Do Advertisements for Smoking Cessation Products Help Smokers Quit?

Tobacco use is the leading preventable cause of death in the U.S., causing more than 400,000 deaths per year. Smoking related medical expenditures are estimated at over $75 Billion per year, much of which is paid for by government health care programs such as Medicare and Medicaid.

In its Healthy People 2010 report, the Department of Health and Human Services set a goal of cutting the prevalence of smoking among U.S. adults in half, from the 1999 level of 24% to 12%. Although policy makers and antismoking advocates have focused much of their attention on discouraging youth from beginning to smoke, the rate of smoking cessation among adults will need to rise substantially in order to meet this goal.

Smoking cessation products such as nicotine replacement therapy are one tool to help smokers quit. In fact, it has been shown that smokers are more likely to quit when they use such a product. The cessation product industry's estimated retail sales are nearly $1 Billion annually and the industry spends $100 Million to $200 Million annually on advertising. If the advertisement of these products encourages smokers to quit, and in particular if it encourages some smokers to quit without the use of a cessation product, or "cold turkey," then there are social returns to advertising above and beyond the private profits created by it.

This question is taken up in "Private Profits and Public Health: Does Advertising Smoking Cessation Products Encourage Smokers to Quit?" (NBER Working Paper 11938), a new study by Rosemary Avery, Donald Kenkel, Dean Lillard, and Alan Mathios.

In their analysis, the authors pay particular attention to the challenge of identifying a causal impact of advertising on quitting behavior. Their strategy is to link survey data on individual smokers with data on magazine advertisements, which allow them to measure smokers' exposure to cessation product advertisements based on their magazine reading habits. As the authors note, because they observe the same demographic information about consumers as do advertisers, they can control for the fact that companies may concentrate their marketing in magazines read by groups that are more likely to quit, such as high income consumers. As they also control for the type of magazines read by the consumer, their strategy essentially relies on the fact that someone who reads Time may be exposed to more smoking cessation advertising than someone who reads Newsweek.

The authors use data from the Simmons National Consumer Survey, a marketing survey with information on consumers' magazine reading habits, demographics, and smoking behavior. Pooling surveys from 1995-1999, they have a sample of over 30,000 smokers. They construct the archive of magazine advertisement data over the same period, collecting data from twenty six magazines that represent between one third and two thirds of all magazine circulation in the U.S.

Forty three percent of the sample report that they attempted to quit smoking within the past year and nine percent report that they do not currently smoke, which the authors use as their measure of quitting. This quit rate is higher than what has been found in other studies, due to the fact that the authors cannot observe subsequent relapses into smoking.

The authors find that exposure to smoking cessation advertising makes smokers both more likely to attempt to quit and more likely to successfully quit. Interestingly, exposure to advertising increases quit attempts and successful quits both with and without the use of products in fact, advertising result in a bigger increase in quit attempts without a product than in quit attempts with a product. Thus advertising results in social returns above and beyond private profits because there are positive spillover effects of advertising on to consumers who quit cold turkey.

The authors conduct a back of the envelope calculation to measure the public health benefits from cessation product advertising. They find than an increase in magazine advertising of $2.6 Million, or 10%, would be likely to generate additional product sales of $3.3 Million for companies and result in 100,000 additional quitters, or a 0.2 percentage point increase in the smoking cessation rate. The authors point out that this increase in the smoking cessation rate would be expected to lower the smoking prevalence rate over time by 1.2 percentage points, or more than half the observed drop between 1990 and 2000.

Direct to consumer advertising in health related markets is currently a very controversial issue. The authors conclude that in the case of smoking cessation products, there is a case to be made for encouraging companies to increase such advertising, for example by loosening government regulations on advertising, because of the significant public gains.

This research was supported by a grant from the National Cancer Institute (R01 CA094020-01), an award from the Substance Abuse Policy Research Program of the Robert Wood Johnson Foundation to the NBER, and an unrestricted educational grant to Cornell University from the Merck Company Foundation, the philanthropic arm of Merck & Co.
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