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

Abstract

We use single equation and system instrumental variable models to explore if individuals smoke during times of stress (the motivation effect) and if they are successful in self-medicating short-term stress (the self-medication effect). Short-term stress is a powerful motivator of smoking, and the decision to smoke could trigger biological feedback that immediately reduces short-term stress. We use data on self-reported smoking and stress from 240,388 current and former smokers. We instrument stress with temporal distance from September 11, 2001 (using date of interview). We instrument smoking with cigarette accessibility measures of cigarette price changes and distance to state borders. In the absence of accounting for endogeneity, we find that smoking is associated with increases in short-term stress. However, when we account for endogeneity we find no evidence of smoking affecting short-term stress. We do find a consistent positive effect of stress on smoking. JEL Classification Numbers: C26, C36, I19Keywords: stress, smoking, self-medication * Corresponding author. Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University. e-mail: mip2037@med.cornell.edu. Please do not repost this draft online. Authors have no conflicts of interest to disclose. We thank Frank Chaloupka, Chad Cotti, Kevin Callison, and numerous seminar participants for helpful comments. Jayme Mendelsohn provided excellent research coordination.† Department of Economics and School of Social Work, Boston College; Department of Macroeconomics, DIW Berlin. e-mail: kit.baum@bc.edu. I IntroductionLowering rates of stress and smoking are important behavioral health priorities. High stress can result in serious health problems including insomnia, muscle pain, high blood pressure, a weakened immune system, heart disease, depression, obesity, and can exacerbate existing illnesses. Americans believe that persistent, high stress is unhealthy and consistently report stress levels that are higher than what they believe to be healthy (American Psychological Association, 2013). Meanwhile, cigarette use accounts for more than 480,000 deaths (including deaths from secondhand smoke), or one of every five deaths, in the United States each year (U.S. DHHS, 2014).Theory and evidence suggest a linkage between stress and smoking. The ability of smoking to improve mood state in the short-term illustrates the self-medication hypothesis. This theory is rooted in neuroscience literature and finds that individuals are able to positively alter negative subjective beliefs through the use of tobacco or other substances. At least one economics study, Barnes and Smith (2009), has used the self-medication hypothesis to explain a contradiction to the rational addiction theory.1 Biochemically, nicotine use increases dopamine levels, and this neurotransmitter is classically associated with altering mood state (Brody et al., 2004;Volkow et al., 2004). However, long-term exposure may cause fewer dopamine receptors that may necessitate ...

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