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BMJ Open. 2012; 2(5): e001386.
Published online 2012 October 8. doi:  10.1136/bmjopen-2012-001386
PMCID: PMC3488705

Economic crisis and smoking behaviour: prospective cohort study in Iceland

Abstract

Objective

To examine the associations between the 2008 economic collapse in Iceland and smoking behaviour at the national and individual levels.

Design

A population-based, prospective cohort study based on a mail survey (Health and Wellbeing in Iceland) assessed in 2007 and 2009.

Setting

National mail survey.

Participants

Representative cohort (n=3755) of Icelandic adults.

Main outcome measure

Smoking status.

Results

A 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).

Conclusions

The 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.

Keywords: Public Health, Epidemiology, Mental Health

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