The relationship between smoking and unemployment: New avenues for interdisciplinary research

It is well accepted that both smoking and unemployment have severe adverse effects on health and well-being (Grossi, Perski, Lundberg, & Soares, 2011; Lim et al., 2012). The Global Burden Disease Study (2010) considered smoking to be the second largest risk factor, based on disability-adjusted life years being a major contributor to cancer and respiratory disease (Lim et al., 2012). Unemployment has been shown to be associated with increased rates of ill health and psychological and psychophysiological symptoms (Grossi et al., 2011). In addition, there is considerable evidence that an association exists between smoking and unemployment. In this letter, we offer some suggestions about how to explore this relationship from an interdisciplinary perspective.

Studies show that rates of unemployment are highest among smokers compared to non-smokers (Ponniah & Bloomfield, 2008; Okechukwu, Bacic, Cheng, & Catalano, 2012; Rizov, Herzfeld, & Huffman, 2012; Prochaska, Shi, & Rogers, 2013; Kaleta, Makowiec-Dąbrowska, Dziankowska-Zaborszczyk, & Fronczak, 2013). This finding is robust to differences across countries such as smoking prevalence, cigarettes per person, gross domestic product (GDP) per capita and unemployment rates. Despite this, the cross-sectional evidence above is only associative and does not address the issue of causality. For example, although unemployment may lead to poor health, those in poor health are more likely to be unemployed. Longitudinal studies are therefore important in order to distinguish between these selection and causal effects. Unfortunately, such studies have presented mixed findings with the causal relationship of unemployment on smoking behaviour being inconsistent across countries studied and methodologies used (Schunck & Rogge, 2012; Marcus, 2014).

One interesting observation is that smoking is more prevalent among the job-seeking unemployed compared to non-job seekers (Prochaska et al., 2013). A possible explanation for this could be that stress is a mediating factor. Although the relationships between stress and smoking and stress and unemployment are well documented (Fielden & Davidson, 1999; Siahpush, Borland, & Scollo, 2003), research linking stress, smoking and unemployment is sparse (De Vogli & Santinello, 2005). We believe that microeconomic experiments could be beneficial in this area. Extending previous research on the neurophysical/behavioural responses to stress (Buckert, Schwieren, Kudielka, & Fiebach, 2014), insights could be made from measuring acute cortisol/adrenaline responses while making economic decisions and testing for smoking status as well as comparing specific participant pools such as those actively seeking work and the long-term unemployed.

Another factor that may explain the relationship between smoking and unemployment is impulsivity. Several studies provide evidence of an association between smoking addiction and impulsivity. Compared to non-smokers, smokers score higher on impulsivity scales (Rezvanfard, Ekhtiari, Mokri, Djavid, & Kaviani, 2010) and display behaviours of elevated temporal discounting (Bickel et al., 2007). Moreover impulsivity, alongside other attention-deficit hyperactivity disorder (ADHD) symptoms, is associated with poor skills in organisation, time management and interpersonal relationships such that this adversely affects performance in the workplace (Sarkis, 2014). We see neuroeconomic research as a way of investigating the role of impulsivity on smoking and unemployment. Impulsivity has been shown to be connected to poor inhibitory control (Dalley, Everitt, & Robbins, 2011), which in turn has been used as a predictor for smoking prevalence (Billieux et al., 2010). Undertaking neuropsychological testing of cognitive control such as performing the stop-signal reaction time task during functional magnetic resonance imaging (fMRI) (Farr, Hu, Zhang, & Li, 2012), may also enable a deeper understanding of the neural processes underlying the relationship between smoking and unemployment.

Finally, we would like to make the wider point that the rewards from combining insights from economics, psychology and neuroscience are not just limited to the issues raised in this letter, but rather we see this interdisciplinary approach as a crucial step in the development of future research.