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One Million Former Smokers Took Up Cigarettes Again After 9/11, Study Suggests


An estimated one million former smokers took up cigarettes again after the 9/11 attacks on America, a new study suggests. The stress of the events of that day led to the resurgence of smoking among people who had previously quit, the researchers report.

Researchers at Weill Cornell Medical College in New York concluded in the two years after 9/11, smoking increased 2.3 percent among adults who had formerly smoked. This resulted in between 950,000 and 1.3 million adult former smokers becoming smokers again because of terrorism, HealthCanal reports. In contrast, they found no increase in smoking following the 1995 Oklahoma City bombing.

The results are published in the journal Contemporary Economic Policy.

“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,” study author Dr. Michael F. Pesko said in a news release. “It sheds light on a hidden cost of terrorism.”

Dr. Pesko used data from the national Behavioral Risk Factor Surveillance System, which tracks yearly rates of risky behavior including smoking. He looked at self-reported days of stress, and whether former smokers began smoking again. “I was really surprised to find that former smokers across the nation resumed their old habit,” he said. “I was expecting to see impacts just in the New York City area — or, at most, the tri-state area.”

In the future, after stress-inducing events, public health officials might want to offer free nicotine replacement therapy, he suggested. Health professionals could be advised to conduct more substance abuse screening during regular medical appointments after events that are likely to cause widespread stress, he added.

2 Responses to this article

  1. Avatar of John R. Polito
    John R. Polito / June 24, 2013 at 5:23 am

    Director of a leading nicotine cessation site, I find shocking Dr. Pesko’s suggestion that smokers consider replacement nicotine use during moments of national crisis such as 9/11. His NRT suggestion evidences amazingly little understanding of nicotine dependency, recovery or relapse.

    The burning question is “why” did stress cause a million U.S. ex-smokers to relapse following the 9/11 attacks? It wasn’t because they couldn’t locate nicotine, Dr. Pesko, but because they did. Maybe you missed it, but roughly 40 percent of replacement nicotine is used by those addicted to this form of delivery.

    Why did they relapse? Because each deeply yet wrongly believed that smoking nicotine is a stress buster. It was a false lesson burned into our brains while still smokers. Stress, like alcohol, turns the urine more acidic, only quicker. The more stressed we became as smokers, the more acidic our urine, and the quicker our kidneys eliminated remaining reserves of the alkaloid nicotine from our bloodstream.

    Urine acidification during stressful situations throws smokers into early withdrawal. For example, if a smoker and a never-smoker both have a flat tire, the never-smoker reaches for a jack, and the smoker reaches for … that’s right, a cigarette. By the time the smoker has finished servicing their addiction, the never-smoker is driving off, while the smoker still has the exact same original stressful situation to confront, changing the tire.

    As smokers, we experienced this false calming effect hundreds or even thousands of times. It is hard work being an actively feeding nicotine addict as we added early withdrawal to every crisis life threw our way. What ex-smokers need to know is that, like alcoholism, nicotine dependency is permanent and cannot be cured or killed but only arrested. The ex-smoker’s brain remains permanently grooved and wired for relapse, and just one puff will cause up to half of their a4b2-type dopamine pathway receptors to become occupied by nicotine.

    While they may walk away from “cheating” feeling like they’ve gotten away with it, you cannot cheat the design of brain circuitry whose job it is to make activating events nearly impossible in the short term (the time needed for recovery) to forget or ignore. Those pathways will again re-assign the same use priority to smoking nicotine as they do to eating food. And it won’t be long before they are wanting or even begging for more.

    What’s sad is how horrible we have done at teaching this critical lesson to ex-smokers. While none of these one million needed to relapse, their use conditioning had primed them for failure. Hopefully, this basic acidification relapse prevention lesson will get broader exposure before the world’s next major crisis.

    John R. Polito
    Nicotine Cessation Educator

  2. Avatar of PATRICK MAHONEY
    PATRICK MAHONEY / June 21, 2013 at 5:05 pm

    Remembering the morning of 9/11 while reading this article triggered a sudden strong craving for a cigarette. I had to remind myself that addiction is often stress related, practice some gratitude for being a nonsmoker, and take some deep slow breaths. The craving has passed, as they always do. LOL

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