title: Economic conditions and health behaviours during the 'Great Recession'.
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.
authors: Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, , Montreal, Quebec, Canada.
authors: Arijit
authors: A
authors: Nandi
authors: Thomas J
authors: TJ
authors: Charters
authors: Erin C
authors: EC
authors: Strumpf
authors: Jody
authors: J
authors: Heymann
authors: Sam
authors: S
authors: Harper
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D040343:Behavioral Risk Factor Surveillance System; D057172:Economic Recession / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D006293:Health Promotion; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D011314:Preventive Health Services / Q000706:statistics & numerical data; D011322:Primary Prevention / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D014478:Unemployment / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult