Changes in household incomes as a result of growing unemployment have an effect on risky behaviours such as levels of smoking and alcohol consumption. Recessions also have an effect on deaths from road traffic accidents, which tend to decline, reflecting lower car use. A reduction in road traffic deaths has been observed in several European countries, especially where rates were initially high (Stuckler et al. 2011). The situation in relation to alcohol is more complicated. Research in the United States indicates that overall consumption may fall during a recession, reflecting affordability, but hazardous consumption by those already at risk may increase (Bor et al. 2013). Evidence from Europe is so far limited.


Alpert HR, Vardavas CI, Chaloupka FJ, Vozikis A, Athanasakis K, Kyriopoulos I, Bertic M, Behrakis PK, Connolly GN. The recent and projected public health and economic benefits of cigarette taxation in Greece. Tob Control. 2013 Mar 6. [Epub ahead of print]

Arechavala T, Continente X, Pérez-Giménez A, Bartoll X, Sánchez-Martí­nez F, López MJ. Food consumption frequency and excess body weight in adolescents in the context of financial crisis in Barcelona (Spain). Gac Sanit. 2016 May 9. [Epub ahead of print]

Asgeirsdóttir TL, Corman H, Noonan K, Olafsdóttir T, Reichman NE. Was the economic crisis of 2008 good for Icelanders? Impact on health behaviors. Econ Hum Biol. 2013 Apr 6. [Epub ahead of print]

Ásgeirsdóttir TL, Corman H, Noonan K, Reichman NE. Lifecycle effects of arecession on health behaviors: Boom, bust, and recovery in Iceland. EconHumBiol. 2016 Mar;20:90-107

Barceló MA, Coll-Negre M, Coll-de-Tuero G, Saez M. Effects of the Financial Crisis on Psychotropic Drug Consumption in a Cohort from a Semi-Urban Region in Catalonia, Spain. PLoS One. 2016;11(2):e0148594.

Benson FE , Kuipers MA, Nierkens V, Bruggink JW, Stronks K, Kunst AE. Socioeconomic inequalities in smoking in The Netherlands before and during the Global Financial Crisis: a repeated cross-sectional study. BMC Public Health. 2015 May 6;15:469.

Bolívar Muñoz J, Bernal Solano M, Mateo Rodríguez I, Daponte Codina A, Escudero Espinosa C, Sánchez Cantalejo C, González Usera I, Robles Ortega H, Mata Martín JL, Fernánndez Santaella MC, Vila Castellar J. [The health of adults undergoing an eviction process]. Gac Sanit. 2015 Nov 5. [Epub ahead of print]

Bonaccio M, Bes-Rastrollo M, de Gaetano G, Iacoviello L. Challenges to the Mediterranean diet at a time of economic crisisMediterranean diet at a time of economic crisis. Nutr Metab Cardiovasc Dis. 2016;26(12):1057-1063.

Bonaccio M, Di Castelnuovo A, Bonanni A, Costanzo S, De Lucia F, Persichillo M, Zito F, Donati MB, de Gaetano G, Iacoviello L. Decline of the Mediterranean diet at a time of economic crisis. Results from the Moli-sani study. Nutr Metab Cardiovasc Dis. 2014 Mar 1.[Epub ahead of print]

Bonaccio M, Di Castelnuovo A, Bonanni A, Costanzo S, Persichillo M, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. INHES Study Investigators. Socioeconomic status and impact of the economic crisis on dietary habits in Italy: results from the INHES study. J Public Health (Oxf) 2017 Nov 8:1-10. doi: 10.1093/pubmed/fdx144. [Epub ahead of print]

Bor J, Basu S, Coutts A, McKee M, Stuckler D. Alcohol use during the great recession of 2008-2009. Alcohol Alcohol. 2013 May-Jun;48(3):343-8.

Bosque-Prous M, Kunst AE, Brugal MT, Espelt A. Changes in alcohol consumption in the 50- to 64-year-old European economically active population during an economic crisis. Eur J Public Health 2017 Apr 27. doi: 10.1093/eurpub/ckx044 [Epub ahead of print].

Brooks-Gunn J, Schneider W, Waldfogel J. The Great Recession and the risk for child maltreatment. Child Abuse Negl. 2013 Oct;37(10):721-9.

Bruggink JW, de Goeij MC, Otten F, Kunst AE. Changes between pre-crisis and crisis period in socioeconomic inequalities in health and stimulant use in Netherlands. Eur J Public Health. 2016 Mar 17. [Epub ahead of print]

Chen C, He W, Wang Y, Deng L, Jia F. Nutritional status of children during and post-global economic crisis in China. Biomed Environ Sci. 2011 Aug;24(4):321-8.

Colell E, Sánchez Niubá² A, Delclos GL, Benavides FG, Domingo-Salvany A. Economic crisis and changes in drug use in the Spanish economically-active population. Addiction. 2015 Mar 16. [Epub ahead of print]

Dalma A, Kastorini CM, Zota D, Veloudaki A, Petralias A, Yannakoulia M, Linos A.Perceptions of parents and children, participating in a school-based feedingprogramme in disadvantaged areas in Greece: a qualitative study. Child Care Health Dev. 2016 Mar;42(2):267-77

De Goeij MC, Suhrcke M, Toffolutti V, van de Mheen D, Schoenmakers TM, Kunst AE. How economic crises affect alcohol consumption and alcohol-related health problems: A realist systematic review. Soc Sci Med. 2015 Apr;131:131-146.

De Goeij MC, van der Wouden B, Bruggink JW, Otten F, Kunst AE. Impact of the post-2008 economic crisis on harmful drinking in the Dutch working-age population. Drug Alcohol Depend. 2016 Apr 1;161:50-8.

De Goeij MC, Bruggink JW, Otten F, Kunst AE. Harmful drinking after job loss: a stronger association during the post-2008 economic crisis? Int J Public Health 2017 Feb 22 [Epub ahead of print].

De Vogli R, Vieno A, Lenzi M. Mortality due to mental and behavioral disorders associated with the Great Recession (2008-10) in Italy: a time trend analysis. Eur J Public Health. 2013 Nov 18. [Epub ahead of print]

Dom G, Samochowiec J, Evans-Lacko S, Wahlbeck K, Van Hal G, McDaid D. The Impact of the 2008 Economic Crisis on Substance Use Patterns in the Countries of the European Union. Int J Environ Res Public Health. 2016 Jan 13;13(1)

Fineberg HV. Public health in a time of government austerity. Am J Public Health. 2013 Jan;103(1):47-9.

Filippidis FT, Agaku IT, Vardavas CI, Majeed A. The association between economic recession and public support for increased tobacco taxation in 27 European countries. Scand J Public Health. 2014 Jul 22. [Epub ahead of print] 

Filippidis FT, Schoretsaniti S, Dimitrakaki C, Vardavas CI, Behrakis P, Connolly GN, Tountas Y. Trends in cardiovascular risk factors in Greece before and during the financial crisis: the impact of social disparities. Eur J Public Health. 2014 Mar 10. [Epub ahead of print] 

Filippidis FT, Tzoulaki I. Greece giving up on tobacco control. Addiction. 2016 Mar 30. [Epub ahead of print] No abstract available.

Filippidis FT. Tobacco control: a victim of political instability in Greece. Lancet. 2016 Jan 23;387(10016):338-9. No abstract available.

Filippidis FT, Gerovasili V, Millett C, Tountas Y. Medium-term impact of the economic crisis on mortality, health-related behaviours and access to healthcare in Greece. Sci Rep 2017 Apr 10;7:46423. doi: 10.1038/srep46423.

Foscolou A, Tyrovolas S, Soulis G, Mariolis A, Piscopo S, Valacchi G, et al. The Impact of the Financial Crisis on Lifestyle Health Determinants Among Older Adults Living in the Mediterranean Region: The Multinational MEDIS Study (2005-2015). J Prev Med Public Health 2017 Jan;50(1):1-9.

Gallus S, Ghislandi S, Muttarak R. Effects of the economic crisis on smoking prevalence and number of smokers in the USA. Tob Control. 2013 Aug 16.

Gallus S, Tramacere I, Pacifici R, Zuccaro P, Colombo P, Ghislandi S, La Vecchia C. Smoking in Italy 2008-2009: a rise in prevalence related to the economic crisis? Prev Med. 2011 Feb;52(2):182-3

Gallus S, Asciutto R, Muttarak R, Pacifici R, La Vecchia C, Lugo A. Which group of smokers is more vulnerable to the economic crisis? Public Health. 2016Jan 2. [Epub aheadof print]

García Rada A. Child poverty and malnutrition rise in Spain as austerity measures bite. BMJ. 2013 Aug 23;347:f5261. doi: 10.1136/bmj.f5261.

Grappasonni I, Scuri S, Tanzi E, Kracmarova L, Petrelli F. The economic crisis and lifestyle changes: a survey on frequency of use of medications and of preventive and specialistic medical care, in the Marche Region (Italy). Acta Biomed. 2018 Mar 27;89(1):87-92. doi: 10.23750/abm.v89i1.7068.

Harhay MO, Bor J, Basu S, McKee M, Mindell JS, Shelton NJ, Stuckler D. Differential impact of the economic recession on alcohol use among white British adults, 2004-2010. Eur J Public Health. 2013 Sep 20. [Epub ahead of print]

He P, Yano E. Tobacco companies are booming despite an economic depression. Tob Induc Dis. 2009 Jun 15;5(1):9. 

Jackson TL, Gjelsvik A, Garro A, Pearlman DN. Correlates of smoking during an economic recession among parents of children with asthma. J Asthma. 2013 Jun;50(5):457-62. 

Jónsdóttir S, Asgeirsdóttir TL. The effect of job loss on body weight during an economic collapse. Eur J Health Econ. 2013 Jun 12. [Epub ahead of print]

Jones-Webb R, Karriker-Jaffe KJ, Zemore SE, Mulia N. Effects of Economic Disruptions on Alcohol Use and Problems: Why Do African Americans Fare Worse? J Stud Alcohol Drugs. 2016 Mar;77(2):261-71.

Kalousova L, Burgard SA. Unemployment, measured and perceived decline of economic resources: Contrasting three measures of recessionary hardships and their implications for adopting negative health behaviors. Soc Sci Med. 2014 Apr;106:28-34.

Kaplan MS, Huguet N, Caetano R, Giesbrecht N, Kerr WC, McFarland BH. Economic contraction, alcohol intoxication and suicide: analysis of the National Violent Death Reporting System. Inj Prev. 2014 Jul 14. [Epub ahead of print].

Kaplan MS, Huguet N, Caetano R, Giesbrecht N, Kerr WC, McFarland BH. Heavy Alcohol Use Among Suicide Decedents Relative to a Nonsuicide Comparison Group: Gender-Specific Effects of Economic Contraction. Alcohol Clin Exp Res. 2016 May 17 [Epub ahead of print]

 Kleanthous K, Dermitzaki E, Papadimitriou DT, Papaevangelou V, Papadimitriou A. Overweight and obesity decreased in Greek schoolchildren from 2009 to 2012 during the early phase of the economic crisisduring the early phase of the economic crisis. Acta Paediatr. 2015 Aug 17. [Epub ahead of print]

Krasovsky K. Sharp changes in tobacco products affordability and the dynamics of smoking prevalence in various social and income groups in Ukraine in 2008-2012. Tob Induc Dis. 2013 Oct 18;11(1):21.

Leinsalu M, Stickley A, Kunst AE. Reduced affordability of cigarettes and socio-economic inequalities in smoking continuation in Stakhanov, Ukraine, 2009. Eur J Public Health. 2014 Jul 27. [Epub ahead of print] 

Levit KR, Mark TL, Coffey RM, Frankel S, Santora P, Vandivort-Warren R, Malone K. Federal spending on behavioral health accelerated during recession as individuals lost employer insurance. Health Aff (Millwood). 2013 May;32(5):952-62.

Leyland AH. Alcohol, financial crisis and reform: learning from the Russian experience. Eur J Public Health. 2012 Jun;22(3):300

Lievens D, Vander Laenen F, Christiaens J. Public spending for illegal drug and alcohol treatment in hospitals: an EU cross-country comparison. Subst Abuse Treat Prev Policy. 2014 Jun 30;9:26. 

Loopstra R, Reeves A, Barr B, Taylor-Robinson D, McKee M, Stuckler D. The impact of economic downturns and budget cuts on homelessness claim rates across 323 local authorities in England, 2004-12. J Public Health (Oxf). 2016;38(3):417-425.

Margerison-Zilko C. Economic contraction and maternal health behaviors during pregnancy in a national sample of U.S. women. Ann Epidemiol. 2014 Jun;24(6):432-40. 

Marra M, Migliardi A, Costa G. [Health inequalities and nutrition in Italy during crisis times]. Epidemiol Prev. 2015 Sep-Dec;39(5-6):322-31. 

Márquez-Calderón S, Villegas-Portero R, Gosalbes Soler V, Martínez-Pecino F. Health promotion and prevention in the economic crisis: the role of the health sector. SESPAS report 2014. Gac Sanit. 2014 Mar 19 [Epub ahead of print] Spanish. 

Mattei G, De Vogli R, Ferrari S, Pingani L, Rigatelli M, Galeazzi GM. Impact of the economic crisis on health-related behaviors in Italy. Int J Soc Psychiatry 2017 Nov;63(7):649-656. doi: 10.1177/0020764017726097 [Epub ahead of print 2017 Aug 23].

McClure CB, Valdimarsdóttir UA, Hauksdóttir A, Kawachi I. Economic crisis and smoking behaviour: prospective cohort study in Iceland. BMJ Open. 2012 Oct 8;2(5).

Mulia N, Zemore SE, Murphy R, Liu H, Catalano R. Economic Loss and Alcohol Consumption and Problems During the 2008 to 2009 U.S. Recession. Alcohol Clin Exp Res. 2013 Nov 20

Murphy RD, Zemore SE, Mulia N. Housing Instability and Alcohol Problems during the 2007-2009 US Recession: the Moderating Role of Perceived Family Support. J Urban Health. 2014 Feb;91(1):17-32.

No authors listed. Economic austerity, food poverty, and health. Lancet. 2014 May 10;383(9929):1609.

O'Dowd A. Recession could increase alcohol and drug addiction and mental health problems, watchdog warns. BMJ. 2009 Aug 17;339:b3361.

Olafsdóttir T, Hrafnkelsson B, Asgeirsdóttir TL. The Icelandic economic collapse, smoking, and the role of labor-market changes. Eur J Health Econ. 2014 Apr 5. [Epub ahead of print] 

Petralias A, Papadimitriou E, Riza E, Karagas MR, Zagouras AB, Linos A; DIATROFI Program Research Team.The impact of a school food aid program on household food insecurity. Eur J Public Health. 2016 Apr;26(2):290-6.

Rajmil L, Medina-Bustos A, Fernández de Sanmamed MJ, Mompart-Penina A. Impact of the economic crisis on children's health in Catalonia: a before-after approach. BMJ Open. 2013 Aug 23;3(8):e003286. doi: 10.1136/bmjopen-2013-003286.

Richman JA, Rospenda KM, Johnson TP, Cho YI, Vijayasira G, Cloninger L, Wolff JM. Drinking in the age of the Great Recession. J Addict Dis. 2012;31(2):158-72

Saridi M, Karra A, Kourakos M, Souliotis K. Assessment of alcohol use in health professionals during the economic crisis. Br J Nurs. 2016 Apr 14;25(7):396-405.

Scuri S, Tesauro M, Petrelli F, Peroni A, Kracmarova L, Grappasonni I. Implications of modified food choices and food-related lifestyles following the economic crisis in the Marche Region of Italy. Ann Ig. 2018 Mar-Apr;30(2):173-172. doi: 10.7416/ai.2018.2208.

Schoretsaniti S, Filippidis FT, Vardavas CI, Dimitrakaki C, Behrakis P, Connolly GN, Tountas Y. 5-Year trends in the intention to quit smoking amidst the economic crisis and after recently implemented tobacco control measures in Greece. Addict Behav. 2013 Sep 20 [Epub ahead of print]

Shin J, Choi JW, Jang SI, Choi Y, Lee SG, Ihm TH, Park EC. The temporal association of excessive health expenditure with suicidal ideation among primary income earners: a cross-sectional design using the Korean Welfare Panel Survey (KoWePS). BMJ Open. 2015 Jun 16;5(6):e007421.

Shin JH, Lee G, Kim JS, Oh HS, Lee KS, Hur Y, Cho BL. Effects of the 2008 Global Economic Crisis on National Health Indicators: Results from the Korean National Health and Nutrition Examination SurveyGlobal Economic Crisis on National Health Indicators: Results from the Korean National Health and Nutrition Examination Survey. Korean J Fam Med. 2015 Jul;36(4):162-7.

Smith LP, Ng SW, Popkin BM. Resistant to the recession: low-income adults' maintenance of cooking and away-from-home eating behaviors during times of economic turbulence. Am J Public Health. 2014 May;104(5):840-6.

Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. Effects of the 2008 recession on health: a first look at European data. Lancet 2011; 378(9786): 124-5.

Tarján A, Dudás M, Gyarmathy VA, Rusvai E, Tresó B, Csohán Ã. Emerging Risks Due to New Injecting Patterns in Hungary During Austerity Times. Subst Use Misuse. 2015 Mar 16:1-11. [Epub ahead of print]

Thomas CP, Hodgkin D, Levit K, Mark TL. Growth in spending on substance use disorder treatment services for the privately insured population. Drug Alcohol Depend. 2016 Mar 1;160:143-50. 

Turunen E, Hiilamo H. Health effects of indebtedness: a systematic review. BMC Public Health. 2014 May 22;14:489.

Ueda P, Kondo N, Fujiwara T. The global economic crisis, household income and pre-adolescent overweight and underweight: a nationwide birth cohort study in Japan. Int J Obes (Lond). 2015 May 18. [Epub ahead of print]

Vardavas CI, Filippidis FT, Agaku I, Mytaras V, Bertic M, Connolly GN, Tountas Y, Behrakis P. Tobacco taxation: the importance of earmarking the revenue to health care and tobacco control. Tob Induc Dis. 2012 Dec 27;10(1):21.

Vijayasiri G, Richman JA, Rospenda KM. The Great Recession, somatic symptomatology and alcohol use and abuse. Addict Behav. 2012 Sep;37(9):1019-24.

Yannakoulia M, Lykou A, Kastorini CM, Saranti Papasaranti E, Petralias A, Veloudaki A, Linos A; DIATROFI Program Research Team. Socio-economic and lifestyle parameters associated with diet quality of children and adolescents using classification and regression tree analysis: the DIATROFI study. Public Health Nutr. 2015 Apr 20:1-9. [Epub ahead of print]

Zemore SE, Mulia N, Jones-Webb RJ, Liu H, Schmidt L. The 2008-2009 recession and alcohol outcomes: differential exposure and vulnerability for Black and Latino populations. J Stud Alcohol Drugs. 2013 Jan;74(1):9-20.