Trends in smoking and obesity among US adults before, during, and after the great recession and Affordable Care Act roll-out

Prev Med. 2017 Sep;102:86-92. doi: 10.1016/j.ypmed.2017.07.001. Epub 2017 Jul 8.


This study examined trends in smoking and overweight/obesity rates among United States (US) adults ages 40years and older by race and socio-economic status (SES) across three study periods; pre-recession (2003-2005), recession (2007-2009), and post-recession/Affordable Care Act (2010-2012). Data was obtained from the Behavioral Risk Factor Surveillance System (BRFSS), and multivariable regression analysis was used to examine changes in overweight/obesity, smoking, physical activity and smoking cessation rates over the study periods. There were 2,805,957 adults included in the analysis; 65.5% of the study population was overweight/obese, and 33.3% were current smokers. Smoking prevalence increased marginally among those with lower SES (income<$10,000) from pre-recession (52.5%) to post-recession (52.9%), but declined in other socio-demographic groups. The odds of overweight/obesity increased in the post-recession (OR: 1.22, 95% CI: 1.21-1.23) and recession (OR: 1.11, 95% CI: 1.11-1.12) periods compared with pre-recession, but odds of smoking overall decreased in the post-recession (OR: 0.93, 95% CI: 0.92-0.94) and recession (OR: 0.95, 95% CI: 0.94-0.97) periods. Overweight/obesity increased over the study periods, regardless of race, SES or healthcare access, while smoking rates showed significant declines post-recession compared with pre-recession, except in low SES groups. These findings suggest that strategies focused on reducing overweight/obesity and increasing access to smoking cessation services, especially among low-income adults, are needed. Prospective studies are needed to better evaluate the influence of the economic recession and Affordable Care Act on behavioral risk factors.

Keywords: Affordable Care Act; Epidemiology; Exercise; Health care access; Health care providers; Obesity; Risk factors; Smoking; Smoking cessation; Socioeconomic factors.

MeSH terms

  • Adult
  • Aged
  • Behavioral Risk Factor Surveillance System
  • Continental Population Groups / statistics & numerical data
  • Economic Recession*
  • Exercise
  • Female
  • Humans
  • Male
  • Middle Aged
  • Obesity / epidemiology*
  • Patient Protection and Affordable Care Act / legislation & jurisprudence*
  • Prevalence
  • Smoking / epidemiology
  • Smoking / trends*
  • Smoking Cessation / statistics & numerical data
  • Socioeconomic Factors
  • United States / epidemiology