Why Do Europeans Smoke More than Americans? It's getting tougher to find places to smoke in America. More and more towns and cities are banning smoking in bars and restaurants. Beleaguered smokers might look across the pond to Europe where their compatriots seem to smoke without a care.

Why Do Europeans Smoke More than Americans?

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NEAL CONAN, host:

The smoking gap is one of those eternal questions. Why do Europeans smoke more than we Americans do? At first blush, the answer might seem obvious: taxes, smoking bans, workplace rules. But when two Harvard economists investigated further, the answers surprised them.

If you have questions about the smoking study, give us a call. The number: 800-989-8255. That's 800-989-TALK. E-mail us, talk@npr.org.

David Cutler is Dean for the Social Sciences at Harvard University, and also one of the authors of this paper. And he's with us now from the studio at Harvard.

Nice to have you on the program today.

Professor DAVID CUTLER (Applied Economics, Harvard University): It's a pleasure to be with you.

CONAN: Being an economist, I assume your first approach was to question whether there was an economic distinction.

Prof. CUTLER: It was indeed. The first thing that you think about is exactly what you mentioned: the price of cigarettes. It turns out in most of western Europe, the price of cigarettes is higher than it is in the U.S. We tax cigarettes, but Europeans tax them much more.

CONAN: Mm hmm. So, uh...

Prof. CUTLER: The second thing you...

CONAN: Yeah, go ahead.

Prof. CUTLER: The second thing you would think about is income. That is, maybe because we're richer we want to live longer and therefore we smoke less. That explains a bit of it, but nowhere near the huge reductions in smoking we see.

CONAN: Well how big is the difference?

Prof. CUTLER: The difference is about a third. Roughly 1 in 4 Europeans smoke compared to about 1 in 7 Americans.

CONAN: We're talking about adults here?

Prof. CUTLER: Yes.

CONAN: And I assume Europe, being a big place, which Europeans smoke the most?

Prof. CUTLER: Non-English speaking Europeans smoke the most. Smoking has declined far and away the largest amount in the U.S., and then in the English-speaking parts of Europe.

CONAN: Hm. And is, anecdotally, you would tend to think that Central and Eastern Europe, places like Poland, people seem to smoke a lot more.

Prof. CUTLER: They do indeed. In poorer countries, people tend to smoke more. The amazing thing about the United States is that even given its much higher income than most of Europe, smoking is still far below what one would think.

CONAN: Mm hm. Now, at least in the parts of Europe that I visited, advertising on cigarette packages for that is even more ferocious than it is in the United States.

Prof. CUTLER: It is, in fact. And in many European countries, regulations on smoking are far, at least on paper, are far bigger than they are in the U.S. The actual degree of enforcement of the regulations is something that will vary from country to country, indeed, within parts of the U.S. The stringency with which things are enforced will vary as well. But on paper it's much, much stricter.

CONAN: So, just like in the United States, at least on paper, you can't smoke in restaurants and bars and that kind of thing.

Prof. CUTLER: That's correct.

CONAN: And so, why do you think, what did you come up with as an explanation for--if it's not economics, if it's not income disparity, why is it?

Prof. CUTLER: What lines up extremely well is the share of the population that believes that smoking is bad for them. Americans, universally, near 100 percent of Americans will tell you that smoking is bad for them--that it leads to diseases like lung cancer and heart disease, that it shortens their life immeasurably. If anything, Americans overestimate how bad smoking is for them. Many Europeans seem not to have received that message.

CONAN: Hm. Do you think that suggests our public service campaigns all these years have been more effective than theirs?

Prof. CUTLER: I think that is part of it, that better public health is an enormously large part of it. There may be different views about science in the U.S. than elsewhere. Medical discoveries are very big news in the United States, and I think in parts of Europe they're a little bit less so. And then I think the public pressure that comes along with the public health messages, the peer pressure, the social pressure among many groups--particularly better educated groups higher up in the social distribution--has led to a sense that smoking is so obviously bad that one should not really engage in it at all.

CONAN: We're talking with David Cutler, an economist at Harvard University about a study he co-wrote about why Europeans smoke more than Americans.

Let's get a caller on the line. If you'd like to join us, 800-989-8255. Justin--Justin's on the line from San Antonio.

JUSTIN (Caller): Hi. How're you doing?

CONAN: Very well Justin. Go ahead.

JUSTIN: Good. I just wanted to know, he was talking about the, how the non-English speaking Europeans will tend to smoke more. I was wondering if the same trends followed with Americans, non-English speaking Americans.

CONAN: Did you look into that David Cutler?

Prof. CUTLER: I haven't looked into it that carefully in the United States. Although, I suspect it's true. In the United States, the biggest thing about smoking is it differs enormously by the level of education. Smoking rates are twice as high among those who have a high school degree or less compared to those who have a college degree or more.

In fact, the single biggest difference between the U.S. and Europe is that in the U.S., it's the highly educated group that doesn't smoke, whereas in Europe they do. The less educated, lower social groups tend to smoke about the same rates in the two regions.

CONAN: Hm.

JUSTIN: Well, that's very interesting.

CONAN: Justin, thanks very much for the call.

JUSTIN: Thank you.

CONAN: You're listening to TALK OF THE NATION, coming to you from NPR News.

And David Cutler, one of the things that I think immediately leaps to mind is that, of course, Americans are fatter--more obese if you wanted to put it that way--than our European counterparts. Maybe we're not paying attention to that part of the public health message.

Prof. CUTLER: It is--you are exactly right. Americans have learned how to do some things extremely well, and other things we have not learned about at all.

This rate of smoking, in addition to being low--it actually used to be much higher in the U.S., but half of the people who ever smoked have quit. Smoking tobacco is one of the most addictive substances we know of, yet people have managed to figure out how to get rid of that. On the obesity side, America is--if you look at the sort of developed countries of Western Europe and North America--America is the most obese country. And the second most obese country isn't even very close. So we have figured out how to cure our addiction to tobacco, and we have substituted an addiction for food in its place.

CONAN: I can hear the public health advocates already, writing in and saying we haven't figured it out quite yet. That statement might be a little bit premature, but I think we get your point in general.

Let's get another caller on the line, Zoey(ph)--Zoey with us from Sacramento in California.

ZOEY (Caller): Hello. Thank you. And I'm glad you mentioned the issue of obesity. Every time I go to Europe, and I will disclose that I am a smoker--every time I go to Europe I ask myself that question: how can these people be so tin and look so healthy when it seems like everybody is smoking?

The question that I have for your guest is what does stress contribute to the issue of smoking or non-smoking? I see smoking as a type of relaxation, and it seems that a lot of people in Europe seem to be a lot more relaxed than us uptight Americans. Is there an issue with stress levels or work ethic, anything like that?

Prof. CUTLER: It's an excellent question. I think part of the reason why people who are less high up on the social scale smoke more is because of the stresses of daily life leave people almost no outs, and so smoking becomes an out for them.

Although, that much said, people who are higher up in the social scale face more stresses than they used to, but they don't take it out by way of smoking. It may be a little bit of that is taken out by way of obesity.

I think, on obesity, there's a big part of it which is just that food is much more available in the U.S. than it is in Europe. You can walk into any building in the U.S. and find a vending machine with snacks that are cheap and that taste reasonably good--certainly much better than they did a couple of decades ago. One doesn't see that in Europe, probably because it's regulated or because it's taxed much higher.

And so, the availability of the food is much greater. Indeed, the way that Americans, availability is a common thread between both smoking and obesity. The way that we get rid of smoking is by keeping cigarettes out of our house, out of our buildings, out of our restaurants, out of our public spaces. The way we get obese is we allow the food into those...

CONAN: All those places. Yes, indeed.

Prof. CUTLER: And then, in each case we find it easy to resist when it's not there, or easier to resist when its not there, and virtually impossible to resist when it is there.

CONAN: Zoey, interesting question. Thanks for the call.

ZOEY: Thank you.

CONAN: Let's see if we can talk with Barrington(ph)--Barrington in Fort Lauderdale, Florida.

BARRINGTON (Caller): Yes, sir. How are you?

CONAN: Good.

BARRINGTON: Okay. My question in reference to the comparison of the European nations as compared to the United States in terms of the smoking or the lack of it. Could it be that the cost of insurance for, in the United States, it costs so much more because the American government does not provide...

CONAN: Health coverage. Yes, indeed.

BARRINGTON: Health coverage.

CONAN: Yeah, a much broader public health coverage in Europe. David Cutler?

BARRINGTON: Right.

Prof. CUTLER: I think that may be part of it with, particularly with life insurance. That is, people who smoke pay more for life insurance, and that's one discouragement for smoking. Health insurance is very interesting in that, in almost no cases do employers make people pay more if they're smokers, even though they will use more in the way of medical care resources. It's one of the things that economists have wondered over, as to why shouldn't we have more of that.

But probably, for some types of insurance, life insurance that would be, that may be part of the explanation.

CONAN: Also in, we just have a few seconds left. And Barrington, thanks very much for the call. We just have a few seconds left, but, you would think that cancer rates would at least, given this disparity, show a similar disparity.

Prof. CUTLER: Indeed, they are starting to show that disparity. Lung cancer seems to lag smoking by about 20 to 25 years. And what we're seeing now in the U.S. is the substantial reductions in smoking that occurred over the past couple of decades seem like they're starting to have an impact on cancer mortality. That's something that the U.S. is likely to enjoy that a lot of Europe will not.

CONAN: David Cutler, thanks very much. Appreciate your time.

Prof. CUTLER: You are quite welcome.

CONAN: David Cutler, Dean for the Social Sciences at Harvard University. He joined us from the studio there in Cambridge.

This is TALK OF THE NATION from NPR News. I'm Neal Conan, in Washington.

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