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Maternal Smoking & the 1998 Master Settlement Agreement

Maternal Smoking & the 1998 Master Settlement Agreement. Douglas E. Levy, Ph.D. Ellen R. Meara, Ph.D. Dept. Health Care Policy, Harvard Medical School Support Provided by AHRQ T32-HS00055 & NIA T32-AG00186. Price Responsiveness of Smoking. Elasticity of smoking participation

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Maternal Smoking & the 1998 Master Settlement Agreement

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  1. Maternal Smoking & the 1998 Master Settlement Agreement Douglas E. Levy, Ph.D. Ellen R. Meara, Ph.D. Dept. Health Care Policy, Harvard Medical School Support Provided by AHRQ T32-HS00055 & NIA T32-AG00186

  2. Price Responsiveness of Smoking • Elasticity of smoking participation • General population  -0.25 • Pregnant women • -0.5 (Evans & Ringel; Natality Files 1989-1992) • -0.7 (Ringel & Evans; Natality Files 1989-1995) • -1.0 (Colman et al.; PRAMS data 1993-1999) • The Master Settlement Agreement led to an immediate 22% (45¢) increase in cigarette prices • Price increase from MSA could reduce • Smoking among pregnant women 10-20% • Low birth weight 2-4% • DID IT?

  3. Study Design • Examined four outcomes • Maternal smoking participation and intensity (# of cigarettes/day) • LBW and birth weight in grams • Used interrupted time-series regressions to determine whether there were important changes in outcomes following the MSA • Subgroup analyses by mothers’ age, race, education

  4. Study Data • National Vital Statistics Natality Detail Files from 1996 to 2000 • We exclude • States not reporting maternal smoking (CA, IN, SD, upstate NY) • Non-singleton birth • Mother <15 or >44 years old • Incomplete data on outcomes and demographics • 4% had missing data given first three criteria • Control variables: • calendar month, state, excise taxes, maternal demographics, pregnancy characteristics, prenatal care, heavy alcohol consumption • N = 9,638,863

  5. Study Period • Infants conceived from January 1996 to February 2000 • Adequately capture pre- and post-MSA trends without picking up later non-price effects of MSA • Exclude infants conceived from March 1998 through November 1998 • Avoid pregnancies only partially affected by MSA

  6. Summary Statistics

  7. More likely to be white Less likely to have attended college Younger Less likely to be married Likely to have fewer and later prenatal care visits More likely to have had a prior preterm birth More likely to drink heavily during pregnancy Maternal Smokers Are…

  8. Regression Analyses • Yits = 0 + timet + MSAt + timet*MSAt + Montht + Demographicsi + us + eist • Time is monthly count; captures secular trend • MSA captures immediate changes beginning Nov. 1998 • Time*MSA captures changes in trend following MSA • Month captures seasonal variation in outcome

  9. Predicted Smoking Prevalence MSA, Nov. 1998

  10. Predicted Smoking Prevalence 15mos Post-MSA

  11. Predicted LBW Prevalence 15mos Post-MSA

  12. Why So Little Effect? • Perhaps remaining smokers are less likely to change habits in response to price hikes • Perhaps earlier estimates based on changes in state excise taxes were confounded • Simultaneous changes in attitude towards smoking • Simultaneous tobacco control legislation

  13. Limitations • No control group • Assumes trend is linear • Maternal smoking is self-reported • Major states were excluded from the analysis • 20% of births during this period

  14. Implications • Pros of price increases for tobacco control • Young women and their infants may benefit • Price changes affect most smokers • Cons of price increases for tobacco control • Less effective than commonly believed • Regressive taxation • Next steps • Results in other populations? • Relate to new evidence re: long-run price-responsiveness

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