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CENTURY
Yale University
School of Medicine
SAC-203
Connecticut
Mental Health Center
34 Park Street
New Haven, CT 06519

Phone:
203-974-7591

Fax:
203-974-7606

E-mail:
infocentury@yale.edu

CENTURY/TTURC Press Release

New Haven, Conn. - New Haven, CT – When someone pays for cigarettes in rural China, they often are doing so at the expense of other critically important household needs, including food, utilities and education, according to a study by Dr. Hong Wang, Ph.D., M.D., a professor at the Yale School of Public Health.

The study, published in the March 2006 issue of Social Science & Medicine, says that smoking in rural China has a big effect on families by siphoning money away from other areas that could benefit the family. Dr. Jody Sindelar, professor and head of the
Division of Health Policy & Administration at the Yale School of Public Health, and Dr. Susan Busch, an assistant professor at the Division of Health Policy and Administration at the Yale School of Public Health, are co-authors on the study.

“We find that tobacco expenditure … crowds out other expenditures,” says the study. “The crowd-out of these expenditures through tobacco consumption could have negative impacts on the well-being of individuals and families, as well as the economy as a whole through reduced investment in human capital and farming.”

“Smoking is not only an unhealthy behavior which has long-term impact on health through biological pathways, it also is an expensive addiction,” the study says. “Given resource constraints, spending on tobacco has an opportunity cost because other desired goods or services must be forgone.”

Dr. Wang, who is an assistant professor in the Division of Global Health at the Yale School of Public Health, said he was surprised to find that education was one of the first household expenditures to be sacrificed to pay for smoking.

“It is an astonishing result,” he said. “Education runs number one, in terms of trade off. “This is so surprising because China has a tradition that families take good care of their children, especially now that households have one child. The child is king or queen of the home and education is the most important thing. But if you look at a home where there are heavy smokers, the number one trade off is educational expenditure.”

The problem is made worse by the fact that many heavy smokers are also heavy drinkers, as in other parts of the world, adding to both the health and economic problems in households where there are heavy smokers, he said.

Dr. Wang said the paper has implications for possible policy changes in China. The results argue for accessible and effective smoking cessation programs, he said.

But, the problem is complicated by the fact that China is not only the largest consumer of tobacco in the world, it also is the largest tobacco producer in the world. The smoking rate is about 38 percent, with 67 percent of men and only 4 percent of women reporting being a current smoker, the study says.

1. "The gender differences in smoking patterns imply that men's smoking is crowding out expenditures that could benefit the wife and children" indicated Dr. Sindelar.

“But it’s hard to change behavior on one study,” he said. “Tobacco production in China is a state-run industry.  In the past, nearly 10 percent of tax revenues come from cigarettes. It was the number one source of tax revenue. Those taxes are used for social welfare, road construction, schools. So you can see the dilemma.”

Dr. Wang has been interviewed by the newspaper of China Health News, the leading Chinese newspaper on health that is distributed nationwide in China. He also has provided the information to officials in the Chinese Ministry of Health.

“They think it is good evidence they can use as material to lobby for tobacco control,” he said. “I think it will have some effect.”

Dr. Wang said he plans to do further studies to examine  spending patterns related to tobacco expenditures. He also plans to do research into intervention programs.

“This is important because we want to show how households benefit when people quit smoking,” he said. “If we can successfully reduce people’s consumption, and money is saved and then put to a more productive use, that will be one more piece of evidence for policy makers to consider.”

The citation for the article is: Wang, H., Sindelar, J.L., Busch, S.H. (2006). The Impact of tobacco expenditure on household consumption patterns in rural China. Social Science & Medicine 62, 1414-1426.