Economic crisis and smoking behaviour: prospective cohort study in Iceland

Abstract

ObjectiveTo examine the associations between the 2008 economic collapse in Iceland and smoking behaviour at the national and individual levels.DesignA population-based, prospective cohort study based on a mail survey (Health and Wellbeing in Iceland) assessed in 2007 and 2009.SettingNational mail survey.ParticipantsRepresentative cohort (n=3755) of Icelandic adults.Main outcome measureSmoking status.ResultsA significant reduction in the prevalence of smoking was observed from 2007 (pre-economic collapse) to 2009 (postcollapse) in both males (17.4–14.8%; p 0.01) and females (20.0–17.5%; p 0.01) in the cohort (n=3755). At the individual level of analysis, male former smokers experiencing a reduction in income during the same period were less likely to relapse (OR 0.37; 95% CI 0.16 to 0.85). Female smokers were less likely to quit over time compared to males (OR 0.65; 95% CI 0.45 to 0.93). Among male former smokers who experienced an increase in income between 2007 and 2009, we observed an elevated risk of smoking relapse (OR 4.02; 95% CI 1.15 to 14.00).ConclusionsThe national prevalence of smoking in Iceland declined following the 2008 economic crisis. This could be due to the procyclical relationship between macro-economic conditions and smoking behaviour (ie, hard times lead to less smoking because of lower affordability), or it may simply reflect a continuation of trends already in place prior to the crisis. In individual-level analysis, we find that former smokers who experienced a decline in income were less likely to relapse; and conversely, an increase in income raises the risk. However, caution is warranted since these findings are based on small numbers.

Impact of the financial crisis on COPD burden: Greece as a case study

“…Smokers may be citing an increase in perceived stress to justify their relapse or failure to quit, and they are unable to quit their ongoing behaviour because of the offsetting increase in stress, thus falling into a vicious circle [74][75][76][77][78][79]. However, other studies have reported that economic recession is associated with a decline in the prevalence of cigarette smoking [1] and that a crisis may be health promoting [68,[80][81][82]. The effects on smoking behaviour appear to be largely influenced by price increases [1].…”

“…Reduced disposable income has been the main driver of this decline potentially leading to a significant long-term health gain [1], as it has transformed cigarettes into luxury goods [1,81]. Additional research in that direction actually characterises cigarette smoking as a cause of stress and, furthermore, smoking cessation as a valuable way to break the stress cycle [80][81][82][83]. Finally, a former smoker who experiences a drop in income may be less tempted to start smoking again because of the reduced affordability of cigarettes [84,85].…”

A Review of Health Consequences of Recessions Internationally and a Synthesis of the US Response during the Great Recession

“…21,25,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] While there is evidence of a decrease in overall alcohol consumption during recessions, 5,53 studies also consistently find an increase in alcohol related traffic accidents 55 (despite an overall decline in deaths from road traffic accidents), binge drinking, 5 and alcohol related hospitalization during economic contractions. 25 In other words, while on average some people reduce their drinking of alcohol, a subpopulation increases its use to potentially dangerous levels, reflecting that the hypotheses above may apply variously to different groups.…”

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.…”