Smoking is a habit long thought to reduce anxiety, and while studies have, historically, shown that the relief is only temporary1, that does little to stop people from self-medicating through smoking. It is, in fact, known that "anxiety disorders are more common among the smoking population" than the non-smoking population, with rates of 22% and 11% respectively.2 With improvements to the accessiblity of healthcare throughout the Obama administration resulting in a easier time acquiring medications that designed to relieve the symptoms of any number of anxiety disorders.
Upon first glance at the maps of smoking in 20103 and anxiety medications usage in 20164, it becomes immediately clear just how related the two are. Many of the highest rates of one bear similar heights on the other, and vice versa. Take, for instance, Findlay and Forward Townships, which are two of the most notable similarities. Both are immediately dark red and dark blue in their respective graphs, showing their relatively high rates of both the medication and the smoking. Alternatively, one need look no further than Fox Chapel to see an example of an area that is low in both respects. While there are a few examples of exceptions—Plum, for instance—many of these appear to be more the result of a lack of data on the map than lack of connection.
Despite the seemingly clear relationship between the two, things get less consistent when looked at on a tract-by-tract basis. In the graph below, there's relatively little in the way of overall trends in the relationship between smoking and anxiety medication usage.
The graph itself uses data from WPRDC's datasets on Smoking in Allegheny County in 2010 and Anxiety Medication Usage in Allegheny County in 2016. It serves as a tract-by-tract comparison of the two sets of data, with the left set of data counting the number of people in that are on one of the medications, while the right is the percentage of the population in the tracts that smokes.
As a result of the format of the data and their inherent differences, the graph itself may not properly represent relationships, as the percent of the population on anxiety medications may be similar across tracts, or it may follow the smoking graph closer, or it may even be the opposite. Without more precise data, it is hard to draw any strong conclusions from this portion of the data.
While the chart shows little relationships—again, possibly as a result of the data type discreptancy—science has historically shown that people with anxiety disorders are incredibly likely to self-medicate, with one study showing that PTSD victims alone have a rate of 20% self-medicating.5 In addition, it has been found that people who smoke are actually more likely to develop an anxiety disorder.2 This may, in part, be a side effect of the fact that a nicotine addiction results in increased anxiety simply from the natural cravings and withdrawal effects that result from it.1
Given that research and data have shown that there are definitive links between anxiety disorders and nicotine usage, as well as the experiencing of the side effects of both, and the strong support of the "self-medication hypothesis,"2, 5 the question must then be asked what pushes people to use alternative methods of medication instead of standard anxiety medication initially.
One possible explanation is stigma. There is, for many, a deeply rooted social stigma that surrounds mental disorders and for standard medication used to treat said disorders. While American society as a whole is moving past such stigmas, the complete disolution of them is far off. For nearly all of history, it has been more acceptable to smoke (and drink) than it has been to have to be medicated for a simple mental disorder.
Another possible hypothesis is financials. While the retail price per pill of Xanax ($.55)6 is greater than the price per singular cigarette ($.34), it's also worth noting that you'll need more cigaretes throughout the day than you would need pills from most anxiety medications, which means that they're likely to balance out price wise initially. Where the medication begins to stack up cost wise is in doctor's visits. Many states, PA included, have refill laws for controlled substances like many anxiety and depression medications. In addition, therapist visits can also be expensive, and for people who may not have medical insurance, it may be more appealing to simply smoke, even if in the long term it likely costs more.
In order to test these hypotheses, more data is likely required. For future studies, it would be worth researching the age distributions and income of each tract in Allegheny county, as these could shed further light on the motives of people who resort to self-medication.