Terrorism-induced smoking is a new explanatory factor that will keep public health academics from accepting that free choice happens - some people will do things that are bad for them.

 A Weill Cornell Medical College public health study is stuck in pre-9/11 determinism too; the author concludes that the September 11th, 2001 terrorist attacks caused 1,000,000 former smokers to take up the noxious weed again - and maintain it.

The analysis in Contemporary Economic Policy is distinct in that it is the first to examine terrorism-induced smoking in the United States and come up with net societal costs they feel are directly linked to terrorism.  All determined by phone surveys.

But not all terrorism. Domestic terrorism in the form of the Oklahoma City bombing didn't affect smoking rates in the U.S. but the paper's author, Dr. Michael F. Pesko, an instructor in Weill Cornell Medical College's Department of Public Health, suggests that 9/11 caused a 2.3 percent increase in smoking nationwide. The increase started after 9/11 and continued through the end of 2003, when analysis of the data ended, he says.  So it may be permanent.

So what will the Boston Bombing in April do to smoking rates? Those were also foreign-born aggressors engaged in Islamic terrorism.  It depends on what self-reported claims are. Self-reported stress was also found to especially increase 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.

"This study provides the first unbiased estimate of the effect of stress on smoking, and the finding that there was such a big increase in smoking nationwide, seemingly due to one event, is extraordinary, and surprising," says Pesko. "It sheds light on a hidden cost of terrorism."

Pesko chose those two 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, etc. The Centers for Disease Control and Prevention then aggregates that data and extrapolates it into an annual, nationally representative report. Since the same questions are asked yearly, responses can be compared over time, Pesko says. He chose to examine self-reported days of stress and what he considers to be a bona fide stress response -- whether former smokers begin smoking again.

Pesko compared 1,657,985 responses to the nationally representative questionnaire, and extrapolated that from the fourth quarter of 2001 through 2003, when the study ended, between 950,000 and 1.3 million adult former smokers resumed smoking, 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.

"I was really surprised to find that former smokers across the nation resumed their old habit,"  Pesko says. "I was expecting to see impacts just in the New York City area -- or, at most, the tri-state area."

He estimated the cost to government of 9/11-induced smoking at $530 million to $830 million, and 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.

The study findings suggest a potential public health response to future stress-inducing events, says Pesko. One possibility would be programs that offer free nicotine replacement therapy soon after the events, he says. "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 says.