Tag Archives: smoking

Fact pattern: Women’s life expectancy advantage

Women live longer than men in all but a small handful of countries. Is that “natural”?

A future post will deal with this more. But here’s a preview.

It partly depends what you think is a “natural” fertility rate. It’s hard to find societies with really high fertility rates nowadays — hardly any countries have 6 or more children per woman. But where fertility rates are higher, women’s advantage in life expectancy is less (click to enlarge).

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Why? Some women die in childbirth, but that’s not a huge factor in life expectancy anymore, thankfully. In sub Saharan Africa about 400-600 mothers die for every 100,000 births, about half of 1%, which isn’t going to drive overall life expectancy that much. Still, those places are rough places to be a woman, apparently.

Some distinctly unnatural elements are at work — besides war, murder, accidents and suicide — especially smoking, which has enlarged the female life expectancy advantage in the U.S. and Europe dramatically. The World Health Organization has smoking rates by sex for 133 countries or so. The differences are huge. Only Austria has more women than men smoking. The average prevalence gap is 21 percentage points, and in Indonesia the smoking gap is 64% (67% for men versus 3% for women). In a bunch of Arab countries almost half the men smoke, along with almost no women.

The effect of the smoking gap is not apparent in the recent cross-sectional data, however. It takes a few decades after men take up smoking at higher rates (peak female advantage for the U.S. was in the 1970s). But this could be an important factor in the world’s life expectancy gender gap for decades to come.

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Warning: What do smokers Google?

If I ran the Federal scary anti-smoking image warning program, I might show smokers the list of health-related terms that show up most in the states with the highest cigarette smoking rates.

The Google Correlate tool is showing the great potential for using Internet search activity to investigate layers of behavior and meaning behind other observable social phenomena, such as race/ethnic composition, health behavior, and family patterns. Today’s example is smoking.

If you take the smoking rates by state, and throw them into the Google Correlate hopper, you can see the 100 search terms that are most highly correlated with that reported smoking behavior. That is, the terms that are most likely to be used in high-smoking states and least likely to be used in the low-smoking states.

Is the result just a lot of noise? Maybe, but I don’t think so. Here are the smoking-related terms in the top 100:

  • camel no 9
  • cigarette coupon
  • cigarette coupons
  • marlboro coupons
  • my time to quit
  • safe cigarettes
  • stopping smoking
  • time to quit
  • fire safe cigarettes
  • ways to stop smoking

So that’s good for face validity — a list of random search terms isn’t likely to have all those smoking terms on it.

But after the smoking terms, the thing that jumps out is the health-related terms. We know from the Google flu tracker that people search for their symptoms. So these caught my eye.

Here is a screen shot of the first page of results:

I selected “stages of copd” as the term to map. The map on the left is the smoking rates; the one on the right is the relative frequency of searches for “stages of copd.” That is, chronic obstructive pulmonary disease, a nasty disease the most common cause of which is smoking.

Here is the complete list of health-related terms among the top-100 correlates with smoking rates:

Lymph node swelling, which is implicated in the jaw and neck searches, most often reflects infection — which smoking causes.

How strong are the connections? They’re not the strongest I’ve seen on Google Correlate. The “stages of copd” search is correlated with smoking rates at .77 on a scale of 0 to 1. It’s not uncommon to find correlations of .93 (which is the relationship between “quiche” and “volvo v70 xc”).

But considering the smoking rates come from a sample survey (the National Survey on Drug Use and Health) which includes random error, and states are somewhat arbitrary geographic units, that correlation seems pretty high to me. Here’s the scatterplot:

What is the correlation causality story here? I can’t say. But the simplest explanation is that these are the terms smokers (and maybe those who know or care for them) are most likely to Google relative to non-smokers — not that they are the most common searches smokers do, of course, but the searches that differentiate them from non-smokers. The simplest explanation is the best place to start.

I like this list of conditions because in my experience smokers sometimes have the attitude of “you have to die of something.” But it’s not just the chance of dying that smoking increases – it’s a lot of possible forms of suffering along the way.

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Do explicit, enforceable policies matter?

Yes.

The Supreme Court’s decision in the Dukes v. Wal-Mart case, Justice Scalia acknowledged that Wal-Mart’s many local managers had a lot of discretion in their personnel decisions, even though the company had a written policy against gender discrimination (who doesn’t?). But he gave the company credit for a vague policy and let it off the hook for a systematic pattern of disparity between men and women. So, when does a toothless, vague policy over wide discretion lead to a bad outcome, and is failing to prevent it the same as causing it?

A path-breaking sociological analysis of organizational affirmative action outcomes has shown that the companies that successfully diversify their management are most likely to have policies with teeth – where accountability is built into the diversity goal. In light of the Wal-Mart case, this led to a rollicking debate about how to think about “corporate culture” versus policies, and when to blame whom, legally or otherwise – which even divided sociologists.

Smoking in the movies

Here’s an interesting, at-least-vaguely related case. Positive depictions of smoking in the movies are widely understood to be harmful. Yet, smoking is also glamorous, artistic, and popular – representing both anti-adult rebellion and maturity. So, what to do? The Centers for Disease Control, in the always-riveting Morbidity and Mortality Weekly Report, has published a fascinating report on this topic. They report the number of tobacco incidents* in top-grossing, youth-rated (G, PG, PG-13) movies, and divide them between those that implemented an anti-tobacco policy and those that didn’t — helpfully cutting the movie industry roughly in half — and provide a simple before-and-after tabulation:

From 2005 to 2010, among the three major motion picture companies (half of the six members of the Motion Picture Association of America [MPAA]) with policies aimed at reducing tobacco use in their movies, the number of tobacco incidents per youth-rated movie decreased 95.8%, from an average of 23.1 incidents per movie to an average of 1.0 incident. For independent companies (which are not MPAA members) and the three MPAA members with no antitobacco policies, tobacco incidents decreased 41.7%, from an average of 17.9 incidents per youth-rated movie in 2005 to 10.4 in 2010, a 10-fold higher rate than the rate for the companies with policies. Among the three companies with antitobacco policies, 88.2% of their top-grossing movies had no tobacco incidents, compared with 57.4% of movies among companies without policies.

The difference is dramatic, as indicated by this image about the images. (Because I turned the columns into cigarettes, this is not just a graph, but an infographic):

The policies provide what may be an ideal mix of accountability and responsibility, short of a simplistic ban.

[The policies] provide for review of scripts, story boards, daily footage, rough cuts, and the final edited film by managers in each studio with the authority to implement the policies. However, although the three companies have eliminated depictions of tobacco use almost entirely from their G, PG, and PG-13 movies, as of June 2011 none of the three policies completely banned smoking or other tobacco imagery in the youth-rated films that they produced or distributed.

Maybe this formula is effective because there already has been a strong cultural shift against smoking — as strong, even, as the shift against excluding women from management positions?

Graphic addendum (disturbing image below)

Whether smoking in movies actually encourages young people to take up smoking is of course a not a settled issue — especially on websites sponsored by tobacco sellers, as seen in this ironic screen-shot from Smokers News:

One reason to have an explicit policy is that it’s easy to assume viewers will see through the glamour to the negative outcomes. “Surely no one will want to be like that character…” But people – maybe especially young people? – have an amazing capacity to celebrate selectively from the characters they see. I have learned from experience that, in children’s stories, even those who get their comeuppance in the end still manage to emerge as role models for their bad behavior. So maybe some people want to relive this from Pulp Fiction…

…and aren’t put off by this:

*”A new incident occurred each time 1) a tobacco product went off screen and then back on screen, 2) a different actor was shown with a tobacco product, or 3) a scene changed, and the new scene contained the use or implied off-screen use of a tobacco product.”

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