« Freakonomics Radio

161. How to Make People Quit Smoking

2014-04-03 | 🔗
The war on cigarettes has been fairly successful in some places. But 1 billion humans still smoke -- so what comes next?
This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
This podcast dynamically inserts audio advertisements of varying lengths for each download. As a result, the transcription time indexes may be inaccurate.
An original. Can you look back to when he met the one you loved him remember exactly how it was peering through me. So brothers joined the army, Tom HOLLAND. I have this joys of some sometimes have already seen. Everything else can have I bear Sherry Radar, just remember an apple tv plus frigate, radio sponsored by three m. What do the adhesives used in both posted no in aeroplanes have in common. They both made with innovations from three m. In fact, there are lots of three M products, hiding in plain sight that you might not realise, including in lending? I've respirators in response to that the banking pandemic. Three M has increased respirator, prick option to make more respirators than ever before, helping those on the front.
I now continue the fight learn more at three m dot com, slash covert a celeb it. What's the most exciting news, you think that we could tell the people who listened to the frequent. Radio broadcasts that, after four or five years we actually managed to write another book. So you want to tell him about a little, but now you Tom you're better talking about the book about we done together. Ok, the date made twelve dragon the date may twelfth try gets may thirteenth guy the day. May thirteen? Ok, the title of the book? Think like a freak hey, you got that right
then so let it would you say this is your most favorite book of all time. You know I really can't tell. I can't tell whether as good a terrible, I mean the one thing I like best about it. His dad aft rewrote supervision hammocks. We said this is not right. The same book, over and over and over and am- and we weren't we never write another book, but then we we had this idea to do something that more, like I'm almost like a how to book. I gotta think like a freak and in its different, it's hard to tell things that are different are good or not, but but at least it's different, I think that's a good start. It is different. The full title is think, like a freak. The authors of freak economics offer
to retrain your brain and we cannot wait for you to read it. You can pre order the book now on Amazon Barnes. Nobody come Itunes, all your better online book vendors. You can also read more about it. At for economics not come, and you can also check out our upcoming in person and media appearances, we will do a: U S book tour about seven cities, a UK book tour, including whales, and you can check out the website to see if we are coming to near where you live. And if so, please come, say hello. You will also be hearing a lot of new pod casts based on our very favorite stories from think like a freak, and here is the best news. We are starting a think like. Freak Book club right here on the pot gas. So once the book is out- and you guys have a chance to read it, let it and I will take your questions or complaints or whatever. If you want advice on how you too can think like a freak will give that to you and we will all have a great time. I promise
and now for our regularly scheduled episode of for economics, radio, ok, here's a riddle, name an activity that many many millions of people do of their own free will, but that seventy percent of them at least in the EU As I say, we don't wanna do doesn't make any sense. Does it what kind of thing could be so in tracing? so unappealing at the same time so it's gonna like when lose lovey. It's got excited killers, gonna like a really five year, rushed from its terrible by it's delicious, delicious, get a rush, gibbey eating chocolate, cake kind of growth, I really hate the way in which they smell. I picked it up when I was young, I was called. Is there more babies alone so
not eating chocolate cake. So what is this delicious? Gross love hate activity No, I just stood. There was a first inhale, that's the best one in areas where that sit there for a while, yet pretty much satisfaction guaranteed you get the flavor feels fantastic. Although cigarettes. I'm here from W. And my see this is free economics, radio, the pot cast that explores the hidden side of everything. Here's your host, Stephen governor. it's hard to find anyone to argue that smoking cigarettes
is on balance, a good thing to do, but even when smokers want to stop the can't what I quit, I end up feeling really good and then I feel like I've achieved something like I deserve a cigarette for that yeah quit before for a few months, but then back in the habit, I feel like a Sunday just like stop I'm trying to quit now forever. It's a process waken up have an all first thing: God do a smoke cigarettes in all and is I can't breathe we still need a quiet. I've tried many times does not work. I fail everyday tremendously know how hard is it to quit when an individual smoker tries to quit many times. In a year. Many of the quit attempts last half a day, most smoke,
is even if they make a serious attempt to quit, have relapse rates that are in the order of ninety percent. Ninety percent yanks. Why so high? This is Jeffrey Harris he's an economist end physician at MIT basically were dealing with a substance nicotine which is addictive, I have a profound appreciation for addiction, and that is Kenneth Warner, he's an economist at the University of Michigan School of Public health. When it comes to smoking and quitting Warner knows whereof. He speaks was very good. Acquitting I quit for six months one year and then I could for three months the next year- and I I quit for a month, you're after that, then I quit quitting for awhile and and finally, I decided I was going to smoke myself silly poker game one December twenty seventh: It was of nineteen. Seventy four. I took an entire pack of cigarettes smoked through the pack and went home feeling sick because I smoke some cigarettes.
I said, I'm never touch him again and I haven't Warner has been doing tobacco policy research since the Nineteenth Seventys, the trends, the health and financial consequences, the politics and so on. I am personally convinced that, when twenty four Century historians, look back on the experience of the rise and fall of the cigarette they're going to call not only one of the most important public health stories but also one of the most interesting public health stories. Ok, what's so interesting, that's just this incredible epidemic, and through the use of various public health techniques through education through tax asian smoke, free laws and so on. We ve managed to cut the rate of, smoking by more than half
Cigarettes first came into popular use in the: U S round the time, the civil war. There is not much thought given to negative health effects. In fact, tobacco is sometimes prescribed, as men The early nineteenth sixties, forty two percent of the adult population. So when the government began collecting data on haste, students in the early nineteen nineties turned out. They smoked uneven. higher rate than adults. So for many many years you had a lot of people doing a lot of smoke. It was pretty sooner I am just two points: downgradings Roguery, my regular wench than you like them, Wednesday cigarettes out Mister Vanstone here earlier in front of my more doctors smoke camels than any other cigarette. Why dont use words from the sale price coolness?
when health experts begin to make connections between smoking and illness and in nineteen sixty four. After a build up of research, the United States, surgeon General issued a milestone report. It is a judgment of the committee. Cigarette smoking contribute substantially immortality from very specific and through the overall rate, Here's Kenneth Warner again really one of the central documents of public health now unfairness the royal com, Physicians in the UK had issued a report in nineteen sixty two, which was also very powerful. The sixty four reports it is really the turning point in smoking in the United States, smoking was rising almost uninterrupted. There were a couple of irruptions, but virtually uninterrupted through nineteen sixty three certain generals report. comes out in nineteen sixty four and it's one of the biggest
news stories of the year. In all this in that year. Smoking drops three and a half percent it waffles around it. couple of years and then it starts. Dropping in nineteen, seventy three to now it has dropped almost every single year. And we're back to where we were in the nineteen thirty's. The surgeon generals report helped start an anti smoking. that over the ensuing decades came to include public service campaigns, advertising bans and the prohibition of smoking in offices on aeroplanes more recently in restaurants and bars even in central Park in New York City. No smoking allowed, but measuring the efficacy of this kind of thing can be hard there, a lot of potentially confounding factors to account, for there is one variable, however, that does lend itself to good measurement the cost of cigarettes, the effects of tax and price are more well studied than any other area of tobacco control. We have.
Lot of data about that. Ok. So what do the data say? What we know is it? If you increase the price by ten percent, you will decrease total cigarette consumption by freedom four percent now you may think well, of course, Warner. We talk about price theories and economist, but even a lay person can look at the data and see the relationship between cigarette prices and smoking. The economist, Frank to LUCA, has calculated the inflation adjusted price bake of cigarettes over the past few decades and where that spike comes from overall, he found that a pack of cigarettes cost more than twice as much today as it did in eighteen. Ninety, some of that increase comes
the manufacturers, especially since the late. Ninety nine is that's one. Cigarette companies began passing along the costs from the master settlement agreement. That was the deal between the big tobacco companies and forty six. The attorney general, which required companies to pay out billions of dollars for essentially producing a dangerous product by passing Some of that settlement costs smokers the company's added about fifty cent's pack, but a variety of taxes also made cigarettes much more expensive between one thousand nine hundred and ninety and two thousand and nine Toluca found the federal excise tax on cigarettes rose from zero dollars and sixteen cents to more than a dollar for pack and state taxes. On average,
quadrupled now. Keep in mind that on average, this huge variance across States Missouri adds only seventeen cents, a pack Rhode Island at the state tax of three dollars and forty six cents per pack. Now, on top of all that some cities at their own taxes in two thousand to, for instance, New York City raised its excise tax from eight cents, a pack to a dollar. Fifty two today, a pack of cigarettes in New York city costs on average more than eleven dollars It's probably not coincidental, therefore, that New York State has one of the lowest smoking rates in the country and who Does an eleven dollars price tag hit the hardest? The smokers, who are most price sensitive, like teenagers? Indeed between two thousand and two thousand and twelve
the smoking rate among high schoolers in New York state fell by fifty six percent. So if you want to fight smoking, you can see why economists at least agree that raising the price will work. Here's Kip the Scuse at Vanderbilt was a very powerful tool, doesn't wear out. If you keep on increasing the price will keep a decrease in the demand for cigarettes, but just as different states in the? U S have wildly different tax rates on cigarettes? Different countries have wildly different cigarette taxes and prices, which are influenced by all sorts of factors. in China, for instance, the average cost is about two dollars per pack of cigarettes in Australia about eleven dollars. With talk of pushing that up to twenty dollars. And smoking rates around the world are extremely diverse. Among the low are the: U S in Canada, Australia, much of South America most of Africa,
Europe is generally in the Middle and Asia. What, if you look at the World Health Organization's map of smoking rate by country, Asia is basically one big clouds. But even in the U S where, as Kenneth Warner told us, we returned to the smoking rate of the nineteen thirties that still translates into a lot of smokers about forty five million adult Americans are smokers. Today, that's approximately eighteen to twenty percent of the adult population cigarettes are only killing four hundred and eighty thousand Americans annually, that's one out of every five deaths, in the nation, in other words, one out of every five deaths is completely avoidable and the people who die as a result of smoking are losing up to twenty years of life. In other words, we ve come a long way baby.
Come on baby, but we still have a long way to go so coming up on economics, radio. What's next your goal is to drive smoking rates down even further, maybe even eliminate smoking. Where do you turn how about Uruguay? Here's a relatively small country in South America they had a president elected who was an m d and was very health conscious, and they have adopted some very significant policy measures that we have an in some instances seen before and will fit this whole conversation on its head and ask what a smoking
before we jokingly say in our lab, you no good drug bad delivery system,. Economics. Radio sponsored by wonder, is business movers podcast when cocoa will it change their recipe to what they called new coke? In nineteen five, the backlash was swift and severe, and yet the man who drove the change Chairman Robert Goya's wetter pulled new coke from the shelves. In a matter of months. Wonder is business movers explores boys what is controversial decision and the public response, but the real story of new Coke is far more human and complex list. to wonder is business movers podcast on Apple Podcast, Amazon, music or
free in the wandering happened frigate. Whose radios brought to you by square. If you run a business, Oh how important it is to have a healthy cashflow. That's. Why will you take payments with square either in person or online. You get your money fast access it. Instantly vs, where Square card a free business, Debit card or transfer it to your bank account on. You reschedule see all the ways Square can health at square dot com, slash, go slash freak though nonsense Thanks to Pennsylvania, lottery, scratch ass, pennsylvanians or scratching their way to find and we'd Newgate every month: big top rises and second chance, drawings, excitements, always in order so try Pennsylvania, lottery, scratch, offer your ticket to fund and get yours. Did I keep on scratch? It must be eighteen or older. Please pay responsibly benefits older pennsylvanians every day
from W and Y see. This is for economics, radio, here's, your host Stephen Dabbler Ok, so do we know so far? Smoking cigarettes it is generally agreed is bad for us. It's also addictive, which makes it hard to quit. What does get people to smoke less making cigarettes really really expensive seems to work pretty well, but a simply raising prices or taxes isn't the thoroughly so simple specially, because people who do smoker happier when prices are lower and be where cigarettes are fairly expensive, like the? U S, the adult smoking rate is still about twenty percent. So what else Where else can we learn from Uruguay
fascinating story! That's Kenneth Warner again he's an economist at the University of Michigan School of Public health is a relatively small country in South America. A hurry, President elected who is an m d and was very health conscious and they have adopted some very significant policy measures that we have an in some instances seen before- and here again is Jeffrey Harris. He's an economist, Slash M D. At the Massachusetts Institute of Technology. So in many ways it's been a pioneer. It's been a laboratory, so to speak, for economists to study What is the impact of smoking Control Programmes Harris, along with two co? Authors recently put out a working paper called tobacco control campaign in Uruguay impact on smoking cessation during pregnancy. You may be thinking why you were away while in two thousand three the World health organism
put together a global health treaty to cut smoking and of the one hundred and seventy seven countries who signed on Uruguay has been among the most aggressive in trying new things. As Jeffrey Harris tells us, Uruguay has been responsible for a lot of bursts. They were first to to do things like banned smoking in all public spaces, but also enclosed privates basis, really was the first country not to just put images on each pack of cigarettes, Part of the warnings, but also demanded that the images be up to eighty percent of the front and back of each What kind of images is Harris talking about? Here's Kenneth Warner, they show disease lungs, they show people smoking through their trachea, They show pregnant women with their feet, is getting exposed to smoke and things like that. Ok, what else did Uruguay do?
was the first country to outlaw multiple version. Of the same brand, you're at manufacturer, could basically, in the past, have a seat. Red Brown that was the main bran a light brown Menthol brand in Uruguay. You can only have What they call a single presentation Uruguay also banned cigarette advertising and raise taxes on cigarettes they enlisted doctors and health centres to encourage people to quit Smoking Jeffrey Harris decided to salmon. All these different anti smoking measures to figure out which of them were most effective. The population he chose to concentrate on was pregnant. Women.
Why two reasons one there and important population since a foetus is particularly susceptible to the harmful effects of smoking and to the pregnant women presented a good, controlled, Dataset Harry and his co authors had access to a national registry of all pregnancies which information on whether the women smoked if they quit and when they quit the researchers tracked about thirty thousand women from two thousand? Seventy two twelve. So what they learn. First of all, the overall quitting rate among these women rose dramatic. As the start of our observation period in two thousand and seven about fifteen percent of women who smoke during pregnancy quit by their third trimester. That is the last three months are the nine month, pregnancy, by two thirds In twelve, the percentage was up to forty two percent. The marked increase from fifteen per SE
in two thousand and seven to forty two percent in two thousand and twelve as far as well that was unprecedented now granted. You might think that pregnant women have a stronger incentive to quit than most smokers, but still only fifteen percent of pregnant smokers were quitting before and now the quit number was forty two percent, that's huge. Now what led to all this quitting member? There is a whole cocktail of anti smoking measures in Uruguay. Tax increases, a ban on advertising the use of graphic imagery on cigarette packs and so on. Jeffrey Harris was able to tease out the most effective. measures from the data raising the cigarette tax, it turned out didn't work as well as it did in the U S. While we have no doubt that price has an effect in the big picture,
Europe why it had a relatively small contribution in part, because the tobacco industry reacted to those price increases. In other words, when the government increase the cigarette tax, the manufacturers lowered their prices for the consumer wouldn't feel such a hit. According to one calculation, the average price of a pack of cigarettes in Uruguay is three dollars and sixty one since compared with six dollars in thirty six cents. In the U S According to Jeff Harris, it was to non price initiatives that really moved it'll in Uruguay. The first was the single presentation rule. Basically, you only get one version of each sick Red Brand, so no menthol, no mild just one choice per brand. The objective of the government really was to avoid any possible implicated that a particular brand was safer or less hazardous than another
earlier on, the government had banned or a prohibited such words ass light. Smooth, low tar, but it Turns out that a lot of research that's been done throughout the world. Not just in Uruguay indicates that even the color falsely suggest that a cigarette is safer. What else worked the graphic grotesque imagery on the cigarette packs, They would have an image of a baby that looked like the baby was neonatal intensive care, sometimes connected to something tat, looked like oxygen and asking the smoker and spanish roughly as this the life you chose to give him now, you may naturally wonder if the U S has reduced its smoking rate so much without the use of graphic imagery. Like that, what would happen if we did use it? That says Kenneth Warner is hard to say
we were supposed to have that here a year ago, Slayer September and of course, the tobacco industry sued to prevent it and were now back- or I should say FDA is now back at the beginning with that. One As we noted earlier. There is a lot of variants. around the world and how smoking is treated? There's all Oh a lotta variants in who smokes and who doesn't is Jeff Harris again approximately Eighty percent of all the tobacco use in the world now occurs in low and middle income countries, within a short amount of time. Eighty percent of all the deaths attributable to tobacco useful also occur in those countries and how many deaths will that be the world health organization is estimated that now, in the order of five million, people will die on an annual basis as a result of tobacco use throughout. World and another six hundred thousand will die from
second hand or environmental tobacco smoke. If you are primarily a humanist, to see all this death is terrible news, five million preventable premature deaths a year. If, however, you are primarily an economist You may also calculate the cost savings for all that smoking death. We actually have a cost per pack, so we actually know the smokers on balance: save us zero dollars and thirty two cents, a pack through smoking, do to decrease pension cost, nursing home care. like this, of course, is a controversial argument in two thousand one. A report commissioned in the Czech Republic by Philip Morris Tobacco company was met with outrage. Kenneth Warner told us
story? Yeah? There was a consultant tobacco industry type consultants who told the check. women, two thousand one but they shouldn't want their citizens to quit smoking, because if they did you of all those horrible old age costs, you have to provide housing for these people it at the time care, their medical carry out to subsidize their incomes with pension would go on and on and on and on course this blew up in their faces when it became public but in others a grain of truth there? For just because economists can measure the medical costs of less death from smoking doesn't mean they're, hoping for more death from smoking. Here's Jeff Harris they have to be careful about this. I dont think that you can just make the argument that quitting smoking, has a certain costs to society without asking the same question. Will any other improvement in our public?
health would have the same cost, is also worth noting that just as low income countries are more likely to have more smoking in the. U S: Also, there is a socio economic split, they helps define who smokes and who doesn't? Here's Kenneth Warner If you look at the population that is at the poverty line or above it about eighteen percent, The more smokers. If you look at the popular mission below the poverty. about twenty nine percent. If you look at college graduates, seven point five percent of them smoke today If you look at people with only nine to eleven years of high school education about thirty six percent, if we go back, the time of the surgeon general's report. That remember was one thousand nine hundred and sixty four those numbers were very close to each other. So that's a huge issue is a so
economic disparity, and then there is one that we have finally started to recognise and talk about in the field of tobacco control when it is very important, perhaps as many as forty to fifty percent of all smokers, have a concurrent mental health disability or morbidity and or other substance abuse problems. The cigarette industry has always liked talk about smoking is being a rational choice of well informed adults. And yet we a strong correlation between smoking and mental illness said this opens up a whole other way to look at some. That is to some degree self medication with side effects. Of course, Paul New House. an empty who runs the centre for cognitive Medicine, Vanderbilt for thirty years,
new House has been studying the effects of nicotine on the brain. We joke They say in our lab you, no good drug bad delivery system. Now house, tells us that nicotine itself has a number of potentially positive characteristics. It appears to activate a class of what we call receptor important for regulating a whole variety of brain functions, and so we think that Nick Atomic receptors are important for things like attention. Bore behavioral strategies for what we call executive functioning, which is the ability to make decisions and evaluating. For me, Can we think it's important from memory, and so that has kind of lead us to thinking about what particular Saunders might be helped by stimulating Nick authentic receptors, either with nicotine or with something else
the new house and others in this field are exploring of nicotine therapy. Might be used to treat schizophrenia, Parkinson's disease or other maladies things like memory loss disorders, Alzheimer's disease, Pre, Alzheimer's disease, which is called mild cognitive impairment. We ve looked at ADHD attention deficit I productivity disorder, other, Esther. Gaiters have looked at everything from direct syndrome to anxiety disorders to depression, and so I think that the full potential she'll live nicotine and naked tunic drugs is is really not even fully known. Yet new house does believe, however, the nicotine has medicinal effect, and that is why some smokers smoke. If you look at heavy smokers, you will find that many of them have mood disorders are anxiety disorders as well the rates of psychological problems among heavy smokers. These
is a very high and we think that one of the reasons they smoke is because it produces benefits to them. Maybe it improve their mood, maybe it stabilizes their anxiety may be. It helps them pay attention or inhibit impulsiveness, etc. so that maybe one reason why so many smokers, even when they say they'd rather not smoke, can't quit. The fact is that all these anti smoking measures we ve talked about today, warnings, taxes, advertising bans and so on for a pale image. Issues of some historic anti smoking measures and they didn't Thirdly, work either Sultan Murad, the fourth Can the early sixteen hundreds prohibited
smoking? Now, obviously, if not cigarettes, but he prohibited the smoking of tobacco Kenneth Warner again and in fact It was a rather severe penalties for smoking. I, it was trouble by death and despite the fact that he had that severe penalty and despite the fact that he executed some smokers, people continue to consume tobacco. when it smoked form- and I want to tell you my there were many ways that he executed smokers, but one of them that dirges makes it very picturesque is. He said that a person would be drawn and quartered by force, strong horses that doesn't get you. Quit smoking? Not much else is going to do and what you may ask did, the Ottoman rulers do when even the death penalty failed to dissuade smokers. Yet the text
A package of measures, as we mentioned at the top of the show lever- and I are putting out a new book, called think like a freak, may thirteenth and so why don't we do one of our frequently asked questions episodes about it. You know how this works. You send us. Whatever since you have to radio at free economic start come, and we will answer on this path. Guest. If you want to learn more about the book before you send your questions, you can visit for economics, dot com where we ve posted the table of contents in some other material thanks in advance, for whatever cos she sent. Meanwhile, on next week's show, we talked to mares from all over the country fast in LOS Angeles, from Albuquerque a new haven, and we ask them what the world would look like if they were in charge that next time Unfrequent emigrating
Economics radio is produced by W and Y see and Dublin productions. Our staff includes David Herman Gregg results. Give credit card a Lamb treaty put him in any Susie Luxembourg and Chris ban it. If you are more frequent, comics radio, you can subscribe to our podcast on Itunes or go to for economics calm, real fine lots of radio applause, the books and more If you're ready to push the boundaries of tomorrow, but the innovation experts at every riddle, aeronautical university help, you explore the possibilities
again this year you s news and will report has reigned. Our online fatuous degree programmes number one in the nation and our distance learning technology put success at your fingertips. Flexible schedules personalized attention at expert faculty combined for a learning experience that open stores around the world to find out more ye. Are you not Slash explore
Transcript generated on 2021-03-13.