The Impact of Terrorism on Stress and Substance Use: Evidence from the Boston Marathon Bombing

Terrorism is major concern in today's world and one of the main challenges to global security. On April 15, 2013, two bombs exploded near the finish line of the Boston Marathon, killing three spectators and wounding more than 260 people. This event triggered a 4-day manhunt in Boston that resulted in substantial media attention before ending with the killing of one suspect and apprehension of another. Over these four days and beyond, individuals may have attempted to self-medicate increases in perceived background risks from the terrorist attacks. Additionally, time use among individuals in Boston may have changed, resulting in greater substance use, due to mandatory lockdowns during the manhunt.

We analyze the effect of the Boston Marathon bombing on stress, smoking, and binge drinking using difference-in-difference-in-difference analyses and Behavioral Risk Factor Surveillance System data. We study how individuals residing in urban counties of Massachusetts were differentially affected by the bombing compared to rural areas and other non-New England states. Additionally, to remove the effect of time use changes due to lockdowns, we examine the effect in non-Massachusetts urban counties of New England.

We find that in the 30 days after the Boston Marathon bombing, binge drinking increased by 1.3 days out of 30 (200% of the mean) in Massachusetts urban areas compared to control areas, and binge drinking increased by 1.6 days out of 30 in other urban parts of New England (250% of the mean). Our results suggest that binge drinking substantially increased in the aftermath of the Boston Marathon bombing, and evidence suggests that the strongest mechanism including this increase is through increases in perceived background risks.