IDEAS home Printed from https://ideas.repec.org/p/iaa/dpaper/202502.html

The Effect of West German Television on Smoking and Health: A Natural Experiment from German Reunification

Author

Listed:
  • Andrea Bernini

    (University of Oxford)

  • Sven A. Hartmann

    (Trier University & Institut für Arbeitsrecht und Arbeitsbeziehungen in der Europäischen Union (IAAEU))

Abstract

This paper examines the long-term impact of West German television exposure on smoking behavior in East Germany, with a focus on gender-specific responses. Using data from 1989 and 2002 and leveraging quasi-random variation in West German TV signal availability across East German regions, we find that TV exposure led to a substantial increase in smoking among women — by 10.7 percentage points in smoking probability and 68% in cigarette consumption — while having no measurable effect on men. This asymmetric effect reflects divergent pre-reunification norms: under socialism, female smoking was heavily stigmatized, and exposure to Western media relaxed these social constraints. The behavioral shift persisted over time, with exposed women reporting worse physical and mental health and higher healthcare utilization in 2002. Back-of-the-envelope calculations suggest a sizable increase in smoking-related mortality and healthcare costs. Our findings highlight how cultural integration through media can alter health behaviors and generate significant public health externalities in transitional societies.

Suggested Citation

  • Andrea Bernini & Sven A. Hartmann, 2025. "The Effect of West German Television on Smoking and Health: A Natural Experiment from German Reunification," IAAEU Discussion Papers 202502, Institute of Labour Law and Industrial Relations in the European Union (IAAEU).
  • Handle: RePEc:iaa:dpaper:202502
    as

    Download full text from publisher

    File URL: https://www.iaaeu.de/images/DiscussionPaper/2025_02.pdf
    File Function: First version, 2025
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Sven A. Hartmann, 2024. "Television and family demography: Evidence from a natural experiment in East Germany," IAAEU Discussion Papers 202407, Institute of Labour Law and Industrial Relations in the European Union (IAAEU).
    2. Pamela Campa & Michel Serafinelli, 2019. "Politico-Economic Regimes and Attitudes: Female Workers under State Socialism," The Review of Economics and Statistics, MIT Press, vol. 101(2), pages 233-248, May.
    3. Hainmueller, Jens, 2012. "Entropy Balancing for Causal Effects: A Multivariate Reweighting Method to Produce Balanced Samples in Observational Studies," Political Analysis, Cambridge University Press, vol. 20(1), pages 25-46, January.
    4. Kern, Holger Lutz & Hainmueller, Jens, 2009. "Opium for the Masses: How Foreign Media Can Stabilize Authoritarian Regimes," Political Analysis, Cambridge University Press, vol. 17(4), pages 377-399.
    5. Slavtchev, Viktor & Wyrwich, Michael, 2023. "The effects of TV content on entrepreneurship: Evidence from German unification," Journal of Comparative Economics, Elsevier, vol. 51(2), pages 696-721.
    6. Hartmann, Sven A., 2024. "Television and family demography: Evidence from a natural experiment in East Germany," Labour Economics, Elsevier, vol. 91(C).
    7. Tim Friehe & Markus Pannenberg, 2020. "Time preferences and political regimes: evidence from reunified Germany," Journal of Population Economics, Springer;European Society for Population Economics, vol. 33(1), pages 349-387, January.
    8. Hyll, Walter & Schneider, Lutz, 2013. "The causal effect of watching TV on material aspirations: Evidence from the “valley of the innocent”," Journal of Economic Behavior & Organization, Elsevier, vol. 86(C), pages 37-51.
    9. Hainmueller, Jens & Xu, Yiqing, 2013. "ebalance: A Stata Package for Entropy Balancing," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 54(i07).
    10. Graham, Hilary, 1996. "Smoking prevalence among women in the European Community 1950-1990," Social Science & Medicine, Elsevier, vol. 43(2), pages 243-254, July.
    11. Rosemary Elliot, 2012. "Smoking for taxes: the triumph of fiscal policy over health in postwar West Germany, 1945–55," Economic History Review, Economic History Society, vol. 65(4), pages 1450-1474, November.
    12. Lars Hornuf & Marc Oliver Rieger & Sven A. Hartmann, 2023. "Can television reduce xenophobia? The case of East Germany," Kyklos, Wiley Blackwell, vol. 76(1), pages 77-100, February.
    13. Charlesworth, Annemarie & Glantz, Stanton A. Ph.D., 2005. "Smoking in the Movies Increases Adolescent Smoking: A Review," University of California at San Francisco, Center for Tobacco Control Research and Education qt9039p7cm, Center for Tobacco Control Research and Education, UC San Francisco.
    14. Schaap, Maartje M. & Kunst, Anton E. & Leinsalu, Mall & Regidor, Enrique & Espelt, Albert & Ekholm, Ola & Helmert, Uwe & Klumbiene, Jurate & Mackenbach, Johan P., 2009. "Female ever-smoking, education, emancipation and economic development in 19 European countries," Social Science & Medicine, Elsevier, vol. 68(7), pages 1271-1278, April.
    15. Miura, Takahiro, 2019. "Does time preference affect smoking behavior? A dynamic panel analysis," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 78(C), pages 170-180.
    16. Hennighausen, Tanja, 2015. "Exposure to television and individual beliefs: Evidence from a natural experiment," Journal of Comparative Economics, Elsevier, vol. 43(4), pages 956-980.
    17. Waldron, Ingrid, 1991. "Patterns and causes of gender differences in smoking," Social Science & Medicine, Elsevier, vol. 32(9), pages 989-1005, January.
    18. Marion Devaux & Franco Sassi, 2015. "The Labour Market Impacts of Obesity, Smoking, Alcohol Use and Related Chronic Diseases," OECD Health Working Papers 86, OECD Publishing.
    19. Cowan, Benjamin & Schwab, Benjamin, 2011. "The incidence of the healthcare costs of smoking," Journal of Health Economics, Elsevier, vol. 30(5), pages 1094-1102.
    20. Chadi, Adrian & Hoffmann, Manuel, 2026. "Television, health, and happiness: A natural experiment in West Germany," Journal of Public Economics, Elsevier, vol. 257(C).
    21. Friehe, Tim & Müller, Helge & Neumeier, Florian, 2018. "The effect of Western TV on crime: Evidence from East Germany," European Journal of Political Economy, Elsevier, vol. 55(C), pages 346-372.
    22. Reiner Hanewinkel & Gudrun Wiborg, 2007. "Smoking in contemporary German television programming," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 52(5), pages 308-312, October.
    23. Goebel Jan & Grabka Markus M. & Liebig Stefan & Kroh Martin & Richter David & Schröder Carsten & Schupp Jürgen, 2019. "The German Socio-Economic Panel (SOEP)," Journal of Economics and Statistics (Jahrbuecher fuer Nationaloekonomie und Statistik), De Gruyter, vol. 239(2), pages 345-360, April.
    24. Brian Hinote & William Cockerham & Pamela Abbott, 2009. "Post-Communism and Female Tobacco Consumption in the Former Soviet States," Europe-Asia Studies, Taylor & Francis Journals, vol. 61(9), pages 1543-1555.
    25. Leonardo Bursztyn & Davide Cantoni, 2016. "Tear in the Iron Curtain: The Impact of Western Television on Consumption Behavior," The Review of Economics and Statistics, MIT Press, vol. 98(1), pages 25-41, March.
    26. Abbott, Pamela A & Turmov, Sergei & Wallace, Claire, 2006. "Health world views of post-soviet citizens," Social Science & Medicine, Elsevier, vol. 62(1), pages 228-238, January.
    27. Bornhäuser, A & McCarthy, J & Glantz, S A, 2006. "German tobacco industry's successful efforts to maintain scientific and political respectability to prevent regulation of secondhand smoke," University of California at San Francisco, Center for Tobacco Control Research and Education qt5ft7x3m2, Center for Tobacco Control Research and Education, UC San Francisco.
    28. Christopoulou, Rebekka & Lillard, Dean R., 2015. "Is smoking behavior culturally determined? Evidence from British immigrants," Journal of Economic Behavior & Organization, Elsevier, vol. 110(C), pages 78-90.
    29. Hafez, N & Ling, P M, 2005. "How Philip Morris built Marlboro into a global brand for young adults: implications for international tobacco control," University of California at San Francisco, Center for Tobacco Control Research and Education qt5tp828kn, Center for Tobacco Control Research and Education, UC San Francisco.
    30. Peter Bönisch & Walter Hyll, 2023. "Television and fertility: evidence from a natural experiment," Empirical Economics, Springer, vol. 64(3), pages 1025-1066, March.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Hartmann, Sven A., 2026. "Fog or smog? The impact of uncensored reporting on pollution on individuals’ environmental preferences," Journal of Environmental Economics and Management, Elsevier, vol. 138(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Hartmann, Sven A., 2026. "Fog or smog? The impact of uncensored reporting on pollution on individuals’ environmental preferences," Journal of Environmental Economics and Management, Elsevier, vol. 138(C).
    2. Hartmann, Sven A., 2024. "Television and family demography: Evidence from a natural experiment in East Germany," Labour Economics, Elsevier, vol. 91(C).
    3. Fieles-Ahmad, Omar & Kvasnicka, Michael, 2026. "Western TV and Crimes against Foreigners in East Germany," IZA Discussion Papers 18648, IZA Network @ LISER.
    4. Omar Martin Fieles-Ahmad & Michael Kvasnica, 2026. "Western TV and Crimes against Foreigners in East Germany," FEMM Working Papers 26009, Otto-von-Guericke University Magdeburg, Faculty of Economics and Management.
    5. Chadi, Adrian & Hoffmann, Manuel, 2026. "Television, health, and happiness: A natural experiment in West Germany," Journal of Public Economics, Elsevier, vol. 257(C).
    6. Laudenbach, Christine & Malmendier, Ulrike & Niessen-Ruenzi, Alexandra, 2024. "The long-lasting effects of experiencing communism on attitudes towards financial markets," SAFE Working Paper Series 429, Leibniz Institute for Financial Research SAFE.
    7. Friehe, Tim & Müller, Helge & Neumeier, Florian, 2020. "Media’s role in the making of a democrat: Evidence from East Germany," Journal of Comparative Economics, Elsevier, vol. 48(4), pages 866-890.
    8. Malmendier, Ulrike M. & Laudenbach, Christine & Niessen-Ruenzi, Alexandra, 2020. "The Long-lasting Effects of Experiencing Communism on Attitudes towards Financial Markets," CEPR Discussion Papers 14939, Centre for Economic Policy Research.
    9. Hyll, Walter & Schneider, Lutz, 2016. "Social Comparisons and Attitudes towards Foreigners. Evidence from the ‘Fall of the Iron Curtain’," IWH Discussion Papers 12/2016, Halle Institute for Economic Research (IWH).
    10. Nikolova, Milena & Popova, Olga, 2024. "Echoes of the past: The enduring impact of communism on contemporary freedom of speech values," Journal of Economic Behavior & Organization, Elsevier, vol. 227(C).
    11. Christine Laudenbach & Ulrike Malmendier & Alexandra Niessen-Ruenzi, 2020. "The Long-lasting Effects of Living under Communism on Attitudes towards Financial Markets," NBER Working Papers 26818, National Bureau of Economic Research, Inc.
    12. Paul Hunermund & Ann Hipp, 2024. "Inventor Mobility After the Fall of the Berlin Wall," Papers 2409.01861, arXiv.org, revised Jan 2025.
    13. Lars Hornuf & Marc Oliver Rieger & Sven A. Hartmann, 2023. "Can television reduce xenophobia? The case of East Germany," Kyklos, Wiley Blackwell, vol. 76(1), pages 77-100, February.
    14. Deter, Max & Lange, Martin, 2023. "Are the supporters of socialism the losers of capitalism? Conformism in East Germany and transition success," European Journal of Political Economy, Elsevier, vol. 76(C).
    15. Max Deter, 2020. "Are the Losers of Communism the Winners of Capitalism? The Effects of Conformism in the GDR on Transition Success," SOEPpapers on Multidisciplinary Panel Data Research 1102, DIW Berlin, The German Socio-Economic Panel (SOEP).
    16. Lange, Martin, 2021. "The legacy of state socialism on attitudes toward immigration," Journal of Comparative Economics, Elsevier, vol. 49(3), pages 733-750.
    17. Slavtchev, Viktor & Wyrwich, Michael, 2017. "TV and entrepreneurship," IWH Discussion Papers 17/2017, Halle Institute for Economic Research (IWH).
    18. Hyll, Walter & Schneider, Lutz, 2018. "Income comparisons and attitudes towards foreigners - Evidence from a natural experiment," Journal of Comparative Economics, Elsevier, vol. 46(2), pages 634-655.
    19. Peter Bönisch & Walter Hyll, 2023. "Television and fertility: evidence from a natural experiment," Empirical Economics, Springer, vol. 64(3), pages 1025-1066, March.
    20. Slavtchev, Viktor & Wyrwich, Michael, 2023. "The effects of TV content on entrepreneurship: Evidence from German unification," Journal of Comparative Economics, Elsevier, vol. 51(2), pages 696-721.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;
    ;

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • N34 - Economic History - - Labor and Consumers, Demography, Education, Health, Welfare, Income, Wealth, Religion, and Philanthropy - - - Europe: 1913-
    • Z13 - Other Special Topics - - Cultural Economics - - - Economic Sociology; Economic Anthropology; Language; Social and Economic Stratification

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:iaa:dpaper:202502. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Adrian Chadi (email available below). General contact details of provider: https://edirc.repec.org/data/iaaegde.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.