Available online 20 October 2025, 103077

This paper examines the long-term impact of West German television exposure on smoking behavior in East Germany, with a focus on gender-specific responses. Using data from 1989 and 2002 and leveraging quasi-random variation in West German TV signal availability across East German regions, we find that TV exposure led to a substantial increase in smoking among women — by 9.5 percentage points in smoking probability and 68% in cigarette consumption — while having no measurable effect on men. This asymmetric effect reflects divergent pre-reunification norms: under socialism, female smoking was heavily stigmatized, and exposure to Western media relaxed these social constraints. The behavioral shift persisted over time, with exposed women reporting worse physical and mental health and higher healthcare utilization in 2002. Back-of-the-envelope calculations suggest a sizable increase in smoking-related mortality and healthcare costs. Our findings highlight how cultural integration through media can alter health behaviors and generate significant public health externalities in transitional societies.

I12

I18

N34

Z13

Health

Smoking

Cultural transmission

Television

Social norms

German reunification

The replication package has been deposited at OpenICPSR under the title “The Effect of West German Television on Smoking and Health: A Natural Experiment from German Reunification.”

© 2025 The Authors. Published by Elsevier B.V.