Cutler and Glaeser on Why do Europeans Smoke More Than Americans? Part I

April 26th, 2006

Posted by: Roger Pielke, Jr.

The relationship of scientific research, industry advocacy, government action, and public behavior on smoking is frequently cited in discussion and debate, but I have actually seen little empirical research that backs up the various claims that are often made on this issue. Two Harvard economists, David Cutler and Edward Glaser, have a paper available at the National Bureau of Economic Research that raises some interesting questions about the role of science and advocacy on the smoking issue.

A few points it seems can be taken as fact:

1. smoking is a health hazard
2. The smoking industry for many years engaged in an active campaign to suggest that smoking is not a health hazard
3. Smoking is addictive
4. Smoking rates, and the change in those rates, are different in different parts of the work

Cutler and Glaeser seek to untangle some aspects of this last point by asking “Why do Europeans Smoke More Than Americans?” The answer that Cutler and Glaeser provide it turns out is complicated, and in my view fundamentally flawed. Here is what they claim in their abstract:

While Americans are less healthy than Europeans along some dimensions (like obesity), Americans are significantly less likely to smoke than their European counterparts. This difference emerged in the 1970s and it is biggest among the most educated. The puzzle becomes larger once we account for cigarette prices and anti-smoking regulations, which are both higher in Europe. There is a nonmonotonic relationship between smoking and income; among richer countries and people, higher incomes are associated with less smoking. This can account for about one-fifth of the U.S./Europe difference. Almost one-half of the smoking difference appears to be the result of differences in beliefs about the health effects of smoking; Europeans are generally less likely to think that cigarette smoking is harmful.

Their findings are interesting, among them:

. . . price differences cannot explain why Americans smoke less than Europeans.

While our conclusions thus need to be interpreted with some care, the U.S. does not appear to tax or regulate tobacco consumption particularly highly, making these explanations unlikely to account for the lower smoking rate in the US.

Given that our model suggests a possible non-monotonic relationship between income and cigarette consumption, the lack of a clear consensus on the income elasticity of smoking is not so surprising.

So price, regulation, and income cannot explain the differences in smoking between the U.S. and Europe. Cutler and Glaeser next turn to beliefs about smoking, for which they begin by noting:

The U.S. has one of the highest rates of believing that smoking is harmful; 91 percent of Americans report believing that smoking causes cancer. Given the high proportion of Americans that believe in UFOs and the literal truth of the bible, this must represent one of the most remarkable instances of the penetration of scientific results in the country. Beliefs about the cancer-causing role of cigarettes in some European countries, like Finland, Greece, Norway, and Portugal, are almost identical to those in the U.S., but in other places beliefs are far weaker. For example in Germany only 73 percent of respondents said that they believed that smoking causes cancer.

An interesting aside, if this recent poll is to be believed more people in Europe believe that global warming is a serious problem than believe that smoking causes cancer. By contrast, in the U.S., the opposite is the case. I’m not sure what to make of this, but the answer is surely tied up in the question Cutler and Glaeser are trying to unravel.

Cutler and Glaser then go out on what I think is thin ice when they assemble an argument based on several lines of reasoning to conclude:

On the whole, our evidence suggests that differences in beliefs are the most important factor explaining the differences in smoking between the U.S. and Europe.

One of the most important lines of evidence is presented in their Figure 11, which I reproduce below.

View image

Figure 11 purports to show a relationship between beliefs about smoking and smoking rates. However, the relationship is entirely a function of excluding Greece from the analysis. Cutler and Glaeser argue earlier in their paper why Greece is excluded from the regressions:

When we examine bivariate relationships between smoking and other factors (prices, regulations, or beliefs), it is important to have a relatively homogeneous sample of countries by income. Within Europe, the major income outlier is Greece, with a per capita income that is 60 percent below the European average ($10,607 in Greece versus $25,858 in Europe in 2000) and 25 percent below the next lowest country (Spain, at $14,138). For this reason, we omit Greece from many of our regressions, though we present raw data for Greece in the tables and show the country in the figures.

I find this justification wholly unsatisfactory. Greece, despite its lower income has the highest rate of belief that smoking causes cancer. Greece is also highly regulated, and does not have unusually cheap cigarettes. In short, its inclusion would certainly muddy the analysis. Excluding it, somewhat arbitrarily in my view, does not add any confidence that Cutler and Glaeser have an adequate explanation for what is going on.

What I get from this paper is that in fact, we don’t yet have an adequate explanation for why we see large differences in smoking between the U.S. and Europe. Consequently, if we can’t explain the role of scientific information in smoking, it is safe to say that our understanding of the role of scientific information in societal outcomes on other more complex issues remains frustratingly undeveloped.

In part II I will take a look at trends in U.S. smoking presented by Cutler and Glaeser and suggest a similar lack of understanding.

8 Responses to “Cutler and Glaeser on Why do Europeans Smoke More Than Americans? Part I”

  1. Jim Says:

    Most people in the US believe smoking causes cancer because they know smokers who have come down with cancer. I am not sure if this is the same in Europe, where smoking is a more recent phenomina. It may have less to do with government reports than personal experience.

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  3. Eli Rabett Says:

    To discuss this sensibly, we need data. Here is the data from the US
    which shows that smoking has decreased from ~42% to 21% in the US since 1965. Here is country by country data from Europe
    (the numbers for Germany look high to me, I found other sources where the prevalence for men was ~38%, and there is an East/West difference.

    The data, and especially the extreme differences between the sexes in many of the former Eastern Bloc countries such as the Russian Federation, Belarus, Armenia, etc. points to what may be an important part of the answer: that smoking is associated with hanging out in bars and coffee houses. The banishing of tobacco from these venues stands a good chance of making a huge difference.

    If I wanted to look for an answer, I would survey how many of the smokers smoked in such places. Going to the local cafe is a much more important part of social life in most of Europe than the US.

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  5. Chad Brick Says:

    Could this phenomenon have anything to do with the observation that Americans (especially young Americans) dramatically overestimate the negative health effects of smoking?

    For example, 16-21 year olds believe that a smoker faces a 49% lifetime chance at suffering from lung cancer, while the actual number is between 6 and 13%. Likewise, smokers believe they will lose 9-10 years of life by being smokers, when the actual value is estimated at 3.6-7.2 years.

    There are definitely times when I feel that the anti-smoking crusade (often government-sponsored) crosses the line from providing information into an area of deceptive spin that differs little from the worst of politics. Perhaps this data is a manifestation of these messages. Frankly, as a non-smoker, few things make me WANT to smoke more than some of the most offensive nanny-state propoganda I see sometimes.

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  7. Eli Rabett Says:

    As in everything else you have to deaggregate data when there are complex interactions. This link shows a fair amount of data in a flash format. The problem with Chad Brick’s numbers is that they are (probably) for all smokers who smoked lightly and heavily, started at all ages, and many of whom quit.

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  9. Eli Rabett Says:

    Sorry, I left the link off

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  11. Dano Says:

    “Frankly, as a non-smoker, few things make me WANT to smoke more than some of the most offensive nanny-state propoganda I see sometimes. ”

    Suuuuuuuure, Chad. Righty-o.



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  13. Patrick G. Says:

    I am from Germany and from my personal impressions with smoking and smokers in Germany I can’t say I know anyone who doesn’t know or believe smoking is harmful.

    It seems to me to be much more a subject for social studies, since acceptance of smokers / smoking is pretty widespread in my country, even if they are in a public space or in a minority.

    If you meet in a cafe or restaurant, the only smoker in a group of many will surely light up one without even asking or caring about what other people a the table may think of it.

    Non-Smokers are much more defensive since even asking a smoker to step outside or wait till the food is had is considered rude or at least unfriendly.

    And legislation isn’t that strict at least in Germany, Non-Smoking-Zones in restaurants are voluntary and even at the workspaces there are only lax regulations that most people don’t bother to apply.

    I think the USA is just ahead of Europe there, maybe because the US tabac lobby had their spine ripped out some time ago, sth. I still wait for in Europe.

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  15. Roger Pielke Jr. Says:

    Thanks Patrick G. for this input!