The self-medication hypothesis: Evidence from terrorism and cigarette accessibility

Area of Science:

• Behavioral Economics
• Public Health
• Econometrics

Background:

• Short-term stress is a known motivator for smoking.
• The self-medication hypothesis suggests smoking reduces stress.

Purpose of the Study:

• To investigate the causal relationship between stress and smoking.
• To determine if smoking alleviates short-term stress (self-medication effect).
• To examine if stress motivates smoking (motivation effect).

Main Methods:

• Utilized single equation and system instrumental variable models.
• Employed data from 240,388 current and former smokers on self-reported smoking and stress.
• Instrumented short-term stress using temporal distance from September 11, 2001.
• Instrumented smoking using cigarette accessibility (price changes, state border proximity).

Main Results:

• Without accounting for endogeneity, smoking appeared associated with increased stress.
• After accounting for endogeneity, no evidence supported smoking reducing short-term stress.
• A consistent positive effect of short-term stress on smoking behavior was observed.

Conclusions:

• The self-medication hypothesis regarding stress reduction through smoking is not supported by this study.
• Short-term stress is a significant driver of smoking initiation or continuation.
• Endogeneity must be addressed to accurately understand the stress-smoking relationship.