Tobacco and alcohol consumption, sedentary lifestyle and overweightness in France: A multilevel analysis of individual and area-level determinants

Using a representative sample of the French population, a multilevel analysis allowed us to examine the effect of the level of consumerism, expressed as the gross domestic product (GDP) per capita in the broad area of residence, on the risks of smoking, drinking, sedentary behaviour and overweightness. After adjustment for potential confounders, we found no GDP effect on the odds of being a moderate smoker. Conversely, the risk of being a highly dependent smoker as opposed to a moderate consumer or an abstainer increased with the area-level GDP per capita (OR: 1.13; 95% CI: 1.04-1.23 for an increment of one standard deviation). A similar pattern was found for alcohol consumption: the odds of being a moderate consumer were not related to the GDP per capita, but a positive effect of the GDP on the odds of being an alcohol-dependent drinker as opposed to a moderate consumer or an abstainer was found among women (OR: 1.14; 95% CI: 1.02-1.28). The gap between the sexes with respect to alcohol-dependency therefore appeared to be narrower when the GDP per capita was high. On the other hand, the risk of overweightness was found to increase with the area-level GDP per capita among blue-collar workers only (OR: 1.21; 95% CI: 1.03-1.43). Beyond the well-documented socioeconomic effects operating at both the individual and the local neighbourhood levels, our study suggests that broader areas of residence, through their level of economic development, may also have an independent impact on health-related behaviour.