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

This study examined trends in smoking and overweight/obesity rates among United States (US) adults ages 40 years and older by race and socio-economic status (SES) across three study periods; pre-recession (20032005), 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. (C) 2017 Elsevier Inc. All rights reserved.