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The effect of stimulants and their combined use with cigarettes on mortality: the case of betel quid

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Abstract

Ten percent of the world’s population use betel quid, making betel quid the fourth most used substance in the world. In Taiwan, there are an estimated 1.5 million users and the majority of them are also smokers. The number of people who died from oral cancer rose more than five times over the period from 1987 to 2006. In this study, we employ propensity score matching and the Weibull hazard model with instrumental variables to examine the health effects of betel quid chewing, in particular the health effect of its combined use with cigarettes. We show that betel quid chewing and smoking have a significant negative effect on health, and that the 10-year death hazard for joint users of betel quid and cigarettes doubles that for abstainers. Moreover, betel quid chewing is as harmful to health as smoking. We also find that betel quid chewing and smoking significantly increase the odds of dying from oral and oesophagus cancers.

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Notes

  1. Good reviews of the health effect of betel quid chewing can be found in IARC [23], Wen et al. [40] and Yen et al. [45].

  2. See [4, 6, 10, 11, 13, 18, 19, 26, 29].

  3. Caliendo and Kopeinig [9] provide a good review of the PSM.

  4. The table includes only those respondents who survived at least two surveys. We exclude 494 respondents who died before the 1993 survey.

  5. The logit estimates are available upon request. Figures 2, 3, 4 have similar frequency distributions.

  6. The results from caliper matching are similar.

References

  1. Abadie, A.A., Imbens, G.W.: Large sample properties of matching estimators for average treatment effects. Econometrica 74(1), 235–267 (2006)

    Article  Google Scholar 

  2. Adda, J., Valérie, L.: On the Identification of the Effect of Smoking on Mortality, Working Paper. Department of Economics, University College London (2004)

  3. Ahmed, W., Quereshi, H., Alam, S.E.A., et al.: Association of upper gastrointestinal lesions with addiction. J. Pakistan Med. Assoc. 43(1), 176–177 (1993)

    CAS  Google Scholar 

  4. Auld, M.C.: Smoking, drinking and income. J. Hum. Resour. 60(2), 505–518 (2005)

    Google Scholar 

  5. Australian New Zealand Food Authority, Canberra, Australia (2001)

  6. Becker, G.S., Grossman, M., Murphy, K.M.: An empirical analysis of cigarette addiction. Am. Econ. Rev. 84(3), 396–418 (1994)

    Google Scholar 

  7. Becker, G., Murphy, K.: A theory of rational addiction. J. Political Economy 96(4), 675–700 (1988)

    Article  Google Scholar 

  8. Boucher, B.J., Mannan, N.: Metabolic effects of the consumption of areca catechu. Addict. Biol. 7(1), 103–110 (2002)

    Article  PubMed  CAS  Google Scholar 

  9. Caliendo, M., Kopeinig, S.: Some practical guidance for the implementation of propensity score matching. J. Econom. Surv. 22(1), 31–72 (2008)

    Article  Google Scholar 

  10. Chaloupka, F.J.: Rational addictive behavior and cigarette smoking. J. Political Economy 99(4), 722–742 (1991)

    Article  Google Scholar 

  11. Chaloupka, F.J., Warner, K.E.: The economics of smoking. In: Culyer, A.J., Newhouse, J.E. (eds.) Handbook of Health Economics, vol. 1, pp. 1541–1566. Elsevier, Holland (2000)

    Google Scholar 

  12. Chu, N.F.: Effects of betel quid chewing on the central and automatic nervous systems. J. Biomed. Sci. 8(3), 229–236 (2001)

    Article  PubMed  CAS  Google Scholar 

  13. Cook, P.J., Moore, M.J.: Alcohol. In: Culyer, A.J., Newhouse, J.E. (eds.) Handbook of Health Economics, vol. 1, pp. 1630–1666. Elsevier Science, North-Holland (2000)

    Google Scholar 

  14. Department of Health, Executive Yuan, Taipei, Taiwan (2003)

  15. DeSimone, J.: Illegal drug use and employment. J. Labor Econ. 20(4), 952–977 (2002)

    Article  Google Scholar 

  16. Evans, W., Ringel, J.: Can higher cigarette taxes improve birth outcomes? J. Public Econ. 72(1), 135–154 (1999)

    Article  Google Scholar 

  17. Grossman, M.: On the concept of human capital and the demand for health. J. Political Economy 80(2), 223–255 (1972)

    Article  Google Scholar 

  18. Grossman, M., Chaloupka, F.J., Sirtalan, I.: An Empirical Analysis of Alcohol Addiction: Results from the Monitoring the Future Panels. NBER Working Paper No. 5200 (1995)

  19. Grossman, M., Chaloupka, F.J., Brown, C.C.: The Demand for Cocaine by Young Adults: A Rational Addiction Approach. Paper presented at the Pacific Rim Allied Economic Organization Conference, Hong Kong (1995)

    Google Scholar 

  20. Grossman, M.: Education and non-market outcomes. In: Hanushek, E., Welch, F. (eds.) Handbook of the Economics of Education, vol. 1, pp. 577–633. Elsevier Science, North-Holland (2006)

    Google Scholar 

  21. Guh, J.-Y., Chen, H.-C., Tsai, J.-F., et al.: Betel-quid use is associated with heart disease in women. Am. J. Clin. Nutr. 85(4), 1129–1135 (2007)

    Google Scholar 

  22. Gupta, P.C., Warnakulasuriya, S.: Global epidemiology of areca nut usage. Addict. Biol. 7(1), 77–83 (2002)

    Article  PubMed  CAS  Google Scholar 

  23. IARC: Betel Quid and Areca Nut Chewing and Some Areca Nut Related Nitrosamines. International Agency for Research on Cancer, Lyon (2004)

    Google Scholar 

  24. Imbens, G.W., Abadie, A.A.: On the failure of the bootstrap for matching estimators. Econometrica 76(6), 1537–1557 (2008)

    Article  Google Scholar 

  25. Kaplan, E.L., Meier, P.: Nonparametric estimation from incomplete observations. J. Am. Statist. Assoc. 53(282), 457–481 (1958)

    Article  Google Scholar 

  26. Keng, S.-H., Huffman, W.: Binge drinking and labor market success: a longitudinal study on young people. J. Population Econ. 20(1), 35–54 (2007)

    Google Scholar 

  27. Lechner, M.: Identification and estimation of causal effects of multiple treatments under the conditional independence assumption. In: Lechner, M., Pfeiffer, F. (eds.) Econometric Evaluation of Labour Market Policies, pp. 43–58. Physica, Heidelberg (2001)

    Chapter  Google Scholar 

  28. Lechner, M.: Some practical issues in the evaluation of heterogeneous labour market programmes by matching methods. J. R. Stat. Soc. Ser. A 165(1), 59–82 (2002)

    Article  Google Scholar 

  29. Lye, J.N., Hirschberg, J.: Alcohol consumption, smoking and wages. Appl. Econ. 36(16), 1807–1817 (2004)

    Article  Google Scholar 

  30. National Health Interview Survey: Bureau of Health Promotion. Department of Health, Taiwan (2001)

    Google Scholar 

  31. Ramlau-Hansen, H.: Smoothing counting process intensities by means of kernel functions. Ann. Stat. 11(2), 453–466 (1983)

    Article  Google Scholar 

  32. Rosenbaum, P.R., Rubin, D.B.: The central role of the propensity score in observational studies for causal effects. Biometrika 70, 41–55 (1983)

    Article  Google Scholar 

  33. Rosenzweig, M., Schultz, P.: The confounding of occupation and smoking and its consequences. Soc. Sci. Med. 30(4), 457–467 (1983)

    Google Scholar 

  34. Rubin, D.B.: The use of matched sampling and regression adjustment to remove bias in observational studies. Biometrics 29(1), 185–203 (1973)

    Article  Google Scholar 

  35. Rubin, D.B.: Estimating causal effects to treatments in randomised and nonrandomised studies. J. Educ. Psychol. 66(5), 688–701 (1974)

    Article  Google Scholar 

  36. Rubin, D.B.: Assignment to treatment group on the basis of a covariate. J. Educational Stat. 2(1), 1–26 (1977)

    Google Scholar 

  37. Rubin, D. B.: Estimating causal effects from large data sets using propensity scores. Ann. Intern. Med. 127(8), part 2, 757–763 (1997)

    Google Scholar 

  38. Sarma, A.B., Chakrabarti, J., Chakrabarti, A., et al.: Evaluation of pan marsala for toxic effects on liver and other organs. Food Chem. Toxicol. 30(1), 161–163 (1992)

    PubMed  CAS  Google Scholar 

  39. Van Ours, J.: Cannabis, cocaine and jobs. J. Appl. Econ. 21(7), 897–917 (2006)

    Article  Google Scholar 

  40. Wen, C.P., Tsai, S.P., Chen, C.J., et al.: Uncovering the relation between betel quid chewing and cigarette smoking in Taiwan. Tob. Control 14(1), 16–22 (2005)

    Article  Google Scholar 

  41. Williams, J., Skeels, C.L.: The impact of cannabis and cigarette use on health. De Economist 154(22), 517–546 (2006)

    Article  Google Scholar 

  42. Winstock, A., Trivedy, C.R., Warnakulasuriya, K.A.A.S., et al.: A dependency syndrome related to areca nut use: some medical and psychological aspects among areca nut users in the Gujarat community in the UK. Addict. Biol. 5(1), 173–179 (2000)

    Article  PubMed  CAS  Google Scholar 

  43. Winstock, A.: Areca nut-abuse liability, dependence, and public health. Addict. Biol. 7(1), 133–138 (2002)

    Article  PubMed  CAS  Google Scholar 

  44. Yen, A.M.-F., Chiu, Y.-H., Chen, L.-S., et al.: A population-based study of the association between betel quid chewing and the metabolic syndrome in men. Am. J. Clin. Nutr. 83(5), 1153–1160 (2006)

    PubMed  CAS  Google Scholar 

  45. Yen, T.-T., Lin, W.-D., Wang, C.-P., et al.: The association of smoking, alcoholic consumption, betel quid chewing and oral cavity cancer: a cohort study. Eur. Arch. Otorhinolaryngol. 265(11), 1403–1407 (2008)

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank two anonymous referees for their constructive suggestions and the National Science Council for its generous financial support (NSC-98-2410-H-390-009). All opinions and any errors are our own.

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Authors and Affiliations

  1. Department of Applied Economics, National University of Kaohsiung, 700 Kaohsiung University Rd., Kaohsiung, 811, Taiwan

    Shao-Hsun Keng & Sheng-Jang Sheu

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  1. Shao-Hsun Keng
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Correspondence to Sheng-Jang Sheu.

Appendix

Appendix

See Figs. 3, 4, 5.

Fig. 3
figure 3

Frequency distribution of the propensity scores with non-smoking chewers as the treatment group

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Fig. 4
figure 4

Frequency distribution of the propensity scores with non-chewing smokers as the treatment group

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Fig. 5
figure 5

Frequency distribution of the propensity scores with joint users as the treatment group

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Keng, SH., Sheu, SJ. The effect of stimulants and their combined use with cigarettes on mortality: the case of betel quid. Eur J Health Econ 14, 677–695 (2013). https://doi.org/10.1007/s10198-012-0415-6

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  • DOI: https://doi.org/10.1007/s10198-012-0415-6

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