SOCIAL STRESS AND STATE-TO-STATE DIFFERENCES IN SMOKING AND SMOKING-RELATED MORTALITY IN THE UNITED-STATES

This paper reports on the relationship between the stressfulness of th e social environment, smoking and mortality rates for malignant neopla sms of the respiratory system and chronic obstructive pulmonary diseas e (COPD). A macro-social approach was employed with the 50 states of t he United States serving as the units of analysis. A 'State Stress Ind ex' was computed using stressful events in 15 categories (divorce rate , business failures, natural disasters, etc.). Smoking behavior was me asured by percentage smokers and the average cigarette sales per capit a. Mortality rates for lung cancer and COPD were standardized by age. The percent population living in metropolitan areas, black, below pove rty line, and with less than high school education were included as co ntrols in the multiple regression analysis. The results show that popu lations that experience higher levels of stressful events smoke more h eavily and eventually experience higher mortality from lung cancer and COPD. These relationships are robust: they are replicated for differe nt time periods, for different measures of the independent and depende nt variables, and with different analytic methods. The pattern of find ings is consistent with a 'health behavior' model of stress in which p opulations under stress engage in behavior which is extremely inimical to health.