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Is Financial Stress the New Smoking?

Having less stress in our lives generally has a positive impact on health. But what about reducing financial stress? Is there really a relationship between financial stress and poorer health outcomes? Three recent studies show strong associations between the two.


This Australian study showed that higher levels of financial stress were associated with fewer quit attempts and higher relapse rates. Over a 9-month period, clients using community and social services in the province of New South Wales were invited to complete a survey that included demographic information, a financial stress scale, and smoking status. Participants were grouped into those who were currently smokers, ex-smokers, and never smokers, and correlations between smoking status and financial stress were examined using regression modelling.

Of the 1463 participants who completed the survey, current smokers had significantly higher total financial stress scores than ex-smokers and non-smokers. They also had almost 2 times the likelihood of reporting severe financial stress indicators, such as going without meals, compared to ex-smokers and nonsmokers. The takeaway for HR? Smokers who are experiencing financial stress may need more tobacco cessation support to successfully quit the habit.

Heart Disease

The Jackson Heart Study is a longitudinal cohort study of cardiovascular disease risks in African Americans living in the Jackson, Mississippi metropolitan area. The study, which began in 2000, is assessing whether the stress of financial hardship is associated with coronary heart disease risk factors, and whether these disproportionately affect some African American groups. As of 2017, there have been 2,256 individuals included in the data analysis.

Participants complete a weekly stress inventory, and are grouped by level: (1) did not experience financial stress, (2) no stress, (3) mild stress, and (4) moderate to high stress. Incidents related to coronary heart disease are also tracked, and are defined as the first event of definite or probable myocardial infarction, definite fatal myocardial infarction, definite fatal coronary heart disease, or cardiac procedure.

Data analysis to date shows that participants with moderate to high financial stress were more than twice as likely to have incident coronary heart disease events compared to those with no stress, even after controlling for demographic factors, socioeconomic status, access to health care, and other traditional clinical risk factors (hazard ratio=2.42). The association between financial stress and coronary heart disease was stronger than the association with smoking, depression, and diabetes combined. The researchers concluded that financial stress may be an unrecognized risk factor for coronary heart disease for African Americans, and recommended additional research on intervention studies that address perceived stress.


Another Australian study examined the association between prolonged financial stress and subsequent obesity, using data from an annual national survey on household income and employment. Financial stress was measured using seven questionnaire items, and prolonged financial stress was defined as experiencing financial stress for two consecutive years. Obesity was then measured in the subsequent year. The data analysis was adjusted for covariates including level of general health, physical activity, income, education, and baseline obesity, to rule these out as explanatory factors.

,,Prolonged financial stress turned out to be a strong predictor of subsequent obesity. The adjusted relative risk of being obese was 20% higher (RR: 1.20) among those individuals who experienced financial stress in both consecutive years compared to those who did not experience financial stress in either year. The relationship was not related to income and remained constant across income categories, showing that financial stress is a concept that is distinct from commonly used indicators of socioeconomic status such as income level.

Advisor takeaways

While associations between two things don’t prove a causal relationship, it shows a possible relationship and is often the starting point for further research. If high levels of financial stress are associated with such negative health outcomes, then perhaps reducing financial stress can have positive health impacts. Financial wellness programs, especially those that offer an element of personalized financial coaching or counseling, may act as a form of ‘preventive’ care, potentially reducing employer health care costs related to these chronic health issues. Plan advisors can use these examples to show the positive impact of offering a financial wellness program to employers who want to do the right thing by taking care of their people.

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