Tobacco Control Campaign in Uruguay: Impact on Smoking Cessation during Pregnancy
Background. In 2005, Uruguay instituted a nationwide tobacco control campaign that has resulted in a substantial decline in nationwide smoking rates. We sought to determine the quantitative contributions of each of the major tobacco control measures adopted by the Uruguayan government. We focused sharply on smoking cessation by pregnant women and on the effect of quitting smoking during pregnancy on birth weight. Data. We analyzed a nationwide registry of all pregnancies in Uruguay during 2007-2012, supplemented by data on cigarette prices and various governmental policies. Methods. We estimated linear probability models of quitting smoking in the third trimester as well as linear models of the effect of quitting on birth weight. Our explanatory variables included maternal characteristics, provider-level and national-level policy interventions, and real price. In our models of quitting smoking, we used taxes as an instrument to address price endogeneity. In our models of birth weight, we used tobacco control policies as instruments to address the endogeneity of smoking cessation. Results. During 2007-2012, the proportion of pregnant women who had quit smoking by their third trimester increased markedly from 15 to 42 percent. Each of the major non-price tobacco control measures - including programs to treat nicotine dependence at health centers, banning of advertising nationwide, rotating warnings with pictograms on each pack, restriction of brands to a single presentation, and an increase in the size of pictograms to 80% of the front and back of each pack - was separately associated with a significant increase in the rate of quitting. During 2007-2009, tobacco manufacturers responded to tax increases and non-price policies by moderating their pretax prices. Quitting smoking by the third trimester increased birth weight by an estimated 163 grams. Conclusion. Uruguay's nationwide tobacco control campaign led to a substantial increase in the likelihood that a pregnant smoker would quit by her third trimester. Each of the major tobacco control measures adopted by the government had a measurable impact on the rate of quitting and thus on neonatal health.
|Date of creation:||Jan 2014|
|Publication status:||published as Jeffrey E. Harris & Ana Inés Balsa & Patricia Triunfo, 2015. "Tobacco control campaign in Uruguay: Impact on smoking cessation during pregnancy and birth weight," Journal of Health Economics, vol 42, pages 186-196.|
|Note:||DEV HC HE PE|
|Contact details of provider:|| Postal: National Bureau of Economic Research, 1050 Massachusetts Avenue Cambridge, MA 02138, U.S.A.|
Web page: http://www.nber.org
More information through EDIRC
References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Diana S. Lien & William N. Evans, 2005. "Estimating the Impact of Large Cigarette Tax Hikes: The Case of Maternal Smoking and Infant Birth Weight," Journal of Human Resources, University of Wisconsin Press, vol. 40(2).
- Joshua D. Angrist & Alan B. Krueger, 2001.
"Instrumental Variables and the Search for Identification: From Supply and Demand to Natural Experiments,"
Journal of Economic Perspectives,
American Economic Association, vol. 15(4), pages 69-85, Fall.
- Joshua Angrist & Alan B. Krueger, 2001. "Instrumental Variables and the Search for Identification: From Supply and Demand to Natural Experiments," NBER Working Papers 8456, National Bureau of Economic Research, Inc.
- Joshua Angrist & Alan B. Krueger, 2001. "Instrumental Variables and the Search for Identification: From Supply and Demand to Natural Experiments," Working Papers 834, Princeton University, Department of Economics, Industrial Relations Section..
- Newey, Whitney K., 1987. "Efficient estimation of limited dependent variable models with endogenous explanatory variables," Journal of Econometrics, Elsevier, vol. 36(3), pages 231-250, November.
- Jason Boardman & Daniel Powers & Yolanda Padilla & Robert Hummer, 2002. "Low birth weight, social factors, and developmental outcomes among children in the United States," Demography, Springer;Population Association of America (PAA), vol. 39(2), pages 353-368, May.
- Colman, Greg & Grossman, Michael & Joyce, Ted, 2003. "The effect of cigarette excise taxes on smoking before, during and after pregnancy," Journal of Health Economics, Elsevier, vol. 22(6), pages 1053-1072, November.
- Greg Coleman & Michael Grossman & Ted Joyce, 2002. "The Effect of Cigarette Excise Taxes on Smoking Before, During and After Pregnancy," NBER Working Papers 9245, National Bureau of Economic Research, Inc.
- Abrevaya, Jason & Dahl, Christian M, 2008. "The Effects of Birth Inputs on Birthweight," Journal of Business & Economic Statistics, American Statistical Association, vol. 26, pages 379-397.
- Jason Abrevaya, 2006. "Estimating the effect of smoking on birth outcomes using a matched panel data approach," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 21(4), pages 489-519.
- Thrasher, James F. & Rousu, Matthew C. & Hammond, David & Navarro, Ashley & Corrigan, Jay R., 2011. "Estimating the impact of pictorial health warnings and "plain" cigarette packaging: Evidence from experimental auctions among adult smokers in the United States," Health Policy, Elsevier, vol. 102(1), pages 41-48, September.
- Christopher F Baum & Mark E. Schaffer & Steven Stillman, 2007. "Enhanced routines for instrumental variables/GMM estimation and testing," CERT Discussion Papers 0706, Centre for Economic Reform and Transformation, Heriot Watt University.
- Christopher F Baum & Mark E. Schaffer & Steven Stillman, 2007. "Enhanced routines for instrumental variables/GMM estimation and testing," Boston College Working Papers in Economics 667, Boston College Department of Economics, revised 05 Sep 2007.
- Nelson, Jon P., 2006. "Cigarette advertising regulation: A meta-analysis," International Review of Law and Economics, Elsevier, vol. 26(2), pages 195-226, June.
- Levy, Douglas E. & Meara, Ellen, 2006. "The effect of the 1998 Master Settlement Agreement on prenatal smoking," Journal of Health Economics, Elsevier, vol. 25(2), pages 276-294, March.
- E. Kathleen Adams & Vincent P. Miller & Carla Ernst & Brenda K. Nishimura & Cathy Melvin & Robert Merritt, 2002. "Neonatal health care costs related to smoking during pregnancy," Health Economics, John Wiley & Sons, Ltd., vol. 11(3), pages 193-206.
- Bharadwaj, Prashant & Johnsen, Julian V. & Løken, Katrine V., 2014. "Smoking bans, maternal smoking and birth outcomes," Journal of Public Economics, Elsevier, vol. 115(C), pages 72-93.
- Bharadwaj, Prashant & Johnsen, Julian V. & Loken, Katrine Vellesen, 2012. "Smoking Bans, Maternal Smoking and Birth Outcomes," IZA Discussion Papers 7006, Institute for the Study of Labor (IZA).
- Bharadwaj, Prashant & Johnsen, Julian V. & Løken, Katrine V., 2012. "Smoking Bans, Maternal Smoking and Birth Outcomes," Working Papers in Economics 17/12, University of Bergen, Department of Economics.
- Mary Beth Walker & Erdal Tekin & Sally Wallace, 2009. "Teen Smoking and Birth Outcomes," Southern Economic Journal, Southern Economic Association, vol. 75(3), pages 892-907, January.
- MaryBeth Walker & Erdal Tekin & Sally Wallace, 2007. "Teen Smoking and Birth Outcomes," NBER Working Papers 13386, National Bureau of Economic Research, Inc.
- Evans, William N. & Ringel, Jeanne S., 1999. "Can higher cigarette taxes improve birth outcomes?," Journal of Public Economics, Elsevier, vol. 72(1), pages 135-154, April.
- William N. Evans & Jeanne S. Ringel, 1997. "Can Higher Cigarette Taxes Improve Birth Outcomes?," NBER Working Papers 5998, National Bureau of Economic Research, Inc.
- Blecher, Evan, 2008. "The impact of tobacco advertising bans on consumption in developing countries," Journal of Health Economics, Elsevier, vol. 27(4), pages 930-942, July.
- Paula Veiga & Ronald P. Wilder, 2006. "Maternal smoking during pregnancy and birthweight - A propensity score matching approach," NIMA Working Papers 32, Núcleo de Investigação em Microeconomia Aplicada (NIMA), Universidade do Minho.
- Jonathan Gruber & Botond Köszegi, 2001. "Is Addiction "Rational"? Theory and Evidence," The Quarterly Journal of Economics, Oxford University Press, vol. 116(4), pages 1261-1303.
- Ji Yan & Peter A. Groothuis, 2013. "Timing of Prenatal Smoking Cessation or Reduction and Infant Birth Weight: Evidence from the United Kingdom Millennium Cohort Study," Working Papers 13-16, Department of Economics, Appalachian State University.
- Deliana Kostova & Evan Blecher, 2013. "Does Advertising Matter? Estimating The Impact Of Cigarette Advertising On Smoking Among Youth In Developing Countries," Contemporary Economic Policy, Western Economic Association International, vol. 31(3), pages 537-548, 07.
- Saffer, Henry & Chaloupka, Frank, 2000. "The effect of tobacco advertising bans on tobacco consumption," Journal of Health Economics, Elsevier, vol. 19(6), pages 1117-1137, November. Full references (including those not matched with items on IDEAS)