Smoking Prevalence In Canada Research Articles

Comparison of smoking prevalence in Canada before and after nicotine vaping product access using the SimSmoke model

ObjectivesThe public health impact of nicotine vaping products (NVPs) is subject to complex transitions between NVP and cigarette use. To circumvent the data limitations and parameter instability challenges in modeling transitions, we indirectly estimate NVPs’ impact on smoking prevalence and resulting smoking-attributable deaths using the SimSmoke simulation model.MethodsCanada SimSmoke uses age- and sex-specific data on Canadian population, smoking prevalence and tobacco control policies. The model incorporates the impact of cigarette-oriented policies on smoking prevalence but not the explicit contribution of NVPs. The model was calibrated from 1999 to 2012, thereby projecting smoking prevalence before NVPs were widely used in Canada. The NVP impact on smoking prevalence is inferred by comparing projected 2012–2020 smoking trends absent NVPs to corresponding trends from two Canadian national surveys. We further distinguish impacts before and after NVPs became regulated in 2018 and more available.ResultsComparing 2012–2020 survey data of post-NVP to SimSmoke projected smoking prevalence trends, one survey indicated an NVP-related relative reduction of 15% (15%) for males (females) age 15+, but 32% (52%) for those ages 15–24. The other survey indicated a 14% (19%) NVP-related smoking reduction for ages 18+, but 42% (53%) for persons ages 18–24. Much of the gain occurred since Canada relaxed NVP restrictions. NVP-related 2012–2020 smoking reductions yielded 100,000 smoking-attributable deaths averted from 2012 to 2060.ConclusionSmoking prevalence in Canada, especially among younger adults, declined more rapidly once NVPs became readily available. The emergence of NVPs into the Canadian marketplace has not slowed the decline in smoking.

The Differential Impact of the 2000 Canadian Graphic Warning Label Policy on Smoking Prevalence by Sex and Education: A Difference-in-Difference-in-Difference Model.

Using a quasiexperimental design, we compared the impact of the 2000 Canadian introduction of graphic warning labels (GWLs) on differences in smoking prevalence by sex and education, to the United States, where no GWLs were introduced. We pooled 1999-2004 data from the Canadian Tobacco Use Monitoring Survey and the U.S. Behavioral Risk Factor Surveillance System. We used a difference-in-difference (DD) model to assess the impact of Canadian policy introduction on smoking prevalence, and a difference-in-difference-in-difference (DDD) model to examine differences in the policy impact by sex and education, comparing Canada (the treatment group) with the United States (the control group). From 1999 to 2004, smoking prevalence decreased from 23.7% to 18.6% in Canada, and from 21.7% to 20.0% in the United States. Results from the DD regression models showed that Canadian respondents reported lower odds of being a current smoker compared to the U.S. respondents following the 2000 introduction of GWLs (OR = 0.84, 95% CI = 0.74-0.94). The DDD model showed that the impact of the Canadian GWLs versus the United States did not differ by sex or education. The 2000 Canadian GWL policy reduced smoking prevalence overall, with similar reductions for males and females and across education levels. The impact of the Canadian GWLs in reducing smoking prevalence did not reduce differences by sex or education. Although beneficial for all smokers, GWLs may not serve to decrease existing disparities, especially those by socioeconomic status. Existing evidence shows that GWL implementation is associated with reductions in smoking prevalence. But there is limited evidence from past evaluation studies on whether the impact of GWLs on smoking prevalence differs by sociodemographic subgroup. Our findings confirm existing studies that the 2000 implementation of GWLs in Canada was significantly associated with an overall reduction in smoking prevalence in Canada compared to the United States. However, our study improves existing evidence by showing that the impact of the Canadian GWLs on smoking prevalence did not differ by sex or education, and thus did not reduce existing smoking disparities by educational levels.

Prevalence of Cigarette Smoking Among Adult Emergency Department Patients in Canada.

IntroductionTobacco smoking is a priority public health concern, and a leading cause of death and disability globally. While the daily smoking prevalence in Canada is approximately 9.7%, the proportion of smokers among emergency department (ED) patients has been found to be significantly higher. The purpose of this survey study was to determine the smoking prevalence of adult ED patients presenting to three urban Canadian hospitals, and to determine whether there was an increased prevalence compared to the general public.MethodsA verbal questionnaire was administered to adult patients aged 18 years and older presenting to Royal University Hospital, St. Paul’s Hospital, and Saskatoon City Hospital in Saskatoon, Saskatchewan. We compared patients’ smoking habits to Fagerström tobacco dependence scores, readiness to quit smoking, chief complaints, Canadian Triage Acuity Scale scores, and willingness to partake in ED-specific cessation interventions.ResultsA total of 1190 eligible patients were approached, and 1078 completed the questionnaire. Adult Saskatoon ED patients demonstrated a cigarette smoking prevalence of 19.6%, which is significantly higher than the adult Saskatchewan public at 14.65% (P<0.0001). Out of the smoking cohort, 51.4% indicated they wanted to quit smoking and would partake in ED-specific cessation counselling, if available. Of the proposed interventions, ED cessation counselling was most popular among patients (62.4%), followed by receiving a pamphlet (56.2%), and referral to a smokers’ quit line (49.5%).ConclusionThe higher smoking prevalence demonstrated among ED patients highlights the need for a targeted intervention program that is feasible for the fast-paced ED environment. Training ED staff to conduct brief cessation counselling and referral to community supports for follow-up could provide an initial point of contact for smokers not otherwise receiving cessation assistance.

Socio-spatial inequalities in smoking among young adults: What a 'go-along' study says about local smoking practices.

Smoking prevalence in Canada has declined; yet, not among all segments of the population. Residents of high-deprivation neighbourhoods and young adults are over-represented among current smokers. There is a dearth of theoretically informed research focused on better understanding the connection between smoking, social inequalities, and place among young adults. To contribute to this understudied area, we undertook a qualitative study drawing upon the collective lifestyles framework. We conducted walking interviews (go-alongs) with 27 young adults (smokers and non-smokers) living in five diverse urban neighbourhoods in Montreal, Canada. We present the findings as neighbourhood portraits wherein participants' accounts revealed how local smoking practices shaped and were shaped by rules and regulations and the meaning and use of neighbourhood resources. In the discussion we reflect on the opportunities and constraints to smoking with a focus on young adults. We also consider the possible implications for socio-spatial inequalities in smoking and the relationship to tobacco control strategies.

Trends in Social Norms Towards Smoking Between 2002 and 2015 Among Daily Smokers: Findings From the International Tobacco Control Four Country Survey (ITC 4C).

ObjectiveTo assess trends in daily smokers' social norms and opinions of smoking between 2002 and 2015 in Canada, the United States, the United Kingdom, and Australia.MethodData were from wave 1 (2002) to wave 9 (2013–2015) of the longitudinal International Tobacco Control Four Country Survey (Canada, the United States, the United Kingdom, Australia), involving 23 831 adult daily smokers. Generalized estimating equation logistic regression models, adjusted for demographics and survey design effects, assessed associations of wave and country with outcomes: (A) over half of five closest friends smoke, (B) agreeing that people important to you believe you should not smoke, (C) agreeing that society disapproves of smoking, and (D) negative opinion of smoking.ResultsBetween 2002 and 2015, adjusting for covariates, (A) over half of five closest friends smoke did not change (56% vs. 55%; adjusted odds ratio [AOR] = 0.95 [95% Confidence Interval = 0.85–1.07]), (B) agreeing that people important to you believe you should not smoke generally decreased (89% vs. 82%; AOR = 0.54 [0.46–0.64]) despite an increase around 2006–2007, (C) agreeing that society disapproves of smoking increased between 2002 and 2006–2007 (83% vs. 87%; AOR = 1.38 [1.24–1.54]) then decreased until 2013–2015 (78%; AOR = 0.74 [0.63–0.88]), and (D) negative opinion of smoking decreased between 2002 and 2010–2011 (54% vs. 49%; AOR = 0.83 [0.75–0.91]) despite an increase around 2005–2006 and at the final wave (2013–2015). Except friend smoking, Canada had the greatest, and the United Kingdom the lowest, antismoking social norms and opinions.ConclusionsExcept friend smoking and opinion of smoking, daily smokers' social norms became less antismoking between 2002 and 2015 despite increases around 2006–2007. Several potential explanations are discussed yet remain undetermined.ImplicationsIncreasingly comprehensive tobacco control policies alongside decreasing smoking prevalence in Canada, the United States, the United Kingdom, and Australia have led to the assumption that smoking has become denormalized in these countries. Absent from the literature is any formal assessment of social norms towards smoking over time. Contrary to our hypotheses, this study found that the injunctive social norms of daily smokers became less antismoking between 2002 and 2015, despite increases around 2006–2007. There was no change over time in the proportion of daily smokers who report that over half of their five closest friends smoke.

LO37: Prevalence of cigarette smoking amongst adult emergency department patients

Introduction: Tobacco smoking is a priority public health concern, and a leading cause of death and disability globally. While the smoking prevalence in Canada is approximately 13-18%, the proportion of smokers among emergency department (ED) patients has been found to be significantly higher. This disparity primes the emergency department as a critical environment to provide smoking cessation counselling and support. Methods: A verbal questionnaire was administered to adult patients (18+) presenting to Royal University, Saskatoon City, and St. Paul's Hospital ED's. Patients were excluded if they were underage, too ill, or physically/mentally unable to complete the questionnaire independently. Patients’ smoking habits were also correlated with Fagerstrom tobacco dependence scores, chief complaints, Canadian Triage Acuity Scale (CTAS) scores, and willingness to partake in ED specific cessation counselling. Data were analyzed using IBM SPSS software to determine smoking prevalence and compared to Statistics Canada data using chi-square tests. Results: In total, 1190 eligible patients were approached, and 1078 completed the questionnaire. Adult Saskatoon ED patients demonstrated a cigarette smoking prevalence of 19.6%, which is significantly higher than the general adult Saskatchewan public at 15.1% (p &amp;lt; 0.0001). Comparing smoking and non-smoking cohorts, there are no significant differences in CTAS scores (p = 0.60). Of the proposed cessation interventions, ED cessation counselling was most popular among patients (62.4%), followed by receiving a pamphlet (56.2%), and being contacted by a smokers’ quit line (49.5%). Out of the smoking cohort, 51.4% indicated they want to quit smoking, and would be willing to partake in ED-specific cessation counselling, if available. Additionally, 88.1% of current smokers started smoking when they were less than 19 years old. Conclusion: The higher smoking prevalence demonstrated in ED patients highlights the need for a targeted intervention program that is feasible for the fast-paced environment. Quit attempts have been demonstrated to be more efficacious with repeated interventions, which could be achieved by training ED staff to conduct brief motivational interviews and faxing referrals to a smokers' quit line for follow-up. Furthermore, pediatric ED's could be a valuable location for cigarette smoking screening, as the majority began smoking in their adolescence.

Is there a link between motor vehicle collisions and being a cigarette smoker in Canada? Analysis of survey data from Ontario from 2002 to 2014

ABSTRACTObjective: Although most research on drugs and driving has focused on the use of alcohol and cannabis, research that has been conducted on cigarette smoking and collisions has found that smokers have an increased collision involvement. Studies dating from 1967 through 2013 have shown a crude relative risk of about 1.5 among smokers compared to nonsmokers. In Canada, the association between smoking and collisions has not been recently investigated. Studies that have examined the association between smoking and collisions often did not control for all confounding factors, such as alcohol use and driving exposure, which have been associated with increased collision rates. Additionally, a number of these studies were examined in countries and at times when prevalence of smoking was much higher than is currently the case in Canada. The purpose of this research is to examine the association between self-reported current smoking and past-year collision involvement, controlling for confounding factors, in a large representative sample of adult drivers in Ontario, Canada, from 2002 and 2014.Method: Data are based on the Centre for Addiction and Mental Health (CAMH) Monitor, an ongoing, rolling telephone survey of Ontario adults that provides epidemiological surveillance of indicators related to alcohol, tobacco, and other drug use, as well as physical and mental health. The survey uses random-digit-dialing methods via Computer-Assisted Telephone Interview, with response rates over 50%.Results: Prevalence of self-reported collision involvement within the past year for 2002–2014 was 8.6% among those who currently smoke compared to 6.5% of nonsmokers. Logistic regression analysis, controlling for the potential confounding effects of sociodemographics, driving exposure measures, drinking frequency, and hazardous alcohol use, found that the overall odds for collision involvement in the preceding year among current smokers for 2002–2014 was 1.27 (95% confidence interval [CI], 1.06–1.53) times that of nonsmokers.Conclusions: These findings indicate that despite a substantial reduction in overall prevalence of smoking in Canada, smokers still have a significantly increased odds of collision involvement, even when controlling for alcohol and exposure. Additionally, the results are consistent with the increased odds/risks of motor vehicle collisions found in other countries.

Estimation of smoking prevalence in Canada: Implications of survey characteristics in the CCHS and CTUMS/CTADS.

One of the main enterprises associated with tobacco control is surveillance, that is, to measure and follow over time the extent of smoking among the Canadian population. While surveillance systems have been in place for more than 50 years, knowing the exact prevalence of smoking in Canada continues to be a complex matter and understanding its estimation requires a critical appreciation of our national surveys' idiosyncrasies. This commentary describes the two Statistics Canada surveys that are most commonly used to examine smoking prevalence in this country: the Canadian Community Health Survey (CCHS) and the Canadian Tobacco, Alcohol and Drugs Survey (CTADS). It compares estimates of smoking prevalence obtained from each source and examines potential reasons for their noticeable discrepancies. Canadian researchers interested in smoking prevalence should be aware of current and future limitations, and should discuss and analyze these accordingly.

Prevalence and characteristics of flavoured tobacco use among students in grades 10 through 12: a national cross-sectional study in Canada, 2012\u20132013

BackgroundTobacco use is the leading cause of preventable death in Canada and the world. Despite documented decreases in the prevalence of smoking in Canada, increases in flavoured tobacco use by its youth poses a serious public health concern. This study examined the prevalence and characteristics of flavoured tobacco use among a national sample of Canadian students in grades 10 through 12.MethodsThis study used a cross-sectional design on a nationally generalizable, school-based, Youth Smoking Survey (YSS), 2012–2013. It incorporated data from a representative sample of 19,979 students in grades 10–12 from across Canada. Univariate and multivariate logistic regression models were used to examine differences in flavoured tobacco use (menthol cigarettes, flavoured little cigar or cigarillo, flavoured cigar, flavoured tobacco in water pipe [hookah]) by demographic (sex, grade and ethnicity) and social characteristics (friends, siblings, parents/guardians who are smokers and weekly personal spending money).ResultsThis study found that 14.8% of the participating students used flavoured tobacco in the past 30-days. Results of the logistic regression analysis show that flavoured tobacco use was significantly higher among male students [(OR = 1.63; 95% CI = 1.36–1.95)], who had at least one friend or sibling who smoke [(OR = 2.20; CI = 1.62 to 2.99) and (OR = 1.51; CI = 1.22 to 1.88), respectively] and who received greater than $20/week in personal spending money [(OR = 1.76; CI = 1.26 to 2.45)].ConclusionsThe results of our study indicate that flavoured tobacco use is a growing public health concern and has a strong appeal among youth in Canada. This is a particularly troubling finding, especially in light of the fact that there is a national ban on certain flavoured tobacco products. To be effective, strategies specifically tailored for youth using flavoured tobacco would require appropriate educational/prevention initiatives, more comprehensive legislation and better regulatory mechanisms.

Hardcore smoking among continuing smokers in Canada 2004-2012.

Decline in adult smoking prevalence in Canada seems to have slowed, suggesting that smoking rate may have plateaued. It is unclear whether this, at least in part, can be interpreted as evidence that some groups or individuals are becoming less resistant to tobacco control measures. This study examined trends in the prevalence of hardcore smoking in Canada. A nationally representative sample of adult daily smokers was drawn from the Canadian Tobacco Use Monitoring Survey 2004 to 2012 (n = 13,861). Hardcore smokers were defined in two ways: Hardcore 1 comprised those that reported no quit attempt, no quit intention, and smoke their first cigarette within 30 min after awakening and hardcore 2 comprised hardcore 1 plus those smoking 15 or more cigarettes per day. Logistic regression was used to examine associations between hardcore measures and year and socio-demographic variables. Overall, there was no significant difference in hardcore smoking over time for the periods covered in this study. Analysis examining a single hardcore component, time-to-first cigarette (TTFC) after awakening as a measure of nicotine dependence showed similar results. A clear marked socioeconomic gradient in TTFC was found, those with university education (OR 0.46, 95 % CI 0.37-0.57), college (OR 0.51, 95 % CI 0.42-0.63), secondary (OR 0.68, 95 % CI 0.57-0.82) were significantly less likely to have TTFC ≤ 30 min compared with less than secondary education. This study does not support the hardening hypothesis when interpreted as the increase in hardcore smokers over time.

Cigarette graphic warning labels and smoking prevalence in Canada: a critical examination and reformulation of the FDA regulatory impact analysis

BackgroundThe estimated effect of cigarette graphic warning labels (GWL) on smoking rates is a key input to the Food and Drug Administration's (FDA) regulatory impact analysis (RIA), required by law...

Smoking in Context: A Multilevel Analysis of 49,088 Communities in Canada

<h3>Background</h3> The extent to which the prevalence of smoking in Canada varies across geographic areas independently of individual characteristics has not been quantified. <h3>Purpose</h3> To estimate the extent and potential sources of geographic variation in smoking among communities, health regions, and provinces/territories in Canada. <h3>Methods</h3> Data are from the Canadian Community Health Surveys conducted between 2001 and 2008 (<i>n</i>=461,709). Current cigarette smoking among adults (aged ≥18 years) was the primary outcome. Individual-level markers of SES were education, household income, and occupation. Contextual variables potentially related to smoking considered were provincial cigarette taxes, workplace smoking bans, and collective family norms discouraging smoking in communities. A multilevel logistic regression analysis was conducted to model variation in smoking at the geographic scale of communities, health regions, and provinces. <h3>Results</h3> Overall, the contribution of geography as a percentage of the total variation in smoking was 8.4%, with 2.4% attributable to provinces, 1.2% attributable to health regions, and 4.8% attributable to communities after adjusting for age, gender and survey period. In models that accounted for socioeconomic and demographic characteristics in addition to age and gender, the contribution of geography to the total variation in smoking was attenuated to 4.1%; with 2.0% at the province level, 0.4% at the health region level, and 1.7% at the community level. Within provinces/territories, the community variation in smoking ranged from 2.4% in Prince Edward Island to 9.1% in British Columbia. Nationally, 71% of community and 21% of provincial differences in smoking were explained by individual, socioeconomic, and demographic factors alone; the inclusion of contextual covariates explained an additional 27% of the variation among communities. Collective family norms discouraging smoking in a community was the strongest contextual predictor of individual smoking; provincial cigarette taxes and workplace bans were only modestly related to individual smoking behavior. <h3>Conclusions</h3> Geographic variation in smoking remained after accounting for individual, socioeconomic, and demographic characteristics, suggesting the importance of place, at the level of provinces and communities in Canada. Remaining community variation in smoking was largely attenuated after accounting for collective family norms discouraging smoking. Area-level influences such as the social and/or environmental conditions of provinces and communities may be important sources of variation in smoking and therefore need to be considered if rates of smoking are to be modified.

Does Level of Tobacco Control Relate to Smoking Prevalence in Canada: A National Survey of Public Health Organizations

To describe levels of tobacco control “effort” in public health organizations across provinces, and to test the hypothesis that “effort” is associated with the prevalence of daily smoking. Data were drawn from a national survey (Oct 2004-Apr 2005) of all public health organizations engaged in chronic disease prevention in Canada in 2004. We investigated the association between “effort” and decline in smoking prevalence (CTUMS, 1 999-2009) across provinces in an écologie study design. “Effort” was assessed using two indicators: percent of public health organizations engaged in tobacco control, and mean level of involvement in engaged organizations. Of 216 organizations, 88% had undertaken tobacco control activities in the three years prior to data collection and were categorized as “engaged". Level of involvement in tobacco control was highest in community-at-large settings; and it was generally higher for population- than for individual-level strategies. Nova Scotia reported higher levels of involvement than other provinces. There was substantial variability in “effort” across provinces. High-"effort” provinces (BC, NS, ON, QC) experienced, on average, improvement in the “change in smoking prevalence” score (1999 to 2009). The findings provide evidence that provincial tobacco control “effort” relates to declines in smoking prevalence. Given that smoking remains a critical public health issue, the kinds of data reported herein are needed to inform the debate on how best to invest in tobacco control infrastructure to combat the most important public health threat of our times.

Does level of tobacco control relate to smoking prevalence in Canada: a national survey of public health organizations.

To describe levels of tobacco control "effort" in public health organizations across provinces, and to test the hypothesis that "effort" is associated with the prevalence of daily smoking. Data were drawn from a national survey (Oct 2004-Apr 2005) of all public health organizations engaged in chronic disease prevention in Canada in 2004. We investigated the association between "effort" and decline in smoking prevalence (CTUMS, 1999-2009) across provinces in an ecologic study design. "Effort" was assessed using two indicators: percent of public health organizations engaged in tobacco control, and mean level of involvement in engaged organizations. Of 216 organizations, 88% had undertaken tobacco control activities in the three years prior to data collection and were categorized as "engaged". Level of involvement in tobacco control was highest in community-at-large settings; and it was generally higher for population- than for individual-level strategies. Nova Scotia reported higher levels of involvement than other provinces. There was substantial variability in "effort" across provinces. High-"effort" provinces (BC, NS, ON, QC) experienced, on average, improvement in the "change in smoking prevalence" score (1999 to 2009). The findings provide evidence that provincial tobacco control "effort" relates to declines in smoking prevalence. Given that smoking remains a critical public health issue, the kinds of data reported herein are needed to inform the debate on how best to invest in tobacco control infrastructure to combat the most important public health threat of our times.

Esophageal Cancer in Canada: Trends according to Morphology and Anatomical Location

Esophageal adenocarcinoma has one of the fastest rising incidence rates and one of the lowest survival rates of any cancer type in the Western world. However, in many countries, trends in esophageal cancer differ according to tumour morphology and anatomical location. In Canada, incidence and survival trends for esophageal cancer subtypes are poorly known. Cancer incidence and mortality rates were obtained from the Canadian Cancer Registry, the National Cancer Incidence Reporting System and the Canadian Vital Statistics Death databases for the period from 1986 to 2006. Observed trends (annual per cent change) and five-year relative survival ratios were estimated separately for esophageal adenocarcinoma and squamous cell carcinoma, and according to location (upper, middle, or lower one-third of the esophagus). Incidence rates were projected up to the year 2026. Annual age-standardized incidence rates for esophageal cancer in 2004 to 2006 were 6.1 and 1.7 per 100,000 for males and females, respectively. Esophageal adenocarcinoma incidence rose by 3.9% (males) and 3.6% (females) per year for the period 1986 to 2006, with the steepest increase in the lower one-third of the esophagus (4.8% and 5.0% per year among males and females, respectively). In contrast, squamous cell carcinoma incidence declined by 3.3% (males) and 3.2% (females) per year since the early 1990s. The five-year relative survival ratio for esophageal cancer was 13% between 2004 and 2006, approximately a 3% increase since the period from 1992 to 1994. Projected incidence rates showed increases of 40% to 50% for esophageal adenocarcinoma and decreases of 30% for squamous cell carcinoma by 2026. Although esophageal cancer is rare in Canada, the incidence of esophageal adenocarcinoma has doubled in the past 20 years, which may reflect the increasing prevalence of obesity and gastroesophageal reflux disease. Declines in squamous cell carcinoma may be the result of the decreases in the prevalence of smoking in Canada. Given the low survival rates and the potential for further increases in incidence, esophageal adenocarcinoma warrants close attention.

Psychiatric Hospitals and Workplace Smoking Bans: A Biological and Sociological Commentary

AbstractSmoking is widely known as an architect of well-documented, negative health outcomes. The advent of legislated actions to ban work- and public-place smoking has reduced the overall smoking prevalence in Canada and around the world. However, what is often overlooked are patients with psychiatric illness who are confined in psychiatric institutions and are not able to take advantage of designated smoking areas. The aim of this commentary is to raise awareness of potential inequitable conditions that are inherent in workplace smoking restrictions particularly for psychiatric patients. A biological and social equity perspective will frame the discourse of the issue.

Tobacco smoking and colorectal cancer: a population-based case-control study in Newfoundland and Labrador.

Newfoundland and Labrador (NL) has the highest incidence rate of both colorectal cancer (CRC) and smoking prevalence in Canada. The objective of this study was to examine if CRC is associated with smoking in this population. Newly diagnosed cases identified between 1999 and 2003 were frequency-matched by 5-year age group and sex with controls selected from the residents of NL through random digit dialing. A total of 702 cases and 717 controls consented to participate in the study and completed a set of self-administered questionnaires. Measures of tobacco use included type of tobacco, age of initiation of smoking, years of smoking, years since started smoking, number of cigarettes smoked daily, pack years, and years since abstention from smoking. Odds ratios were estimated using multivariate logistic regression. In comparison with non-smokers, former and current smokers were at a significantly elevated risk of CRC with corresponding odds ratios of 1.36 and 1.96. The risk significantly increased with cigarette smoking years, the amount of cigarettes smoked daily, and cigarette pack years. The risk significantly decreased with years of abstention from smoking cigarettes. This association was stronger among drinkers and in men. In addition, this effect was observed to be slightly stronger for rectum than colon cancer. In summary, cigarette smoking increased the risk of CRC in the NL population. The risk of CRC associated with cigarette smoking varies by sex, drinking status, and site of CRC.

Tobacco Control and Nicotine Addiction in Canada: Current trends, Management and Challenges

Despite a significant decrease in tobacco use over the past four decades, cigarette smoking remains the leading preventable cause of death and disease in Canada. Nicotine addiction, unequal access to available support programs and gaps in continuity of health care are recognized as the main barriers to smoking cessation. To overcome these obstacles and to reach the Federal Tobacco Control Strategy goal of reducing smoking prevalence in Canada from 19% to 12% by 2011, several Canadian health care organizations developed extensive sets of recommendations. Improved access to affordable pharmacotherapies and behavioural counselling, better training of health care professionals and the addition of systemic cessation measures appear to be the key components in all of the proposed recommendations. The present article provides an overview of the current approaches to smoking cessation in Canada, describes the remaining challenges, and outlines recent recommendations that are geared toward not only tobacco control but also overall improvement in long-term health outcomes.

What are the effects of tobacco policies on vulnerable populations? A better practices review.

While comprehensive tobacco policies have reduced the prevalence of smoking in Canada, some groups remain vulnerable to tobacco use and display high rates of smoking. This article reviews three types of tobacco policies--tax and price, smoking location restrictions and sales restrictions--and examines the consequences for Aboriginal people, youth and low-income people. A better practices review model was used to assess the strength of studies published between 1990 and 2004 that examined the effects of these tobacco policies on the three vulnerable populations of interest. A total of 72 studies were assessed and 42 judged medium or high strength. A gender-based and diversity analysis was applied to assess the differential impacts on females and males and/or diverse characteristics within these populations. Intended and unintended consequences were examined. Few studies assessed the potential or differential effects of tobacco policies on the three selected populations. In these, it was difficult to disentangle the effects of each policy in a comprehensive tobacco control environment, and there is need for improved indicators and greater attention to sex and gender analysis. Research is required to measure the intended and unintended impacts of tobacco policies on populations vulnerable to tobacco use. There are problems in assessing these studies that could be resolved with more precise indicator development. An equity-based framework for assessing the effects of tobacco policies is needed that is conceptually linked to health determinants and inequities. The article concludes with a set of recommendations for research, evaluation, policy and ethics arising from this review.

What Are the Effects of Tobacco Policies on Vulnerable Populations?

Methods: A better practices review model was used to assess the strength of studies published between 1990 and 2004 that examined the effects of these tobacco policies on the three vulnerable populations of interest. A total of 72 studies were assessed and 42 judged medium or high strength. A gender-based and diversity analysis was applied to assess the differential impacts on females and males and/or diverse characteristics within these populations. Intended and unintended consequences were examined. Findings: Few studies assessed the potential or differential effects of tobacco policies on the three selected populations. In these, it was difficult to disentangle the effects of each policy in a comprehensive tobacco control environment, and there is need for improved indicators and greater attention to sex and gender analysis. Conclusions: Research is required to measure the intended and unintended impacts of tobacco policies on populations vulnerable to tobacco use. There are problems in assessing these studies that could be resolved with more precise indicator development. An equity-based framework for assessing the effects of tobacco policies is needed that is conceptually linked to health determinants and inequities. The article concludes with a set of recommendations for research, evaluation, policy and ethics arising from this review. Background: While comprehensive tobacco policies have reduced the prevalence of smoking in Canada, some groups remain vulnerable to tobacco use and display high rates of smoking. This article reviews three types of tobacco policies - tax and price, smoking location restrictions and sales restrictions - and examines the consequences for Aboriginal people, youth and low-income people.