Annals of Health Law
STRATEGY AGAINST SMOKING
However, tobacco use remains widespread among people of low
socioeconomic status. 7 Similar developments can be found in other HICs. 8
In low and middle-income countries (LIC and MIC), the total number of
smokers is still increasing, 9 largely due to the aggressive marketing of
transnational tobacco companies searching for new markets. 10
Aguably, smoking is a modifiable behavior. It is therefore crucial to find
a mechanism other than the existing tobacco control strategies, a
mechanism that can influence people in their decision to refrain from
beginning to smoke or convince them to cease smoking. Based on insights
from behavioral economics, this paper develops a novel regulatory model
providing positive economic incentives to affect people’s choice regarding
tobacco use. The model takes a dual approach consisting of a weekly
lottery as well as an account with an increasing credit balance that can only
be accessed after a specific period of non-smoking. Given the required
administrative efforts, particularly the process of verifying the smoking
status, the model’s implementation at present seems more realistic in HICs.
This does not mean that it is not transferable to the situation in LICs and
MICs. 11 The following will focus specifically on the United States.
IN CURRENT CIGARETTE SMOKING AMONG HIGH SCHOOL STUDENTS AND ADULTS, UNITED
STATES, 1965-2010 (2011), available at http://www.cdc.gov/tobacco/data_statistics/
7. Ctrs. for Disease Control and Prevention, Health Disparities and Inequalities Report
– United States, 2011, 60 (SUPPL. 1) MORBIDITY AND MORTALITY WEEKLY REP. 1, 109-112
(2011); FOCUS GROUP, SMOKING HABITS AND PREVENTION STRATEGIES IN LOW SOCIO-
ECONOMIC STATUS POPULATIONS 1 (2004). See also Roland Bayer & Jennifer Stuber,
Tobacco Control, Stigma, and Public Health: Rethinking the Relations, 96 AM. J. PUB.
HEALTH 47, 49 (2006); LUIS G. ESCOBEDO ET AL., Sociodemographic Characteristics of
Cigarette Smoking Initiation in the United States – Implications for Smoking Prevention
Policy, 264 J. AM. MED. ASS’N 1550 passim (1990).
8. MARTIN BOBAK, PRABHAT JHA, SON NGUYEN & MARTIN JARVIS, Poverty and
Smoking, in TOBACCO CONTROL IN DEVELOPING COUNTRIES 41 passim (Prabhat Jha & Frank
J. Chaloupka eds., 2000); Gary A. Giovino et al., Epidemiology of Tobacco Use and
Dependence, 17 EPIDEMIOLOGIC REV. 48 passim (1995); Knut-Olaf Haustein, Smoking and
Poverty, 13 EUR. J. CARDIOVASCULAR PREVENTION & REHABILITATION 312 passim (2006);
Richard Layte & Christopher T. Whelan, Explaining Social Class Inequalities in Smoking:
The Role of Education, Self-Efficacy, and Deprivation, 25 EUR. SOCIOLOGICAL REV. 399
passim (2009). But see BÖRN HIBELL, ET AL., THE ESPAD REPORT 2003: ALCOHOL AND
OTHER DRUG USE AMONG S TUDENTS IN 35 EUROPEAN COUNTRIES 196-197 (2004).
9. See, e.g., JESSE B. BUMP, MICHAEL R. REICH, OLUSOJI ADEYI & S. KHETRAPAL,
TOWARDS A POLITICAL ECONOMY OF TOBACCO CONTROL IN LOW- AND MIDDLE-INCOME
COUNTRIES 17-19 (2009); INST. OF MED., supra note 3, at 72; RICHARD PETO & ALAN D.
LOPEZ, Future Worldwide Health Effects of Current Smoking Patterns, in CRITICAL ISSUES
IN GLOBAL HEALTH 154 passim ( C. Everett Koop, Clarence E. Pearson, M. Roy Schwarz
10. MICHAEL ERIKSEN, JUDITH MACKAY, HANA ROSS, THE TOBACCO ATLAS 60 (4th ed.