to meet financial obligations. Failure to pay mortgage payments or to pay rent may lead to homelessness through foreclosure or eviction. Across the United States the growing ranks of people made homeless in the foreclosure crisis are generating tent cities. Unemployment increases susceptibility to cardiovascular disease, somatization, anxiety disorders, depression, and suicide. In addition, unemployed people have higher rates of medication use, poor diet, physician visits, tobacco smoking, alcoholic beverage consumption, drug use, and lower rates of exercise. According to a study published in Social Indicator Research, even those who tend to be optimistic find it difficult to look on the bright side of things when unemployed. Using interviews and data from German participants aged 16 to 94, including individuals coping with the stresses of real life and not just a volunteering student population, the researchers determined that even optimists struggled with being unemployed. In 1979, M. Harvey Brenner found that for every 10% increase in the number of unemployed, there is an increase of 1.2% in total mortality, a 1.7% increase in cardiovascular disease, 1.3% more cirrhosis cases, 1.7% more suicides, 4.0% more arrests, and 0.8% more assaults reported to the police. A study by Christopher Ruhm in 2000 on the effect of recessions on health found that several measures of health actually improve during recessions. As for the impact of an economic downturn on crime, during the Great Depression, the crime rate did not decrease. The unemployed in the US often use welfare programs such as food stamps or accumulating debt because unemployment insurance in the US generally does not replace most of the income that was received on the job, and one cannot receive such aid indefinitely. Not everyone suffers equally from unemployment. In a prospective study of 9,570 individuals over four years, highly-conscientious people suffered more than twice as much if they became unemployed. The authors suggested that may because of conscientious people making different attributions about why they became unemployed or through experiencing stronger reactions following failure. There is also the possibility of reverse causality from poor health to unemployment. Some researchers hold that many of the low-income jobs are not really a better option than unemployment with a welfare state, with its unemployment insurance benefits. However, since it is difficult or impossible to get unemployment insurance benefits without having worked in the past, those jobs and unemployment are more complementary than they are substitutes.