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Gender Imbalance and Parental Health-Compromising Behavior in Rural China

China and some other countries have experienced unbalanced sex ratios in the marriage market, which triggers intense competition and pressure to get married. This paper utilizes two household longitudinal datasets from rural China – a secondary national survey and a primary regional survey – to examine parental substance use in response to skewed sex ratios. Sex ratios are calculated using a 1‰ sample of the 2000 China Population Census. Strikingly, paternal smoking and alcohol use are more intense for families with son living in communities with higher sex ratios. In contrast, those with daughter do not demonstrate this pattern. Both direct and indirect evidence suggests that coping with the marriage market pressure is a more plausible pathway linking the observed skewed sex ratios and intense substance use, while we do not find evidence supporting income effect and status seeking motives. Considering the highly competitive marriage market in the coming decade and prevalent substance use that generates lasting health impacts and large negative externalities to society, policies that correct the skewed sex ratios could lead to substantial welfare gains.