title: Associations between U.S. Adult Obesity and State and County Economic Conditions in the Recession.
abstract: This study examines the association between state and county unemployment rates and individuals' body weight status during the latest recession in the U.S. We used the U.S. Behavioral Risk Factor Surveillance System (BRFSS) data in 2007, 2009 and 2011, which were collected from 722,692 American adults aged 18 or older. Overweight and obesity were defined as body mass index (BMI) ≥25, and ≥30, respectively. Multivariate linear and logistic regressions were applied to assess the association between BMI, risks of overweight and obesity, and state and county unemployment rates. State unemployment rates were negatively associated with individual BMI across years, while county unemployment rates were significantly positively associated with BMI and obesity rates in all years (p < 0.05). However, the scale of the positive relationship was reduced in 2009 and 2011. Stratified analyses were conducted among adults with employment and without employment. The unemployed group's body weight status was not related to state- and county-level economic conditions in most times. In the pooled analyses with all three years' data, the relationship between unemployment rates and body weight status were consistently reduced after the recession of 2008-2009. Our results indicated that macroeconomic conditions at different levels can have different associations with individuals' obesity risk across time.
authors.affiliation: School of Community and Environmental Health, Old Dominion University, 3138 Health Sciences Building, Norfolk, VA 23529, USA. qzhang@odu.edu.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Mathematics, Texas A & M University-Kingsville, Rhode Hall 231, MSC 172, Kingsville, TX 78363, USA. rajan.lamichhane@tamuk.edu.
authors.forename: Rajan
authors.initials: R
authors.lastname: Lamichhane
authors.affiliation: Department of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, State University of New York, Farber Hall, Room 270, Buffalo, NY 14214, USA. youfawan@buffalo.edu.
authors.forename: Youfa
authors.initials: Y
authors.lastname: Wang
keywords: employment status; obesity; recession; unemployment rate