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Sunday, 16 October 2011

Cigarette Smoking

Introduction


 


Cigarette smokers are known to be more frequently involved in driving accidents; it has been found that extraverts tend to be more frequently involved in driving accidents than are introverts. It has been found that divorced people tend to smoke more whereas single people tend not to smoke; we have already noted that introverts tend to marry less and extraverts to be more frequently involved in a change of marital partner. It has been found that people who change jobs frequently tend to smoke more; again extraverts are known to change jobs more frequently. Several studies have tended to show that people who are relatively unsuccessful academically, both at school and university, tend to smoke more; it has also been found that introverts are more successful at school and at university. People who smoke a lot have been found to be ‘chance oriented’; this agrees well with the findings that extraverts tend to be impulsive.


 


Many European studies have also been concerned with neuroticism or emotionality, and it must be said that here agreement is much less obvious. Most of the European studies have found a positive relationship between smoking and neuroticism. Admittedly many of these studies were carried out on relatively small groups, and in most cases groups chosen were quite unrepresentative. Nevertheless, the amount of agreement reported must make one cautious of dismissing these results. The European report summarizes the findings in the following sentence: ‘Despite the individual deficiencies of many of the studies, despite the great diversity in conceptualization and research methods used and despite discrepancies in reported findings the presence of some comparability between them and the relative consistency of findings lend support to the existence of a relationship between the smoking habit and a personality configuration that is vaguely described as “neurotic”.’ The tortured structure and syntax of this sentence adequately indicate the difficulty which the authors had in coming to a conclusion on this point; it must be left to further research to say whether the difference between our findings and those mentioned are due to national differences between England and America or whether there is some other cause for the discrepancy.


 


Smoking in United Kingdom


 


Cigarette smokers are known to be more frequently involved in driving accidents; it has been found that extraverts tend to be more frequently involved in driving accidents than are introverts. It has been found that divorced people tend to smoke more whereas single people tend not to smoke; we have already noted that introverts tend to marry less and extraverts to be more frequently involved in a change of marital partner. It has been found that people who change jobs frequently tend to smoke more; again extraverts are known to change jobs more frequently. Several studies have tended to show that people who are relatively unsuccessful academically, both at school and university, tend to smoke more; it has also been found that introverts are more successful at school and at university. People who smoke a lot have been found to be ‘chance oriented’; this agrees well with the findings that extraverts tend to be impulsive. Last it has been found that on various personality questionnaires of gregariousness, social introversion, and the Pd scale of the M.M.P.I. smokers score in the extraverted direction. All these findings come from European studies and they all support the generalization that cigarette smoking is correlated with extraversion.


 


Many European studies have also been concerned with neuroticism or emotionality, and it must be said that here agreement is much less obvious. Most of the European studies have found a positive relationship between smoking and neuroticism. Admittedly many of these studies were carried out on relatively small groups, and in most cases groups chosen were quite unrepresentative. Nevertheless, the amount of agreement reported


 


The consumption of cigarette and tobacco products in United Kingdom is modelled using the rational addiction theory of Becker and Murphy, augmented by data on advertising, regulatory intervention, and demographic factors. Over the past 35 years, price (including tobacco taxes), real income, and demographic effects explain most of the variation in tobacco consumption. Advertising by tobacco companies has had a relatively small direct effect on consumption. Work-place smoking bans and health warnings on cigarette packs have had a relatively minor impact, while antismoking advertising and bans on electronic media advertising have had no detectable direct effect.


 


The cigarette and tobacco consumption in United Kingdom over the period from 1962/63 to 1995/96 and to understand the effect of government policies aimed at reducing cigarette and tobacco consumption. In order to isolate the effects of government intervention, it is necessary to understand all the other factors that have also influenced consumption. The approach that we adopt is based on   (1988) rational addiction model.


 


In United Kingdom, as in many other countries, smoking has been a major public health concern in recent decades. It is the leading cause of preventable morbidity and premature death in United Kingdom and is responsible for over half of all drug-caused hospital bed days (1995). Approximately 15 per cent of all recorded deaths in United Kingdom can be attributed to tobacco related causes such as lung cancer, coronary heart disease and chronic bronchitis and emphysema. Habitual smokers (those who consume at least one packet a day) have their average life expectancy reduced by around six years (1993). In response to these public health concerns, a variety of anti-tobacco public policies have been implemented in United Kingdom. These policies include a mixture of taxation measures, provision of public health information and health warnings, and prohibitive actions. In addition, public funds have been used for a number of years to sponsor anti-smoking advertising campaigns. The amount of money devoted to these campaigns has been quite small relative to the amount spent on pro-tobacco advertising by the tobacco companies themselves. Nevertheless, the anti-smoking campaigns have achieved a reasonably high profile, particularly since the gradual phasing in of pro-tobacco advertising bans. Advertising by tobacco companies is now almost totally prohibited, the only exceptions being point-of-sale advertising and incidental advertising associated with tobacco companies’ sponsorship of major sporting events. Other government interventions include a requirement that cigarette and tobacco packaging carry prominent warnings of the dangers of smoking, and a ban on smoking in many public places (including on aircraft, on public transport, and in all government office buildings). Fiscal initiatives have also been important: around 65 per cent of the retail price for a pack of cigarettes is now accounted for by the Federal excise duty and State licence fees (1995). As a consequence, the real price of cigarette and tobacco products has increased by over 175 per cent over our sample period.


 


The effect of these policies and quantify the relative contribution that each intervention has made to changes in cigarette and tobacco consumption. We also consider the possible countervailing effect of advertising and promotion by tobacco companies. Tobacco producers have argued that industry advertising has little impact on the total size of the market, and that the main effect of their advertising is on market share (1992). If this claim is true, then the public health case for advertising bans would be considerably weakened.


 


The data include information on prices, taxes and consumption as well as advertising expenditure by tobacco sellers, expenditure on anti-smoking advertising and education, and major regulatory changes. We also consider the influence of the changing age structure of the population over the sample period.


The analytic framework that we use is Becker and Murphy’s (1988) model of rational addiction. This model takes into account, in a straight-forward way, the intertemporal dependence of preferences that is characteristic of addiction. It is sufficiently general to accommodate a wide range of dynamic behaviours associated with addictive consumption ( 1992). The Becker-Murphy model has now been successfully applied to a number of addictive commodities, including tobacco, gambling and caffeine ( 1991, 1993, 1996). The fact that tobacco-delivered nicotine is physiologically addictive reinforces the potential usefulness of the Becker-Murphy framework to model cigarette and tobacco consumption.


 


The history of tobacco consumption in United Kingdom shows several distinct phases. Consumption prior to 1939 was relatively static with a slight increase in the years following World War I offset by a fall in demand during the Depression. Consumption jumped noticeably under war-time conditions between 1940 and 1945, when cigarettes were readily available to the military, and then grew strongly in the post-war decades. Consumption peaked in the 1960s, and then began to fall quite rapidly after about 1975. There are a number of factors which may have contributed to this fall in consumption. During the late 1950s and early 1960s it gradually became apparent that there is a connection between smoking and health, culminating in the 1964 statement by the US Surgeon General. In response to these health concerns, State and Federal taxes on tobacco increased steadily. As a result, the real price of cigarettes increased, rising quite rapidly after 1982.


 


As well as increasing taxes, the government has progressively restricted advertising by the tobacco industry. A ban on cigarette and tobacco advertising in the electronic media was phased in over the period September 1973 to September 1976, with allowances made for ‘accidental or incidental’ exposure of tobacco products as a result of the sponsorship of sporting or cultural events. By April 1996, even this loophole was closed. Over time, the prohibition has been extended to other forms of advertising. The print media were targeted in legislation enacted in 1989 while advertising on billboards, illuminated and other outdoor signs has been banned since the beginning of 1996. Point-of-sale advertising is still allowed.


 


Government funded anti-smoking campaigns date back to the period 1972 to 1975 when a Federal government initiative, the ‘National Warning against Smoking,’ was implemented. Since 1983, anti-smoking campaigns have been conducted with funding from both State and Federal governments. The most notable of these campaigns have been carried out by the Quit organization, which provides a variety of resources (primarily educational) to encourage a reduction in tobacco consumption. This is reinforced by high-profile print and television advertising campaigns, and sponsorship of sporting programs. However, these expenditures have been quite small relative to the amounts that have been spent by the tobacco companies on advertising. In real per capita terms advertising expenditure has, on average, been more than 20 times higher than anti-smoking expenditure.


 


In addition to placing restrictions on advertising, the government has directly regulated cigarette smoking in various other ways. From 1972, a mandatory health warning has been required on cigarette packs. Federal workplaces have been required to be smoke-free since 1986, and smoking has been banned on aircraft since 1987. Demographic effects are also likely to have had an important influence on consumption. A casual examination suggests that the decline in consumption over recent years may be due in art to the diminishing size of the population who became heavily addicted to tobacco during and after World War II. Over our sample period, the proportion of the total adult population who were of adult age in 1940 has fallen from being half the population to now comprising less than 10 per cent of the population. In addition, smoking propensities vary across ages and genders and that this has changed over time. In 1945, 72 per cent of men and 26 per cent of women in United Kingdom smoked; by 1992 these proportions were 28 per cent and 24 per cent respectively (1995).


 


Tobacco consumption in United Kingdom peaked in 1969/70. Since that date consumption has fallen by about 60 per cent, the price of tobacco products (including taxes) has increased by 174 per cent, real income has increased by 39 per cent, and the ‘baby boomers’ have moved through into middle age. Government has increasingly intervened to discourage tobacco consumption. How important have these factors been in explaining cigarette and tobacco consumption? The Becker-Murphy model describes a dynamic process in which consumption adjusts over time towards a steady state value. This steady state is the long-run value at which consumption would settle if prices, income and all other influences were henceforth kept fixed through time. As policy shifts the underlying parameters, the location of the steady state will change. Movements In the observed data are thus due to a combination of drift towards the steady state and shifts of the steady state. From a policy point of view the steady state is more important than the transient adjustment dynamics, and we concentrate here on explaining how and why this steady state has shifted over time.


 


The result of simulation experiments which illustrate how changes in the various explanatory variables have shifted the steady state consumption through time. In each case, one explanatory variable is singled out and allowed to take its actual historical values. All other explanatory variables are held frozen at their 1963 values. The cumulative effect of income changes, of price changes (including taxes), and of demographic changes. Each of these has had an important effect. Consumption has been driven up by rising real income, and it has been driven down by tax and price increases, especially during the last decade. Consumption is sensitive to the age structure of the population, increasing as the population ages.


 


The effect of advertising, workplace bans and health warnings, it is immediately apparent that the effect of these influences is an order of magnitude less than the effects of income, price and demographics. Contrary to tobacco industry views, industry advertising (holding prices fixed) does appear to have increased consumption. In 1972 up to 7 per cent of aggregate consumption may be attributed to advertising. However we are unable to detect any significant effect of the form of advertising. Beginning in 1973, advertising in the main electronic media was virtually banned, but the coefficient related to this event is not significant. The impact of industry advertising falls to zero after 1993, when most advertising was banned. The effect of advertising must be interpreted with considerable care. It can be argued that, as well as shifting demand, industry advertising may also increase price (by facilitating product differentiation). This price effect (which is held constant at zero in this simulation) would be expected to act in the opposite direction to the demand shift, tending to reduce consumption. Our analysis of advertising impact holds prices fixed, so it provides an upper bound on the effect of advertising. Therefore, it is not clear whether the total effect of advertising, when any price effects are included, has been to increase consumption significantly.


 


Health warnings on cigarette packs have caused a statistically significant but very small decrease in consumption. Smoking bans in public spaces and in the workplace has reduced consumption by about 5 per cent since they were introduced in 1989. Anti-smoking advertising (the Quit campaign) and education have had no detectable direct effect on aggregate consumption; we discuss below whether they may have had an indirect effect. One message is clear. Compared to price, income and demographic influences, the effect on aggregate consumption of industry advertising and of direct regulatory intervention has been small. The combined effect of all these explanatory variables. The predicted steady state tracks the actual values quite closely.


 


The estimates of short- and long-run price elasticities. These elasticities are calculated at the steady state consumption value at each date. The short-run price elasticity appears to be about –.2 throughout the first 20 years of the data, but then as prices increase and consumption falls it rapidly becomes more elastic. It is natural to ask whether this is a real effect or an artefact imposed by the choice of functional form. The functional form that we have used, following (1991), is a flexible quadratic approximation to the true utility function which should fit well close to the steady state saddle point. In fact,  consumption throughout the period does appear to have remained quite close to the steady state value. We thus conclude that the shifting elasticity estimate is unlikely to be driven by the functional form. There is, in fact, evidence of a change in market structure consistent with a change in elasticities. Product differentiation has increased, pack sizes have increased, a series of price wars has been observed, and margins appear to have decreased ( 1995). These changes are consistent with a decrease in oligopoly rent in the industry and an increase in demand elasticity. The increase in elasticity may be associated with regulatory bans on product-differentiating advertising


 


There is strong support for the Becker-Murphy rational addiction model of aggregate consumption over this period. Current consumption is affected by past and anticipated future consumption, and price and income are both significant. All of the sign restrictions implied by the model are satisfied. The steady state consumption implied by the model tracks actual consumption quite closely.


The estimated model is consistent with quite rapid decay of the addictive stock. It cannot reject the hypothesis that the addictive stock has fully depreciated within a year. However this short-lived physical addiction, when coupled with the consumption feedback, drives a long-lived economic addiction. Long-run elasticities are around 2.7 times as large as short-run elasticities.


Most of the variation in consumption has been driven by price (including taxes), by income and by demographic effects. The model suggests that, other factors being held constant, consumption will rise as the population ages and as real incomes rise. This suggests that if current tobacco tax and regulatory policies are held constant, then consumption may begin to rise again in the future.


The effects of industry advertising and regulatory intervention are relatively small. Advertising bans reduce consumption, but the effect is small and may be over-stated if price effects are considered. Health warnings on cigarette packs reduce consumption by a detectable but very small amount. ‘Quit’ anti-smoking education and advertising has had no detectable direct effect (but see below). Work-place smoking bans have reduced consumption by about 5 percent since their introduction, but there is limited scope for further reductions as around 66 per cent of the population is now subject to work-place bans.


 


Virtually all of the reduction in tobacco consumption can thus be attributed to tobacco taxes. Income growth and demographic effects have tended to increase consumption, and direct regulatory intervention has had a very small effect. It is tempting to conclude that direct government interventions (other than tobacco taxes) have been ineffective, but we consider that such a conclusion may be premature. It could be argued that anti-smoking education and other interventions, while having only a small direct effect, may have created a climate in which government has been able to raise tobacco taxes to unprecedented high levels. It is also important to remember that we are considering only aggregate consumption. There may be particular groups within the population where these interventions are more effective than is evident in aggregate data.


 


The implication for United Kingdom is that if tobacco consumption is to be held at current levels, taxes on tobacco must remain high. As incomes increase and the population ages, even higher taxes may be required to counteract income and demographic effects. Regulatory restrictions of advertising and consumption can be expected to play a secondary role. Whether it is socially desirable to restrict tobacco consumption is of course another question, which we do not consider here. It would be interesting to know whether these conclusions apply to other economies and to other societies. Tobacco-related public health issues are important in United Kingdom and other developed countries. They are even more important throughout the less developed world. If our findings apply to these societies, then income growth and demographic transition may lead to a significant worldwide increase in tobacco consumption and in tobacco-related public health problems.


 


Health Inequalities


 


In the United Kingdom, equity in the health sector has also been a common topic for debates. Issues regarding health inequalities have been argued in the UK since the 19th century ( 1995). Similar to the United States setting, the prevalence of health inequalities in the United Kingdom has been related to socio-economic differences among various ethnic minority groups in the society as well as among the individuals within these groups ( 1999; 1995).


In terms of behavioural processes, the attitudes and outlook of the poor appear to affect their health status as well. In particular, their lack of education seems to cause their negligent behaviour towards the administration of proper medical care.


            Indeed, literacy levels as well as the education process obtained by the poor affect their health status in one way or another ( 1995). The significant impact of the education process on the health status of the poor has been evident among minorities and various cultural groups. Due to poor income, the poor are unable to gain a high level of education. This in turn lowers their awareness on proper medical attention and health care. The relative lack of education certainly tends to promote poor understanding of preventive health care as well as less sophistication in drawing appropriate and timely benefits from the health care systems. The behavioural make up of the poor towards health and care have been established through their unawareness and illiteracy.  In addition to negligence, the hardships, insufficiency and difficulties brought about by poverty affects how people behave and act. Thus, in most cases, the poor have higher rates of violent behaviour, alcoholism, physical and mental illness, drug addiction and drug addiction.


Poverty is a broad term which can be defined and understood in many ways. While people would normally relate poverty as a state of having insufficient resources to provide for daily need, various authors have also given their own definitions. In general, poverty is defined as the situation wherein resources are depleted, making the person unable to interact or participate socially. At varying levels, poverty has been a condition observed in all parts of the world.


            Indeed, poverty has been a growing problem worldwide. Yet, in spite of the problem’s worsening status, a solution is yet to be identified. Meanwhile, a growing number of people under the poverty line suffer from this economic and social problem. While poverty has led to several difficulties and challenges, the health status of the poor have been recognized as among the major concerns.


Several processes have affected the health status of the poor. One of which is the psychological process that has emphasized on the increasing inequality between the rich and the poor. The effect of behavioural process brought about by low literacy levels has also affected the poor people and their health. Due to lack of education, the poor people have been negligent on the significance of being medically aware. The inadequate levels of education poor people receive make them behave in a way that makes them disregard the importance of good health and proper medication. Moreover behavioural impact of poverty tends to make poor people subject themselves to alcoholism, addiction and other violent acts. Child poverty in Britain affects several children physiologically. Due to lack of resources, poor children are likely to experience poor cognitive development and physical growth.


            While poverty continues to be a problem and the health status of the poor is still affected, certain movements, policies and plan of actions can be helpful to alleviate these effects. The government for instance should coordinate with various health departments for better healthcare programs, reforms and services for the poor. Education for the poor and health awareness should be prioritized as well. Efforts to eradicate child poverty should be extended as well. Poverty may appear to be difficult to solve considering the uncontrollable factors that cause it. Nonetheless, ways and means may be developed in order to resolve it.


 


 


 


 


 



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