Healthy, nudged, and wise: Experimental evidence on the role of information salience in reducing tobacco intake
- For policymakers
- Summary created: 2024
Evaluates the impact of behavioral interventions on tobacco consumption in an ultra-poor rural area in Bangladesh, where traditional policy tools like taxation and warning labels are often ineffective.
This summary, including its recommendations and ideas, was created by Adnan Fakir and is based on original research. The original research itself was conducted in collaboration with the following researcher.
Bangladesh’s healthcare system faces severe strain from preventable lifestyle diseases, with tobacco use being a significant factor. Bangladesh has high smoking rates, especially in rural regions, where unique socio-economic and cultural factors contribute to tobacco dependency. This study, conducted in the chars (riverine islands) of Gaibandha district, targets an exceptionally isolated and impoverished population with high tobacco use and limited access to healthcare, education, or national anti-tobacco campaigns. Men predominantly smoke cigarettes or bidis, and some also use smokeless tobacco (SLT), while women exclusively consume SLT for social and perceived health benefits. This high tobacco dependency is rooted in a cultural tradition where tobacco consumption symbolizes hospitality, social belonging, and a means to cope with high-stress living conditions. The experimental site is highly relevant due to these factors and the inadequacy of conventional tobacco control methods.
Insights
The logbook intervention (LT), which required participants to record daily tobacco expenditures, reduced household tobacco spending by 22.8%, but led to substitution to smokeless tobacco (SLT).
Evidence
LT lowered overall tobacco expenditure in participating households by 22.8%, but men shifted from cigarettes to cheaper SLT, increasing SLT spending by 22%. This substitution suggests that highlighting the immediate financial costs can inadvertently promote the use of cheaper, equally harmful tobacco products when such options are available.
What it means
The LT's focus on immediate costs may not promote net reductions in tobacco consumption in low-income settings with access to cheaper alternatives.
The poster intervention (PT), which displayed the health risks of tobacco use, particularly on children, reduced both smoking and SLT use without triggering substitution behaviors.
Evidence
PT reduced tobacco expenditure by 25.3% in participant households and was associated with an 8.7% reduction in breath carbon monoxide levels among men. PT also significantly reduced SLT consumption in women (by 10.7%). While both interventions lowered tobacco spending, PT's emphasis on health risks, particularly to children, was more effective in reducing both smoking and SLT use.
What it means
Health-focused interventions that leverage parental concerns about children's wellbeing may more effectively reduce tobacco use without promoting harmful substitutes.
Males whose spouses did not consume tobacco exhibited greater reductions in smoking and expenditure on smoking tobacco following the interventions.
Evidence
Men with non-tobacco-consuming spouses reduced smoking tobacco spending and smoking rates more significantly than those with tobacco-using spouses in both LT and PT groups. This effect suggests that household social dynamics and partner behaviors reinforce intervention impacts.
What it means
Household composition, specifically the tobacco consumption habits of spouses, can amplify or hinder intervention outcomes.
Higher tobacco expenditure at baseline and risk aversion among participants were associated with a stronger response to LT, while participants with children under five were particularly responsive to PT.
Evidence
LT prompted greater tobacco reductions among men with risk-averse attitudes and those whose tobacco spending exceeded 5.5% of household expenditures. PT was most effective for men with children under five, who were motivated by the health risks to children displayed on the posters.
What it means
Tailoring interventions based on risk attitudes, expenditure levels, and parental status can enhance their effectiveness in tobacco control.
Both interventions were relatively cost-effective, with PT achieving larger reductions without substitution at a cost of approximately USD 11 per participant, compared to USD 13 for LT.
Evidence
Costs included materials, training, and monitoring for one month. PT's costs were 15% lower, yet it achieved larger reductions in tobacco use without substitution to SLT, making it more effective per dollar spent.
What it means
Behavioral interventions that leverage health concerns (particularly those targeting parental motivations) may offer a more sustainable and cost-effective alternative to purely financial nudges in tobacco control for low-income regions.
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