Economic conditions and health behaviours during the 'Great Recession'. Issue 12 (22nd August 2013)

• Record Type: Journal Article
• Authors: Nandi, Arijit; Charters, Thomas J; Strumpf, Erin C; Heymann, Jody; Harper, Sam
• Is Part Of: Journal of epidemiology and community health. Volume 67:Issue 12(2013)
• Page Start: 1038
• Page End: 1046
• Publication Date: 2013-08-22
• Subjects: Public health -- Periodicals; Epidemiology -- Periodicals; 614.4
• DOI: 10.1136/jech-2012-202260
• Languages: English
• ISSNs: 0143-005X

Abstract

Abstract : Background: The adoption of healthier behaviours has been hypothesised as a mechanism to explain empirical findings of population health improvements during some economic downturns. Methods: We estimated the effect of the local unemployment rate on health behaviours using pooled annual surveys from the 2003–2010 Behavioral Risk Factor Surveillance Surveys, as well as population-based telephone surveys of the US adult general population. Analyses were based on approximately 1 million respondents aged 25 years or older living in 90 Metropolitan Statistical Areas and Metropolitan Divisions (MMSAs). The primary exposure was the quarterly MMSA-specific unemployment rate. Outcomes included alcohol consumption, smoking status, attempts to quit smoking, body mass index, overweight/obesity and past-month physical activity or exercise. Results: The average unemployment rate across MMSAs increased from a low of 4.5% in 2007 to a high of 9.3% in 2010. In multivariable models accounting for individual-level sociodemographic characteristics and MMSA and quarter fixed effects, a one percentage-point increase in the unemployment rate was associated with 0.15 (95% CI −0.31 to 0.01) fewer drinks consumed in the past month and a 0.14 (95% CI −0.28 to 0.00) percentage-point decrease in the prevalence of past-month heavy drinking; these effects were driven primarily by men. Changes in the unemployment rate were not consistently associated with other health behaviours. Although individual-level unemployment status was associated with higher levels of alcohol consumption, smoking and obesity, the MMSA-level effects of the recession were largely invariant across employment groups. Conclusions: Our results do not support the hypothesis that health behaviours mediate the effects of local-area economic conditions on mortality.