Which group of smokers is more vulnerable to the economic crisis?

• 1919 Italian smokers reported how they changed smoking intensity after the crisis.
• Due to the economic crisis, 19.1% of smokers reduced and 3.5% increased smoking intensity.
• Smokers reducing and increasing intensity both shared similar characteristics.
• Modifiers were more likely to be young, unemployed, and low socio-economic status individuals.

ObjectivesStudies investigating whether smoking increases or decreases during economic downturn provided contrasting results. For the first time, we used direct questions to analyse changes in smoking behaviour due to the 2008 financial crisis, comparing socio-economic characteristics of smokers who changed with those who kept their smoking intensity.Study designCross-sectional survey.MethodsWe used data from three annual surveys conducted in Italy in 2012–2014 on representative samples of the Italian general population aged ≥15 years.ResultsA total of 1919 current smokers were asked specific questions on the influence of the economic crisis that started in 2008 on their smoking behaviour. Overall, 77.4% of 1919 current smokers reported not to have changed their smoking behaviour, 19.1% to have reduced, and 3.5% to have increased their smoking intensity as a consequence of the economic crisis. The reduction in cigarette smoking increased with age: compared to the respondents aged <25 years, the multivariate odds ratio (OR) for those aged 25–44, 45–64 and ≥65 years were 0.65, 0.46 and 0.33, respectively (P for trend<0.001). Reduction was significantly lower among intermediate (OR = 0.68 compared to low) and high education levels (OR = 0.28; P for trend<0.001). A significant inverse trend for increasing consumption was observed with age (P = 0.022), education (P = 0.003) and family income (P < 0.001).ConclusionsThe large majority of current smokers did not change their smoking habit following the economic crisis. However, there are specific vulnerable subgroups of smokers, constituted by the young and subjects with low socio-economic status, that were reactive to the global economic crisis. These groups are more prone to change their smoking behaviours, either for better or –, in a smaller proportion –, for worse.