Smoking prevalence and economic crisis in Brazil

Souza, Luis Eugenio de; Rasella, Davide; Barros, Rafael; Lisboa, Erick; Malta, Déborah; Mckee, Martin

doi:10.11606/s1518-8787.2021055002768

Brasil

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Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.2021055002768 linkcopy

Smoking prevalence and economic crisis in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE To estimate the impact of the 2015–2018 economic crisis on tobacco consumption in Brazil.

METHODS This is an interrupted time series analysis conducted with data from 27 cities collected by VIGITEL, using linear regression models to account for first-order autocorrelation. Analyses were conducted based on gender, age group, and education level.

RESULTS Smoking rates decreased between 2006 and 2018, decelerating after the crisis onset. Differently than women, men showed an immediate but transient increase in smoking, followed by a decelerated decrease. Those over 65 also showed increased smoking rates immediately after the economic crisis onset, but decline accelerated later on. In turn, we found a trend reversal among those aged 31–44. Rates also decreased among those with lower education levels, but decelerated among those with more years of schooling.

CONCLUSION An economic crisis have varied impacts on the smoking habits of different population groups. Tobacco control policies should entail a detailed understanding of smoking epidemiology, especially during an economic crisis.

Tobacco Use Disorder, epidemiology; Poverty; Health Impact Assessment; Financial Management

	Overall population	Men	Women
Yearly average percentage variation of smoking prevalence in the 2006–2014 period	-0.63^a	-0.79^a	-0.49^a
	[-0.76 to -0.51]	[-0.94 to -0.64]	[-0.68 to -0.31]
Yearly average percentage variation of smoking prevalence in the 2015–2018 period	-0.36^a	-0.12	-0.45^a
	[-0.62 to -0.10]	[-0.44 to 0.18]	[-0.60 to -0.29]
Level change in 2015 vs predicted level without economic crisis	0.19	0.13	-0.03
	[-0.39 to 0.77]	[-0.92 to 1.19]	[-1.03 to 0.95]
Difference in trends (2015–2018 period – 2006-2014 period)	0.27	0.66^a	0.04
Difference in trends (2015–2018 period – 2006-2014 period)	[-0.02 to 0.58]	[0.33 to 1.00]	[-0.26 to 0.34]

	18–30 years old	31–44 years old	45–64 years old	65 and older
Yearly average percentage variation of smoking prevalence in the 2006–2014 period	-0.61^a	-0.75^a	-0.81^a	-0.22^a
	[-0.75 to -0.48]	[-0.82 to -0.69]	[-1.05 to -0.58]	[-0.34 to -0.11]
Yearly average percentage variation of smoking prevalence in the 2015–2018 period	-0.34^a	0.07	-0.50^a	-0.70^a
	[-0.45 to -0.23]	[-0.31 to 0.46]	[-0.87 to -0.14]	[-0.84 to -0.56]
Level change in 2015 vs predicted level without economic crisis	0.43	-0.12	0.03	1.25^a
	[-0.28 to 1.16]	[-.06 to 0.81]	[-.36 to 1.43]	[0.30 to 2.20]
Difference in trends (period 2015-2018; period 2006–2014)	0.27^a	0.83^a	0.30	-0.47^a
Difference in trends (period 2015-2018; period 2006–2014)	[0.12 to 0.42]	[0.45 to 1.21]	[-0.16 to 0.78]	[-0.61 to -0.34]

	0–8 years of education	9–11 years of education	12 years and more of education
Yearly average percentage variation of smoking prevalence in the 2006–2014 period	-0.64^a [-0.88 to -0.39]	-0.48^a [-0.63 to -0.34]	-0.59^a [-0.83 to -0.36]
Yearly average percentage variation of smoking prevalence in the 2015–2018 period	-0.55^a [-0.89 to -0.21]	-0.02 [-0.33 to 0.27]	-0.18 [-0.46 to 0.09]
Level change in 2015 vs predicted level without economic crisis	0.56 [-0.48 to 1.61]	0.19 [-0.84 to 1.23]	0.42 [-0.90 to 1.76]
Difference in trends (2015–2018 period; 2006–2014 period)	0.08 [-0.42 to 0.59]	0.45^a [0.14 to 0.77]	0.41^a [0.07 to 0.75]

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Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
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[TFN1] 95% confidence intervals in brackets.

[TFN2] ^a p < 0.05.

[TFN3] Models considered autocorrelation and used robust standard errors to account for repeated measures.