Article Text

Download PDFPDF

Economic crisis and smoking behaviour: prospective cohort study in Iceland
  1. Christopher Bruce McClure1,3,
  2. Unnur A Valdimarsdóttir1,
  3. Arna Hauksdóttir1,
  4. Ichiro Kawachi2
  1. 1Department of Medicine, Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland
  2. 2Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, USA
  3. 3College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
  1. Correspondence to Christopher Bruce McClure; cbm1{at}


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.

  • Public Health
  • Epidemiology
  • Mental Health

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.