The Effects of Smoking Cessation on Weight Gain: New Evidence Using Workplace Smoking Bans

Jason M. Fletcher

doi:10.1515/fhep-2013-0004

Article

The Effects of Smoking Cessation on Weight Gain: New Evidence Using Workplace Smoking Bans

Jason M. Fletcher

Published/Copyright: November 7, 2014

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From the journal Forum for Health Economics and Policy Volume 17 Issue 2

Abstract

Both tobacco use and obesity are among the most important and costly health challenges faced in developed countries. Unfortunately, they may be inversely linked. While policy interventions that have placed limits on tobacco use have increased substantially over time, one unintended consequence may be to increase obesity rates. Issues of selection and unobserved heterogeneity make it difficult to empirically assess the relationship between the two health outcomes. Additionally, there may be heterogeneous policy effects by cessation cause – smoking bans or medical treatments or tobacco prices. This paper focuses on the effects of a rapidly expanding policy by using within-individual differences in exposure to workplace smoking bans to estimate the impact of smoking cessation on weight gain using a large study of over 5000 White and Black respondents followed since 1986. Findings suggest that individuals affected by the smoking bans gained more weight in the short-term than suggested by OLS estimates.

Keywords: smoking cessation; weight gain; workplace smoking restrictions

Corresponding author: Jason M. Fletcher, La Follette School of Public Affairs, University of Wisconsin-Madison, 1225 Observatory Dr, Madison, WI 53706, USA, e-mail: jmfletcher@wisc.edu

Acknowledgments

The author thanks Sean Coady for assistance with the occupation code data for wave 6 of the survey and Daniel Eisenberg and Jody Sindelar for helpful comments. Coronary Artery Risk Development in Young Adults (CARDIA) is conducted and supported by the NHLBI in collaboration with the CARDIA Study Investigators. This Manuscript was prepared using a limited access dataset obtained from the NHLBI and does not necessarily reflect the opinions or views of the CARDIA or the NHLBI.

Appendix Tables

Table 1A

Descriptive Statistics Comparing Analysis Sample and Full Sample.

Variable	Obs.	Analysis Sample			Full Sample
Variable	Obs.	Mean	Std. Dev.	Obs.	Mean	Std. Dev.
Weight	10677	176.34	41.66	25562	168.57	40.33
BMI	10654	27.27	6.00	25509	26.22	5.84
Obese	10654	0.26	0.44	25509	0.21	0.40
Overweight	10654	0.58	0.49	25509	0.49	0.50
Smoke	10677	0.39	0.49	25599	0.40	0.49
Age	10677	33.43	5.14	25599	30.05	5.98
Black	10677	0.45	0.50	25599	0.49	0.50
Male	10677	0.46	0.50	25599	0.45	0.50
Education	10677	14.19	2.19	25550	13.88	2.20
Married	10677	0.48	0.50	25511	0.39	0.49
Maternal Education	10677	13.28	1.93	25554	13.22	1.90
Maternal Weight Category	10677	4.52	1.43	25285	4.49	1.45
Maternal Smoke	10677	0.50	0.50	25529	0.50	0.49
Wave 4	10677	0.23	0.42	25599	0.16	0.36
Wave 5	10677	0.27	0.45	25599	0.15	0.36
Wave 6	10677	0.25	0.43	25599	0.14	0.35
Full Time Employment	10677	0.87	0.34	25509	0.70	0.46
Manager/Professional	10677	0.41	0.49	25550	0.31	0.46
Sales/Admin	10677	0.34	0.47	25550	0.34	0.47
Service	10677	0.11	0.32	25550	0.15	0.35
Farming	10677	0.06	0.23	25550	0.06	0.23
Laborers	10677	0.06	0.23	25550	0.10	0.30
Unknown	10677	0.02	0.15	25550	0.05	0.21
Missing Data	10677	0.08	0.26	25599	0.10	0.29
No Smoking Ban	10677	0.13	0.34	11677	0.14	0.35
Limits Smoking	10677	0.31	0.46	11677	0.31	0.46
Prohibits Smoking	10677	0.56	0.50	11677	0.55	0.50

Table 2A

Descriptive Statistics for Analysis Sample Males vs. Females.

Variable	Males			Females
Variable	Obs.	Mean	Std.	Obs.	Mean	Std.
Weight	4939	189.61	35.54	5738	164.91	43.13
BMI	4932	27.02	4.57	5722	27.49	7.00
Obese	4932	0.22	0.41	5722	0.30	0.46
Overweight	4932	0.62	0.48	5722	0.55	0.50
Smoke	4939	0.45	0.50	5738	0.34	0.48
Age	4939	33.58	5.07	5738	33.29	5.20
Black	4939	0.39	0.49	5738	0.51	0.50
Male	4939	1.00	0.00	5738	0.00	0.00
Education	4939	14.29	2.32	5738	14.09	2.07
Married	4939	0.53	0.50	5738	0.44	0.50
Maternal Education	4939	13.39	1.94	5738	13.20	1.92
Maternal Weight Category	4939	4.48	1.37	5738	4.55	1.47
Maternal Smoke	4939	0.48	0.49	5738	0.51	0.50
Wave 4	4939	0.23	0.42	5738	0.24	0.42
Wave 5	4939	0.28	0.45	5738	0.27	0.44
Wave 6	4939	0.26	0.44	5738	0.25	0.43
Full Time Employment	4939	0.91	0.28	5738	0.82	0.38
Manager/Professional	4939	0.42	0.49	5738	0.40	0.49
Sales/Admin	4939	0.26	0.44	5738	0.41	0.49
Service	4939	0.11	0.31	5738	0.11	0.32
Farming	4939	0.10	0.30	5738	0.02	0.15
Laborers	4939	0.08	0.27	5738	0.04	0.19
Unknown	4939	0.04	0.19	5738	0.01	0.11
Missing Data	4939	0.08	0.27	5738	0.07	0.26
No Smoking Ban	4939	0.18	0.38	5738	0.09	0.29
Limits Smoking	4939	0.33	0.47	5738	0.30	0.46
Prohibits Smoking	4939	0.50	0.50	5738	0.61	0.49

Table 3A

Smoking Restrictions Over Time. ^[13]

Wave	Year	No Limitations	Limitations	Prohibition
3	1990–1991	18.66%	39.32%	42.02%
4	1992–1993	12.96%	33.87%	53.17%
5	1995–1996	13.11%	26.13%	60.76%
6	2000–2001	10.89%	36.89%	63.11%

Table 4A

Descriptive Statistics Separated by Workplace Type.

Variable	No Limitations			Limitations			Prohibition
Variable	Obs.	Mean	Std.	Obs.	Mean	Std.	Obs.	Mean	Std.
Weight	1392	177.14	39.23	3344	177.69	41.09	5941	175.39	42.50
BMI	1391	26.86	5.66	3340	27.39	5.85	5923	27.30	6.15
Obese	1391	0.23	0.42	3340	0.27	0.44	5923	0.26	0.44
Overweight	1391	0.57	0.50	3340	0.59	0.49	5923	0.58	0.49
Smoke	1392	0.51	0.50	3344	0.46	0.50	5941	0.33	0.47
Age	1392	32.38	5.12	3344	32.68	5.08	5941	34.09	5.09
Black	1392	0.45	0.50	3344	0.54	0.50	5941	0.41	0.49
Male	1392	0.62	0.49	3344	0.49	0.50	5941	0.41	0.49
Education	1392	13.56	2.13	3344	13.79	2.09	5941	14.55	2.19
Married	1392	0.43	0.50	3344	0.45	0.50	5941	0.51	0.50
Maternal Education	1392	13.24	1.90	3344	13.02	1.82	5941	13.44	1.98
Maternal Weight Category	1392	4.50	1.43	3344	4.54	1.45	5941	4.51	1.41
Maternal Smoke	1392	0.52	0.50	3344	0.49	0.49	5941	0.50	0.50
Wave 4	1392	0.22	0.42	3344	0.25	0.43	5941	0.22	0.42
Wave 5	1392	0.25	0.43	3344	0.23	0.42	5941	0.30	0.46
Wave 6	1392	0.19	0.40	3344	0.21	0.41	5941	0.29	0.45
Full Time Employment	1392	0.82	0.39	3344	0.88	0.32	5941	0.87	0.34
Manager/Professional	1392	0.29	0.45	3344	0.33	0.47	5941	0.49	0.50
Sales/Admin	1392	0.25	0.43	3344	0.37	0.48	5941	0.35	0.48
Service	1392	0.19	0.39	3344	0.14	0.35	5941	0.08	0.27
Farming	1392	0.13	0.33	3344	0.06	0.25	5941	0.04	0.18
Laborers	1392	0.10	0.30	3344	0.07	0.26	5941	0.03	0.18
Unknown	1392	0.04	0.19	3344	0.03	0.16	5941	0.02	0.13
Missing Data	1392	0.12	0.32	3344	0.08	0.27	5941	0.06	0.24
No Smoking Ban	1392	1	0	3344	0	0	5941	0	0
Limits Smoking	1392	0	0	3344	1	0	5941	0	0
Prohibits Smoking	1392	0	0	3344	0	0	5941	1	0

Table 5A

Descriptive Statistics for Analysis Sample and Ever-Smokers.

Variable	Obs.	Mean	Std. Dev.	Obs.	Mean	Std.
Weight	10677	176.34	41.66	6455	177.04	40.73
BMI	10654	27.27	6.00	6442	27.19	5.83
Obese	10654	0.26	0.44	6442	0.25	0.43
Overweight	10654	0.58	0.49	6442	0.58	0.49
Smoke	10677	0.39	0.49	6455	0.65	0.48
Age	10677	33.43	5.14	6455	33.37	5.13
Black	10677	0.45	0.50	6455	0.43	0.49
Male	10677	0.46	0.50	6455	0.51	0.50
Education	10677	14.19	2.19	6455	13.98	2.15
Married	10677	0.48	0.50	6455	0.46	0.50
Maternal Education	10677	13.28	1.93	6455	13.29	1.93
Maternal Weight Category	10677	4.52	1.43	6455	4.45	1.41
Maternal Smoke	10677	0.50	0.50	6455	0.52	0.49
Wave 4	10677	0.23	0.42	6455	0.23	0.42
Wave 5	10677	0.27	0.45	6455	0.27	0.45
Wave 6	10677	0.25	0.43	6455	0.25	0.44
Full Time Employment	10677	0.87	0.34	6455	0.86	0.35
Manager/Professional	10677	0.41	0.49	6455	0.39	0.49
Sales/Admin	10677	0.34	0.47	6455	0.33	0.47
Service	10677	0.11	0.32	6455	0.12	0.33
Farming	10677	0.06	0.23	6455	0.06	0.25
Laborers	10677	0.06	0.23	6455	0.06	0.25
Unknown	10677	0.02	0.15	6455	0.03	0.17
Missing Data	10677	0.08	0.26	6455	0.08	0.27
No Smoking Ban	10677	0.13	0.34	6455	0.15	0.36
Limits Smoking	10677	0.31	0.46	6455	0.34	0.47
Prohibits Smoking	10677	0.56	0.50	6455	0.51	0.50

Table 6A

Estimates of the Effects of Smoking Cessation on Weight Outcomes Combined IV-FE Evidence: LIML and GMM Specifications.

Outcome	BMI	Weight	Overweight	Obese	BMI	Weight	Overweight	Obese
	LIML	LIML	LIML	LIML	GMM	GMM	GMM	GMM
Sample	Ever Smokers	Ever Smokers	Ever Smokers	Ever Smokers	Ever Smokers	Ever Smokers	Ever Smokers	Ever Smokers
Current Smoker	–4.242**	–29.893**	–0.102	–0.441	–4.231**	–29.900**	–0.101	–0.373
	(2.123)	(14.206)	(0.255)	(0.320)	(2.116)	(14.187)	(0.247)	(0.243)
Married	0.446***	2.842***	0.051***	0.024*	0.447***	2.842***	0.051***	0.026**
	(0.119)	(0.799)	(0.015)	(0.014)	(0.119)	(0.798)	(0.015)	(0.013)
Wave 4 Dummy	0.515***	3.956***	0.050***	0.033***	0.515***	3.956***	0.049***	0.033***
	(0.072)	(0.480)	(0.009)	(0.009)	(0.072)	(0.480)	(0.009)	(0.008)
Wave 5 Dummy	1.117***	7.796***	0.093***	0.057***	1.118***	7.796***	0.093***	0.059***
	(0.105)	(0.701)	(0.012)	(0.014)	(0.105)	(0.701)	(0.012)	(0.012)
Wave 6 Dummy	2.227***	15.010***	0.183***	0.113***	2.227***	15.010***	0.183***	0.116***
	(0.147)	(0.981)	(0.017)	(0.021)	(0.147)	(0.981)	(0.017)	(0.017)
Full Time Employment	0.036	0.411	–0.012	0.007	0.036	0.411	–0.011	0.006
	(0.123)	(0.823)	(0.014)	(0.014)	(0.122)	(0.821)	(0.014)	(0.013)
Sales	–0.190*	–1.228*	–0.014	–0.017	–0.190*	–1.228*	–0.014	–0.016
	(0.104)	(0.704)	(0.013)	(0.012)	(0.104)	(0.704)	(0.013)	(0.011)
Service	–0.329**	–2.221**	0.004	–0.020	–0.328**	–2.221**	0.004	–0.018
	(0.158)	(1.069)	(0.019)	(0.019)	(0.158)	(1.069)	(0.019)	(0.018)
Farming	–0.321*	–2.206*	0.009	–0.021	–0.321*	–2.207*	0.009	–0.019
	(0.182)	(1.251)	(0.022)	(0.022)	(0.182)	(1.251)	(0.022)	(0.021)
Laborers	–0.348*	–2.421*	–0.001	–0.037	–0.347*	–2.422*	–0.001	–0.034
	(0.193)	(1.321)	(0.024)	(0.024)	(0.193)	(1.320)	(0.024)	(0.022)
Unknown	–0.523**	–3.580**	–0.015	–0.032	–0.523**	–3.580**	–0.014	–0.028
	(0.261)	(1.733)	(0.033)	(0.035)	(0.261)	(1.732)	(0.033)	(0.032)
Observations	6938	6958	6938	6938	6938	6958	6938	6938
Number of pid	2232	2237	2232	2232	2232	2237	2232	2232

Robust standard errors in parentheses (clustered at the person level), ***p<0.01, **p<0.05.

Appendix Figure 1

Figure 1

Survey question of weight status of mother during childhood (9 categories).

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Published Online: 2014-11-7

Published in Print: 2014-9-1

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Articles in the same Issue

https://doi.org/10.1515/fhep-2013-0004

Keywords for this article

smoking cessation; weight gain; workplace smoking restrictions