Send to

Choose Destination
J Hosp Manag Health Policy. 2018 Sep;2. pii: 47. doi: 10.21037/jhmhp.2018.08.04. Epub 2018 Sep 27.

Does daughter deficit promote paternal substance use? Evidence from China.

Chen X1,2.

Author information

Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
Department of Economics, Yale University, New Haven, CT, USA.



China and various other countries have experienced unbalanced sex ratios in the marriage market, which triggers intense competition and pressure to get married. Meanwhile, China has more smokers and drinkers than any other countries in the world. This paper provides evidence on smoking and alcohol use as a stress coping strategy for the competitive marriage market.


This paper utilizes two household longitudinal datasets from rural China-a national survey and a regional survey-to examine paternal substance use in response to skewed sex ratios of their children's generation. The longitudinal feature of the two datasets enables us to explore within household variation in smoking and alcohol use. Sex ratios are matched using a 1% sample of the 2000 China Population Census.


Strikingly, paternal smoking and alcohol use are more intense for families with a son living in communities with higher sex ratios. In contrast, those with a daughter do not demonstrate this pattern. Coping with the marriage market pressure is a plausible pathway linking the observed skewed sex ratios and intense substance use.


High male-to-female sex ratios promote smoking and alcohol drinking among fathers with sons. Considering the highly competitive marriage market in the coming decade and the prevalent substance use that generates lasting health impacts and large negative externalities to society, policies that address the skewed sex ratios could lead to substantial welfare gains.


Skewed sex ratios; alcohol use; marriage market; smoking; substance use

Supplemental Content

Full text links

Icon for PubMed Central
Loading ...
Support Center