There has been a limited amount of research on smoking determinants
in China. For example, Gruder et al. (2013) studied the
roles of several factors, e.g., the extent of addiction at baseline, but
did not investigate effects of peers’ or neighbors’ experiences on
belief updating which is the focus of our research. Kenkel et al.
(2009) used data from the longitudinal China Health and Nutrition
Survey (CHNS) to analyze determinants of current smoking, smoking
initiation, and cessation. However, they focused on the role of
demographic factors and cigarette prices on smoking decisions, not
on the role of risk perceptions.
This study uses data from a survey of over 5000 Chinese men
specifically conducted for this research to learn about risk perceptions,
sources of variation in risk perceptions, and how changes in
risk perceptions affect quitting behavior and quitting intentions.
To identify the effect of risk perceptions on smoking decisions, we
develop an innovative instrument for smoking risk perceptions:
whether male smokers live in a building with a male smoker diagnosed
with lung cancer, compared with otherwise similar males
living in another building in the same community of apartments,
but with no male smoker with a diagnosis of lung cancer.
Our empirical analysis yields three major findings. First, in spite
of widespread publicity about the health harms of smoking worldwide,
a high proportion of male smokers in China do not believe
there aremajorhealthrisks fromsmoking. Second, a smoker’sproximity
to a smoker newly diagnosed with lung cancer affects the
smoker’s subjective beliefs about the causal link between smoking
and lung cancer and other smoking-related diseases. Third,
changes in these subjective beliefs affect smokers’ decisions about
continued smoking and intentions to quit.
This study makes three contributions to the literature on risk
perceptions and choice. First, we study why risk perceptions of
harms from smoking differ among male smokers. No study to date
has assessed how information obtained from proximity to nonfamily
members with a smoking-related disease affects such risk
perceptions. The second contribution is to overcome the endogeneity
problem by using proximity to a lung cancer neighbor as
plausibly exogenous source of variation in risk perception. Third,
most evidence linking individuals’ risk perceptions is based on data
from high-income countries. Such evidence may not generalize to
middle-income and low-income countries where most smokers
reside (Jha et al., 2006).
In Section 2, we describe a conceptual framework for belief
updating. Section 3 describes our data, empirical specification, and
estimation procedure. Section 4 presents empirical results, followed
by a discussion of the results in Section 5.