July 28, 2010

Anti-smoking Spending is Down and Obesity Spending is Up. So?

Large woman smoking(toby_otter/Flickr)Obesity and smoking prevention campaigns are increasingly fighting over funding. The New York Times documents the drop in money from foundations, federal sources, and statehouses. According to one report, state-funded anti-smoking programs decreased from $717 million two years ago, to $567 million last year.

Well-known nutritionist Marion Nestle, who has been tracking this issue for some time, responded on her blog that "Health should not be a zero-sum game," and recommended cooperation between advocates of the two issues.

Much money is still being spent on smoking prevention, clearly, and anti-smoking laws and cigarette taxes keep the "price" of smoking high. Yet the national smoking rate appears to be stuck at 20%.

But pulling back on obesity prevention, and/or demanding funding equity for these two public health issues may not be the best course.

Political scientist (and, full disclosure, an old friend of mine) James Fowler of the University of California, San Diego has some interesting thoughts about all this. He and his Harvard Medical School collaborator, Dr. Nicholas Christakis, have published studies of both smoking [PDF] and obesity [PDF] from the perspective of social networks, i.e. how smokers' and the obese's social relationships interact. Their work resulted in the startling conclusion that obesity is "contagious."

The basis for their research is the Framingham Heart study, a dataset that tracked a large group of individuals' relationships and habits for more than 30 years. Fowler and Christakis found that people stopped smoking in groups, and then pushed smokers out to the edge of their networks.

As a result, smokers tend to cluster; i.e. they stop hanging out with non-smokers. This means that the social pressure on smokers dissipates -- and they can use their solidarity to withstand the outside pressure that does exist. As Fowler described the effect to NPR, using the metaphor of people at a party: "[B]y the end of the party, by the end of our 32-year study, the people in the center of the room are not smoking. And the people who continue to smoke have been literally pushed to the outside of the party, so that they're in places where they're only connected to one or two other people."

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