BACKGROUND: Child malnutrition is shaped by various factors, including maternal education and access to sanitation. However, a less explored but critical determinant is household expenditure on tobacco, which can divert resources away from essential goods like food. This study examines the "crowding-out" effect of tobacco expenditure and its implications for child nutrition and health outcomes.
METHODS: Using data from South Africa’s National Income Dynamics Study (NIDS), a nationally representative panel survey (2008–2017), child nutritional status was assessed through anthropometric measures—height-for-age (HAZ) and weight-for-age (WAZ)—expressed as z-scores. Cross-sectional regression models with lagged expenditure and instrumental variables, such as adult-sex ratio and community characteristics, were employed to address endogeneity concerns.
RESULTS: Between 2008 and 2017 there have been notable improvements in child nutritional status, with declines in stunting (from 17.2% to 11.8%), underweight prevalence (from 9.6% to 5.5%), and wasting (from 4.7% to 3.3%). Household income consistently shows a positive and statistically significant association with both HAZ and WAZ scores, supporting the expectation of improved access to nutrition and healthcare. However, lagged household expenditure on cigarettes shows no statistically significant effect on HAZ and WAZ scores, suggesting that resource diversion from products for essential needs may be mitigated by compensatory household behaviors or informal support systems. Child age is weakly but consistently negatively associated with WAZ, likely reflecting age-related nutritional changes, while gender effects are modest and inconsistent.
CONCLUSIONS: These findings highlight the complex interplay of socioeconomic and demographic factors in child health. While reducing tobacco expenditure could theoretically free up resources for essential goods, the nuanced effects observed underscore the need for a comprehensive approach. Policies such as tobacco tax increases and public health education should be complemented by deeper investigations into intra-household dynamics and broader poverty alleviation efforts to sustainably improve child nutrition and health outcomes.