Abstract
ObjectiveTo describe the socioeconomic and geographic distribution of smoking behaviour in Canada among 19,383 individuals (51% women) aged 15–85 years.MethodsCurrent smoking and quitting were modeled using standard and multilevel logistic regression. Markers of socioeconomic status (SES) were education and occupation. Geography was defined by Canadian Provinces.ResultsThe adjusted prevalence of current smoking was 20.2% (95% confidence interval [CI]: 18.8–21.7) and 63.7% (95% CI: 61.1–66.3) of ever smokers had quit. Current smoking decreased and quitting increased with increasing SES. The adjusted prevalence of current smoking was 32.8% (95% CI: 28.4–37.5) among the least educated compared to 11.0% (95% CI: 8.9–13.4) for the highest educated. Among the least educated, 53.0% (95% CI: 46.8–59.2) had quit, rising to 68.7% (95% CI: 62.7–74.1) for the most educated. There was substantial variation in current smoking and quitting at the provincial level; current smoking varied from 17.9% in British Columbia to 26.1% in Nova Scotia, and quitting varied from 57.4% in Nova Scotia to 67.8% in Prince Edward Island. Nationally, increasing education and occupation level were inversely associated with current smoking (odds ratio [OR] 0.64, 95% CI: 0.60–0.68 for education; OR 0.82, 95% CI: 0.77–0.87 for occupation) and positively associated with quitting (OR 1.27, 95% CI: 1.16–1.40 for education; OR 1.20, 95% CI: 1.12–1.27 for occupation). These associations were consistent in direction across provinces although with some variability in magnitude.ConclusionOur findings indicate that socioeconomic inequalities in smoking have persisted in Canada; current smoking was less likely and quitting was more likely among the better off groups and in certain provinces. Current prevention and cessation policies have not been successful in improving the situation for all areas and groups. Future efforts to reduce smoking uptake and increase cessation in Canada will need consideration of socioeconomic and geographic factors to be successful.
Highlights
In 2010, the Canadian Tobacco Use Monitoring Survey (CTUMS) reported an overall smoking prevalence of 17% in the Canadian population, down from 25% and the lowest since the surveys began in 1999 [11]; the rate of decline appears to have slowed in recent years
[21] Despite these important findings, many questions remain including: to what extent are socioeconomic differences a source of variation in current smoking and quitting across provinces? And is the between-provincial variation consistent for all socioeconomic status (SES) groups? Identifying geographic variation that is independent of individual characteristics and the consistency of this variation across SES groups will be an important step in tailoring future tobacco control priorities and/or priorities for resource allocations to programs aimed at tobacco use prevention and/or cessation
We summarized this model by presenting the odds ratio for current smoking and quitting overall in Canada and for each province given a 1-category increase in education and occupation
Summary
Smoking is the leading cause of death in high income countries such as Canada [1] and is a major risk factor for cardiovascular disease and cancer. [2,3] In Canada, approximately 20% of all deaths are attributable smoking according to 2005 estimates. [4] The majority of these deaths are due to the following causes: lung cancer, chronic obstructive pulmonary disease and ischemic heart disease. [5] About 50% of smokers die of smoking-related diseases and smokers who die between the ages of 35 and 69 in Canada lose on average more than 20 years of life.[6,7,8] Importantly, smoking cessation can reverse the risk for mortality; quitting by age 50 can halve the lifetime risk, while quitting by age 30 can reduce the risk close to that of never smokers. [9,10].In 2010, the Canadian Tobacco Use Monitoring Survey (CTUMS) reported an overall smoking prevalence of 17% in the Canadian population (aged 15 years and older), down from 25% and the lowest since the surveys began in 1999 [11]; the rate of decline appears to have slowed in recent years. [12] declines in the rates of smoking are good news, the overall trends may hide important socioeconomic and/or geographic variation. Identifying geographic variation that is independent of individual characteristics and the consistency of this variation across SES groups will be an important step in tailoring future tobacco control priorities and/or priorities for resource allocations to programs aimed at tobacco use prevention and/or cessation. It has not previously been shown whether the SES-smoking and SES-quitting relationships are qualitatively similar in both direction and magnitude across Canadian provinces. Identifying provinces where the gradients are shallower may be indicative of the success of certain programs aimed at tobacco use prevention and/or cessation in reaching all SES groups or suggestive of other social programs which aim to reduce overall inequalities in the provinces
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