1
|
Asare S. Association of cigarette smoking with changes in macroeconomic conditions. ECONOMICS AND HUMAN BIOLOGY 2024; 54:101397. [PMID: 38703460 DOI: 10.1016/j.ehb.2024.101397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 04/08/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
This study uses data from the 1987-2022 Behavioral Risk Factor Surveillance System and state-level employment rates from the US Bureau of Labor Statistics to estimate the association between macroeconomic conditions and cigarette smoking. Our finding suggests a positive association, which constantly declined with time after the 2001 recession. We find that a one percentage point increase in the employment rate is associated with a 1.4% higher likelihood of smoking cigarettes in the overall sample but declined to 0.4% among cohorts surveyed from 2011 to 2022. We also find strong positive and heterogeneous associations among sociodemographic groups, except among Blacks and persons aged 65 years and older, among whom there is no association; however, the positive associations consistently decreased among these sociodemographic groups. Consequently, the strong positive association disappeared in several sociodemographic groups in cohorts surveyed over the last decade.
Collapse
Affiliation(s)
- Samuel Asare
- Tobacco Control Research, Surveillance and Health Equity Science, American Cancer Society, United States of America.
| |
Collapse
|
2
|
Gaffney A, Himmelstein DU, Woolhandler S. Reply: Trends in Smoking Prevalence and the Continuing Imperative of Tobacco Control. Ann Am Thorac Soc 2022; 19:1441-1442. [PMID: 35533311 PMCID: PMC9353966 DOI: 10.1513/annalsats.202204-354le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Adam Gaffney
- Cambridge Health AllianceCambridge, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | - David U. Himmelstein
- Cambridge Health AllianceCambridge, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
- City University of New YorkNew York, New York
| | - Steffie Woolhandler
- Cambridge Health AllianceCambridge, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
- City University of New YorkNew York, New York
| |
Collapse
|
3
|
Drydakis N. The perceived social rejection of sexual minorities: Substance use and unprotected sexual intercourse. Drug Alcohol Rev 2022; 41:1341-1354. [PMID: 35737568 DOI: 10.1111/dar.13500] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 04/24/2022] [Accepted: 05/11/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION This study presents associations between the perceived social rejection of sexual minorities and tobacco, alcohol and cannabis consumption and unprotected sexual intercourse in the capital of Greece, Athens. This is the first Greek study to evaluate the concept of the minority stress theory on sexual minorities' substance use and unprotected sexual intercourse. In addition, this is among the first international studies to examine whether periods of adverse economic conditions are associated with sexual minorities' substance use and unprotected sexual intercourse. METHODS Two-panel datasets covering the periods 2013-2014 and 2018-2019 were used to determine the perceived social rejection, that is, whether sexual minorities have been rejected by friends, treated unfairly in educational and/or workplace environments, treated negatively in social situations and received poor health and public services due to their sexuality. RESULTS The estimates indicate that perceived social rejection is associated with the increased consumption of tobacco (by 9.1%, P < 0.01), alcohol (by 7.1%, P < 0.01) and cannabis (by 12.5%, P < 0.01), as well as unprotected sexual intercourse (by 6.5%, P < 0.01). In the first three cases, the magnitude of the associations is stronger for men than women and there is increased cannabis consumption during periods of deteriorated economic conditions (by 5.5%, P < 0.01). DISCUSSION AND CONCLUSIONS In the European Union, reducing stigma, substance use, risky sexual behaviours and health inequalities for sexual minorities is a goal of public health. If minority stress is correlated with substance use and risky sexual behaviours leading to detrimental physical/mental health outcomes then prevention and support interventions should be designed.
Collapse
Affiliation(s)
- Nick Drydakis
- School of Economics, Finance and Law, Centre for Pluralist Economics, Faculty of Business and Law, Anglia Ruskin University, Cambridge, UK.,Pembroke College, University of Cambridge, Cambridge, UK.,Centre for Science and Policy, University of Cambridge, Cambridge, UK.,Global Labor Organization, Essen, Germany.,Institute of Labor Economics, Bonn, Germany
| |
Collapse
|
4
|
Wahlenmayer E, Soni A. Association between state unemployment rate and inpatient
hospitalizations for tobacco use disorder. Tob Prev Cessat 2022; 8:21. [PMID: 35664292 PMCID: PMC9132110 DOI: 10.18332/tpc/149482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Elizabeth Wahlenmayer
- Peace and Violence Research Lab, School of Public Affairs, American University, Washington, United States
| | - Aparna Soni
- Department of Public Administration and Policy, School of Public Affairs, American University, Washington, United States
- IZA Institute for Labor Economics, Bonn, Germany
- Center for Financial Security, University of Wisconsin-Madison, Madison, United States
| |
Collapse
|
5
|
|
6
|
Hall J, Goranitis I, Kigozi J, Guariglia A. New evidence on the impact of the Great Recession on health-compromising behaviours. ECONOMICS AND HUMAN BIOLOGY 2021; 41:100980. [PMID: 33571870 DOI: 10.1016/j.ehb.2021.100980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 06/12/2023]
Abstract
Using data from the English Longitudinal Study of Ageing over the period 2004-2017, this paper explores the effects of the Great Recession and its aftermath upon health-compromising behaviours in adults aged 50 and over. We introduce new techniques into this area of research, namely dynamic random-effects logit estimators which control for initial conditions and correlated individual effects. We observe a lack of crisis effect upon the probabilities of smoking and being physically inactive, as well as of transitioning in and out of these behaviours. In line with other recent literature, this suggests that the relationship between economic recessions and smoking and physical inactivity may have broken down. Alternatively, the over 50s may have been protected from the crisis and subsequent austerity measures. Nonetheless, both the crisis and post-crisis period were associated with a lower probability of drinking frequently.
Collapse
Affiliation(s)
- James Hall
- Institute for Primary Care & Health Sciences, David Weatherall Building, Keele University, Newcastle-under-Lyme, ST5 5BG, United Kingdom.
| | - Ilias Goranitis
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, B15 2TT, United Kingdom.
| | - Jesse Kigozi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, B15 2TT, United Kingdom.
| | - Alessandra Guariglia
- Department of Economics, University of Birmingham, University House, Edgbaston, Birmingham, B15 2TY, United Kingdom.
| |
Collapse
|
7
|
Malta DC, Gomes CS, Souza Júnior PRBD, Szwarcwald CL, Barros MBDA, Machado ÍE, Romero DE, Lima MG, Silva AGD, Prates EJS, Cardoso LSDM, Damacena GN, Werneck AO, Silva DRPD, Azevedo LO. Factors associated with increased cigarette consumption in the Brazilian population during the COVID-19 pandemic. CAD SAUDE PUBLICA 2021; 37:e00252220. [PMID: 33852666 DOI: 10.1590/0102-311x00252220] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/01/2021] [Indexed: 01/08/2023] Open
Abstract
Social distancing measures adopted in various countries to mitigate the impact of the COVID-19 pandemic can lead to unwanted effects on their populations' health and behaviors. This study aimed to investigate smoking behavior in the Brazilian adult population during the COVID-19 pandemic and analyze factors associated with the increase in cigarette consumption. An online survey was performed, and the final sample included 45,160 individuals. The study used post-stratification weights and calculated crude prevalence ratios (PR) and adjusted by sex, age, and schooling, and respective 95% confidence intervals (95%CI). Poisson regression models with robust variance were applied to analyze associations between increased cigarette consumption and sociodemographic variables and adherence to social distancing, quality of sleep, state of mind, and changes in work and earnings. Prevalence of smokers was 12% (95%CI: 11.1-12.9), 34% of whom reported an increase in cigarette consumption. The increase was greater among women (PR = 1.27; 95%CI: 1.01-1.59) and individuals with incomplete secondary schooling (PR = 1.35; 95%CI: 1.02-1.79). The increase in cigarette consumption was associated with worse quality of sleep, feeling isolated from family members or sad, depressed, or anxious, loss of earnings, and worse self-rated health. Health promotion strategies, smoking prevention, and encouragement for smoking cessation, as well as mental health interventions, should be continued and reinforced in the context of social distancing during the COVID-19 pandemic.
Collapse
Affiliation(s)
| | - Crizian Saar Gomes
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | - Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Ísis Eloah Machado
- Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, Brasil
| | - Dalia Elena Romero
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | | | | | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | - Luiz Otávio Azevedo
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| |
Collapse
|
8
|
Souza LED, Rasella D, Barros R, Lisboa E, Malta D, Mckee M. Smoking prevalence and economic crisis in Brazil. Rev Saude Publica 2021; 55:3. [PMID: 33825798 PMCID: PMC8009317 DOI: 10.11606/s1518-8787.2021055002768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/21/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To estimate the impact of the 2015-2018 economic crisis on tobacco consumption in Brazil. METHODS This is an interrupted time series analysis conducted with data from 27 cities collected by VIGITEL, using linear regression models to account for first-order autocorrelation. Analyses were conducted based on gender, age group, and education level. RESULTS Smoking rates decreased between 2006 and 2018, decelerating after the crisis onset. Differently than women, men showed an immediate but transient increase in smoking, followed by a decelerated decrease. Those over 65 also showed increased smoking rates immediately after the economic crisis onset, but decline accelerated later on. In turn, we found a trend reversal among those aged 31-44. Rates also decreased among those with lower education levels, but decelerated among those with more years of schooling. CONCLUSION An economic crisis have varied impacts on the smoking habits of different population groups. Tobacco control policies should entail a detailed understanding of smoking epidemiology, especially during an economic crisis.
Collapse
Affiliation(s)
| | - Davide Rasella
- Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Rafael Barros
- Universidade Federal da Bahia. Escola de Enfermagem. Salvador, BA, Brasil
| | - Erick Lisboa
- Universidade Federal da Bahia. Programa de Pós-Graduação em Saúde Coletiva. Salvador, BA, Brasil
| | - Déborah Malta
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Belo Horizonte, MG, Brasil
| | - Martin Mckee
- London School of Hygiene and Tropical Medicine. London, UK
| |
Collapse
|
9
|
Silva AGD, Teixeira RA, Prates EJS, Malta DC. Monitoring and projection of targets for risk and protection factors for coping with noncommunicable diseases in Brazilian capitals. CIENCIA & SAUDE COLETIVA 2020; 26:1193-1206. [PMID: 33886750 DOI: 10.1590/1413-81232021264.42322020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 11/21/2022] Open
Abstract
This study aimed to monitor the trends and projections of targets of risk and protection factors for coping with noncommunicable diseases in Brazilian capitals and verify whether the economic crisis and austerity policies have interfered with these targets' behavior. This is a time-series study with data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey. We analyzed the trends in the prevalence of tobacco use, obesity, physical activity, consumption of fruits and vegetables, and alcohol abuse, and their projections until 2025. The Prais-Winsten regression was employed. We adopted the Interrupted Time-Series, considering the 2006-2014 and 2015-2019 periods. A reduction in tobacco use, increase in obesity, consumption of fruits and vegetables, physical activity, and alcohol use was observed between 2006 and 2014. Most indicators have shown worse performance since 2015. Projections foresee that targets for curbing obesity and alcohol abuse will not be achieved. Some changes were identified in the indicators profiles, reinforcing the importance of the continuous monitoring and sustainability of actions, policies, and programs to promote health and control these diseases and their risk factors.
Collapse
Affiliation(s)
- Alanna Gomes da Silva
- Escola de Enfermagem, Universidade Federal de Minas Gerais (UFMG). Av. Professor Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | | | - Elton Junio Sady Prates
- Escola de Enfermagem, Universidade Federal de Minas Gerais (UFMG). Av. Professor Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Deborah Carvalho Malta
- Escola de Enfermagem, Universidade Federal de Minas Gerais (UFMG). Av. Professor Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| |
Collapse
|
10
|
Lee JJ, Wang MP, Yang SC. Will the tobacco industry ultimately triumph in the midst of COVID-19 pandemic?: A call for nurses' action in tobacco control. Int J Nurs Stud 2020; 115:103726. [PMID: 32778333 PMCID: PMC7382356 DOI: 10.1016/j.ijnurstu.2020.103726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Jung Jae Lee
- School of Nursing, University of Hong Kong, Hong Kong.
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong
| | - Sook Ching Yang
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom
| |
Collapse
|
11
|
Uphoff EP, Small N, Pickett KE. Using Birth Cohort Data to Assess the Impact of the UK 2008-2010 Economic Recession on Smoking During Pregnancy. Nicotine Tob Res 2020; 21:1021-1026. [PMID: 29741730 DOI: 10.1093/ntr/nty083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 05/07/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Despite the well-known link between stress and smoking, evidence for associations between economic recession, financial stress, and smoking is contradictory. In this study, we assess whether women were more likely to continue smoking during pregnancy if they were exposed to the UK 2008-2010 economic recession during pregnancy than those who were unexposed, and whether this relationship is mediated by financial stress. METHODS We used cross-sectional data on 2775 pregnant women who were regular smokers before pregnancy and who were enrolled in the UK Born in Bradford cohort study between March 2007 and December 2010. The cutoff date for exposure to recession was set as August 1, 2008, based on local and national economic data. Multivariable logistic regression analysis included potential confounders: maternal age, parity, cohabitation, ethnicity, and maternal age. The mediating role of financial stress was analyzed using "worse off financially" and a "difficult financial situation" as indicators of financial stress in Sobel-Goodman mediation tests with bootstrap resampling. RESULTS After taking into account potential confounders, exposure to recession was associated with continued smoking during pregnancy (OR = 1.19, 95% CI = 1.01 to 1.41, p = 0.03). A worse financial situation and a difficult financial situation were identified as mediators, explaining 8.4% and 17.6%, respectively, of the relationship between exposure to recession and smoking during pregnancy. CONCLUSIONS Smoking during pregnancy is associated with exposure to the UK 2008-2010 economic recession during pregnancy, and this relationship is partly mediated by financial stress. IMPLICATIONS Health inequalities in smoking during pregnancy are affected by economic recession, as those who are most likely to smoke are also most likely to experience the financial stress resulting from economic recession. Socioeconomic conditions at the societal and individual level are important targets when aiming to reduce rates of smoking during pregnancy.
Collapse
Affiliation(s)
- Eleonora P Uphoff
- Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, UK.,Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, UK
| | - Neil Small
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Kate E Pickett
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, UK
| |
Collapse
|
12
|
Paes-Sousa R, Schramm JMDA, Mendes LVP. Fiscal austerity and the health sector: the cost of adjustments. CIENCIA & SAUDE COLETIVA 2019; 24:4375-4384. [PMID: 31778488 DOI: 10.1590/1413-812320182412.23232019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 07/12/2019] [Indexed: 12/30/2022] Open
Abstract
Fiscal austerity policies have been used as responses to economic crises and fiscal deficits in both developed and developing countries. While they vary in regard to their content, intensity and implementation, such models recommend reducing public expenses and social investments, retracting the public service and substituting the private sector in lieu of the State to provide certain services tied to social policies. The present article discusses the main effects of the recent economic crisis on public health based on an updated review with consideration for three dimensions: health risks, epidemiological profiles of different populations, and health policies. In Brazil, the combination of economic crisis and fiscal austerity policies is capable of producing a direr situation than those experienced in developed countries. The country is characterized by historically high levels of social inequality, an under-financed health sector, highly prevalent chronic degenerative diseases and persisting preventable infectious diseases. It is imperative to develop alternatives to mitigate the effects of the economic crisis taking into consideration not only the sustainability of public finance but also public well-being.
Collapse
Affiliation(s)
- Romulo Paes-Sousa
- Centro de Pesquisas René Rachou, Fiocruz Minas. Av. Augusto de Lima 1715, Barro Preto. 30190-002 Belo Horizonte MG Brasil.
| | | | | |
Collapse
|
13
|
Single transitions and persistence of unemployment are associated with poor health outcomes. BMC Public Health 2019; 19:740. [PMID: 31196081 PMCID: PMC6567908 DOI: 10.1186/s12889-019-7059-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 05/29/2019] [Indexed: 12/23/2022] Open
Abstract
Background Although job loss has been associated with decline in health, the effect of long term unemployment is less clear and under-researched. Furthermore, the impact of an economic recession on this relationship is unclear. We investigated the associations of single transitions and persistence of unemployment with health. We subsequently examined whether these associations are affected by the latest recession, which began in 2008. Methods In total, 57,911 participants from the Dutch Health Interview Survey who belonged to the labour force between 2004 and 2014 were included. Based on longitudinal tax registration data, single employment transitions between time point 1 (t1) and time point 2 (t2) and persistent unemployment (i.e. number of years individuals were unemployed) between t1 and time point 5 (t5) were defined. General and mental health, smoking and obesity were assessed at respectively time point 3 (t3) and time point 6 (t6). Logistic regression models were performed and interactions with recession indicators (year, annual gross domestic product estimates and regional unemployment rates) were tested. Results Compared with individuals who stayed employed at t1 and t2, the likelihood of poor mental health at the subsequent year was significantly higher in those who became unemployed at t2. Persistent unemployment was associated with poor mental health, especially for those who were persistently unemployed for 5 years. Similar patterns, although less pronounced for smoking, were found for general health and obesity. Indicators of the economic recession did not modify these associations. Conclusions Single transitions into unemployment and persistent unemployment are associated with poor mental and general health, obesity, and to a lesser extend smoking. Our study suggests that re-employment might be an important strategy to improve health of unemployed individuals. The relatively extensive Dutch social security system may explain that the economic recession did not modify these associations.
Collapse
|
14
|
Sun R, Mendez D. Finding the optimal mix of smoking initiation and cessation interventions to reduce smoking prevalence. PLoS One 2019; 14:e0212838. [PMID: 30822321 PMCID: PMC6396906 DOI: 10.1371/journal.pone.0212838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 02/11/2019] [Indexed: 11/18/2022] Open
Abstract
There are more than one billion smokers globally according to the World Health Organization (WHO) report in 2017. Every year tobacco use causes nearly 6 million deaths worldwide. To deal with the smoking epidemic, society needs to invest resources efficiently. In this paper we introduce an optimal control model to determine the optimal mix of smoking initiation and cessation interventions to reduce smoking. We construct the model to reach a smoking prevalence target within a specific time horizon while minimizing cost. Our performance measure captures the cost of policy implementation over time, adjusting for inflation and social discounting. The analytical solutions to the model are presented in forms of ordinary differential equations (ODE). We then conduct several numerical simulations using data from the National Health Interview Survey (NHIS) and empirical studies. We first present analytical solutions for our model to solve for the optimal mix of smoking interventions. Then we simulate a public health policy to achieve 5% smoking prevalence in the US by 2030 using different combinations of real-life interventions. We examine the optimal trajectories, allocative efficiency and annual total cost of smoking cessation and initiation interventions. We find consistent results across all simulations. Our specific example reveals that the most efficient way to reach stated goal is by targeting cessation interventions first, and then gradually shifting resources to initiation interventions over time. While our numerical results are specific to the intervention we selected, our framework can be easily expanded to consider other potential interventions. We discuss the implications of our approach for the formulation of dynamic public health policies.
Collapse
Affiliation(s)
- Ruoyan Sun
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, United States of America
- * E-mail:
| | - David Mendez
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, United States of America
| |
Collapse
|
15
|
Sandoval JL, Leão T, Cullati S, Theler JM, Joost S, Humair JP, Gaspoz JM, Guessous I. Public smoking ban and socioeconomic inequalities in smoking prevalence and cessation: a cross-sectional population-based study in Geneva, Switzerland (1995-2014). Tob Control 2018; 27:663-669. [PMID: 29374093 DOI: 10.1136/tobaccocontrol-2017-053986] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Smoking bans were suggested to reduce smoking prevalence and increase quit ratio but their equity impact remains unclear. We aimed to characterise the socioeconomic status (SES)-related inequalities in smoking prevalence and quit ratio before and after the implementation of a public smoking ban. METHODS We included data from 17 544 participants in the population-based cross-sectional Bus Santé study in Geneva, Switzerland, between 1995 and 2014. We considered educational attainment (primary, secondary and tertiary) as a SES indicator. Outcomes were smoking prevalence (proportion of current smokers) and quit ratio (ex-smokers to ever-smokers ratio). We used segmented linear regression to assess the overall impact of smoking ban on outcome trends. We calculated the relative (RII) and slope (SII, absolute difference) indexes of inequality, quantifying disparities between educational groups in outcomes overall (1995-2014), before and after ban implementation (November 2009). RESULTS Least educated participants displayed higher smoking prevalence (RII=2.04, P<0.001; SII=0.15, P<0.001) and lower quit ratio (RII=0.73, P<0.001; SII=-0.18, P<0.001). As in other studies, smoking ban implementation coincided with a temporary reduction of smoking prevalence (P=0.003) and increase in quit ratio (P=0.02), with a progressive return to preban levels. Inequalities increased (P<0.05) in relative terms for smoking prevalence (RIIbefore=1.84, P<0.001 and RIIafter=3.01, P<0.001) and absolute terms for both outcomes (smoking prevalence: SIIbefore=0.14, P<0.001 and SIIafter=0.19, P<0.001; quit ratio: SIIbefore=-0.15, P<0.001 and SIIafter=-0.27, P<0.001). CONCLUSIONS Implementation of a public smoking ban coincided with a short-lived decrease in smoking prevalence and increase in quit ratio but also with a widening in SES inequalities in smoking-related outcomes.
Collapse
Affiliation(s)
- José Luis Sandoval
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of General Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Teresa Leão
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Stéphane Cullati
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of General Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.,Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Geneva, Switzerland
| | - Jean-Marc Theler
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Joost
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Laboratory of Geographical Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Jean-Paul Humair
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Michel Gaspoz
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Ambulatory and Community Medicine, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
16
|
Rathmann K, Pförtner TK, Elgar FJ, Hurrelmann K, Richter M. The Great Recession, Adolescent Smoking, and Smoking Inequalities: What Role Does Youth Unemployment Play in 24 European Countries? Nicotine Tob Res 2018; 19:1284-1291. [PMID: 27794036 DOI: 10.1093/ntr/ntw298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 10/25/2016] [Indexed: 11/14/2022]
Abstract
Introduction Conflicting evidence has been reported on smoking behavior among adults during times of economic downturn. No study has yet investigated young people's smoking and inequalities in smoking during economic recessions. This study examines the association between country-level youth unemployment due to the economic recession and adolescent smoking and smoking inequalities in Europe. Methods The WHO collaborative "Health Behaviour in School-aged Children" study in 2009/2010 included 15-year-old adolescents from 24 European countries (N = 43 093). Socioeconomic position (SEP) was measured by the Family Affluence Scale. Logistic multilevel models were conducted. The absolute rate of youth unemployment in 2010 (during the recession) and the relative change rate in youth unemployment (2005/2006-2009/2010) were regressed on smoking and SEP inequalities in smoking in 2010, respectively. Results Youth unemployment rates were not significantly associated with overall smoking in adolescents. A higher absolute youth unemployment rate in 2010 related to lower likelihoods of smoking among middle (OR: 0.99; 95% CI: 0.98-0.99) and low affluent adolescents (OR: 0.99; 95% CI: 0.98-0.99) compared to high affluent adolescents. In contrast, an increase in youth unemployment (2005/2006-2009/2010) was not associated with overall likelihoods of smoking and inequalities in smoking. Conclusions Our findings indicate that an increase in youth unemployment was not related to smoking and smoking inequalities. However, higher absolute levels of youth unemployment are related to lower likelihoods of smoking in lower SEP adolescents. Thus, smoking among vulnerable groups is more linked to the overall insecure circumstances and the affordability of cigarettes rather than to the economic recession itself. Implications Economic recessions have often led to increases in adult and youth unemployment rates. Conflicting evidence has been reported on smoking behavior among adults during times of economic downturn. This study examines for the first time the impact of the economic recession on young people's smoking and socioeconomic inequalities in smoking. Findings highlight that rather than an increase in youth unemployment, the overall country-level youth unemployment rate is related to young people's tobacco use and particularly to lower odds in smoking among less affluent adolescents across Europe, a finding which is likely to be linked to the affordability of tobacco use.
Collapse
Affiliation(s)
- Katharina Rathmann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Timo-Kolja Pförtner
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany.,Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences and the Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Frank J Elgar
- Institute for Health and Social Policy, McGill University, Montreal, QC, Canada
| | | | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| |
Collapse
|
17
|
Samson FL. Immigration concern and the white/non-white difference in smoking: Group position theory and health. SSM Popul Health 2017; 3:111-120. [PMID: 29349209 PMCID: PMC5769020 DOI: 10.1016/j.ssmph.2016.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/31/2016] [Accepted: 12/15/2016] [Indexed: 11/23/2022] Open
Abstract
National data indicate that U.S. whites have a higher prevalence of smoking compared to non-whites. Group position theory and public opinion data suggest racial differences in immigration concern. This study examines whether immigration concern mediates the racial difference in smoking. Drawing on the 2012 General Social Survey, the 2012 American National Election Study, and the 2006 Portraits of American Life Study, immigration concern was associated with smoking, controlling for covariates across all three nationally representative surveys. Mediation analysis indicated that immigration concern partially mediated the higher odds of smoking among whites across all surveys. Immigration concern also presents a possible explanation for the healthy immigrant advantage and Hispanic paradox as they pertain to smoking differences.
Collapse
|
18
|
Pernenkil V, Wyatt T, Akinyemiju T. Trends in smoking and obesity among US adults before, during, and after the great recession and Affordable Care Act roll-out. Prev Med 2017; 102:86-92. [PMID: 28694062 DOI: 10.1016/j.ypmed.2017.07.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 11/29/2022]
Abstract
This study examined trends in smoking and overweight/obesity rates among United States (US) adults ages 40years and older by race and socio-economic status (SES) across three study periods; pre-recession (2003-2005), recession (2007-2009), and post-recession/Affordable Care Act (2010-2012). Data was obtained from the Behavioral Risk Factor Surveillance System (BRFSS), and multivariable regression analysis was used to examine changes in overweight/obesity, smoking, physical activity and smoking cessation rates over the study periods. There were 2,805,957 adults included in the analysis; 65.5% of the study population was overweight/obese, and 33.3% were current smokers. Smoking prevalence increased marginally among those with lower SES (income<$10,000) from pre-recession (52.5%) to post-recession (52.9%), but declined in other socio-demographic groups. The odds of overweight/obesity increased in the post-recession (OR: 1.22, 95% CI: 1.21-1.23) and recession (OR: 1.11, 95% CI: 1.11-1.12) periods compared with pre-recession, but odds of smoking overall decreased in the post-recession (OR: 0.93, 95% CI: 0.92-0.94) and recession (OR: 0.95, 95% CI: 0.94-0.97) periods. Overweight/obesity increased over the study periods, regardless of race, SES or healthcare access, while smoking rates showed significant declines post-recession compared with pre-recession, except in low SES groups. These findings suggest that strategies focused on reducing overweight/obesity and increasing access to smoking cessation services, especially among low-income adults, are needed. Prospective studies are needed to better evaluate the influence of the economic recession and Affordable Care Act on behavioral risk factors.
Collapse
Affiliation(s)
- Vikash Pernenkil
- University of South Alabama College of Medicine, Mobile, AL, United States
| | - Taylor Wyatt
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tomi Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States.
| |
Collapse
|
19
|
Bruggink JW, de Goeij MC, Otten F, Kunst AE. Changes between pre-crisis and crisis period in socioeconomic inequalities in health and stimulant use in Netherlands. Eur J Public Health 2016; 26:772-777. [DOI: 10.1093/eurpub/ckw016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
20
|
Margerison-Zilko C, Goldman-Mellor S, Falconi A, Downing J. Health Impacts of the Great Recession: A Critical Review. CURR EPIDEMIOL REP 2016; 3:81-91. [PMID: 27239427 DOI: 10.1007/s40471-016-0068-6] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The severity, sudden onset, and multipronged nature of the Great Recession (2007-2009) provided a unique opportunity to examine the health impacts of macroeconomic downturn. We comprehensively review empirical literature examining the relationship between the Recession and mental and physical health outcomes in developed nations. Overall, studies reported detrimental impacts of the Recession on health, particularly mental health. Macro- and individual-level employment- and housing-related sequelae of the Recession were associated with declining fertility and self-rated health, and increasing morbidity, psychological distress, and suicide, although traffic fatalities and population-level alcohol consumption declined. Health impacts were stronger among men and racial/ethnic minorities. Importantly, strong social safety nets in some European countries appear to have buffered those populations from negative health effects. This literature, however, still faces multiple methodological challenges, and more time may be needed to observe the Recession's full health impact. We conclude with suggestions for future work in this field.
Collapse
Affiliation(s)
- Claire Margerison-Zilko
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Fee Rd., Rm 601, East Lansing, MI 48824, Ph: 517-353-8623
| | - Sidra Goldman-Mellor
- Department of Public Health, University of California, Merced, 5200 N. Lake Rd., Merced, CA 95342, Ph: (209) 228-2498
| | - April Falconi
- General Internal Medicine, Stanford University, Palo Alto, CA 94305, Ph: (703) 328-4851
| | - Janelle Downing
- School of Public Health, University of California, Berkeley, 545 University Hall, University of California, Berkeley, CA 94720-7360, Ph: (510) 643-8571
| |
Collapse
|
21
|
Liu L, Edland S, Myers MG, Hofstetter CR, Al-Delaimy WK. Smoking prevalence in urban and rural populations: findings from California between 2001 and 2012. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:152-61. [PMID: 26821213 DOI: 10.3109/00952990.2015.1125494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tobacco smoking and related health problems are still major public health concerns in the United States despite the declining smoking prevalence. OBJECTIVES This study explored differences in smoking prevalence between urban and rural areas potentially relevant to tobacco control efforts in California. METHODS Public use adult smoking data from the California Health Interview Survey (CHIS) between 2001 and 2011-2012 were analyzed. A total of 282 931 adults were surveyed across the six CHIS cycles. A ZIP code-based geographic classification (Urban, Second-City, Suburban, and Town/Rural) was used to examine the association between smoking prevalence and area of residency. RESULTS The overall smoking prevalence in California decreased from 17.0% in 2001 to 13.8% in 2011-2012. Within each CHIS cycle, the Town/Rural areas had the highest smoking prevalence, followed by Urban and Second-City areas, and Suburban areas had the lowest. Pooled data from all CHIS cycles showed a similar pattern, with rates in Urban, Second-City, Suburban and Town/Rural areas being 15.2%, 15.2%, 13.1% and 17.3%, respectively. Weighted multivariate logistic regression analysis indicated significantly higher odds of smoking in Urban, Second-City and Town/Rural areas compared to Suburban areas (all adjusted odds ratios > 1.10), although this trend varied by race/ethnicity, being present in non-Hispanic Whites and not present in Hispanics. CONCLUSIONS Town/Rural and Urban populations of California are consistently at higher risk of smoking than Suburban populations. These results indicate a need for population-specific tobacco control approaches that address the lifestyle, behavior, and education of disparate populations within the same state or region.
Collapse
Affiliation(s)
- Lianqi Liu
- a Department of Family Medicine and Public Health , University of California, San Diego , La Jolla , CA , USA
| | - Steven Edland
- a Department of Family Medicine and Public Health , University of California, San Diego , La Jolla , CA , USA
| | - Mark G Myers
- b Psychology Service, Veterans Affairs San Diego Healthcare System, and the Department of Psychiatry , University of California, San Diego , La Jolla , CA , USA
| | - C Richard Hofstetter
- c Graduate School of Public Health and the Department of Political Science, San Diego State University , San Diego , CA , USA
| | - Wael K Al-Delaimy
- a Department of Family Medicine and Public Health , University of California, San Diego , La Jolla , CA , USA
| |
Collapse
|
22
|
Lahelma E, Pietiläinen O, Ferrie J, Kivimäki M, Lahti J, Marmot M, Rahkonen O, Sekine M, Shipley M, Tatsuse T, Lallukka T. Changes Over Time in Absolute and Relative Socioeconomic Differences in Smoking: A Comparison of Cohort Studies From Britain, Finland, and Japan. Nicotine Tob Res 2016; 18:1697-704. [PMID: 26764256 DOI: 10.1093/ntr/ntw004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 01/05/2016] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Socioeconomic differences in smoking over time and across national contexts are poorly understood. We assessed the magnitude of relative and absolute social class differences in smoking in cohorts from Britain, Finland, and Japan over 5-7 years. METHODS The British Whitehall II study (n = 4350), Finnish Helsinki Health Study (n = 6328), and Japanese Civil Servants Study (n = 1993) all included employed men and women aged 35-68 at baseline in 1997-2002. Follow-up was in 2003-2007 (mean follow-up 5.1, 6.5, and 3.6 years, respectively). Occupational social class (managers, professionals and clerical employees) was measured at baseline. Current smoking and covariates (age, marital status, body mass index, and self-rated health) were measured at baseline and follow-up. We assessed relative social class differences using the Relative Index of Inequality and absolute differences using the Slope Index of Inequality. RESULTS Social class differences in smoking were found in Britain and Finland, but not in Japan. Age-adjusted relative differences at baseline ranged from Relative Index of Inequality 3.08 (95% confidence interval 1.99-4.78) among Finnish men to 2.32 (1.24-4.32) among British women, with differences at follow-up greater by 8%-58%. Absolute differences remained stable and varied from Slope Index of Inequality 0.27 (0.15-0.40) among Finnish men to 0.10 (0.03-0.16) among British women. Further adjustment for covariates had modest effects on inequality indices. CONCLUSIONS Large social class differences in smoking persisted among British and Finnish men and women, with widening tendencies in relative differences over time. No differences could be confirmed among Japanese men or women. IMPLICATIONS Changes over time in social class differences in smoking are poorly understood across countries. Our study focused on employees from Britain, Finland and Japan, and found relative and absolute and class differences among British and Finnish men and women. Key covariates had modest effects on the differences. Relative differences tended to widen over the 4- to 7-year follow-up, whereas absolute differences remained stable. In contrast, class differences in smoking among Japanese men or women were not found. Britain and Finland are at the late stage of the smoking epidemic model, whereas Japan may not follow the same model.
Collapse
Affiliation(s)
- Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland;
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jane Ferrie
- Department of Epidemiology and Public Health, University College London, London, UK; School of Community and Social Medicine, University of Bristol, Bristol, UK
| | - Mika Kivimäki
- Department of Public Health, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, UK; Centre of Expertise for Development of Work and Organizations, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jouni Lahti
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Michael Marmot
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Michikazu Sekine
- Department of Epidemiology and Health Policy, University of Toyama, Toyama, Japan
| | - Martin Shipley
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Takashi Tatsuse
- Department of Epidemiology and Health Policy, University of Toyama, Toyama, Japan
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland; Centre of Expertise for Development of Work and Organizations, Finnish Institute of Occupational Health, Helsinki, Finland
| |
Collapse
|
23
|
Dom G, Samochowiec J, Evans-Lacko S, Wahlbeck K, Van Hal G, McDaid D. The Impact of the 2008 Economic Crisis on Substance Use Patterns in the Countries of the European Union. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13010122. [PMID: 26771628 PMCID: PMC4730513 DOI: 10.3390/ijerph13010122] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/29/2015] [Accepted: 01/04/2016] [Indexed: 11/16/2022]
Abstract
Background: From 2008 on, a severe economic crisis (EC) has characterized the European Union (E.U.). However, changes in substance use behavioral patterns as a result of the economic crisis in Europe, have been poorly reflected upon, and underlying mechanisms remain to be identified; Methods: In this review we explore and systematize the available data on the effect of the 2008 economic crisis on patterns of substance use and related disorders, within the E.U. countries; Results: The results show that effects of the recession need to be differentiated. A number of studies point to reductions in population’s overall substance use. In contrast, an increase in harmful use and negative effects is found within specific subgroups within the society. Risk factors include job-loss and long-term unemployment, and pre-existing vulnerabilities. Finally, our findings point to differences between types of substances in their response on economic crisis periods; Conclusions: the effects of the 2008 economic crisis on substance use patterns within countries of the European Union are two-sided. Next to a reduction in a population’s overall substance use, a number of vulnerable subgroups experience serious negative effects. These groups are in need of specific attention and support, given that there is a real risk that they will continue to suffer negative health effects long after the economic downfall has formally been ended.
Collapse
Affiliation(s)
- Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Antwerp 2640, Belgium.
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin 71-460, Poland.
| | - Sara Evans-Lacko
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, SE5 8AF, UK.
| | | | - Guido Van Hal
- Medical Sociology and Health Policy, Antwerp University, Antwerp 2640, Belgium.
| | - David McDaid
- Personal Social Services Research Unit, London School of Economics and Political Science, London WC2A 2AE, UK.
| |
Collapse
|
24
|
Gallus S, Asciutto R, Muttarak R, Pacifici R, La Vecchia C, Lugo A. Which group of smokers is more vulnerable to the economic crisis? Public Health 2016; 134:34-8. [PMID: 26753896 DOI: 10.1016/j.puhe.2015.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 11/19/2015] [Accepted: 11/29/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Studies investigating whether smoking increases or decreases during economic downturn provided contrasting results. For the first time, we used direct questions to analyse changes in smoking behaviour due to the 2008 financial crisis, comparing socio-economic characteristics of smokers who changed with those who kept their smoking intensity. STUDY DESIGN Cross-sectional survey. METHODS We used data from three annual surveys conducted in Italy in 2012-2014 on representative samples of the Italian general population aged ≥15 years. RESULTS A total of 1919 current smokers were asked specific questions on the influence of the economic crisis that started in 2008 on their smoking behaviour. Overall, 77.4% of 1919 current smokers reported not to have changed their smoking behaviour, 19.1% to have reduced, and 3.5% to have increased their smoking intensity as a consequence of the economic crisis. The reduction in cigarette smoking increased with age: compared to the respondents aged <25 years, the multivariate odds ratio (OR) for those aged 25-44, 45-64 and ≥65 years were 0.65, 0.46 and 0.33, respectively (P for trend<0.001). Reduction was significantly lower among intermediate (OR = 0.68 compared to low) and high education levels (OR = 0.28; P for trend<0.001). A significant inverse trend for increasing consumption was observed with age (P = 0.022), education (P = 0.003) and family income (P < 0.001). CONCLUSIONS The large majority of current smokers did not change their smoking habit following the economic crisis. However, there are specific vulnerable subgroups of smokers, constituted by the young and subjects with low socio-economic status, that were reactive to the global economic crisis. These groups are more prone to change their smoking behaviours, either for better or -, in a smaller proportion -, for worse.
Collapse
Affiliation(s)
- S Gallus
- Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - R Asciutto
- Department of Sciences for the Health Promotion and Mother and Child Care "G. D'Alessandro", Hygiene Section, University of Palermo, Palermo, Italy
| | - R Muttarak
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/ÖAW, WU), Vienna Institute of Demography, Austrian Academy of Sciences, Vienna, Austria
| | - R Pacifici
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - A Lugo
- Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| |
Collapse
|
25
|
Torbica A, Maggioni AP, Ghislandi S. The Economic Crisis and Acute Myocardial Infarction: New Evidence Using Hospital-Level Data. PLoS One 2015; 10:e0142810. [PMID: 26574745 PMCID: PMC4648494 DOI: 10.1371/journal.pone.0142810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/27/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This research sought to assess whether and to what extent the ongoing economic crisis in Italy impacted hospitalizations, in-hospital mortality and expenditures associated with acute myocardial infarction (AMI). METHODS The data were obtained from the hospital discharge database of the Italian Health Ministry and aggregated at the hospital level. Each hospital (n = 549) was observed for 4 years and was geographically located within a "Sistema Locale del Lavoro" (SLL, i.e., clusters of neighboring towns with a common economic structure). For each SLL, the intensity of the crisis was determined, defined as the 2012-2008 increase in the area-specific unemployment rate. A difference-in-differences (DiD) approach was employed to compare the increases in AMI-related outcomes across different quintiles of crisis intensity. RESULTS Hospitals located in areas with the highest intensity of crisis (in the fifth quintile) had an increase of approximately 30 AMI cases annually (approximately 13%) compared with hospitals in area with lower crisis intensities (p<0.001). A significant increase in total hospital days was observed (13%, p<0.001) in addition to in-hospital mortality (17%, p<0.001). As a consequence, an increase of around €350.000 was incurred in annual hospital expenditures for AMI (approximately 36%, p<0.001). CONCLUSIONS More attention should be given to the increase in health needs associated with the financial crisis. Policies aimed to contrast unemployment in the community by keeping and reintegrating workers in jobs could also have positive impacts on adverse health outcomes, especially in areas of high crisis intensity.
Collapse
Affiliation(s)
- Aleksandra Torbica
- Department of Policy Analysis and Public Management - Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
- * E-mail:
| | - Aldo Pietro Maggioni
- Italian Association of Hospital Cardiologists (ANMCO) Research Center, Florence, Italy
| | - Simone Ghislandi
- Department of Policy Analysis and Public Management - Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| |
Collapse
|
26
|
Bartoll X, Toffolutti V, Malmusi D, Palència L, Borrell C, Suhrcke M. Health and health behaviours before and during the Great Recession, overall and by socioeconomic status, using data from four repeated cross-sectional health surveys in Spain (2001-2012). BMC Public Health 2015; 15:865. [PMID: 26346197 PMCID: PMC4561448 DOI: 10.1186/s12889-015-2204-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 09/01/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The objective of this study was to estimate changes over time in health status and selected health behaviours during the Great Recession, in the period 2011/12, in Spain, both overall, and according to socioeconomic position and gender. METHODS We applied a before-after estimation on data from four editions of the Spanish National Health Survey: 2001, 2003/04, 2006/07 and 2011/12. This involved applying linear probability regression models accounting for time-trends and with robust standard errors, using as outcomes self-reported health and health behaviours, and as the main explanatory variable a dummy "Great Recession" for the 2011/12 survey edition. All the computations were run separately by gender. The final sample consisted of 47,156 individuals aged between 25 and 64 years, economically active at the time of the interview. We also assessed the inequality of the effects across socio-economic groups. RESULTS The probability of good self-reported health increased for women (men) by 9.6 % (7.6 %) in 2011/12, compared to the long term trend. The changes are significant for all educational levels, except for the least educated. Some healthy behaviours also improved but results were rather variable. Adverse dietary changes did, however, occur among men (though not women) who were unemployed (e.g., the probability of declaring eating fruit daily changed by -12.1 %), and among both men (-21.8 %) and women with the lowest educational level (-15.1 %). CONCLUSIONS Socioeconomic inequalities in health and health behaviour have intensified, in the period 2011/12, in at least some respects, especially regarding diet. While average self-reported health status and some health behaviours improved during the economic recession, in 2011/12, this improvement was unequal across different socioeconomic groups.
Collapse
Affiliation(s)
- Xavier Bartoll
- Agència de Salut Pública de Barcelona, Barcelona, Spain.
- Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain.
| | - Veronica Toffolutti
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - Davide Malmusi
- Agència de Salut Pública de Barcelona, Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
- Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain.
| | - Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
- Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain.
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
- Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain.
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York, United Kingdom.
- Centre for Diet and Activity Research (CEDAR), Institute of Public Health, Cambridge, United Kingdom.
| |
Collapse
|
27
|
Abstract
The Great Recession produced the highest rates of unemployment observed in decades, in part due to particularly high rates of people losing work involuntarily. The impact of these job losses on health is unknown, due to the length of time required for most disease development, concerns about reverse causation, and limited data that covers this time period. We examine associations between job loss, employment status and smoking, the leading preventable cause of death, among 13,571 individuals participating in the 2001-2011 waves of the U.S.-based Panel Study of Income Dynamics. Results indicate that recent involuntary job loss is associated with an average 1.1 percentage point increase in smoking probability. This risk is strongest when people have returned to work, and appears reversed when they leave the labor market altogether. Although some job loss is associated with changes in household income and psychological distress levels, we find no evidence that these changes explain smoking behavior modifications. Smoking prevention programs and policies targeted at displaced workers or the newly employed may alleviate some negative health effects produced by joblessness during the Great Recession.
Collapse
|
28
|
Benson FE, Kuipers MAG, Nierkens V, Bruggink JW, Stronks K, Kunst AE. Socioeconomic inequalities in smoking in The Netherlands before and during the Global Financial Crisis: a repeated cross-sectional study. BMC Public Health 2015; 15:469. [PMID: 25943385 PMCID: PMC4429724 DOI: 10.1186/s12889-015-1782-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/22/2015] [Indexed: 11/12/2022] Open
Abstract
Background The Global Financial Crisis (GFC) increased levels of financial strain, especially in those of low socioeconomic status (SES). Financial strain can affect smoking behaviour. This study examines socioeconomic inequalities in current smoking and smoking cessation in The Netherlands before and during the Global Financial Crisis (GFC). Methods Participants were 66,960 Dutch adults (≥18 years) who took part in the annual national Health Survey (2004–2011). Period was dichotomised: ‘pre-’ and ‘during-GFC’. SES measures used were income, education and neighbourhood deprivation. Outcomes were current smoking rates (smokers/total population) and smoking cessation ratios (former smokers/ever smokers). Multilevel logistic regression models controlled for individual characteristics and tested for interaction between period and SES. Results In both periods, high SES respondents (in all indicators) had lower current smoking levels and higher cessation ratios than those of middle or low SES. Inequalities in current smoking increased significantly in poorly educated adults of 45–64 years of age (Odds Ratio (OR) low educational level compared with high: 2.00[1.79-2.23] compared to pre-GFC 1.67[1.50-1.86], p for interaction = 0.02). Smoking cessation inequalities by income in 18–30 year olds increased with borderline significance during the GFC (OR low income compared to high income: 0.73[0.58-0.91]) compared to pre-GFC (OR: 0.98[0.80-1.20]), p for interaction = 0.051). Conclusions Overall, socioeconomic inequalities in current smoking and smoking cessation were unchanged during the GFC. However, current smoking inequalities by education, and smoking cessation inequalities by income, increased in specific age groups. Increased financial strain caused by the crisis may disproportionately affect smoking behaviour in some disadvantaged groups.
Collapse
Affiliation(s)
- Fiona E Benson
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Mirte A G Kuipers
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Vera Nierkens
- Department of Public Health and First Line Medicine, LUMC, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
| | | | - Karien Stronks
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Anton E Kunst
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| |
Collapse
|
29
|
Affiliation(s)
- Raya Muttarak
- Wittgenstein Centre for Demography and Global Human Capital, International Institute for Applied Systems, Analysis, Laxenburg, Austria.
| | - Nadia Steiber
- Department of Economic Sociology, University of Vienna, Vienna, Austria
| | - Silvano Gallus
- Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| |
Collapse
|
30
|
Mead EL, Cohen JE, Kennedy CE, Gallo J, Latkin CA. The role of theory-driven graphic warning labels in motivation to quit: a qualitative study on perceptions from low-income, urban smokers. BMC Public Health 2015; 15:92. [PMID: 25880277 PMCID: PMC4349464 DOI: 10.1186/s12889-015-1438-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Use of communication theories in the development of pictorial health warning labels (graphic warning labels) for cigarette packaging might enhance labels' impact on motivation to quit, but research has been limited, particularly among low socioeconomic status (SES) populations in the U.S. This qualitative study explored perceptions of theory-based graphic warning labels and their role in motivation to quit among low-income smokers. METHODS A cross-sectional qualitative study was conducted with 25 low-income adult smokers in Baltimore, Maryland, who were purposively sampled from a community-based source population. Semi-structured, in-depth interviews were conducted from January to February 2014. Participants were asked about the motivational impact of 12 labels falling into four content categories: negative depictions of the health effects of smoking to smokers and others, and positive depictions of the benefits of quitting to smokers and others. Data were coded using a combined inductive/deductive approach and analyzed thematically through framework analysis. RESULTS Labels depicting negative health effects to smokers were identified as most motivational, followed by labels depicting negative health effects to others. Reasons included perceived severity of and susceptibility to the effects, negative emotional reactions (such as fear), and concern for children. Labels about the benefits of quitting were described as motivational because of their hopefulness, characters as role models, and desire to improve family health. Reasons why labels were described as not motivational included lack of impact on perceived severity/susceptibility, low credibility, and fatalistic attitudes regarding the inevitability of disease. CONCLUSIONS Labels designed to increase risk perceptions from smoking might be significant sources of motivation for low SES smokers. Findings suggest innovative theory-driven approaches for the design of labels, such as using former smokers as role models, contrasting healthy and unhealthy characters, and socially-oriented labels, might motivate low SES smokers to quit.
Collapse
Affiliation(s)
- Erin L Mead
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. .,Tobacco Center of Regulatory Science, Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD, 20742-2611, USA.
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Joseph Gallo
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
31
|
Pförtner TK, Moor I, Rathmann K, Hublet A, Molcho M, Kunst AE, Richter M. The association between family affluence and smoking among 15-year-old adolescents in 33 European countries, Israel and Canada: the role of national wealth. Addiction 2015; 110:162-73. [PMID: 25220260 DOI: 10.1111/add.12741] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/27/2013] [Accepted: 09/09/2014] [Indexed: 11/27/2022]
Abstract
AIMS To examine the role of national wealth in the association between family affluence and adolescent weekly smoking, early smoking behaviour and weekly smoking among former experimenters. DESIGN AND PARTICIPANTS Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 in 35 countries from Europe and North America that comprises 60 490 students aged 15 years. Multi-level logistic regression was conducted using Markov chain Monte Carlo methods (MCMC) to explore whether associations between family affluence and smoking outcomes were dependent upon national wealth. MEASUREMENT Family Affluence Scale (FAS) as an indicator for the socio-economic position of students. Current weekly smoking behaviour is defined as at least weekly smoking (dichotomous). Early smoking behaviour is measured by smoking more than a first puff before age 13 years (dichotomous). Weekly smoking among former experimenters is restricted to those who had tried a first puff in the past. FINDINGS The logistic multi-level models indicated an association of family affluence with current weekly smoking [odds ratio (OR) = 1.088; 95% credible interval (CrI) = 1.055-1.121, P < 0.001], early smoking behaviour (OR = 1.066; CrI = 1.028-1.104, P < 0.001) and smoking among former experimenters (OR = 1.100; CrI = 1.071-1.130; P < 0.001). Gross domestic product (GDP) per capita was associated positively and significantly with the relationship between family affluence and current weekly smoking (OR = 1.005; CrI = 1.003-1.007; P < 0.001), early smoking behaviour (OR = 1.003; CrI = 1.000-1.005; P = 0.012) and smoking among former experimenters (OR = 1.004; CrI = 1.002-1.006; P < 0.001). The association of family affluence and smoking outcomes was significantly stronger for girls. CONCLUSIONS The difference in smoking prevalence between rich and poor is greater in more affluent countries.
Collapse
Affiliation(s)
- Timo-Kolja Pförtner
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Medical Faculty, University of Cologne, Cologne, Germany
| | | | | | | | | | | | | |
Collapse
|
32
|
Verlato G, Accordini S, Nguyen G, Marchetti P, Cazzoletti L, Ferrari M, Antonicelli L, Attena F, Bellisario V, Bono R, Briziarelli L, Casali L, Corsico AG, Fois A, Panico M, Piccioni P, Pirina P, Villani S, Nicolini G, de Marco R. Socioeconomic inequalities in smoking habits are still increasing in Italy. BMC Public Health 2014; 14:879. [PMID: 25159912 PMCID: PMC4159540 DOI: 10.1186/1471-2458-14-879] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/18/2014] [Indexed: 11/10/2022] Open
Abstract
Background Socioeconomic inequalities in smoking habits have stabilized in many Western countries. This study aimed at evaluating whether socioeconomic disparities in smoking habits are still enlarging in Italy and at comparing the impact of education and occupation. Methods In the frame of the GEIRD study (Gene Environment Interactions in Respiratory Diseases) 10,494 subjects, randomly selected from the general population aged 20–44 years in seven Italian centres, answered a screening questionnaire between 2007 and 2010 (response percentage = 57.2%). In four centres a repeated cross-sectional survey was performed: smoking prevalence recorded in GEIRD was compared with prevalence recorded between 1998 and 2000 in the Italian Study of Asthma in Young Adults (ISAYA). Results Current smoking was twice as prevalent in people with a primary/secondary school certificate (40-43%) compared with people with an academic degree (20%), and among unemployed and workmen (39%) compared with managers and clerks (20-22%). In multivariable analysis smoking habits were more affected by education level than by occupation. From the first to the second survey the prevalence of ever smokers markedly decreased among housewives, managers, businessmen and free-lancers, while ever smoking became even more common among unemployed (time-occupation interaction: p = 0.047). At variance, the increasing trend in smoking cessation was not modified by occupation. Conclusion Smoking prevalence has declined in Italy during the last decade among the higher socioeconomic classes, but not among the lower. This enlarging socioeconomic inequality mainly reflects a different trend in smoking initiation.
Collapse
Affiliation(s)
- Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|