Wednesday, January 04, 2006

Why stopping smoking is hard

Every January perhaps as many as half a million people resolve to give up smoking. By the start of each February most of them are back on the cigarettes again. If, like me, you never started, thank your lucky stars. The latest economic research suggests that it's far more difficult to give up than had previously been believed.

Even people who think they are giving up may be filling their bodies with just as much nicotine as before. And some of the measures designed to cut back smoking and protect the rest of us may be counterproductive.

Each year 11,000 Australians take part in a survey run by the Melbourne Institute of Applied Economic and Social Research and originally designed to measure changes in income and working arrangements. It also asks participants whether they smoke.

Last year two of the institute's researchers, Hielke Buddelmeyer and Roger Wilkins, looked for common threads linking those Australians who had succeeded in giving up smoking between one survey and the next. The biggest was pregnancy. The biggest thread linking those Australians who had taken up smoking was divorce.

Then they examined the effect of the extra bans on smoking in public places introduced in some states... They found that while these encouraged older Australians and the very young to quit, people aged 18 to 24 were actually less likely to quit in those states in which a ban had been introduced.

This "rebellion" effect appears to pop up all over the place when it comes to fighting smoking. It had been thought that increasing the price of cigarettes would cut the number sold and improve the health of smokers. It certainly cuts the number sold. In Australia, a price increase of 10 per cent cuts sales by about 4 per cent. But a price increase doesn't necessarily cut the amount of nicotine taken into smokers' bodies.

Late last year an economist, Francesca Cornaglia, decided to measure nicotine levels directly, or as directly as she could. Continine is a byproduct of nicotine, present in saliva. With a colleague from the Institute for Fiscal Studies at University College London, she linked records of continine concentrations state by state in the United States with information on the number of cigarettes sold per person and their price.

She found that while increases in cigarette taxes did cut the number of cigarettes sold, they appeared not to cut at all the level of continine in smokers' saliva. As she put it: smokers were smoking fewer cigarettes but were smoking each one "more intensively".

Smokers appear to adjust by having more puffs from each cigarette, inhaling for longer and (perhaps subconsciously) blocking the ventilation holes on the filter. (Interestingly she found that so-called heavy smokers may not be smoking that heavily at all. After about 10 cigarettes a day, they smoke each extra one far less intensively in order to merely top up their nicotine levels while avoiding an overdose. They appear to have an inbuilt nicotine regulation mechanism.)

Cornaglia found that smoking intensity increased throughout the 1990s as cigarettes became more highly taxed, and that this itself may be a health hazard. Smoking down to the filter leads smokers to inhale more dangerous chemicals. And she found that it's the poorer, mainly black Americans whom higher prices have forced to smoke the most intensively.

Cornaglia then turned her attention to the level of continine in the saliva of non-smokers. Her findings have made her particularly unpopular among those who would like to ban smoking everywhere they could. She presented them to economists at the Australian National University in November.

She found that increases in the tax on cigarettes improve the saliva of non-smokers quite dramatically, especially the saliva of children exposed to their parents' smoke. Throughout the 1990s the number of non-smoking Americans taking in dangerous levels of nicotine halved. Higher cigarette prices improve the health of the rest of us.

But when it comes to banning smoking, a more complex picture emerges. Banning smoking on public transport, in shopping centres and in schools appears to improve non-smokers' health. But banning it in places where smokers "go out", such as restaurants and bars, makes the health of non-smokers worse. It pushes smokers away from those establishments and back into their homes where they pump smoke into the air breathed by their children and loved ones.

Cornaglia suggested a better public health measure would be to allow the creation of special smoking establishments where smokers could breathe smoke over each other. It is a suggestion unlikely to cut ice with NSW's crusading Minister for Cancer, Frank Sartor.

From mid-next year all areas of all hotels, clubs and nightclubs open to the public will be completely smoke-free. Smoking in the indoor areas of cafes and restaurants was banned in 2000.

But Cornaglia said it is more important to protect the health of children at home than the health of the non-smoking adults who choose to go into smoking establishments. Children at home have no say in their exposure to smoke, they are particularly prone to tobacco-related diseases, and if they are exposed they may do worse at school and earn less in later life.

As uncomfortable as her arguments may be to anti-smoking zealots, they are unlikely to be welcomed by the cigarette manufacturers. They have been arguing for years that second-hand smoke at home does no damage.

The latest economic research on smoking provides little comfort to anyone, and certainly not to anyone trying to give up as part of a new year's resolution. Short of getting pregnant there's no particularly successful way to do it, and merely cutting back won't make all that much difference to your health.

The best advice from the economics profession is to go cold turkey. Little wonder it's called the dismal science.