacco control measures implemented in the last decade hardly influenced smoking participation among youths. Another strategy that could potentially influence the behavior of this population is the dissemination of proper deterrent messages. The second essay specifically looks at the relative importance that young individuals put on the consequences of smoking. I show that apart from lung cancer, reduced life expectancy, and cardiovascular diseases, youths are also concerned by more immediate consequences, such as a reduction of physical capacity and sexual dysfunction. I also show that smoking participation is negatively associated with the level of far-sightedness, defined as the level of concern for long-term health risks. The last essay focuses on smoking cessation. Smokers make repeated attempts to quit and are rarely successful, mainly due to the negative effects of addiction, i.e., physical and psychological craving. One way to improve the cessation rates is to increase the use in the population of an appropriate smoking cessation support. To understand what drives the demand for smoking cessation drugs and how smokers value their potential benefits and disadvantages, I collected data on hypothetical choices and focused on treatment efficacy, minor side effects, price, availability, and ability to prevent smoking-cessation-associated weight intake. I was able to estimate willingness-to-pay for each dimension and for improved medications as a whole and also to point out some individual characteristics that determine the decisions to use such products.
Thèse de doctorat : Université de Neuchâtel, 2011 ; 2194
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