Abstract
BackgroundSmoking prevalence varies over time and place due to various social, environmental and policy influences. However, its spatio-temporal patterns at small-area level are poorly understood. This paper attempts to describe spatio-temporal patterns of adult (age > 18) and youth (age 12–18) smoking prevalence at the municipality level in Ontario, Canada and identify potential socio-demographic, environmental, and policy factors that may affect the patterns.MethodsMultilevel temporal and spatio-temporal models were fitted to the Canadian Community Health Surveys (2000–2008) data. In total, approximately 160,000 respondents 12 years of age and over living in Ontario were used for this analysis.ResultsThe results indicate that during the time period 2003–2008, age-sex stratified smoking prevalence dropped for both the adult and youth populations in Ontario. The tendency is more obvious for youth than for adults. Smoking restriction at home is a leading factor associated with the decline of adult smoking prevalence, but does not play the same role for youth smoking. Despite the overall reduction, smoking prevalence varies considerably across the province and inequalities among municipalities have increased. Clusters of high and low smoking prevalence are both found within the study region.ConclusionThe identified spatial and temporal variations help to indicate problems at the local level and suggest future research directions. Identifying these variations helps to strengthen surveillance and monitoring of smoking behaviours and the evaluation of policy and program development at the small-area level.
Highlights
Smoking prevalence varies over time and place due to various social, environmental and policy influences
Data Data on 165,372 respondents from 2000 to 2008 in Ontario, Canada were collected in the Canadian Community Health Surveys (CCHS)
In Ontario, about half of the sample respondents were selected from an area frame and the other half from a list frame of telephone numbers
Summary
Smoking prevalence varies over time and place due to various social, environmental and policy influences. This paper attempts to describe spatio-temporal patterns of adult (age > 18) and youth (age 12–18) smoking prevalence at the municipality level in Ontario, Canada and identify potential socio-demographic, environmental, and policy factors that may affect the patterns. In Canada, the production and sale of contraband tobacco products has become widespread [5,6] All these trends may undermine the effectiveness of tobacco control policies and result in a rebound or a halt to the decline of smoking prevalence. Accurate estimation of smoking prevalence over time and over small areas is important for measuring progress towards antismoking objectives, revealing underlying social and environmental determinants, evaluating current antismoking campaigns and policies, and planning for specific area-based anti-smoking programs
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