Do smokers know what they are doing to their life expectancy?

By Valeria Bordone, University of Munich Department of Sociology and IIASA World Population Program

Everyone, consciously or unconsciously, formulates in their own mind a subjective survival probability– i.e., an estimate of how long they are going to live. This will affect decisions in different spheres of later life: retirement, investments, and healthy behaviors. Moreover, previous research has found that subjective survival probability is a good predictor of mortality. In fact, on average, people somehow know better than standard health measures the effect that their characteristics and their behavior have on life expectancy. It is however plausible not only to expect differences within the population in terms of survival, but also in the ability to predict their own survival.

(cc) roujo | Flickr

In a recent publication with Bruno Arpino from the University Pompeu Fabra and Sergei Scherbov from the Wittgenstein Centre (IIASA, VID/ÖAW, WU)., we presented for the first time joint analyses of the effect of smoking behavior and education on subjective survival probabilities and on the ability of survey respondents to predict their real survival, using longitudinal data on people aged 50-89 years old in the USA drawn from the Health and Retirement Study.

We found that, consistent with real mortality, smokers report the lowest subjective survival probabilities. Similarly, less educated people report lower subjective survival probabilities than higher education people. This is in line with the well-known positive correlation between education and life expectancy. However, despite being aware of their lower life expectancy as compared to non-smokers and past smokers, people currently smoking at the time of the survey tended to overestimate their survival probabilities. This holds especially for less educated people.

This graph shows the probability of correctly estimating the own survival probabilities with 95% confidence intervals, by smoking behavior and educational attainment. ©Arpino B, Bordone V, & Scherbov S (2017)

Our study suggests that in fact, education also plays an important role in shaping people’s ability to estimate their own survival probability. Whether or not they smoke, we found that more highly educated people are more likely to correctly predict their survival probabilities.

In view of the high proportion of the American population that consists of current or past smokers, a percentage that reached 77% in some male cohorts, our findings emphasize the need to disseminate more information about risks of smoking, specifically targeting people with less education.

By showing that smoking and education play together in determining how well people can assess the own survival potential, this study extends our understanding of the variability of subjective survival probabilities within a population. The fact that sub-groups within the population differently incorporate the effects of smoking into their assessment of survival probabilities may have important consequences for example on when people exit the labor market or whether they buy a life insurance, as individuals are likely to base their decisions also on their longevity expectations.

Policymakers can therefore draw some relevant conclusions from our study to design policies concerned with health and survivorship in later life. Despite the various anti-smoking campaigns and smoking restrictions, smokers may not be fully aware of the risks of smoking. In particular, educational groups seem to be differently exposed to the information that is disseminated to the public. Our study suggests that there is a need to target such information to less educated people, who are the most likely to underestimate the risks of smoking. Providing information on how survival probabilities vary by smoking behavior may not only reduce smoking but it may also increase individuals’ ability to assess their own survival.

(cc) Quinn Dombrowski | Flickr

Reference
Arpino B, Bordone V, & Scherbov S (2017). Smoking, Education and the Ability to Predict Own Survival Probabilities: An Observational Study on US Data. IIASA Working Paper. IIASA, Laxenburg, Austria: WP-17-012 [pure.iiasa.ac.at/14692]

This article gives the views of the author, and not the position of the Nexus blog, nor of the International Institute for Applied Systems Analysis.

Healthy living in hard times?

By Raya Muttarak, Research Scholar, IIASA World Population Program

  Some rights reserved by danieljordahl on FlickrFor many years social scientists have observed a connection between economic downturns and a reduction in both unhealthy behaviors and mortality—a paradigm known as “healthy living in hard times.” One possible explanation for such counterintuitive findings was that people when people lose their jobs, have more spare time to dedicate to physical activities. Moreover, under an increased threat of unemployment, those who were still employed might limit their smoking and alcohol consumption in order to reduce their chances of being laid off. So the general agreement among social scientists has been that we should not worry too much about the impact of an economic crisis on health and mortality.

Our current global economic recession is the worst economic recession in contemporary history, however. And in a new study we found out that in fact, its consequences for health are very different from previous economic downturns. Since 2008, the number of smokers has increased substantially along with the increase in unemployed people.

In the new study, published in the journal Tobacco Control, we analyzed the effects of the current economic crisis on smoking in the United States, using  data for around 2 million people from the Center for Disease Control’s Behavioral Risk Factor Surveillance System (BRFSS) survey for 2005 to 2010. In contrast to previous economic literature, we found an estimated increase of around 600,000 smokers due to the economic crisis.

Our study took into account the increase of the US population, the pre-crisis trends in smoking prevalence and the change in the distribution of population by socio-demographic characteristics.

We did find that “healthy living in hard times” still holds true for the employed individuals. Perhaps for fear of being laid off due to insurance reasons, these people maintain their healthy lifestyle. On the other hand, once without a job, people either started smoking or relapsed, possibly because of stress related to their new economic situation.

© Alexander Babich | Dreamstime.com

In contrast to previous economic literature, the new study finds an estimated increase of around 600,000 smokers due to the economic crisis. © Alexander Babich | Dreamstime.com

Since smoking prevalence by employment status remained more or less the same as before the crisis, a sharp increase in the number of unemployed individuals consequently led to a massive rise in the number of smokers. This has counterbalanced the trend in declining smoking rate among the employed.

Two main lessons can be drawn from our findings. First of all, YES…. this time it is different. The magnitude of the crisis has substantially changed the share of those with and without a job, with the latter being much more likely to engage in risky health behaviors. This in turns reversed most of the conclusions drawn by the previous literature. Second, we should not underestimate the impact of job-related stress factors on healthy behaviors. The idea that joblessness could be seen as a holiday where someone can engage in self-empowering activities is nice and reassuring, but it is meant to fail when unemployment is essentially unexpected and unwanted.

Reference
Gallus S, Ghislandi S, Muttarak R. Effects of the economic crisis on smoking prevalence and number of smokers in the USA. Tob Control. 2013 Aug 16. doi: 10.1136/tobaccocontrol-2012-050856. [Epub ahead of print] PubMed PMID: 23956058.

About the author
Raya Muttarak is a Research Scholar with the World Population (POP) Program. She came to IIASA in September 2011. Her current research covers three broad themes: 1) educational inequality and vulnerability and adaptation to climate change, 2) immigrant integration and ethnic inequality in education, the labor market and climate change adaptation, and 3) socioeconomic determinants of health risks and behaviors. More>>

Note: This article gives the views of the author, and not the position of the Nexus blog, nor of the International Institute for Applied Systems Analysis.