Stress resulting from the September 11, 2001 terrorist attacks seems to have caused about 1 million former smokers to start smoking again, according to a new study.
The analysis by a researcher at Weill Cornell Medical School is the first to look at the societal costs of terrorism-induced smoking in the United States after 9/11 and the 1995 Oklahoma City bombings.
“This helps us better understand what the real costs of such disasters are in human and economic tolls, and it suggests ways that such future stressful reactions that result in excess smoking might be avoided,” said Michael F. Pesko, Ph.D., an instructor in the college’s Department of Public Health.
“It sheds light on a hidden cost of terrorism.”
While the Oklahoma City bombing didn’t affect smoking rates, Pesko estimates that 9/11 caused a 2.3 percent increase nationwide. The increase started after 9/11 and continued through the end of 2003, when analysis of the data ended, he noted.
Self-reported stress was also found to increase especially in communities with a higher concentration of active-duty and reserve members of the military, and among higher-educated groups. The increase in stress following 9/11 was found to account for all of the increase in smoking, according to the researcher.
Pesko noted he has been interested in the relationship between stress and substance abuse for a long time.
“There is a consensus in the research community that stress is a very large motivator for individuals to use substances, but this has not really been studied very thoroughly,” he said.
To study the relationship, Pesko chose two domestic terrorist attacks and examined data from the Behavioral Risk Factor Surveillance System, which tracks annual rates of risky personal behavior across the nation.
Health departments in every state conduct monthly phone surveys of residents, asking about seat-belt use, smoking and drinking habits, the last time they visited a doctor or dentist, and other behaviors. The Centers for Disease Control and Prevention aggregates the data and extrapolates it into an annual, nationally representative report.
Since the same questions are asked yearly, responses can be compared over time, Pesko noted. For his study, he examined self-reported days of stress and whether former smokers begin smoking again.
He compared 1,657,985 responses to the nationally representative questionnaire, and extrapolated that from the fourth quarter of 2001 through 2003, between 950,000 and 1.3 million adult former smokers starting smoking again — representing a 2.3 percent increase in adult smokers across the country.
There was no increase in the months and years following the Oklahoma City bombing, he noted.
“I was really surprised to find that former smokers across the nation resumed their old habit,” he said. “I was expecting to see impacts just in the New York City area or, at most, the tri-state area.”
He estimated the cost of the 9/11-induced smoking for the government falls somewhere between $530 million to $830 million — and could be potentially higher if the smoking continued beyond 2003.
These figures represent changes in the use of Medicare and Medicaid, productivity losses associated to illness from smoking, and decreased tax revenue linked to lost work. The figure also takes into account increased tax revenue from cigarette purchases, according to the researcher.
The study’s findings suggest some potential public health initiatives following future stress-inducing events, Pesko said.
One possibility would be programs that offer free nicotine replacement therapy soon after the events, he said.
“Another strategy would be to alert health professionals to do more substance abuse screening during regular medical appointments following terrorist attacks, or any such event that is likely to stress the nation,” he concluded.
The study was published in the journal Contemporary Economic Policy.
Source: Weill Cornell Medical College