The Impact of Tobacco Control Policies on Adolescent Smoking: Comparing Self-Reports and Biomarkers

Abstract

This paper provides new evidence on how tobacco control policies affect adolescent smoking as measured by self-reported measures and serum cotinine levels, a biomarker of nicotine exposure. I use data from the National Health and Nutrition Examination Surveys covering 1988-1994 and 1999-2012. Higher cigarette excise taxes lead to statistically significant decreases in smoking prevalence as measured by both self-reports and serum cotinine levels. Among self-reported smokers, cigarette excise taxes are associated with statistically significant reductions in serum cotinine levels but not in cigarette consumption. Among likely smokers, as defined by serum cotinine levels, I do not find that cigarette excise taxes reduce serum cotinine levels on the intensive margin, but I do find that tobacco control policies, especially policies directed at minors, may increase the incidence of misreported smoking status.

Cigarette taxes, prices, and disparities in current smoking in the United States

“…One possible strategy for evaluating the extent of this bias in future research is to use biomarkers for smoking, which could help identify respondents who are “likely smokers” based on their serum cotinine levels but who self-report as nonsmokers. In a study using National Health and Nutrition Examination Survey data with biomarkers, Nesson finds higher cigarette taxes to be associated with lower serum cotinine levels among smokers, but also a greater incidence of smoking status misreporting ( Nesson, 2017 ). Because the TUS-CPS does not collect biomarkers, we are unable to evaluate the extent to which social desirability bias influenced our estimates.…”

The Economics of Tobacco Regulation: A Comprehensive Review

“…A third source of bias is measurement error: individuals may misreport whether and how much they smoke. Comparisons of reported smoking to blood cotinine levels(Adda and Cornaglia 2006;Nesson 2017b) and…”

Tobacco Sales Prohibition and Teen Smoking

“…Here, we briefly discuss the validity in the context of our paper. Self-reported smoking is very closely related to biomarkers indicating smoking for adults and teens (Patrick et al, 1994;Benowitz et al, 2009;Nesson, 2017). The main drawback of biomarkers is that researchers cannot track smokers who rarely smoke because cotinine depletes completely within 1 week.…”

“…5 Powell, Tauras and Ross (2005) use cross-sectional variation across states and find a negative correlation between the index and smoking prevalence. Nesson (2017) studies more recent data from the United States and finds a positive association of tobacco control policies and youth smoking prevalence as measured by a biomarker. In Appendix D, we provide a brief evaluation of the use of biomarker data in comparison to survey data to assess teen smoking prevalence.…”

“…Other studies use variation in indexes summarizing the strictness of diverse policies for teens in the United States. Findings are mixed, with studies reporting positive, negative, or statistically imprecisely estimated correlations between such indexes and smoking prevalence among teens (see, e.g., Gruber and Zinman, 2000;Cawley, Markowitz and Tauras, 2006;Nesson, 2017). 5 As these indexes are a summary measure for diverse policy tools for preventing teen smoking (including packaging restrictions, regulations on possession, minimum smoking age, restrictions on free distribution of samples, advertising, licensing, and regulation of use) it is 4 We are only aware of one case study by Macinko and Silver (2018) which uses both, several yearly waves of cross-sectional data prior to the adoption of a higher minimum legal purchase age and a comparison group.…”