Effects of the economic crisis on smoking prevalence and number of smokers in the USA

Abstract

Objective: Scanty and controversial information is available on the impact of macroeconomic fluctuations on smoking behaviour. No study has quantified the effects of fiscal crises on smoking prevalence. This study aimed to investigate the effects of the 2007–2008 economic crisis on smoking prevalence and number of smokers in the USA. Methods: Using data from the repeated Behavioural Risk Factor Surveillance System (BRFSS) surveys in precrisis (2005–2007) and post-crisis (2009–2010) periods on a total of 1 981 607 US adults, we separated the expected (after allowance for the demographic growth of the US population, secular smoking prevalence trends and changes in sociodemographic characteristics) from the unexpected (assumed attributable to the economic crisis) changes in the number of smokers across different employment statuses. Results: Joinpoint regression analysis revealed no significant changes in smoking prevalence trends over the period 2005–2010. The crisis resulted in an increase in the number of smokers in the US by 0.6 million. This is largely due to an unexpected decrease of 1.7 million smokers among employed and an increase of 2.4 million smokers among unemployed individuals, whose smoking prevalence also remains extremely high in the post-crisis period (32.6%). Conclusions: The 2008 financial crisis had a weak effect on smoking prevalence. The pro-cyclical relationship (ie, the crisis results in a lower number of smokers) found among the employed is offset by the counter-cyclical relationship (ie, the crisis results in a higher number of smokers) found among unemployed individuals. Public health interventions should specifically target those in unemployment, particularly in hard times

Changes Over Time in Absolute and Relative Socioeconomic Differences in Smoking: A Comparison of Cohort Studies From Britain, Finland, and Japan

“…[8][9][10] At the early stages, the upper classes are the first to take up smoking, but over time the habit spreads disproportionately to the lower classes, with emerging socioeconomic differences. The patterning of smoking over time is further shaped by macro level national developments, such as economic fluctuations and social structural transformations, [11][12][13] as well as individual level sociodemographic and health-related factors. [14][15][16] The epidemic model finds support from western time trend studies suggesting that socioeconomic differences in smoking remain or even widen, [8][9][10]17 and it offers a framework and context for examining socioeconomic differences in smoking over time and across countries.…”

Which group of smokers is more vulnerable to the economic crisis?

“…[7][8][9][10][11][12] On the other hand, some of the most recent studies based on ex-post analysis of smoking behaviour after the 2008 financial crisis reported a null or even a counter-cyclical relationship (the crisis increased tobacco smoking), possibly explained by an increased psychological stress in selected vulnerable populations. [13][14][15][16][17][18][19][20] In the UK, for instance, the attempt rates for smoking cessation steadily declined after the onset of the economic crisis. 21 In Italy, the crisis had dramatic socio-economic consequences: unemployment rate has increased from 6.1% in 2007, to 10.7% in 2012 and up to 12.7% in 2014.…”

“…20,21,27 On the other hand, a minority of the same population reacts to the stressful consequences of an economic shock by increasing their smoking intensity. 18,20 Accordingly, the economic crisis has been shown to be stressful for subgroups of population with a disadvantaged socio-economic status. 28,29 Likewise, a study based on large repeated cross-sectional surveys, analysing smoking prevalence before and after the onset of the 2008 economic crisis in the United States, showed a counter-cyclical relationship among the unemployed population.…”

“…28,29 Likewise, a study based on large repeated cross-sectional surveys, analysing smoking prevalence before and after the onset of the 2008 economic crisis in the United States, showed a counter-cyclical relationship among the unemployed population. 18 This relationship, unfavourable from a public health perspective, may have been exacerbated by the availability of relatively cheap tobacco products in the market, including roll-your-own (RYO) tobacco.…”

“…Longitudinal studies have not yet been published and available repeated cross-sectional surveys or before/after studies (without direct questions on individual's behaviour) are not able to address this specific issue. 18 The change in tobacco use, if any, points to a decrease in smoking intensity, which is indeed a welcoming move from a public health perspective. However, the reduction in tobacco consumption due to affordability reasons has been observed in specific vulnerable populations.…”