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BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Tobacco use and household expenditures on food, education, and healthcare in low- and middle-income countries: a multilevel analysis

Authors: Young Kyung Do, Mary Ann Bautista

Published in: BMC Public Health | Issue 1/2015

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Abstract

Background

The majority of one billion smokers worldwide live in low- and middle-income countries (LMICs) and the highest proportion of smokers in most of these countries belong to the lower socioeconomic groups. This study aimed to investigate the associations between tobacco use within households and expenditures on food, education, and healthcare in LMICs.

Methods

Using data from the World Health Survey, this cross-sectional study included a sample of 53,625 adult males aged <60 years from 40 LMICs. Multilevel, mixed-effects linear regression was used to determine the association between current tobacco use status of the main income provider (daily; occasional; no use) and three categories of (logged) household expenditures: food, education, and healthcare; controlling for age, level of education, household wealth quintile, marital status, urban–rural setting, country-level income group, and region.

Results

In the preferred random-slope models that controlled for covariates, daily tobacco use was associated with lower household expenditures on education and healthcare by 8.0 % (95 % confidence interval: −12.8 to –3.2 %) and 5.5 % (−10.7 to –0.3 %), respectively. The association between tobacco use and food expenditure was inconsistent across models.

Conclusions

Tobacco use in LMICs may have a negative influence on investment in human capital development. Addressing the tobacco use problem in LMICs could benefit not only the health and economic well-being of smokers and their immediate families but also long-run economic development at a societal level.
Literature
1.
Yanbaeva DG, Dentener MA, Creutzberg EC, Wesseling G, Wouters EFM. Systemic effects of smoking*. CHEST Journal. 2007;131(5):1557–66.CrossRef
2.
Warner KE, Mackay J. The global tobacco disease pandemic: nature, causes, and cures. Glob Public Health. 2006;1(1):65–86.CrossRefPubMed
3.
4.
Peto R, Lopez AD, Boreham J, Thun M, Heath C, Doll R. Mortality from smoking worldwide. Br Med Bull. 1996;52(1):12–21.CrossRefPubMed
5.
WHO. World health statistics. Geneva, Switzerland: World Health Organization; 2012.
6.
7.
Wong PKK, Christie JJ, Wark JD. The effects of smoking on bone health. Clin Sci. 2007;113(5):233–41.CrossRefPubMed
8.
Gandini S, Botteri E, Iodice S, Boniol M, Lowenfels AB, Maisonneuve P, et al. Tobacco smoking and cancer: A meta-analysis. Int J Cancer. 2008;122(1):155–64.CrossRefPubMed
9.
Flensborg-Madsen T, Bay Von Scholten M, Flachs EM, Mortensen EL, Prescott E, Tolstrup JS. Tobacco smoking as a risk factor for depression. A 26-year population-based follow-up study. J Psychiatr Res. 2011;45(2):143–9.CrossRefPubMed
10.
US DHHS: The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. In. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health 2006.
11.
WHO. WHO report on the global tobacco epidemic. In: The MPOWER Package. Geneva: World Health Organization; 2008.
12.
C-y P, Lan V, Chou Y-J, Lan C-f. The crowding-out effects of tobacco and alcohol where expenditure shares are low: Analyzing expenditure data for Taiwan. Soc Sci Med. 2008;66(9):1979–89.CrossRef
13.
Wang H, Sindelar JL, Busch SH. The impact of tobacco expenditure on household consumption patterns in rural China. Soc Sci Med. 2006;62(6):1414–26.CrossRefPubMed
14.
Rice DP, Hodgson TA, Sinsheimer P, Browner W, Kopstein AN. The economic costs of the health effects of smoking, 1984. Milbank Q. 1986;64(4):489–547.CrossRefPubMed
15.
American Lung Association: Trends in Tobacco Use. American Lung Association 2011.
16.
Hosseinpoor AR, Parker LA, Tursan d’Espaignet E, Chatterji S. Socioeconomic inequality in smoking in Low-income and middle-income countries: results from the world health survey. PLoS One. 2012;7(8):e42843.CrossRefPubMedPubMedCentral
17.
John RM, Sung H-Y, Max WB, Ross H. Counting 15 million more poor in India, thanks to tobacco. Tob Control. 2011;20(5):349–52.CrossRefPubMed
18.
19.
Ruff L, Volmer T, Nowak D, Meyer A. The economic impact of smoking in Germany. Eur Respir J. 2000;16(3):385–90.CrossRefPubMed
20.
Efroymson D, Ahmed S, Townsend J, Alam SM, Dey AR, Saha R, et al. Hungry for tobacco: an analysis of the economic impact of tobacco consumption on the poor in Bangladesh. Tob Control. 2001;10(3):212–7.CrossRefPubMedPubMedCentral
21.
Choi BCK, Nethercott JR. The economic impact of smoking in Canada. Int J Health Plann Manage. 1988;3(3):197–205.CrossRefPubMed
22.
Max W, Sung HY, Tucker LY, Stark B. The cost of smoking for California’s Hispanic community. Nicotine Tob Res. 2011;13(4):248–54.CrossRefPubMed
23.
24.
Max W. The financial impact of smoking on health-related costs: a review of the literature. Am J Health Promot. 2001;15(5):321–31.CrossRefPubMed
25.
26.
Nakamura K, Okamura T, Hayakawa T, Kanda H, Okayama A, Ueshima H. Medical expenditures of men with hypertension and/or a smoking habit: a 10-year follow-up study of National Health Insurance in Shiga. Japan Hypertension Research. 2010;33(8):802–7.CrossRefPubMed
27.
The World Bank. The rationale for government intervention. In: Musgrove P, editor. Health economics in development (health, nutrition, and population series). Washington: The World Bank; 2004.
28.
Block S, Webb P. Up in smoke: tobacco Use, expenditure on food, and child malnutrition in developing countries. Econ Dev Cult Chang. 2009;58(1):1–23.CrossRef
29.
Reddy KS, Yadav A, Arora M, Nazar GP. Integrating tobacco control into health and development agendas. Tob Control. 2012;21(2):281–6.CrossRefPubMed
30.
Phillips A. Bellagio statement on tobacco and sustainable development. CMAJ. 1995;153(8):1109–10.
31.
Jha P, Chaloupka F. Tobacco control in developing countries. Oxford: Oxford University Press; 2000.
32.
Leeder KMESR. The Millennium development goals and tobacco control : an opportunity for global partnership. Geneva: World Health Organization; 2004.
33.
Bloom DE, Fink G: The Economic Case for Devoting Public Resources to Health. In: Institute for the Study of Labor Policy Paper Series. 2013.
34.
John RM. Crowding out effect of tobacco expenditure and its implications on household resource allocation in India. Soc Sci Med. 2008;66(6):1356–67.CrossRefPubMed
35.
Busch SH, Jofre-Bonet M, Falba TA, Sindelar JL. Burning a hole in the budget: tobacco spending and its crowd-Out of other goods. Appl Health Econ Health Policy. 2004;3(4):263–72.CrossRefPubMed
36.
John RM, Ross H, Blecher E. Tobacco expenditure and its implications for household resource allocation in Cambodia. Tob Control. 2011;21(3):341–6.CrossRefPubMed
37.
Xin Y, Qian J, Xu L, Tang S, Gao J, Critchley JA. The impact of smoking and quitting on household expenditure patterns and medical care costs in China. Tob Control. 2009;18(2):150–5.CrossRefPubMedPubMedCentral
38.
Efroymson D, Pham HA, Jones L, FitzGerald S, Thu LT, Thu Hien LT. Tobacco and poverty: evidence from Vietnam. Tob Control. 2011;20(4):296–301.CrossRefPubMed
39.
Hosseinpoor AR, Parker LA, Tursan d’Espaignet E, Chatterji S. Social determinants of smoking in Low- and middle-income countries: results from the world health survey. PLoS One. 2011;6(5):e20331.CrossRefPubMedPubMedCentral
40.
41.
WHO. The world health surveys. In: Evidence and information for policy global programme on evidence for health policy classification, assessment, surveys and terminology. Geneva: Organization WH; 2012.
42.
43.
44.
The World Bank: Data: PPP conversion factor, private consumption. The World Bank 2013.
45.
WHO: World Health Survey (Survey Manual). World Health Organization 2002.
46.
WHO: Guide to Administration and Question by Question Specifications. World Health Organization 2002.
47.
Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21(6):459–68.CrossRefPubMed
48.
Mills A. Health policy and systems research: defining the terrain; identifying the methods. Health Policy Plan. 2012;27(1):1–7.CrossRefPubMed
49.
50.
Cascio EU, Reber S. The Poverty Gap in School Spending Following the Introduction of Title I. Am Econ Rev. 2013;103(3):423–7.CrossRef
51.
Duflo E. Schooling and labor market consequences of school construction in Indonesia: evidence from an unusual policy experiment. Am Econ Rev. 2001;91(4):795–813.CrossRef
52.
Peretti-Watel P, L’Haridon O, Seror V. Time preferences, socioeconomic status and smokers’ behaviour, attitudes and risk awareness. Eur J Public Health. 2013;23(5):783–8.CrossRefPubMed
53.
Jindal SK, Sapru RP, Aggarwal AN, Chaudhry K. Excess morbidity and expenditure on healthcare in families with smokers: a community study. Natl Med J India. 2005;18(3):123–6.PubMed
54.
55.
Haas SA, Glymour MM, Berkman LF. Childhood health and labor market inequality over the life course. J Health Soc Behav. 2011;52(3):298–313.CrossRefPubMed
56.
Case A, Fertig A, Paxson C. The lasting impact of childhood health and circumstance. J Health Econ. 2005;24(2):365–89.CrossRefPubMed
57.
Singh PN, Washburn D, Yel D, Kheam T, Job JS. Poverty does Not limit tobacco consumption in Cambodia: quantitative estimate of tobacco Use under conditions of No income and adult malnutrition. Asia Pac J Public Health. 2013;25(5 Suppl):75S–83S.CrossRefPubMed
58.
Choudhury K, Hanifi SM, Mahmood SS, Bhuiya A. Sociodemographic characteristics of tobacco consumers in a rural area of Bangladesh. J Health Popul Nutr. 2007;25(4):456–64.PubMedPubMedCentral
59.
Zhang J, Ou JX, Bai CX. Tobacco smoking in China: prevalence, disease burden, challenges and future strategies. Respirology. 2011;16(8):1165–72.CrossRefPubMed
Metadata
Title
Tobacco use and household expenditures on food, education, and healthcare in low- and middle-income countries: a multilevel analysis
Authors
Young Kyung Do
Mary Ann Bautista
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2423-9

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