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Social stress and state-to-state differences in smoking and smoking related mortality in the United States


  • Colby Jr, John P.
  • Linsky, Arnold S.
  • Straus, Murray A.


This paper reports on the relationship between the stressfulness of the social environment, smoking and mortality rates for malignant neoplasms of the respiratory system and chronic obstructive pulmonary disease (COPD). A macro-social approach was employed with the 50 states of the United States serving as the units of analysis. A 'State Stress Index' was computed using stressful events in 15 categories (divorce rate, business failures, natural disasters, etc.). Smoking behavior was measured by percentage smokers and the average cigarette sales per capita. Mortality rates for lung cancer and COPD were standardized by age. The percent population living in metropolitan areas, black, below poverty line, and with less than high school education were included as controls in the multiple regression analysis. The results show that populations that experience higher levels of stressful events smoke more heavily and eventually experience higher mortality from lung cancer and COPD. These relationships are robust: they are replicated for different time periods, for different measures of the independent and dependent variables, and with different analytic methods. The pattern of findings is consistent with a 'health behavior' model of stress in which populations under stress engage in behavior which is extremely inimical to health.

Suggested Citation

  • Colby Jr, John P. & Linsky, Arnold S. & Straus, Murray A., 1994. "Social stress and state-to-state differences in smoking and smoking related mortality in the United States," Social Science & Medicine, Elsevier, vol. 38(2), pages 373-381, January.
  • Handle: RePEc:eee:socmed:v:38:y:1994:i:2:p:373-381

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    References listed on IDEAS

    1. Halkos, George, 1993. "Economic incentives for optimal sulphur abatement in Europe," MPRA Paper 33705, University Library of Munich, Germany.
    2. Ger Klaassen & David Pearce, 1995. "Introduction," Environmental & Resource Economics, Springer;European Association of Environmental and Resource Economists, vol. 5(2), pages 85-93, March.
    3. Michael Grossman, 1972. "The Demand for Health: A Theoretical and Empirical Investigation," NBER Books, National Bureau of Economic Research, Inc, number gros72-1, January.
    4. Tietenberg, T H, 1990. "Economic Instruments for Environmental Regulation," Oxford Review of Economic Policy, Oxford University Press, vol. 6(1), pages 17-33, Spring.
    5. Halkos, George E., 1993. "Sulphur abatement policy: Implications of cost differentials," Energy Policy, Elsevier, vol. 21(10), pages 1035-1043, October.
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    Cited by:

    1. Ayyagari Padmaja & Sindelar Jody L, 2010. "The Impact of Job Stress on Smoking and Quitting: Evidence from the HRS," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 10(1), pages 1-32, March.
    2. Vibeke Koushede & Ola Ekholm & Bjørn Holstein & Anette Andersen & Ebba Hansen, 2011. "Stress and use of over-the-counter analgesics: prevalence and association among Danish 25 to 44-year-olds from 1994 to 2005," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 56(1), pages 81-87, February.
    3. Takeuchi, Kenji & Aida, Jun & Morita, Manabu & Ando, Yuichi & Osaka, Ken, 2012. "Community-level socioeconomic status and parental smoking in Japan," Social Science & Medicine, Elsevier, vol. 75(4), pages 747-751.
    4. Nystedt, Paul, 2006. "Marital life course events and smoking behaviour in Sweden 1980-2000," Social Science & Medicine, Elsevier, vol. 62(6), pages 1427-1442, March.
    5. Gerdtham, Ulf-G. & Johannesson, Magnus, 2005. "Business cycles and mortality: results from Swedish microdata," Social Science & Medicine, Elsevier, vol. 60(1), pages 205-218, January.
    6. Charters, Thomas J. & Harper, Sam & Strumpf, Erin C. & Subramanian, S.V. & Arcaya, Mariana & Nandi, Arijit, 2016. "The effect of metropolitan-area mortgage delinquency on health behaviors, access to health services, and self-rated health in the United States, 2003–2010," Social Science & Medicine, Elsevier, vol. 161(C), pages 74-82.

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