title: 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.
  
  
  METHODS
  A population-based, prospective cohort study based on a mail survey (Health and Wellbeing in Iceland) assessed in 2007 and 2009.
  
  
  METHODS
  National mail survey.
  
  
  METHODS
  Representative cohort (n=3755) of Icelandic adults.
  
  
  METHODS
  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.
authors.affiliation: Department of Medicine, Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Christopher Bruce
authors.initials: CB
authors.lastname: McClure
authors.forename: Unnur A
authors.initials: UA
authors.lastname: Valdimarsdóttir
authors.forename: Arna
authors.initials: A
authors.lastname: Hauksdóttir
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi