Employment fluctuations and tobacco: How changing employment conditions impact smoking behavior and cigarette tax policy.

摘要

In the last 35 years, the United States has experienced periods of extraordinary job growth, as well as four economic recessions, one of which was the longest downturn since the Great Depression. Although cyclical variation triggers questions about economic and housing stability, changing labor market conditions may also impact population health through financial and psychosocial mechanisms. This dissertation assesses the impact of both aggregate and individual level employment conditions on smoking, the leading preventable cause of death in this country. Understanding relationships between employment and smoking can help policymakers and health professionals design targeted health promotion programs, enhance tobacco control policies, and plan for future healthcare needs.;In the first essay, I use nationally representative data to examine the influence of state labor market conditions on smoking behaviors, finding that smoking probabilities decline as state unemployment rates rise, but only in relatively strong economies. In the second essay, I assess how individual employment changes impact smoking status and intensity. Analyses of repeated observations of individuals over time suggest that people smoke more when they are unemployed than when they are working, but smoke less when they are out of the labor market altogether. In the third essay, I use thirty years of data from all 50 states to explore predictors of higher state cigarette tax rates, which are associated with lower smoking prevalence. My results demonstrate little support for claims that high state unemployment rates drive higher cigarette tax rates.;As the economy continues to recover from recent downturns, the results presented here illustrate several opportunities to enhance progress toward national smoking-related goals. In these analyses, economic growth and employment are associated with greater smoking risks, underscoring the need for continued workplace programs and policies that discourage or prohibit smoking. Looking for work also appears to be a smoking risk factor; pairing smoking prevention resources with unemployment assistance programs could help ameliorate this risk. Finally, while economic and employment conditions are not key predictors of cigarette excise taxes in my analyses, other political or regional factors may create policy windows that advocates can leverage to foster tobacco control policy.