Up in Smoke Tobacco Use, Expenditure On Food, and Child Malnutrition in Developing Countries

Up in Smoke: Tobacco Use, Expenditure on Food, and
Child Malnutrition in Developing Countries
steven block and patrick webb

Tufts University
I. Introduction
Smoking is bad for you; that much is known. The negative impacts of tobacco
use on health via cancer, coronary heart disease, decreased bone density (leading
to osteoporosis and bone fractures), and myriad other health complications
have been established (Benson and Shulman 2005; WHO 2005b; Kuller 2006;
CDC 2009). But does smoking also have negative repercussions for nutrition
as distinct from health? Secondary effects can be anticipated as a result of
tobaccos associations with intrauterine growth retardation, compromised appetite, or disease-mediated effects on growth. There is some evidence that
smoking can impair the functions or absorption of certain micronutrients,
such as vitamins C and E, as a result of oxidative stress caused by induced
inflammatory response and the free radicals present in smoke (Alberg 2002;
Bruno and Traber 2005). By contrast, this paper explores the extent to which
smoking impairs child nutrition by displacing food expenditures in favor of
tobacco expenditures.
It has been shown that children of low-income smokers in Canada had a
poorer diet (higher saturated fat and cholesterol content) than low-income
children of nonsmokers, presumably because of a combination of income constraint and lack of education (Johnson et al. 1996). Another study of lowincome families in North America showed that smokers intakes of five important nutrients (folate, protein, vitamin C, iron, and thiamine) were
significantly lower than among nonsmokers, although total energy intake was
not different. The implication is that a poor-quality diet for smokers is associated not only with the tobacco itself but also with income status and
constraints in food choices (Starkey, Gray-Donald, and Kuhnlein 1999). Indeed,
more recent work on the determinants of health among low-income earners
We gratefully acknowledge Helen Keller International, Jakarta, for sharing its survey data with
us and Julie Schaffner, John Strauss, Peter Timmer, and Parke Wilde for useful comments and
suggestions.
2009 by The University of Chicago. All rights reserved. 0013-0079/2009/5801-0006$10.00
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economic development and cultural change
consistently points to the interactions among smoking as a detrimental behavior linked to stress, expenditure on tobacco as crowding out expenditures
that could have been used for improving health and nutrition, and negative
impacts on such choices on health outcomes such as heart disease (Busch et
al. 2004; Wang, Sindelar, and Busch 2006; Hemingway 2007).
It has been noted in a few developing countries, such as Bangladesh, that
male cigarette smokers spend more than twice as much on cigarettes as per
capita expenditure on clothing, housing, health and education combined
(Efroymson et al. 2001, 212). Thus, it can be hypothesized that in poorer
developing country households facing income constraints for food, consumption of tobacco products can itself impair food intake and that this may have
negative impacts on the nutritional status of smokers children. Our central
hypotheses are thus that (1) household expenditures on cigarettes primarily
displace expenditures on food, and (2) reduced expenditures on food due to
a crowding out by tobacco purchases effectively, albeit indirectly, negatively
affect child nutritional status.
On the basis of data from a detailed, multiround survey of more than
33,000 households in rural Java, Indonesia, this paper explores the association
between tobacco expenditures and food expenditures at a household level, with
a view to assessing nutritional outcomes of children under 5 years of age. The
essence of our argument lies in the following descriptive statistics: households
of nonsmokers in our sample on average allocate 75% of their budget to food
(and 25% to nonfood/noncigarette expenditures). Households in which at least
one member smokes allocate 68% of their budget on average to food, almost
10% to cigarettes, and 22% to nonfood/noncigarette expenditures.1 This suggests that 70% of the expenditures on tobacco products are financed by a
reduction in food expenditure (with the remaining 30% possibly including
reductions in expenditures on health, housing, and other basic needs that are
also associated with child nutritional outcomes).2 In addition, mean heightfor-age among preschool children in the households of smokers is slightly
lower (by .013 standard deviations below the international mean, p p .12)
than that of children in nonsmoking households. However, such two-dimen1
The mean cigarette budget share for the full sample is 7.0%, fairly close to the 6.1% for 2000
reported from Indonesia Family Life Survey data by Witoelar, Rukumnuaykit, and Strauss (2005)
but higher than the 4.75% reported in the Social and Economic Survey (SUSENAS) for 1999.
2
Other expenditure categories for which we have specific data also reflect different allocations
between smoking and nonsmoking households, but the magnitudes are quite small compared with
the difference in food budget shares. For instance, smoking households reduce their budget share
for education from 1.7% to 1.4%, their budget share for clothing from 0.37% to 0.23%, and their
budget share for medicine from 0.53% to 0.33% as compared with nonsmoking households (all
differences are significant at greater than the .01 level).

Block and Webb
sional comparisons may reflect numerous confounding factors, such as per

capita expenditures, education levels, and other household and child characteristics. Sorting out these potential confounding factors is a central goal of
this paper.
Section II of the paper outlines why tobacco use, measured in terms of
household expenditure share, represents an important, underexamined element
of the poverty and food insecurity problem in developing countries and hence
of the search for solutions. Section III presents the data used to examine the
nutrition impacts of expenditure on tobacco products from a sample of rural
Indonesian households. Section IV tests the plausibility of our hypotheses
using a series of nonparametric analyses. Section V describes our parametric
estimation approach and results, and Section VI offers conclusions and recommendations.
II. Smoking as a Development Issue
The World Health Organization (WHO) estimates that annual worldwide
deaths from tobacco-related illness were almost 5 million per year in the year
2000, a figure that is projected to rise to 10 million per year by 2030; 70%
of these illnesses are expected to be in developing countries (WHO 2000;
Mackay, Eriksen, and Shafey 2006). Such large health effects related to smoking
are of increasing public health concern. Tobacco use has been associated with
pneumococcal disease among children in Gambia, presumably from secondary
smoking (ODempsey et al. 1996); high blood pressure among adults in Dar
es Salaam (Bovet et al. 2002); ischemic heart disease and thromboangiitis
obliterans in Bangladesh (Rahman et al. 2000); and malnutrition among adult
stroke patients in Singapore (Chai et al. 2008).
Such negative health outcomes have serious implications for already underresourced health delivery systems but also for reduced labor productivity,
for constrained school attendance and learning, and hence on national economic
growth. There have been generic statements to the effect that smoking creates
more poverty (Assunta 2001; WHO 2004) or that tobacco expenditures
exacerbate the effects of poverty (Efroymson et al. 2001, 212). There have
also been claims that smoking can worsen malnutrition (De Beyer, Lovelace,
and Yurekli 2001, 210). However, few detailed household-level studies have
been conducted to document the extent to which this may be true, and as a
result the links between nutrition, household poverty, and smoking have remained poorly elaborated. Indeed, according to Baris et al. (2000, 219), significant gaps exist in our understanding of the current and potential socioeconomic burden of tobacco [consumption] . . . in developing countries. The
result is a serious gap in the evidence base required for appropriate policy

making aimed not only at counteracting the expansion in tobacco use among
the poorest households on health grounds but also for tackling persistent
household food insecurity.
While important to all developing regions, the need for such information
is of particular urgency in Asia, where tobacco use is higher and rising the
fastest, in large part because of the large populations of, and recent economic
growth in, China and India. In China, it has been calculated that an epidemic
of tobacco-related deaths is building, expected to peak around 2030 (Boyle
et al. 2006, 1711). One study in China found that farmers were more likely
to smoke tobacco than any other category of occupation, which itself carries
worrying implications for agricultural output and rural productivity toward
the middle of this century (Hu and Tsai 2000). Similarly, India has around
200 million adults (over age 15) who smoke or chew tobacco, with rates
significantly higher among the poor, the less educated, and scheduled castes
and tribes (Rani et al. 2003). India also has large numbers of users of
smokeless tobacco, which itself causes oral and oropharynx cancers (Boyle et
al. 2006, 1711). As a result, Rijo (2008, 1356) found that in a nationally
representative sample of Indian households, higher consumers of tobacco had
lower consumption of commodities such as milk, clean fuels, and entertainment, from which it was inferred that tobacco spending has negative effects
on per capita nutrition intake (meaning food consumption).
However, the trend is visible in other poor countries as well. For example,
in Bangladesh the chewing of tobacco, as well as smoking of bidis3 and
cigarettes, is widespread. It was estimated that as of 1998 around 40% of
men and 10%15% of women in Bangladesh were smokers, with the female
rate rising rapidly, possibly as a result of advertising and eroding stigma (Jha
and Chaloupka 2000). In Cambodia, the incidence of smoking has been found
to be higher among low-income and poorly educated households (Smith,
Umenai, and Radford 1998).
In Indonesia (the focus of this paper), smoking prevalence is thought to be
roughly 3% for women but around 60% for men (MacKay et al. 2006),
increasing at a rate of 6% per year (Datamonitor 2007). Our sample of rural
households in Central Java confirms this high prevalence rate for men. These
figures reflect the rapid increase in cigarette consumption in Indonesia, which
has increased from 35 billion cigarettes in 1960 to 217 billion in 2004
(Government of Indonesia 2004). Roughly 57,000 Indonesians die of smoking3
Bidis are homemade cigarettes made of crushed, low-grade tobacco leaves rolled in a dried leaf
(usually of the tendu, Diospyrus mebunoxylon). Bidi smoking is widespread in rural areas and among
the urban poor.

Block and Webb
related diseases each year according to the countrys Ministry of Health, and
this may be increasing as more people shift from smoking traditional clove
cigarettes (kreteks) to imported tobacco (Arnold 2003). Smet et al. (1999)
similarly point to growing peer pressure, particularly in urban Indonesia, as
tobacco smoking is increasingly associated with a certain projected lifestyle
(linked to certain heavily advertised international brands). Barraclough (1999)
argues that women are also increasingly taking up smoking as a result of a
weakening stigma and growing Western cultural influences.
All of this matters beyond the immediate danger of smoke inhalation.
Households in rural Asian countries allocate between 50% and 80% of total
expenditure to food (FAO 2005). These high levels are indicative of persistent
and widespread food insecurity that affects the lowest-income groups in rural
areas the worst. For example, mean urban incomes in China were almost double
rural incomes in the late 1990s, whereas in Myanmar urban incomes were five
to 10 times above their rural equivalent (Webb and Lapping 2002). Large
expenditure shares on food among poorer rural households mean that there is
limited income left over for additional, equally pressing, basic needs such as
health care, education, clothing, transportation, and fuel. This forces tradeoffs between the quantity and quality of food consumed, on the one hand,
and between food and nonfood consumption goods, on the other. To the extent
that some poor households divert expenditures from food to tobacco products,
they create the potential for reduced food consumption and worse nutritional
outcomes.
Semba et al. (2007) examine the effect of paternal smoking on the risk of
child malnutrition among the urban poor in Indonesia.4 They find significantly
higher risk among the children of smokers and posit a budgetary linkage
similar to that proposed here. Our analysis differs, however, in our explicit
modeling and measurement of these budgetary linkages and the effect of food
expenditures on child height, in addition to our concern for potential problems
arising from endogeneity (issues that are not addressed by Semba et al.). In
addition, the World Bank (2006a) notes that tobacco is the second-largest
expenditure category among the poor in Indonesia (after rice) and that the
tobacco industry in Indonesia is a substantial source of both employment and
government revenue.
Data constraints prevent us from directly measuring the distribution of
reduced food consumption within smokers households. In principle, it is
4
Best et al. (2007) provide a parallel analysis, with quite similar findings for Bangladesh. Nonnemaker and Sur (2007) also focus on Bangladesh in their analysis of the correlation between tobacco
prices and height-for-age (which they find to be significant and inverse).

possible that adult smokers could reduce their own food consumption in an
effort to buffer their childrens food consumption, thus mitigating the nutritional impact of their decision to smoke. This response seems unlikely, however,
since the decision to smoke, in itself, signals a willingness to (a) accept a loss
of income that could be allocated to alternative investments that also have
positive associations with improved nutrition, such as health care, improved
water, and education, and (b) impose negative externalities in the form of
secondhand smoke on other members of the household (assuming that this
problem is understood locally). Thus, this paper examines the opportunity
cost of nutrient loss represented by household expenditure among households
that are already income constrained. The key question is, What is the nutritional impact on children of tobacco use in households that do not enjoy an
adequate diet?
III. Data
Nutrition surveillance activities were started in rural Central Java in December
1995 as part of a monitoring and evaluation system for a social marketing
campaign focused on vitamin A. Five rounds of data collection were completed
through January 1997. Nutrition surveillance system data collection was reinitiated in Central Java in June 1998 and continued at approximately 3-month
intervals. The present analysis uses the seven rounds of data for which detailed
expenditure data were available, covering the period from June 1998 through
January 2001.
For each round, a random sample of 8,218 households (on average across
rounds) was selected using a multistage cluster sampling design. A total of
30 villages were selected from each of rural Central Javas six ecological zones
by probability proportional to size sampling techniques. Each village provided
a list of households containing at least one child under 36 months of age (the
age eligibility criterion was expanded to 59 months in round 7 in August
1998). From this list, 40 households were selected by fixed interval systematic
sampling using a random start. The total sample size for the 14 rounds is
57,525 households, providing observations on 70,218 children under 6.
While the population represented in this sample is rural, only 20% own
their own rice fields. The plurality of males (32%) work as daily laborers, and
an additional 15% are employees or civil servants. Among women, 76%
describe themselves as housewives or unemployed. Both men and women
complete on average approximately 7 years of schooling, and the average family
size in our sample was 5.3 (where inclusion in the sample required one child
under 36 months) and 5.2 when this ceiling was raised to 59 months. Table
1 provides descriptive statistics for variables included in the analysis.

Block and Webb
TABLE 1
DESCRIPTIVE STATISTICS
Variable
Log food expenditure per capita
Log cigarette expenditure per capita
Log nonfood/noncigarette expenditure
Log PCE
Child health-for-age z-score
Fathers years of schooling
Mothers years of schooling
Fathers age
Family size
Respiratory infection (dummy)
Tap water (community average)
Closed latrine (community average)
House size per capita
Remittance income
Mean
Standard
Deviation
9.317
5.334
7.96
9.73
1.49
7.71
7.07
32.83
5.18
.13
.11
.496
19.67
6.23 million
.411
5.388
1.014
.446
1.33
3.19
3.07
6.63
1.83
.34
.23
.276
10.42
4.85 million
57,327
57,525
57,349
57,333
57,497
56,940
57,466
30,948
57,494
57,483
57,525
57,525
56,995
56,463
Source. Nutrition surveillance system, Helen Keller International, Jakarta.
IV. Nonparametric Evidence

Our central hypotheses are laid out in this section in a sequence of nonparametric and semiparametric relationships.5 If the substantial budget shares
devoted to cigarettes are predominantly inframarginal expenses, then it becomes important to understand the sources of such budgetary reallocation in
favor of cigarettes. This question is of particular concern with respect to
households at the lower end of the income distribution, whose budget constraints are more binding and whose children are typically more vulnerable
to ill health and poor nutrition.
Food expenditures are a likely candidate for displacement in favor of cigarettes, if for no other reason than food occupies a dominant position within
household budgets. The median household budget share for food is 68.7% in
this sample, increasing to 77% at the 75th percentile of the food budget share
distribution but falling to 60% at the 25th percentile of the distribution of
food budget shares. Figure 1 plots food budget shares as a function of log per
capita household expenditures, thus creating nonparametric Engel curves for
food, splitting the sample between smoking and nonsmoking households.6
While food is a normal good for both groups (conforming to expected Engel
5
Multiple regression analysis typically imposes linearity on the hypothesized relationships. Nonparametric analysis completely relaxes this assumption, allowing the function relationship between
Y and X to take any form. Semiparametric analysis takes the same approach for the relationship
between Y and X but expands the dimensions of the analysis by controlling linearly for the
relationship between Y and a set of other control variables, Z.
6
Engel curves relate household budget shares on a particular commodity to per capita expenditures.
A negative association reflects that expenditures on that commodity grow more slowly than income,
indicating that income elasticity of demand is less than unity (e.g., that the good is a necessity).

Figure 1. Food budget shares, households of smokers versus nonsmokers (vertical lines at 25th, 50th,
and 75th percentiles of the expenditure distribution).
function curves), it is clear that the food budget shares of nonsmoking households are substantially greater than in smoking households. This holds true
across the entire income distribution. Importantly, the difference is proportionately greater at the lower end of the distribution. The mean budget share
of food among nonsmoking households is 75%, compared with a mean food
budget share of 68% among smoking households (t p 40.6, p p .000). On
average, this difference of 7 percentage points indicates that the food budget
share of nonsmoking households is over 10% greater than that of smoking
households. Figure 1 confirms these differences nonparametrically, highlighting both the magnitude of the differences across household types and the
statistical significance of the difference.
The smaller food budget shares for smokers households are also reflected
in lower absolute expenditures on food among such households, again at all
levels of income. Figure 2 presents further nonparametric Engel curves in
terms of log food expenditures, the sample split between smoking and nonsmoking households. As before, households of smokers spend less on food
a difference that is consistent across the income distribution.
From the perspective of food intake, child nutritional status is a function
of both dietary quantity and quality. It is thus informative to distinguish
within-household food budgets between the allocation to rice (the staple grain
of Indonesia, though one with little nutritional content beyond calories) and

Block and Webb
Figure 2. Food expenditures, households of smokers versus nonsmokers
high-quality (micronutrient-rich) foods.7 Rice constitutes on average 21% of

total household expenditure and 30% of household food expenditures in our
rural sample. Disaggregating between rice and micronutrient-rich foods in
households diets permits us to assess whether smoking is associated with
reduced dietary quality in addition to the reduced impact on quantity suggested above.
Figure 3 illustrates the share of household food budgets allocated to rice
among smokers versus nonsmokers. It is clear that households with smokers
allocate a larger share of their food budget to rice. On average, this difference
is 2 percentage points of the food budget (t-statistic 14.3), though at the low
end of the expenditure distribution, this difference increases to approximately
5 percentage points. By contrast, figure 4 demonstrates that households of
nonsmokers allocate a larger portion of their food budget to micronutrientrich foods (also 2 percentage points), suggesting an improved dietary quality
in those households.
Figure 5 illustrates the trade-off that households make in reallocating their
budgets from food to cigarettes. In depicting this function, it is important
7
Our category of micronutrient-rich foods is a composite that includes beef, fish, chicken, vegetables, fruit, milk, and eggs. The food budget share for micronutrient-rich foods is the sum of
households expenditures on these commodities divided by total food expenditures. It is not possible
with the present data to convert total household food consumption into its dietary nutrient equivalents, as has been done in other studies.

10
Figure 3. Share of rice in food budgets of smokers versus nonsmokers
Figure 4. Share of micronutrient-rich foods in food budgets of smokers versus nonsmokers
to eliminate the confounding effect of total household per capita expenditures

and other relevant characteristics. We solve this problem by estimating a
semiparametric model of the form y p zb f(x) . This approach allows
us to control parametrically for the z vector of controls, thus isolating the
remaining two-dimensional nonparametric partial relationship between food

Block and Webb
11
Figure 5. Food budget share as a function of cigarette budget share (semiparametric, controlling for
PCE, household characteristics, survey round, and zone).
budget share and cigarette budget share.8 Figure 5 suggests that the rate at
which cigarette expenditure displaces food expenditures is both substantial
and consistent across the distribution of cigarette budget shares. The effect of
this increasing budget allocation to cigarettes is connected, through its effect
on food budget shares, to child nutritional outcomes. Figure 6 provides additional semiparametric evidence, consistent with our central argument, that
cigarette expenditures are negatively associated with child height-for-age zscores.
The nonparametric evidence presented above supports our central hypotheses
that cigarette expenditures displace food in the household budgets of smokers
and that decreased food expenditures are associated with reduced child nutrition (as measured in terms of linear growth, or height-for-age). Parametric
techniques increase the dimensionality of such analyses and sustain the implications of the evidence presented so far.
V. Estimation Strategy and Parametric Results
Estimation Strategy
The ideal approach to providing parametric support for the nonparametric
evidence presented above would be to estimate structural equations to explain
8
As discussed below, this z vector includes per capita expenditures, maximum parental years of
schooling, mothers and fathers age, log price of rice, the number of household members greater
than age 6, and the households distance to a health center (in addition to dummy variables for
survey round and geographic zone).

12
Figure 6. Child height-for-age z-score as a function of cigarette budget share (semiparametric regression,
controlling for PCE, household and child characteristics, survey round, and zone).
food expenditure as a function of cigarette expenditure and then an additional

structural equation to estimate child height as a function of food expenditure.
However, that approach suffers from the problem of endogeneityof cigarette
expenditures in the first equation and of food expenditures (and possibly per
capita household expenditures) in the second equation. Unfortunately, the data
available to us provide no plausibly exogenous instruments (e.g., variables that,
for instance, affect food expenditures exclusively through their effect on cigarette expenditures or variables that effect child height only through their
effect on food expenditures), which would be required for full estimation of
these structural equations.9
In light of this critical constraint, we adopt a more modest and pragmatic
empirical strategy. We estimate a set of reduced-form equations for food expenditures, cigarette expenditures, and child height against a common set of
covariates. This approach does not allow us directly to estimate the displacement of food expenditures by cigarette expenditures (as implied in fig. 5).
Yet, by comparing the effects of a common set of covariates across these
dependent variables, we may be able to infer a set of influences consistent
with our hypotheses and our nonparametric results.10 This would be the case,
for instance, if the same exogenous variables that tend to reduce food expenditures and child height also tend to increase cigarette expenditures. As in
9
Results of structural estimation using the more controversial approach of identification through
heteroskedasticity are available on request.
10
We are grateful to John Strauss for suggesting this approach.

Block and Webb
13
the nonparametric analysis, we differentiate between the shares of household

food expenditures allocated to rice versus a composite of high-quality (micronutrient-rich) foods. This distinction can be informative because child height
reflects the long-term effects of both dietary quantity and quality.
We thus estimate the following set of equations:
qij p f(PCEj , Hj , Pj,rice , HCdistj ),
(1)
PCEij p f(PCEj , Hj , Pj,rice , HCdistj ),
(2)
CHAZkj p g(PCEj , Hj , Pj,rice , HCdistj , Ckj ),
(3)
where qij is the budget share of commodity i (or the share of commodity i
in the food budget) for household j, PCEj is log per capita expenditure of
household j, Hj is a vector of characteristics of household j (including maximum
parental years of schooling, mothers and fathers ages, and the number of
members of the household greater than 6 years of age), Pj,rice is the log price
of rice reported by household j, HCdistj is the distance (in meters) from the
home of household j to the nearest health center (posyandu), PCEij is per capita
expenditures on commodity i by household j, CHAZkj is the z-score of heightfor-age of child k in household j, and Ckj is a vector of characteristics of child
k in household j (including gender and a third-order polynomial of child age,
in months).
Results
Table 2 presents results for budget shares and expenditures on food and the
food budget shares and expenditures on rice and micronutrient-rich foods.
Columns 13 compare budget shares, and columns 46 compare the determinants of per capita expenditures. Consistent with Engels law, we find that
the food budget share is a declining function of household expenditures. This
is true for the share of rice in the food budget as well. Yet, as expenditures
increase, micronutrient-rich (e.g., high-quality) foods constitute an increasing
share of household food expenditures, which suggests that such foods are luxury
goods. The maximum years of parental schooling similarly has a negative effect
on the rice share of food expenditures, as well as per capita expenditures on
rice, and a positive effect on the micronutrient-rich food share of food expenditures as well as per capita expenditures on micronutrient-rich foods. This
suggests that parental education has a positive effect on dietary quality (controlling for per capita expenditures) as well as on quantity.
As noted above, rice is the dominant staple grain for Indonesians and is

14

Rice Share
of Food
Budget
(2)
.142***
(.018)
.006***
(.002)
.000
(.001)
.001
(.002)
.171***
(.048)
.001
(.004)
.000007
(.000)
.292
(.370)
.45
Food
Budget
Share
(1)
.160***
(.021)
.006***
(.002)
.000
(.001)
.004***
(.001)
.105**
(.048)
.014***
(.002)
.00004**
(.000)
1.391***
(.371)
.33
.080***
(.019)
.009***
(.002)
.000
(.001)
.002
(.001)
.085
(.065)
.006a
(.004)
.00007***
(.000)
.377
(.467)
.36
MN-Rich
Share of
Food
Budget
(3)
.720***
(.036)
.009***
(.003)
.000
(.002)
.005**
(.002)
.185**
(.075)
.025***
(.004)
.00008**
(.000)
1.971***
(.604)
.83
Log PCE
Food
(4)
.167***
(.059)
.017***
(.005)
.009
(.007)
.009
(.009)
.739***
(.226)
.020*
(.012)
.00004
(.000)
1.462
(1.835)
.21
Log PCE
Rice
(5)
.893***
(.062)
.029***
(.006)
.000
(.004)
.008*
(.004)
.025
(.132)
.039***
(.010)
.0001**
(.000)
.804
(1.042)
.72
Log PCE
MN-Rich
Foods
(6)
Note. Robust standard errors (clustered at the village level) are in parentheses. Dummies for survey round and zone are included (not reported). MNp micronutrient.
a
p-value p .108.
* Significant at 10%.
** Significant at 5%.
*** Significant at 1%.
R2
Constant
Distance home to health center (meters)
Number household members 1 6 years
Log rice price
Mothers age
Fathers age
Maximum years parental school
Log PCE
TABLE 2
REDUCED-FORM ESTIMATES OF THE DETERMINANTS OF FOOD EXPENDITURES (N p 25,830)
Block and Webb
15
the largest single food expenditure for most households. We therefore include
the rice price in our specifications. As we would expect for a commodity with
inelastic demand, both the food budget share and per capita expenditures on
rice increase with its price; yet we find no statistically significant effect of rice
prices on food budget shares and expenditures on micronutrient-rich foods.
We also control for the number of household members greater than 6 years
of age. Our data do not provide a direct measure of the number of adults in
the household, which is relevant since the number of potential smokers increases with the number of adult males.11 The number of household members
greater than 6 years of age is an imperfect indicator of this. While the number
of household members over 6 years old still includes older children, it is also
notable that Witoelar et al. (2005) report that the average age at which men
begin smoking in Indonesia has declined over time and was as low (on average)
as 14 for men born in the early 1980s. While, in general, we would expect
per capita food expenditures to decline with the number of household members
over 6 years old (as demonstrated in col. 4), it is striking that this variable
also reduces the share of food in overall household expenditures (as seen in
col. 1). The number of household members over 6 years old also reduces both
per capita expenditures on high-quality foods and the share of high-quality
foods in the food budget (this latter effect being marginally statistically significant, with p p .108).
We also control for the distance (in meters) from the households home to
the nearest health center. We posit that this variable proxies for maternal
nutrition knowledge, which previous work on Indonesia has shown to be an
important determinant of both child nutritional status and household dietary
quality (Block 2004, 2007; Webb and Block 2004). Our data set provides
information on mothers reported source of nutrition knowledge. Nearly half
of the respondents cited health workers as their sourcefar in excess of any
other source cited for nutrition knowledge.12 While nutrition knowledge itself
would be endogenous in the present setting, we introduce household distance
to the health center as an exogenous proxy for nutrition knowledge in our
reduced-form equations. Block (2004) establishes a negative association between household distance from the health center and nutrition knowledge.
Consistent with that interpretation, we find in columns 3 and 6 of table 2
that both the share of the food budget allocated to high-quality foods and
per capita expenditures decline as a function of household distance from the
11
For this reason, Witoelar et al. (2005) control more directly for the household demographic
structure in estimating tobacco expenditure shares in Indonesian households.
12
Sources of nutrition knowledge include health workers (cited by 47% of mothers), school (22%),
friends (11%), media (5%), and other (16%).

16

TABLE 3
REDUCED-FORM ESTIMATES OF THE DETERMINANTS OF SMOKING AND SMOKING EXPENDITURES
(N p 25,830)
Log PCE
Maximum years parental schooling
Fathers age
Mothers age
Log rice price
Number household members 1 6 years old
Constant
Father Smokes
(Probit)
(1)
Budget Share
Cigarettes (Tobit)
(2)
Expenditures
Cigarettes (Tobit)
(3)
.593***
(.184)
.042**
(.021)
.014
(.017)
.006
(.019)
.578
(.485)
.185***
(.041)
.001***
(.000)
9.221**
(3.625)
.023***
(.001)
.001***
(.000)
.001***
(.000)
.001***
(.000)
.058***
(.004)
.008***
(.000)
.00005***
(.000)
.598***
(.033)
7,633.038***
(125.228)
86.265***
(13.915)
92.856***
(11.470)
97.857***
(13.032)
4,790.934***
(378.826)
1,795.889***
(31.248)
3.665***
(.127)
104,870.273***
(2,824.174)
Note. Robust standard errors (clustered at the village level) are in parentheses. Dummies for survey
round and zone are included (not reported).
health center (despite increases in food budget shares and per capita food
expenditures, as seen in cols. 1 and 4).
Summarizing to this point, we find that parental education increases both
dietary quantity and quality, that the number of household members over age
6 decreases both dietary quantity and quality, that distance to the health center
(consistent with previous work on the effects and sources of nutrition knowledge) decreases dietary quality while increasing quantity, and that increases
in the price of rice result in increased per capita expenditures on rice as well
as increased allocation of food budgets to rice. Table 3 shows that these effects
are generally reversed when we examine these variables as determinants of
smoking and cigarette expenditures.
Table 3 first presents probit results for these same covariates as determinants
of whether the father smokes. While parental education increased both the
quantity and quality of the household diet, it reduced the probability that
the father smokes. Similarly, while the number of household members greater
than age 6 decreased both the quantity and quality of the households diet,
it substantially increases the probability that the father smokes. Further, the
probability that the father smokes increases as a function of the households
distance from the health center (a proxy for nutrition knowledge), whereas
that distance was found to reduce dietary quality.

Block and Webb
17
Columns 2 and 3 of table 3 present Tobit estimations of the determinants

of cigarette budget shares and expenditures.13 The results in both specifications
are consistent with those for the determinants of smoking. Those factors that
increase dietary quantity and quality uniformly decrease smoking expenditures
and budget shares. The specification for cigarette budget share (col. 2) also
permits us to estimate the expenditure elasticity for cigarettes, which we find
to be 1.23 (SE p 0.015) at the mean budget share for cigarettes (among
households of smokers). This result is nearly identical to that found by Witoelar
et al. (2005) using a completely different data set (the Indonesia Family Life
Survey), adding to our confidence in our own data and results.14
Having now shown that the same exogenous factors that tend to increase
dietary quantity and quality also tend to decrease smoking and smoking
expenditures, our final approach is to examine the effects of those same factors
on child height. Table 4 provides two sets of results. The specification is the
same in each case; however, the first estimation includes all observations used
in the previous regressions, and the second eliminates gross outliers (e.g., the
420 observations with Cooks D-statistic 1 1). Eliminating these outliers has
little effect on the point estimates but marginally reduces the standard errors.
A key finding in common across both set of results is that parental education
previously found to increase dietary quantity and quality and to decrease
smoking prevalence and smoking expendituresincreases child height-for-age
z-scores. We find a similar pattern for the number of household members
above age 6.
Increases in the price of rice also suggestively reduce dietary quality (note
the negative point estimate, though not statistically significant, for rice price
in the micronutrient food budget share equation), increase cigarette budget
shares, and reduce child height. The findings on effects of household distance
to the health center are also suggestive and consistent with our broad hypothesis: this proxy for nutrition knowledge is associated with improved dietary
quantity and quality, reduced expenditures on cigarettes, and (excluding outliers) increased child height (although this effect is imprecisely measured). An
additional pattern in these findings that is consistent with our hypothesis,
though one for which the interpretation is not clear, is that maternal age is
associated with reduced dietary quantity and quality, increased budget allocation to cigarettes, and reduced child height.
Thus, while we are precluded from estimating our ideal structural equations
13
Nearly one-third of the observations included in the Tobit regressions are left-censored at zero.
The budget share on tobacco products reported by Adioetomo, Djutaharta, and Hendratno (2005)
using 1999 SUSENAS household data was 6.2% on average, rising among lower-income households.
14

18

TABLE 4
REDUCED-FORM ESTIMATES OF THE DETERMINANTS OF CHILD HEIGHT-FOR-AGE Z-SCORE
Log PCE
Maximum years parental schooling
Fathers age
Mothers age
Log rice price
Number household members 1 6 years old
Child gender (femalep1)
Child age (months)
Child age (squared)
Child age (cubed)
Constant
Observations
R2
Child HAZ
(1)
Child HAZ
without Outliers
(2)
.037
(.134)
.035***
(.013)
.008
(.006)
.010
(.007)
.455
(.317)
.026
(.016)
.000
(.000)
.058
(.062)
.155***
(.014)
.004***
(.001)
.00002***
(.000)
3.012
(2.764)
25,830
.22
.057
(.124)
.035***
(.013)
.009
(.006)
.012*
(.006)
.577*
(.302)
.026*
(.015)
.000
(.000)
.071
(.057)
.149***
(.013)
.004***
(.001)
.000***
(.000)
3.744
(2.629)
25,410
.27
Note. Robust standard errors (clustered at the village level) are in parentheses. Dummies for
survey round and zone are included (not reported). HAZ p height-for-age z-score.
by the lack of appropriate instrumental variables, we have provided evidence

that is consistent with our central hypothesis that the decision to smoke and
subsequent expenditures on cigarettes reduce child height by diverting household resources from food expenditures in general (and high-quality foods in
particular). This indirect evidence lies in a series of reduced-form equations,
in which we demonstrate that the same exogenous covariates that are associated
with improved dietary quantity and quality are also associated with reduced
allocation of household resources to tobacco and with increased child height.
VI. Conclusions
Tobacco is considered to be the leading cause of preventable adult mortality
worldwide (Ezzati and Lopez 2003; WHO 2005b). As a result of changing
global patterns in tobacco use, the burden of such mortality is now mainly

Block and Webb
19
in developing countries. Indeed, it is estimated that 10 million people will

die from tobacco use annually by 2030, with 70% of them occurring in
developing countries, such as Indonesia and India (Reddy et al. 2006). This
makes smoking not simply a major public health problem but a potential
threat to the development process itself. However, malnutrition among children remains one of the worlds leading public health challenges (WHO
2005a), being implicated in more than 50% of the 11 million estimated
preventable child deaths each year (World Bank 2006b). In other words, the
combination of direct health threats from smoking coupled with potential loss
of consumption among children linked to tobacco expenditure presents a
development challenge of the highest order.
The findings of this study show that (a) low-income households containing
at least one smoker tend to divert a significant amount of (already scarce)
income to tobacco products, (b) more of that income is diverted from potential
food expenditure than from nonfood purchases, (c) this results in a real decline
in the quantity and quality of food consumed in poorest households, and (d)
there is a statistically significant (if functionally small) reduction in the nutritional status of children in such households. In other words, smoking has
a strong, albeit indirect, impact on child malnutrition via its displacement
effect on food consumption. Our results further suggest that the nutritional
consequences of this effect could be mitigated by households substituting
toward lower-quality calories as their cigarette expenditures increase.
In most instances, spending on tobacco products increases with income,
but (a) since education also increases with income, smoking may decline as a
function of knowledge of adverse health effects (and arguably reduced stress
and monotony of income-earning tasks); and (b) spending on tobacco in the
total budget is offset by the fact that absolute income spent on food and
health also increases as the relative share on tobacco decreases. The latter is
linked to education (as noted in the analysis above). Some caution is required
in interpreting findings that education reduces smoking, as Fuchs (1982) has
argued strongly that such correlations may be spurious if smoking is merely
a proxy for a persons underlying impatience. Nonetheless, given research
showing that informal sources of health and nutrition-specific knowledge may
matter as much as formal education in generating positive child nutrition
outcomes in Indonesia (Webb and Block 2004; Block 2007), more attention
to public awareness campaigns explicitly linking tobacco use to nutrition and
health information has a potentially high payoff.
These findings invite further investigation along several dimensions. With
some of the basic nutritional impacts in Central Java of rural household
expenditure on smoking products established, a next step should be to dif-

20
ferentiate these impacts by types of household in policy-relevant ways that

can better inform the design of interventions to mitigate the most damaging
nutritional impacts of this global tobacco epidemic. Are certain types of
poor rural households more vulnerable to the loss of available income implicit
in smoking than others? More generally, what are the roles of maternal versus
paternal education, nutrition knowledge, occupation, and other household
characteristics in determining the demand for reduced expenditure on smoking
and its substitution for expenditure of benefit to child nutrition (such as food,
clean water, health care, etc.)? Answers to such questions would greatly facilitate investment prioritization choices for developing country policy makers.
References
Adioetomo, Sri Moertiningsih, Triasih Djutaharta, and Hendratno. 2005. Cigarette
Consumption, Taxation and Household Income: Indonesia Case Study. Economics
of Tobacco Control Paper no. 26, Health, Nutrition, and Population, World Bank,
Washington, DC.
Alberg, Anthony. 2002. The Influence of Cigarette Smoking on Circulating Concentrations of Antioxidant Micronutrients. Toxicology 180:12137.
Arnold, Wayne. 2003. Indonesias Cigarette Tax Singes Producers. International
Herald Tribune, October 1112.
Assunta, Mary. 2001. Tobacco and Poverty. International Tobacco-Control Network,
GLOBALink. http://www.globalink.org/tobacco/docs/ap-docs/tobpov.shtml.
Baris, Enis, Linda Waverley Brigden, Joanne Prindiville, Vera Luiza da Costa e Silva,
Hatai Chitanondh, and Stephen Chandiwana. 2000. Research Priorities for Tobacco Control in Developing Countries: A Regional Approach to a Global Consultative Process. Tobacco Control 9:21723.
Barraclough, Solon. 1999. Women and Tobacco in Indonesia. Tobacco Control 8,
no. 3:32732.
Benson, Brian, and Jay Shulman. 2005. Inclusion of Tobacco Exposure as a Predictive
Factor for Decreased Bone Mineral Content. Nicotine and Tobacco Research 7, no.
5:71924.
Best, Cora, Kai Sun, Saskia de Pee, Martin Bloem, Gudrun Stallkamp, and Richard
D. Semba. 2007. Parental Tobacco Use Is Associated with Increased Risk of Child
Malnutrition in Bangladesh. Nutrition 23, no. 10:73138.
Block, Steven. 2004. Nutrition Knowledge and the Demand for MicronutrientRich Foods: Evidence from Indonesia. Journal of Development Studies 40, no. 6:
82105.
. 2007. Maternal Nutrition Knowledge versus Schooling as Determinants
of Child Micronutrient Status. Oxford Economic Papers 59:33053.
Bovet, Pascal, Allen Ross, Jean-Pierre Gervasconi, Mashombo Mkamba, Deo Mtasiwa, C. Lengeler, David Whiting, and Fred Paccaud. 2002. Distribution of
Blood Pressure, Body Mass Index and Smoking Habits in the Urban Population
of Dar es Salaam, Tanzania, and Associations with Socioeconomic Status. International Journal of Epidemiology 31:24047.

Block and Webb
21
Boyle, Peter, et al. 2006. Tobacco: Deadly in Any Form or Disguise. Lancet 367,
no. 9524:171012.
Bruno, Richard, and Maret Traber. 2005. Cigarette Smoke Alters Human Vitamin
E Requirements. Journal of Nutrition 135:67174.
Busch, Susan, Mireia Jofre-Bonet, Tracy Falba, and Jody Sindelar. 2004. Burning
a Hole in the Budget: Tobacco Spending and Its Crowd-out of Other Goods.
Applied Health Economics and Health Policy 3, no. 4:26372.
CDC (Centers for Disease Control and Prevention). 2009. Health Effects of Cigarette Smoking. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health
_effects/effects_cig_smoking/.
Chai, J., F. Chu, T. Chow, and N. Shum. 2008. Prevalence of Malnutrition and Its
Risk Factors in Stroke Patients Residing in an Infirmary. Singapore Medical Journal
49, no. 4:29096.
Datamonitor. 2007. Tobacco in Indonesia to 2011. http://www.reportlinker.com/
p050884/Tobacco-in-Indonesia-to-2011.html.
De Beyer, Joy, Chris Lovelace, and Ayda Yurekli. 2001. Poverty and Tobacco.
Tobacco Control 10, no. 3:210.
Efroymson, Debra, Saifuddin Ahmed, Joy Townsend, Syed Alam, Amit Dey, Ranjit
Saha, Biplob Dhar, Aminul Sujon, Kayum Ahmed, and Oliur Rahman. 2001.
Hungry for Tobacco: An Analysis of the Economic Impact of Tobacco Consumption on the Poor in Bangladesh. Tobacco Control 10:21217.
Ezzati, Majid, and Alan Lopez. 2003. Estimates of Global Mortality Attributable
to Smoking in 2000. Lancet 362:84752.
FAO (Food and Agricultural Organization of the United Nations). 2005. State of
Food Insecurity in the World, 2005. Rome: FAO.
Fuchs, Victor. 1982. Time Preference and Health: An Exploratory Study. Working
Paper no. 539, National Bureau of Economic Research, Cambridge, MA.
Government of Indonesia. 2004. Tobacco Source Book, 2004. Jakarta: Ministry of
Health.
Hemingway, Ann. 2007. Determinants of Coronary Heart Disease Risk for Women
on a Low Income: Literature Review. Journal of Advanced Nursing 60, no. 4:
35967.
Hu, Teh-wei, and Yi-wen Tsai. 2000. Cigarette Consumption in Rural China: Survey
Results from Three Provinces. Report to Research for International Tobacco
Control at the International Development Research Center, Ottawa, Department
of Health Economics, University of California, Berkeley.
Jha, Prabhat, and Frank J. Chaloupka, eds. 2000. Tobacco Control in Developing Countries. New York: Oxford University Press for the World Bank.
Johnson, Rachel, MinQi Wang, Melissa Smith, and Gregory Connolly. 1996. The
Association between Parental Smoking and the Diet Quality of Low-Income Children. Pediatrics 97, no. 3:31217.
Kuller, Lewis. 2006. Nutrition, Lipids and Cardiovascular Disease. Nutrition Reviews
64, no. 2, pt. 2:S15S26.
Mackay, Judith, Michael Eriksen, and Omar Shafey. 2006. The Tobacco Atlas. 2nd
ed. Brighton, UK: Myriad Editions for the American Cancer Society.
Nonnemaker, James, and Mona Sur. 2007. Tobacco Expenditures and Child Health

22
and Nutritional Outcomes in Rural Bangladesh. Social Science and Medicine 65,
no. 12:251726.
ODempsey, T., T. McArdle, J. Morris, N. Lloyd-Evans, I. Baldeh, B. Laurence, O.
Secka, and B. Greenwood. 1996. A Study of Risk Factors for Pneumococcal
Disease among Children in a Rural Area of West Africa. International Journal of
Epidemiology 25, no. 4:88593.
Rahman, Mahbubur, Abdus Chowdhury, Tsuguya Fukui, Kenji Hira, and Takuro
Shimbo. 2000. Association of Thromboangiitis Obliterans with Cigarette and
Bidi Smoking in Bangaldesh: A Case-Control Study. International Journal of Epidemiology 29:26670.
Rani, Manju, Sekhar Bonu, Prabhat Jha, Son Nguyen, and L. Jamjoum. 2003.
Tobacco Use in India. Tobacco Control 12, no. 4:e4.
Reddy, K. Srinath, Cheryl Perry, Melissa Stigler, and Monica Arora. 2006. Differences in Tobacco Use among Young People in Urban India by Sex, Socioeconomic
Status, Age, and School Grade: Assessment of Baseline Survey Data. Lancet 367:
58994.
Rijo, John. 2008. Crowding Out Effect of Tobacco Expenditure and Its Implications
on Household Resource Allocation in India. Social Science and Medicine 66:
135667.
Semba, Richard, Leah M. Kalm, Saskia de Pee, M. O. Ricks, Mayang Sari, and
Martin W. Bloem. 2007. Paternal Smoking Is Associated with Increased Risk
of Child Malnutrition among Poor Urban Families in Indonesia. Public Health
Nutrition 10, no. 1:715.
Smet, Bart, Lea Maes, Linda De Clerq, Kristiana Haryanti, and Rachmad Winarno.
1999. Determinants of Smoking Behaviour among Adolescents in Semarang,
Indonesia. Tobacco Control 8, no. 2:18691.
Smith, Marshall, Takusei Umenai, and Colin Radford. 1998. Prevalence of Smoking
in Cambodia. Journal of Epidemiology 8, no. 2:8589.
Starkey, Linda, Katherine Gray-Donald, and Harriet Kuhnlein. 1999. Nutrient
Intake of Food Bank Users Is Related to Frequency of Food Bank Use, Household
Size, Smoking, Education and Country of Birth. Journal of Nutrition 129:88389.
Wang, Hong, Jody Sindelar, and Susan Busch. 2006. The Impact of Tobacco Expenditure on Household Consumption Patterns in Rural China. Social Science and
Medicine 62, no. 6:141426.
Webb, Patrick, and Steven Block. 2004. Nutrition Information and Formal Schooling as Inputs to Child Nutrition. Economic Development and Cultural Change 52,
no. 4:80120.
Webb, Patrick, and Karin Lapping. 2002. Are the Determinants of Malnutrition
the Same as for Food Insecurity? Recent Findings from 6 Developing Countries
on the Interaction between Food and Nutrition Security. Discussion Paper no.
6, Friedman School of Nutrition Science and Policy, Tufts University.
WHO (World Health Organization). 2000. WHO Framework Convention on Tobacco
Control. 11th Conference on Tobacco or Health. Geneva: WHO.
. 2004. Tobacco Is Bad Economics All Around. Media release, May 31,
WHO, Geneva.

Block and Webb
23
. 2005a. Communicable Diseases and Severe Food Shortage Situations. Geneva:

WHO, Communicable Diseases Working Group on Emergencies.
. 2005b. The Millennium Development Goals and Tobacco Control. Geneva: WHO.
Witoelar, Firman, Pungpong Rukumnauykit, and John Strauss. 2005. Smoking
Behavior among Youth in a Developing Country: Case of Indonesia. Photocopy,
Department of Economics, University of Southern California.
World Bank. 2006a. Making the New Indonesia Work for the Poor. Washington, DC:
World Bank.
. 2006b. Repositioning Nutrition. Washington, DC: World Bank.


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Up in Smoke: Tobacco Use, Expenditure on Food, and

Child Malnutrition in Developing Countries

steven block and patrick webb

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economic development and cultural change

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Block and Webb

sional comparisons may reflect numerous confounding factors, such as per

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economic development and cultural change

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Block and Webb

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economic development and cultural change

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Block and Webb

Source. Nutrition surveillance system, Helen Keller International, Jakarta.

IV. Nonparametric Evidence

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economic development and cultural change

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Block and Webb

Figure 2. Food expenditures, households of smokers versus nonsmokers

high-quality (micronutrient-rich) foods.7 Rice constitutes on average 21% of

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economic development and cultural change

Figure 3. Share of rice in food budgets of smokers versus nonsmokers

Figure 4. Share of micronutrient-rich foods in food budgets of smokers versus nonsmokers

to eliminate the confounding effect of total household per capita expenditures

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Block and Webb

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economic development and cultural change

food expenditure as a function of cigarette expenditure and then an additional

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Block and Webb

the nonparametric analysis, we differentiate between the shares of household

PCEij p f(PCEj , Hj , Pj,rice , HCdistj ),

CHAZkj p g(PCEj , Hj , Pj,rice , HCdistj , Ckj ),

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Distance home to health center (meters)

Number household members 1 6 years

Log rice price

Maximum years parental school

Block and Webb

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economic development and cultural change

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Block and Webb

Columns 2 and 3 of table 3 present Tobit estimations of the determinants

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economic development and cultural change

by the lack of appropriate instrumental variables, we have provided evidence

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Block and Webb

in developing countries. Indeed, it is estimated that 10 million people will

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economic development and cultural change

ferentiate these impacts by types of household in policy-relevant ways that

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Block and Webb

This content downloaded from 128.252.067.066 on July 25, 2016 19:33:55 PM