Behavioral Economics of Tobacco Smoking
Kenneth A. Perkins Mary E. Hickcox James E. Grobe University of Pittsburgh
Tobacco smoking remains the greatest preventable cause of mortality in the United States, accounting for at least 400,000 annual deaths, as well as 3 million worldwide ( Peto et al., 1996). Primary prevention efforts have been instrumental in helping to reduce the prevalence of smoking in the United States from 40% to 25% of adults since the 1950s. However, in the 1990s this trend has flattened, and teenage smoking may be increasing ( Giovino, Henningfield, Tomar, Escobedo, & Slade, 1995). Moreover, tobacco use is increasing in developing countries ( Peto et al., 1996). Thus, improved interventions to help smokers quit will be needed in order to reduce further health costs due to tobacco.
Using a behavioral economics perspective, we describe factors that promote smoking behavior and smoking cessation interventions that counter these factors, mostly at the individual level but with some discussion of societal influences. After an overview of basic concepts in the behavioral economics of tobacco smoking, historical and individual factors that enhance smoking are presented. In general, the currently low social, behavioral, and economic response cost required to obtain nicotine reinforcement from smoking is the primary factor promoting smoking. The bulk of the chapter reviews various commonly employed interventions for smoking cessation, including behavioral counseling treatments as well as pharmacological strategies. Regardless of the approach, these interventions can be seen as increasing the response cost of smoking or reducing the cost of abstaining from smoking. Viewing interventions within a behavioral economics framework