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A Question Many of Us Have Asked While Traveling:

"Why Do Europeans Smoke More than Americans?"

NBER Working Paper No. W12124

Contact: DAVID M. CUTLER Harvard University - Department of Economics, National Bureau of Economic Research (NBER) Auth-Page: http://ssrn.com/author=42210

Co-Author: EDWARD L. GLAESER Harvard University - Department of Economics, John F. Kennedy School of Government, The Brookings Institution, National Bureau of Economic Research (NBER) Auth-Page: http://ssrn.com/author=20261

Full Text: http://ssrn.com/abstract=893779

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.

R. Gould-Saltman (mail):
One of the many things that astonished me about Japan, the first time I went, was the contrast between continuous emphasis on respiratory health (the ubiquitous surgical masks in urban areas, including the availability of custom fit and styled ones in fashionable colors; TV ad after TV ad for health products, exercise machines, etc.) and the relatively chimney-like tobacco use. Apparently, this also caught the collectve eye of the Diet while I was there, since they announced an intention to explore reducing use by taxing cigarettes. . . Anyone know if it happened?



r gould-saltman
5.30.2006 2:41pm
Goober (mail):
Because Europeans are cooler.

Duh.
5.30.2006 2:48pm
John Armstrong (mail):
Admittedly this is a bit of a chicken-egg problem, but might it be due to lower restrictions? You can smoke every-damn-where in Europe, inside or out, and so more people smoke. If people weren't allowed to smoke before, during, and after a meal in a restaurant, would as many people smoke?

The flip side, of course, is that maybe there are fewer restrictions because it's more popular to begin with.
5.30.2006 3:01pm
Jeek:
I never knew how much I appreciated the American restrictions on smoking until I went to Europe a couple of weeks ago. Freaking disgusting! Everyone, everywhere, puffing away. I dozed off in a supposedly non-smoking car on the train, and woke up with my eyes and nose streaming because two smokers had created a mini-tear gas attack. Yech!
5.30.2006 3:06pm
jallgor (mail):
I have always attributed it to the relative success of U.S. media and PR efforts against smoking. I was born in 1973 and I can attest to the fact that as far back as I can remember I have been bombarded with anti-smoking PR. In addition to TV and print adds, the dangers of smoking were covered extensively in every health class I ever had from about 3rd grade on. I don't know if Europeans ever got the same media blitz that we did about not smoking but I am guessing they did not.
5.30.2006 3:09pm
Houston Lawyer:
I think it's because smoking goes so well with the crooked teeth.
5.30.2006 3:14pm
Commenterlein (mail):
(Western) Europe is fast moving in the direction of the U.S. - various kind of smoking bans have been enacted over the last five years in several countries. Give them ten years and it won't look much different.
5.30.2006 3:14pm
brett (mail):
> because two smokers had created a mini-tear gas attack. Yech!

Well, there's part of your answer right there: Hypersensitive Americans are more prone to overreaction.
5.30.2006 3:17pm
Abe Delnore:
You can smoke every-damn-where in Europe, inside or out, and so more people smoke.

But you can't, at least not legally!

Currently the European legal landscape is not so different from that in the USA. Most European countries restrict restaurant smoking to special smoking sections or have banned it entirely.

For my part, I was amazed to go into pubs all over Ireland this year and not find a single smoker. People really do follow the law and go outside to smoke. It makes the whole pub experience much more pleasant.

I was also struck by the size and language of the warnings on cigarette packaging.

So there's certainly no lack of government action. But, these are mostly new initiatives. Maybe in ten years smoking rates will have decreased.

—Abe Delnore
5.30.2006 3:28pm
Richard Aubrey (mail):
They smoke so as to have something to do whilst holding up buildings with their backs. Or wandering up and down whatever part of town is supposed to have the action, watching people who are looking for the action, which is the action.
And if you watch, there is some studied flair--or an attempt thereof--which is an unnecessary addition to simple nicotine consumption.

Busy people don't smoke. And, with the exception of poor Mexicans, nobody is busier than Americans.
5.30.2006 3:29pm
anonymous coward:
Perhaps smoking is reduced by the enactment of shall-carry laws?
5.30.2006 3:31pm
Alex R:
Here's another question that I think is a *very* interesting one: Given the long-observed (at least anecdotally, by dieters and by those quitting smoking) negative correlation between smoking and weight, how much of the US "obesity epidemic" can be explained by the fact that Americans smoke less than Europeans or Asians?
5.30.2006 3:40pm
Ross Levatter (mail):
There IS a famous risk-assessment study by economist Kip Viscusi (I think he was at Harvard at the time) which indicated that if Americans knew the true statistical risks of smoking, smoking would INCREASE 6%.

Both smokers and non-smokers OVERestimated the risks of dying of smoking, though smokers were more accurate in their risk assessment (i.e., less overestimation).

This was largely attributable to the massive "education" provided by our government such that many people think everyone who smokes will die of smoking-related problems.

So perhaps the Europeans are simply less brainwashed than Americans. (Please note I speak as a physician well aware of the risks of smoking and also someone who has never smoked and finds second-hand smoke very unpleasant, but who doesn't feel the need to restrict other peoples' pleasures nor the need, as our former Vice-President might put it, of over-representing the facts of smoking's risk...)
5.30.2006 4:12pm
uh clem (mail):
I think Commenterlein has it. There's been a drastic decline in smoking in America, but it has taken time to spread. 20 years ago most of America was quite smoke friendly. Sometime in the mid eighties "progressive" areas of the country (California, the People's Republic of Ann Arbor, etc.) started restricting smoking, then it spread to the hinterlands. Eventually it will work it's way to Europe - from what I understand it's already underway as I write this.

So, the simplest explanation is that they're just behind the curve.
5.30.2006 4:14pm
Matthew in Denver:
From my experiences in the Netherlands, not only do Europeans smoke more than Americans, but they spoke more hazardous cigarettes. In the US, "light" cigarettes are the norm, while in the Netherlands, I constantly saw people handrolling pure tobacco and smoking without filters (and no - I did not mistake a joint for a cigarette). I don't know if I've ever witnessed an American smoking a cigarette without a filter.

Does anyone have statistics to show whether Europeans get more lung cancer than Americans?
5.30.2006 4:23pm
uh clem (mail):
Several studies have shown that "light" cigarettes are not really any less dangerous than the heavy cigarettes common in Europe. The reason is that smokers adjust their inhalation to ingest roughly the same amount of nicotine regardless of the potency of the actual cigarette. IOW, reduce the nicotine content and the addicts simply inhale more deeply, hold it longer, and smoke more of them.

Moreover, "light" cigarettes are loaded with chemical additives and flavorings which may add to the carcenogenic cocktail in ways that are not well researched. Basically, it's legal to put anything in a cigarette that is approved for food even though burning a substance and inhaling the fumes means that you are ingesting a completely different chemical than the one that has been approved.
5.30.2006 4:35pm
Rodger Lodger (mail):
Note: there seems to be discordance between the article statement that there are more smoking regs in Europe than here, and some of the comments...where is it harder to light up in public, here or there?
Anyway, I was in a Tokyo airport a couple of years ago and they had a little glass walled-off area for smoking...it was air sealed and presumably had special air flow tubes. So help me Hannah, it looked like a parody from SCTV, the people seemed so unhealthy. A couple of men looked like they might be dying right then and there. No women were inside, if memory serves (which it doesn't always....)
5.30.2006 4:40pm
Harry Eagar (mail):
The most interesting part is that consumption goes down as income goes up, unusual behavior for a luxury, no?

I'd like to see the free-marketers explain that one.

Dr. Levatter's idea that Europeans are 'less brainwashed' is hard to square with their laws -- evidently based on sincerely held but insane beliefs -- against GMO corn.
5.30.2006 4:41pm
Stryker:
Did a little research (30-45 secs.) at the WHO site. It seems that MORE europeans smoke (as percentage) but each smokes far less. The numbers of cigs per person in France was around 2100, and in the US, 2600.
I'd guess that the Europeans are more likely to just smoke a couple cigarettes a day, whereas we have more 2 pack a day people. If that is the case, doctors are less likely to come down on their patients.
Smoking is the only habit I know of where they study the effect of 40 "servings" a day for years.
5.30.2006 4:49pm
Stryker:
Harry,

That's easy. The "Rich" don't see it as a wealthy luxury. How's this:
"The most interesting part is that consumption of Natural Ice goes down as income goes up, unusual behavior for a luxury, no?"
That said, there is plenty of troubling activity with big tobacco regarding 3rd world countries.
5.30.2006 4:52pm
Stryker:
citations, a little old, but I don't think the change has been THAT drastic:
http://www.cdc.gov/tobacco/who/usa.htm -- 2600 in '91
http://www.cdc.gov/tobacco/who/france.htm -- 2100 in '91
http://www.cdc.gov/tobacco/who/germany.htm -- 2400 in '91
5.30.2006 5:27pm
chwalker (mail):
Very likely one factor is that a great deal of money has been spent in the US creating intolerance around this unimportant issue.

I don't smoke, myself. I have other reasons for preferring a non-coercive society. Health is important, but it isn't even on the same page, with liberty.
5.30.2006 5:50pm
DK:
I was once stuck for a week with an ill family member in a French hospital outside Paris. The stairwells and elevator waiting areas in the hospital, every day, were clogged with patients smoking. Many of them were on IV's and had rolled their IV's along with them to smoke. None of the doctors or nurses seemed to find that notable or even a problem.

Otherwise, BTW, the medical care in that hospital was fantastic and in some ways better than what I've seen in American hospitals. But that's a pretty big "otherwise".
5.30.2006 5:51pm
Bruce Hayden (mail) (www):
A lot of this sounds like America of yesteryear. I was listening to a Sunday night old radio program a couple of days ago, and was struck by a scene where police are going in to interview a dying woman in a crime investigation. The doctor cautioned the police to put out their cigarettes (in the handy ash tray) before entering the woman's hospital room.

What struck me was how common it all sounded. The police were, of course, smoking, and there were ashtrays in the halls right outside the rooms.

And over Memorial Day, I saw some WWII movies. In the clubs, everyone was smoking. It just came with being sophisticated back then. And you see it in the military too of that era. I remember a number of scenes where the Duke was smoking, as a matter of course.

Now, when you see it in a movie, it is invariably scripted in to make some point. It is no longer a matter of course.
5.30.2006 6:05pm
Bruce Hayden (mail) (www):
In, Summit County, CO, we passed a fairly strict no-smoking ordinance a couple of years ago. A friend of mine, who was originally from Europe, had a bar in Vail, and when I asked him about them replicating the law over the pass in Vail, he responded that they would never pass it there, because there were so many Europeans in Vail. Well, they passed one in Vail this year that, if anything, is even stricter, and it apparently passed with an even bigger margin.

Final note for awhile - the one place that I do see smoking rooms in airports is Salt Lake City. I always found this interesting, given that the LDS Church is still the predominent church there, and have always been strongly opposed to tobacco usage. They aren't quite as bad as the Japanese one described above.
5.30.2006 6:15pm
jimbino (mail):
In 1973, in an elevator at Siemens AG in Munich, I had the pleasure of putting out a German smoker's cigarette with a fully charged selzer bottle. "Rauchen verboten" signs had been posted there and ignored, for years. The poor soaking sucker went on to report me to the Personalabteilung, which had been fully prepared for him by my earlier report to them that the Munich Fire Department had advised me that they would come close down all of Siemens' elevators at the first report of smoking in one! Ha!
5.30.2006 6:22pm
markm (mail):
Harry Eagar:
"The most interesting part is that consumption goes down as income goes up, unusual behavior for a luxury, no?" Stryker gave one answer to that. I think another factor (at least as regards richer and poorer Americans) is that smoking has often been represented as romantically "rebellious". The "rebellious" (in very small ways) kids are far more likely to become addicted to nicotine, and also far more likely to flunk school and wind up working for barely above minimum wage. I have no idea if the same could apply to Europe.

"Dr. Levatter's idea that Europeans are 'less brainwashed' is hard to square with their laws -- evidently based on sincerely held but insane beliefs -- against GMO corn." Being sane and well-informed on one subject doesn't protect you against being brainwashed on a different one.
5.30.2006 6:34pm
jimbino (mail):
The classic case consumption going down with rising income is that of potatoes. Poor people simply eat more potatoes (rice, beans and chitlins, ...). My experience with Europeans was that many, particularly young women, smoked only when taking an occasional beer at a pub. I found that unusual, since I had been used to 2-pack-a-day American smokers.

I also found Europeans to be much less individualistic. This is reflected in their socialist culture that requires the public to pay for all the stupid individual decisions like smoking and making babies (through socialist healthcare, pregnancy leave and tax incentives).
5.30.2006 6:48pm
John Armstrong (mail):
Abe Delnore: I think the difference is, as someone else partly noted, Eastern vs. Western Europe. The bans you mention were nowhere to be seen when I spent a summer in Pest a few years ago. Buda (being more touristy) is a somewhat different story, but that seemed to be voluntary.

On a different note, I am shocked by the blatant identity politics going on in here. "Houston Lawyer" cites the stereotype of crooked teeth. "Richard Aubrey" asserts that Europeans are lazy and have nothing better to do. Can't people make their points without drawing caricatures? What's next: a connection between Japanese smoking and carrying a dozen cameras? I'm almost expecting an assertion that European Jews smoke less than other Europeans to save money.
5.30.2006 6:54pm
Colin (mail):
Jimbino, I'm intrigued. Are you in the habit of carrying a fully, or even partially, charged seltzer bottle at all times? Is this the lighter side of a "must-carry" culture? Or were you merely steeling yourself for an inevitable and satisfying clash of elevator cultures?
5.30.2006 7:01pm
poster child (mail):

On a different note, I am shocked by the blatant identity politics going on in here. "Houston Lawyer" cites the stereotype of crooked teeth. "Richard Aubrey" asserts that Europeans are lazy and have nothing better to do. Can't people make their points without drawing caricatures? What's next: a connection between Japanese smoking and carrying a dozen cameras? I'm almost expecting an assertion that European Jews smoke less than other Europeans to save money.


Actually, the real reason is to cover up all the body odor caused by infrequent showering and failure to observe American norms of personal hygiene.
5.30.2006 7:04pm
KeithK (mail):

The most interesting part is that consumption goes down as income goes up, unusual behavior for a luxury, no?

I'd like to see the free-marketers explain that one.

This doesn't seem difficult to explain to me. I'll postulate that tobacco consumption decreases with education in this country, now that smoking is no longer viewed as "sophisticated". Anecdotal evidence seems to bear this out in my experience. Education and income are positively correlated. So higher income folks may tend to consume less tobacco but not as a direct effect of income but through the education variable.
5.30.2006 7:47pm
Harry Eagar (mail):
I don't consider potatoes as luxury goods in most places, although they are (or were, until the collapse of the world potato market) a slight luxury in Hawaii, where I live. The stores sell rice below cost, but you pay through the nose for potatoes.

If smokes are not a luxury good, then the relentless attempt to curb smoking by raising the taxes on them seems objectionable on at least a couple of grounds -- at least to liberals (regressive taxation) and libertarians (personal conduct). Conservatives, on the other hand, ought to be conflicted (they don't like taxes but they do like sumptuary laws).

I agree, in part, with markm about smoking being rebellious (perhaps not 'romantically,' though), but would emphasize it as a marker of adulthood even more than rebellion.

That could be a pretty fine line. The rebellion could be against still being treated as a 'baby.' I had a woman friend who told me she started smoking and screwing at age 13, in part because she identified herself as a 'bad girl.' The thing about that which surprised me was that she equated the two as equally 'bad' for a 13-year-old. (Must be my Catholic upbringing peeking through.)

In her 30s, she quit smoking and died in her 40s of a sexually transmitted disease.

Smoking is also partly prole chic, like a preference for beer over fine wines in country song lyrics.
5.30.2006 8:55pm
Not a lawyer, but ...:
One difference is that in the United States, advertising of tobacco products on television and radio was banned starting in January 1971. That followed an FCC decision that television and radio stations had to air anti-tobacco ads at no cost ("fairness doctrine"). Even though such ads did not get equal time, they provided sufficiently devasting that the tobacco companies decided the best way out was to abandon such ads (via a Congressional ban, essentially a cartel approach to keep the playing field level, as well as eliminate one marketing approach for new entrants) and to shift dollars to print media, events sponsorship, free samples, etc. Arguably, television and radio (which continued to be used in Europe) were more effective mediums for hooking new users (teenagers), an avenue unavailable in the US starting in 1971.
5.30.2006 10:38pm
Shangui (mail):
Busy people don't smoke. And, with the exception of poor Mexicans, nobody is busier than Americans.

What? Plenty of busy people smoked at lot in the US before the various new regulations in the past 15 years or so. The Japanese, the Koreans, and in many parts of the country, the Chinese are busier than Americans and smoke far more than we do.
5.31.2006 12:37am
Lev:

"Houston Lawyer" cites the stereotype of crooked teeth.


Except in the UK where they have no teeth. Well, no more than one.
5.31.2006 1:18am
M. Simon (mail) (www):
Tobacco is an anti-depressant.

Obviously European Governments are totally depressing. And not just economically.
5.31.2006 2:23am
JGR (mail):
Scotland and Ireland both ban smoking in public places. ("public" is defined to include private property such as restaurants). Individual British cities such as Liverpool also ban smoking in public places. I'm not really sure how this squares with the facts of the article. One explanation is that Nanny State legislation is simply more prevalent in Europe, as is a disregard for property rights. In America, bans on smoking on private property meet at least some resistance from our libertarian heritage, whereas in Europe debates of this type are expressed in Statist terms ("The government has a duty to ban X because X is bad for people").
5.31.2006 2:36am
M. Simon (mail) (www):
Of course comsumption goes down with wealth. The wealthy have fewer worries.
5.31.2006 2:37am
A.C.:
Americans who smoke these days tend to be under 25 or working class. Middle class people seem to quit smoking around the time they start worrying about marriage, retirement schemes, and whether they can afford to buy real estate. It's not just individual choice, either. Existing bosses and potential spouses have real concerns about people who smoke too much, and the social pressure is pretty strong. And that's before you consider the life insurance rates...

Does the same pressure exist in Europe? Do middle class people who acted like maniacs in their teens and early twenties "clean up" once they start to think seriously about adult roles? If not, why not?
5.31.2006 9:36am
eoe (www):
the US has long restricted tobacco advertising, and has for many years issued warnings about the dangers of smoking. if you assume that 1) advertisements have a greater effect on young people 2) older people are less likely to quit than are young people and 3) young people start smoking because they see adults smoking, it seems to me these efforts will take a generation or two to catch on.

it would be interesting to learn if there is a "government trust" component involved - ie are americans more likely that europeans to believe the warnings coming from their governments? can smoking in spite of government warnings be attributed to any sort of anti-government/rebellious attitudes?

i also wonder how much of it has to do with the difference in health care systems - given the relative ease of accessibility of health care in the US (for the insured), US residents are probably more likely to endure a long and drawn out battle with lung cancer or emphysema. seeing family members go through this may encourage the young to shy away from smoking.
5.31.2006 3:03pm
A.C.:
I can see how promotion campaigns might keep teenagers from taking up smoking in the first place, but what about all the people who smoke in college and then seem to give it up as young adults? Most people I know (I'm American) are like that. Is this a common pattern in Europe? And do 20-something Europeans who smoke tend to get hassled by romantic partners and work colleagues until they do something about it? I started to feel that pressure when I was around 25 -- smoking was okay (or even cool) until then, but after that it was taboo.
5.31.2006 5:01pm