{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T19:08:08Z","timestamp":1788376088759,"version":"build-2803163510"},"reference-count":46,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100015283","name":"Bloomberg Philanthropies","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015283","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Tobacco use, a major preventable risk factor for premature death and morbidity, profoundly shapes individual and household decision-making.  Tobacco spending in lower-income economies exacerbates economic strain of the households. To accommodate tobacco costs, many households are forced to reduce essential expenditures on health and education\u2014a phenomenon known as the crowding out effect. This study uses data from Albania\u2019s national Household Budget Survey and applies a three-stage least squares method with instrumental variables to estimate Engel curves to shed light on how tobacco use influences household financial decisions. The findings reveal that tobacco spending significantly reduces expenditures on essential needs such as health, education, housing, and clothing. Additionally, tobacco use shows a positive correlation with alcohol spending, revealing another negative influence of an addictive behavior on household resource allocation. The results emphasize the urgent need for stronger tobacco control measures promote better economic decision-making within households. Such measures would enhance public health, improve economic stability, and encourage more equitable resource distribution.<\/jats:p>","DOI":"10.1038\/s41598-025-08648-1","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T08:47:44Z","timestamp":1752137264000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The dual impact of tobacco spending: crowding out essentials and crowding in addictive behaviors"],"prefix":"10.1038","volume":"15","author":[{"given":"Elvina","family":"Merkaj","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drini","family":"Imami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Drope","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"key":"8648_CR1","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.1001\/jama.1993.03510180077038","volume":"270","author":"JM McGinnis","year":"1993","unstructured":"McGinnis, J. M. & Foege, W. H. Actual causes of death in the United States. JAMA 270, 2207\u20132212 (1993).","journal-title":"JAMA"},{"key":"8648_CR2","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1046\/j.0887-378X.2003.00296.x","volume":"81","author":"HM Leichter","year":"2003","unstructured":"Leichter, H. M. \u201cEvil habits\u201d and \u201cpersonal choices\u201d: Assigning responsibility for health in the 20th century. Milbank Q. 81, 603\u2013626 (2003).","journal-title":"Milbank Q."},{"key":"8648_CR3","doi-asserted-by":"publisher","first-page":"2337","DOI":"10.1016\/S0140-6736(21)01169-7","volume":"397","author":"MB Reitsma","year":"2021","unstructured":"Reitsma, M. B. et al. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: A systematic analysis from the Global Burden of Disease Study 2019. Lancet 397, 2337\u20132360 (2021).","journal-title":"Lancet"},{"key":"8648_CR4","doi-asserted-by":"publisher","first-page":"30","DOI":"10.3109\/00952990.2011.643978","volume":"38","author":"KR Hamilton","year":"2012","unstructured":"Hamilton, K. R. & Potenza, M. N. Relations among delay discounting, addictions, and money Mismanagement: implications and future directions. Am. J. Drug Alcohol Abuse 38, 30\u201342 (2012).","journal-title":"Am. J. Drug Alcohol Abuse"},{"key":"8648_CR5","volume-title":"It Will Never Happen to Me: Growing Up with Addiction as Youngsters, Adolescents, and Adults","author":"C Black","year":"2020","unstructured":"Black, C. It Will Never Happen to Me: Growing Up with Addiction as Youngsters, Adolescents, and Adults (Central Recovery Press, 2020)."},{"key":"8648_CR6","doi-asserted-by":"publisher","first-page":"4796","DOI":"10.1038\/s41598-024-55256-6","volume":"14","author":"A Machulska","year":"2024","unstructured":"Machulska, A., Woud, M. L., Brailovskaia, J., Margraf, J. & Klucken, T. Nicotine-related interpretation biases in cigarette smoking individuals. Sci. Rep. 14, 4796 (2024).","journal-title":"Sci. Rep."},{"key":"8648_CR7","first-page":"95","volume-title":"Handbook of Health Economics","author":"J Cawley","year":"2011","unstructured":"Cawley, J. & Ruhm, C. J. The economics of risky health behaviors. In Handbook of Health Economics Vol. 2 (eds Pauly, M. V. et al.) 95\u2013199 (Elsevier, 2011)."},{"key":"8648_CR8","doi-asserted-by":"publisher","first-page":"1414","DOI":"10.1016\/j.socscimed.2005.07.032","volume":"62","author":"H Wang","year":"2006","unstructured":"Wang, H., Sindelar, J. L. & Busch, S. H. The impact of tobacco expenditure on household consumption patterns in rural China. Soc. Sci. Med. 62, 1414\u20131426 (2006).","journal-title":"Soc. Sci. Med."},{"key":"8648_CR9","doi-asserted-by":"publisher","first-page":"1356","DOI":"10.1016\/j.socscimed.2007.11.020","volume":"66","author":"RM John","year":"2008","unstructured":"John, R. M. Crowding out effect of tobacco expenditure and its implications on household resource allocation in India. Soc. Sci. Med. 66, 1356\u20131367 (2008).","journal-title":"Soc. Sci. Med."},{"key":"8648_CR10","doi-asserted-by":"publisher","first-page":"s68","DOI":"10.1136\/tc-2022-057791","volume":"33","author":"AM S\u00e1nchez","year":"2024","unstructured":"S\u00e1nchez, A. M. & G\u00f3mez, A. G. Crowding out and impoverishing effect of tobacco in Mexico. Tob. Control 33, s68\u2013s74 (2024).","journal-title":"Tob. Control"},{"key":"8648_CR11","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1016\/S0277-9536(01)00180-0","volume":"55","author":"E Lindbladh","year":"2002","unstructured":"Lindbladh, E. & Lyttkens, C. H. Habit versus choice: the process of decision-making in health-related behaviour. Soc. Sci. Med. 55, 451\u2013465 (2002).","journal-title":"Soc. Sci. Med."},{"key":"8648_CR12","doi-asserted-by":"publisher","first-page":"94","DOI":"10.20882\/adicciones.1403","volume":"34","author":"JM Mart\u00edn \u00c1lvarez","year":"2022","unstructured":"Mart\u00edn \u00c1lvarez, J. M., Barrientos Mar\u00edn, J. & Mill\u00e1n, J. M. The relationship between the socio-economic gradient and cigarette consumption in Spain. Adicciones 34, 94\u2013109 (2022).","journal-title":"Adicciones"},{"key":"8648_CR13","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1136\/tobaccocontrol-2016-053091","volume":"25","author":"PTH Anh","year":"2016","unstructured":"Anh, P. T. H. et al. Direct and indirect costs of smoking in Vietnam. Tob. Control 25, 96\u2013100 (2016).","journal-title":"Tob. Control"},{"key":"8648_CR14","doi-asserted-by":"publisher","first-page":"s38","DOI":"10.1136\/tc-2023-058196","volume":"33","author":"E Merkaj","year":"2024","unstructured":"Merkaj, E. et al. Impact of cigarette price and tobacco control policies on youth smoking experimentation in Albania. Tob. Control 33, s38\u2013s43 (2024).","journal-title":"Tob. Control"},{"key":"8648_CR15","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1080\/09581596.2014.980396","volume":"26","author":"S Blue","year":"2016","unstructured":"Blue, S., Shove, E., Carmona, C. & Kelly, M. P. Theories of practice and public health: Understanding (un)healthy practices. Crit. Public Health 26, 36\u201350 (2016).","journal-title":"Crit. Public Health"},{"key":"8648_CR16","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1016\/S0167-6296(99)00018-1","volume":"18","author":"TS Dee","year":"1999","unstructured":"Dee, T. S. The complementarity of teen smoking and drinking. J. Health Econ. 18, 769\u2013793 (1999).","journal-title":"J. Health Econ."},{"key":"8648_CR17","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1080\/00036840410001674295","volume":"36","author":"M Bask","year":"2004","unstructured":"Bask, M. & Melkersson, M. Rationally addicted to drinking and smoking?. Appl. Econ. 36, 373\u2013381 (2004).","journal-title":"Appl. Econ."},{"key":"8648_CR18","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1111\/1475-4932.00002","volume":"77","author":"L Cameron","year":"2001","unstructured":"Cameron, L. & Williams, J. Cannabis, alcohol and cigarettes: Substitutes or complements?. Econ. Rec. 77, 19\u201334 (2001).","journal-title":"Econ. Rec."},{"key":"8648_CR19","doi-asserted-by":"crossref","unstructured":"Picone, G. & Sloan, F. Smoking cessation and lifestyle changes. Forum Health Econ. Policy 6 (2003).","DOI":"10.2202\/1558-9544.1048"},{"key":"8648_CR20","unstructured":"Kostakis, I. Does tobacco spending crowd-out the household budget? Preliminary results using nationwide survey data. https:\/\/mpra.ub.uni-muenchen.de\/102251\/ (2020)."},{"key":"8648_CR21","doi-asserted-by":"publisher","first-page":"107","DOI":"10.4278\/0890-1171-15.2.107","volume":"15","author":"J Ma","year":"2000","unstructured":"Ma, J., Betts, N. M. & Hampl, J. S. Clustering of lifestyle behaviors: The relationship between cigarette smoking, alcohol consumption, and dietary intake. Am. J. Health Promot. 15, 107\u2013117 (2000).","journal-title":"Am. J. Health Promot."},{"key":"8648_CR22","unstructured":"Gjika, A., Gjika, I., Zhllima, E. & Imami, D. Smoking uptake, prevalence, and cessation in Albania. Tirana Albania Dev. Solut. Assoc. https:\/\/www.economicsforhealth.org\/files\/research\/646\/208-alb-report.pdf (2020)."},{"key":"8648_CR23","doi-asserted-by":"publisher","DOI":"10.1007\/s00787-024-02629-x","author":"O Dadras","year":"2024","unstructured":"Dadras, O. Temporal changes and correlates of tobacco and E-cigarettes use among school-going students in Albania: Insights from global youth tobacco surveys (2015\u20132020). Eur. Child Adolesc. Psychiatry https:\/\/doi.org\/10.1007\/s00787-024-02629-x (2024).","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"8648_CR24","doi-asserted-by":"publisher","first-page":"ckaa165-848","DOI":"10.1093\/eurpub\/ckaa165.848","volume":"30","author":"G Burazeri","year":"2020","unstructured":"Burazeri, G. Burden of non-communicable diseases and behavioral risk factors in Albania. Eur. J. Public Health 30, ckaa165-848 (2020).","journal-title":"Eur. J. Public Health"},{"key":"8648_CR25","unstructured":"INSTAT. Income and Living Conditions in Albania, 2022. https:\/\/www.instat.gov.al\/media\/13064\/silc-2022_final_anglisht_ezh.pdf (2024)."},{"key":"8648_CR26","unstructured":"Merkaj, E., Imami, D., & Zhllima, E. The impoverishing effect of tobacco use in Albania. (Tobacconomics Working Paper No. 23\/2\/1). DSA. https:\/\/tobacconomics.org\/research\/the-impoverishingeffect-of-tobacco-use-in-albania-working-paper-series\/ (2023)."},{"key":"8648_CR27","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1136\/tobaccocontrol-2014-052000","volume":"25","author":"S San","year":"2016","unstructured":"San, S. & Chaloupka, F. J. The impact of tobacco expenditures on spending within Turkish households. Tob. Control 25, 558\u2013563 (2016).","journal-title":"Tob. Control"},{"key":"8648_CR28","doi-asserted-by":"publisher","first-page":"s326","DOI":"10.1136\/tobaccocontrol-2019-055307","volume":"29","author":"N-M Nguyen","year":"2020","unstructured":"Nguyen, N.-M. & Nguyen, A. Crowding-out effect of tobacco expenditure in Vietnam. Tob. Control 29, s326\u2013s330 (2020).","journal-title":"Tob. Control"},{"key":"8648_CR29","doi-asserted-by":"publisher","first-page":"s88","DOI":"10.1136\/tc-2022-057727","volume":"33","author":"M Vladisavljevic","year":"2024","unstructured":"Vladisavljevic, M., Zubovi\u0107, J., Jovanovic, O. & \u0110uki\u0107, M. Crowding-out effect of tobacco consumption in Serbia. Tob. Control 33, s88\u2013s94 (2024).","journal-title":"Tob. Control"},{"key":"8648_CR30","doi-asserted-by":"publisher","first-page":"s75","DOI":"10.1136\/tc-2022-057786","volume":"33","author":"A Mugosa","year":"2024","unstructured":"Mugosa, A., Cizmovic, M. & Vulovic, V. Impact of tobacco spending on intrahousehold resource allocation in Montenegro. Tob. Control 33, s75\u2013s80 (2024).","journal-title":"Tob. Control"},{"key":"8648_CR31","doi-asserted-by":"publisher","first-page":"60","DOI":"10.2307\/1883993","volume":"83","author":"RA Pollak","year":"1969","unstructured":"Pollak, R. A. Conditional demand functions and consumption theory. Q. J. Econ. 83, 60\u201378 (1969).","journal-title":"Q. J. Econ."},{"key":"8648_CR32","doi-asserted-by":"publisher","first-page":"925","DOI":"10.2307\/2938167","volume":"59","author":"M Browning","year":"1991","unstructured":"Browning, M. & Meghir, C. The effects of male and female labor supply on commodity demands. Econometrica 59, 925\u2013951 (1991).","journal-title":"Econometrica"},{"key":"8648_CR33","first-page":"1","volume":"4","author":"F Vermeulen","year":"2003","unstructured":"Vermeulen, F. Do smokers behave differently? A tale of zero expenditures and separability concepts. Econ. Bull. 4, 1\u20137 (2003).","journal-title":"Econ. Bull."},{"key":"8648_CR34","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1162\/003465397557015","volume":"79","author":"J Banks","year":"1997","unstructured":"Banks, J., Blundell, R. & Lewbel, A. Quadratic Engel curves and consumer demand. Rev. Econ. Stat. 79, 527\u2013539 (1997).","journal-title":"Rev. Econ. Stat."},{"key":"8648_CR35","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1111\/1467-8268.12116","volume":"26","author":"G Chelwa","year":"2014","unstructured":"Chelwa, G. & Van Walbeek, C. Assessing the causal impact of tobacco expenditure on household spending patterns in Zambia. Afr. Dev. Rev. 26, 597\u2013610 (2014).","journal-title":"Afr. Dev. Rev."},{"key":"8648_CR36","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1177\/1536867X1201200306","volume":"12","author":"BP Poi","year":"2012","unstructured":"Poi, B. P. Easy demand-system estimation with quaids. Stata J. 12, 433\u2013446 (2012).","journal-title":"Stata J."},{"key":"8648_CR37","unstructured":"John, R. M., Chelwa, G., Vulovic, V. & Chaloupka, F. J. Updated toolkit on using household expenditure surveys for research in the economics of tobacco control. Tobacconomics https:\/\/www.economicsforhealth.org\/files\/research\/856\/tobacconomics-updated-hes-tool-kit-2nd-ed-eng-v2.1.pdf(2023)."},{"key":"8648_CR38","volume-title":"Econometric Analysis","author":"WH Greene","year":"2018","unstructured":"Greene, W. H. Econometric Analysis 8th edn. (Pearson, 2018).","edition":"8"},{"key":"8648_CR39","volume-title":"Econometric Analysis of Cross Section and Panel Data","author":"JM Wooldridge","year":"2010","unstructured":"Wooldridge, J. M. Econometric Analysis of Cross Section and Panel Data 2nd edn. (MIT Press, 2010).","edition":"2"},{"key":"8648_CR40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1086\/605207","volume":"58","author":"S Block","year":"2009","unstructured":"Block, S. & Webb, P. Up in smoke: Tobacco use, expenditure on food, and child malnutrition in developing countries. Econ. Dev. Cult. Change 58, 1\u201323 (2009).","journal-title":"Econ. Dev. Cult. Change"},{"key":"8648_CR41","doi-asserted-by":"publisher","first-page":"e0222000","DOI":"10.1371\/journal.pone.0222000","volume":"14","author":"G Chelwa","year":"2019","unstructured":"Chelwa, G. & Koch, S. F. The effect of tobacco expenditure on expenditure shares in South African households: A genetic matching approach. PLoS ONE 14, e0222000 (2019).","journal-title":"PLoS ONE"},{"key":"8648_CR42","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.healthpol.2020.08.004","volume":"125","author":"HJ Jin","year":"2021","unstructured":"Jin, H. J. & Cho, S. M. Effects of cigarette price increase on fresh food expenditures of low-income South Korean households that spend relatively more on cigarettes. Health Policy 125, 75\u201382 (2021).","journal-title":"Health Policy"},{"key":"8648_CR43","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1186\/s12889-015-2423-9","volume":"15","author":"YK Do","year":"2015","unstructured":"Do, Y. K. & Bautista, M. A. Tobacco use and household expenditures on food, education, and healthcare in low- and middle-income countries: A multilevel analysis. BMC Public Health 15, 1098 (2015).","journal-title":"BMC Public Health"},{"key":"8648_CR44","doi-asserted-by":"publisher","first-page":"e0303328","DOI":"10.1371\/journal.pone.0303328","volume":"19","author":"JM Gallego","year":"2024","unstructured":"Gallego, J. M., Paraje, G. & Rodr\u00edguez-Lesmes, P. Inequality of the crowding-out effect of tobacco expenditure in Colombia. PLoS ONE 19, e0303328 (2024).","journal-title":"PLoS ONE"},{"key":"8648_CR45","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1136\/tobaccocontrol-2016-053424","volume":"27","author":"ES Rogers","year":"2018","unstructured":"Rogers, E. S., Dave, D. M., Pozen, A., Fahs, M. & Gallo, W. T. Tobacco cessation and household spending on non-tobacco goods: Results from the US Consumer Expenditure Surveys. Tob. Control 27, 209\u2013216 (2018).","journal-title":"Tob. Control"},{"key":"8648_CR46","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.addbeh.2004.04.009","volume":"30","author":"M Fendrich","year":"2005","unstructured":"Fendrich, M., Mackesy-Amiti, M. E., Johnson, T. P., Hubbell, A. & Wislar, J. S. Tobacco-reporting validity in an epidemiological drug-use survey. Addict. Behav. 30, 175\u2013181 (2005).","journal-title":"Addict. Behav."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-08648-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-08648-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-08648-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T02:25:48Z","timestamp":1757211948000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-08648-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,9]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["8648"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-08648-1","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,9]]},"assertion":[{"value":"20 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was funded by Bloomberg Philanthropies through Economics for Health at the Johns Hopkins Bloomberg School of Public Health. The study represents the views of the authors and not necessarily those of the funder. The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"24648"}}