T H E J O U R N A L O F H U M A N R E S O U R C E S • 45 • 3
Education, Information, and Smoking Decisions
Evidence from Smoking Histories in the United States, 1940–2000
Damien de Walque
A B S T R A C T
This paper tests the hypothesis that education improves health and in- creases life expectancy. The analysis of smoking histories shows that after
1950, when information about the dangers of tobacco started to diffuse, the prevalence of smoking declined earlier and most dramatically for col-
lege graduates. I construct panels based on smoking histories in an at- tempt to isolate the causal effect of smoking from the influence of time-
invariant unobservable characteristics. The results suggest that, at least among women, college education has a negative effect on smoking preva-
lence and that more educated individuals responded faster to the diffusion of information on the dangers of smoking.
I. Introduction
The strong correlation between education and health outcomes, even after controlling for income, has been recognized as a robust empirical observation
in the social sciences and economic literature Cutler and Lleras-Muney 2006; Dea- ton and Paxson 2003; Fuchs 1982; Grossman 2006; Lleras-Muney 2005. The de-
cision to smoke or not to smoke is a conscious choice that directly affects the health
Damien de Walque is a Senior Economist at the World Bank, Development Research Group. He thanks Gary Becker, Pedro Carneiro, Raphael De Coninck, Mark Duggan, Michael Greenstone, Michael
Grossman, Ted Joyce, Donald Kenkel, Fabian Lange, Steven Levitt, Ellen Meara, Chris Rohlfs, Tomas Philipson, and participants in the Applications Workshop at the University of Chicago, the NBER Health
economics seminar, the 24th Arne Ryde Symposium on the Economics of Substance Use at Lund Univer- sity Sweden, the Econometric Society World Congress University College London 2005, the AEA
Meetings Boston 2006, and Lehigh University for helpful comments and discussions. The findings, in- terpretations, and conclusions expressed in this paper are those of the author and do not necessarily
represent the views of the World Bank, its Executive Directors, or the governments they represent. The data used in this article can be obtained beginning February 2011 through January 2014 from Damien
de Walque, 1818 H Street, NW, Washington, DC 20433, USA. ddewalqueworldbank.org [Submitted November 2007; accepted April 2009]
ISSN 022-166X E-ISSN 1548-8004 䉷 2010 by the Board of Regents of the University of Wisconsin System
de Walque 683
status and ultimately the mortality of individuals. Smoking behaviors therefore pro- vide an interesting opportunity to investigate how education, by influencing behav-
iors, affects health outcomes. Smoking habits were not initially perceived as dangerous. The information re-
vealing the health-damaging consequences of cigarette smoking emerged gradually between 1950 and 1970. Variations in smoking prevalence across education groups
during this period might inform us about the way individuals reacted to that infor- mation and how education helps in accessing and processing this information.
This paper, using smoking behavior as an example, examines whether the effect of education on improving health outcomes can be considered as causal. It turns out
smoking is the leading cause of premature adult mortality. Each year in the United States, tobacco use causes more than 438,000 deaths.
1
The issue of the causality in the relationship between education and health is important in the health economics literature. Theoretical explanations for this cor-
relation can be classified into three broad categories. One explanation stresses that education is an investment. Education will deliver a higher income, a higher con-
sumption level in the future, and raises the value of staying alive Becker 1993; Becker 2007. More educated individuals are healthier because their investment in
the future gives them the right incentives to protect their health. Another explanation, based on education entering as a factor in the health production function Grossman
1972, emphasizes that education improves the access to health-related information and the processing of that information to make health-related decisions. A third view
Farrell and Fuchs 1982; Fuchs 1982 claims that the observed correlation between health and education is mainly due to unobservables, like the discount factor or the
ability that causes the same individuals both to study longer and to take greater care of their health. This study will attempt to distinguish the first two explanations from
the third one, but will not attempt to separate the first two.
I investigate whether the effect of education in reducing smoking is causal in three steps. I first analyze smoking behaviors across education groups in the United
States from 1940 to 2000. Despite the lack of surveys linking education and smoking before 1966, I obtain this information by using retrospective smoking histories con-
structed from the smoking supplements of National Health Interview Surveys con- ducted between 1978 and 2000 U.S. Department of Health and Human Services,
1978–2000. Such a reconstruction had never been done systematically and is a useful contribution to the knowledge of historical patterns in smoking behaviors.
The conclusion from the analysis is that the smoking prevalence among more edu- cated individuals, college graduates in particular, declined earlier and most dramat-
ically than in any other education category. The decline for college graduates started in 1954, four years after the medical consensus on the health consequences of smok-
ing and ten years before the publication of the first Surgeon General’s Report on this issue. This suggests that they had easier access to the information andor were
more able to process that information.
Farrell and Fuchs 1982, however, challenge this conclusion taken from cross- sectional analysis. They show that the strong negative relation between schooling
1. http:www.cdc.govtobaccoissue.htm accessed on February 12, 2009.
684 The Journal of Human Resources
and smoking observed at age 24 is accounted for by differences in smoking prev- alence at age 17, when schooling is still very similar across individuals. Using the
smoking histories constructed for this paper, my second step is to reproduce results similar to Farrell and Fuchs 1982. From their analysis, it would therefore appear
that a causal link between education and smoking cannot be established and that a “third unobservable variable” should be preferred as the hypothesis to explain the
correlation between smoking and education.
But, by limiting their analysis to the 17 to 24 age range, Farrell and Fuchs 1982 omit most of people’s smoking histories, and, in particular, they almost entirely
ignore smoking cessation. This paper uses the information recovered from the smoking histories to construct
a series of panels and analyze smoking behavior in a way that allows accounting for time-invariant unobservable characteristics. Given a date of smoking initiation
and of smoking cessation, the smoking status of an individual can be reconstructed for each age. Assuming that college graduation takes place between ages 17 and 25,
allows one to analyze smoking behavior for the same individual before and after college.
Comparing the results from an individual-level panel data analysis using fixed effects with cross-sectional estimates is instructive as the panel data analysis allows
removing the influence of unobserved individual time-invariant characteristics like time preference or ability. In the cross-sectional analysis, for males, the negative
gradient between education and smoking is present for all birth cohorts starting with those born between 1910 and 1919 but its magnitude increases with age and
with later birth cohorts, while the negative association between schooling and smok- ing among females begins to appear around the time that evidence of a causal link
between smoking and lung cancer became widely known. In the fixed effect panel regressions, the negative gradient between smoking and college takes longer to ap-
pear. For females, the negative association is still roughly coincident with the wide- spread knowledge of the smoking-cancer link. But this is not true for males. It is
not until the male birth cohorts of 1950–59 that the negative association appears.
The paper is structured as follows. Section II presents descriptive results from the analysis of the smoking prevalence in the United States from 1940 to 2000. Section
III focuses on a multivariate, cross-sectional, analysis of smoking behaviors, includ- ing a replication of results similar to Farrell and Fuchs 1982. Section IV presents
the results of the panel regressions. Section V concludes.
II. Evidence from Smoking Histories in the United States, 1940–2000
