Cigarette and alcohol expenditures and body weight outcomes among rural households

While cigarette and alcohol (CA) consumption are widely recognized as major public health risk factors, little is known about how expenditures on these addictive goods influence body weight outcomes in rural populations of developing countries. In rural China, where nutrition transitions and lifestyle changes are reshaping health risks, understanding the relationship between CA expenditures and body weight outcomes, as measured by body mass index (BMI), is particularly important. This study examines how household CA expenditure affects body weight outcomes among rural household heads. We also investigate whether cigarette expenditure and alcohol expenditure affect body weight outcomes in heterogeneous ways, and whether there are gendered differences in the association between CA expenditures and body weight outcomes among rural residents. This study uses cross-sectional survey data from 1,487 rural households collected from November 2023 to January 2024 across Jiangsu, Hubei, and Yunnan provinces in China. Body weight outcomes were classified into four BMI-based categories: underweight, normal weight, overweight, or obese. To address potential endogeneity in CA expenditures, a two-stage residual inclusion (2SRI) approach combining Tobit and multinomial logit models was employed. Higher CA expenditures are associated with lower probabilities of being underweight and a higher likelihood of obesity among rural household heads, and the effects of alcohol expenditure are larger than the effects of cigarette expenditure. Besides, CA expenditure increases tuber expenditure but reduces expenditure on fruits, eggs, and beef and lamb. For male household heads, CA expenditure, cigarette expenditure, and alcohol expenditure all significantly reduce the probability of being underweight and increase the probability of obesity. In contrast, none of these expenditure variables has a statistically significant effect on female household heads’ body weight outcomes. Household expenditures on cigarettes and alcohol are important behavioural determinants of body weight outcomes in rural China, particularly by increasing obesity risks. The findings highlight the dual nutritional and economic pathways through which addictive consumption affects health and suggest that policies aimed at reducing tobacco and alcohol use, especially among rural men, can contribute to healthier weight outcomes and improved rural public health management.