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. 2013;8(2):e57646.
doi: 10.1371/journal.pone.0057646. Epub 2013 Feb 28.

Socioeconomic and geographic patterning of smoking behaviour in Canada: a cross-sectional multilevel analysis

Daniel J Corsi  1 , Scott A Lear, Clara K Chow, S V Subramanian, Michael H Boyle, Koon K Teo
Affiliations

Socioeconomic and geographic patterning of smoking behaviour in Canada: a cross-sectional multilevel analysis

Daniel J Corsi et al. PLoS One. 2013.

Abstract

Objective: To describe the socioeconomic and geographic distribution of smoking behaviour in Canada among 19,383 individuals (51% women) aged 15-85 years.

Methods: Current 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.

Results: The 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.

Conclusion: Our 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.

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Conflict of interest statement

Competing Interests: All authors declare no conflicts of interest or competing interests.

Figures

Figure 1
Figure 1. Adjusted prevalence of current smoking in Canadian provinces for men (left) and women (right) aged 15 years and above, Canadian Tobacco Use Monitoring Survey 2010.
Darker colours indicate higher prevalence. Estimates adjusted for age, sex, marital status, occupation, education. Province name abbreviations: Alta. Alberta; B.C. British Columbia; Man. Manitoba; N.B. New Brunswick; N.L. Newfoundland; N.S. Nova Scotia; O.N. Ontario; P.E.I. Prince Edward Island; Que. Quebec; Sask. Saskatchewan; data not available for Yukon Territory (Y.T.), Northwest Territories (N.W.T), or Nunavut (Nvt.).
Figure 2
Figure 2. Adjusted prevalence of quitting in Canadian provinces for men (left) and women (right) aged 15 years and above, Canadian Tobacco Use Monitoring Survey 2010.
Darker colours indicate higher prevalence. Estimates adjusted for age, sex, marital status, occupation, education. Province name abbreviations: Alta. Alberta; B.C. British Columbia; Man. Manitoba; N.B. New Brunswick; N.L. Newfoundland; N.S. Nova Scotia; O.N. Ontario; P.E.I. Prince Edward Island; Que. Quebec; Sask. Saskatchewan; data not available for Yukon Territory (Y.T.), Northwest Territories (N.W.T), or Nunavut (Nvt.).
Figure 3
Figure 3. Adjusted prevalence of current smoking and quitting in Canada by demographic and socioeconomic characteristics and province.
BC British Columbia; PEI Prince Edward Island.
Figure 4
Figure 4. Comparison of adjusted prevalence estimates for current smoking and quitting for Canadian provinces based on mutually adjusted fixed effects and multilevel logistic regression models.
Province name abbreviations: AB Alberta; BC British Columbia; MB Manitoba; NB New Brunswick; NL Newfoundland; NS Nova Scotia; ON Ontario; PE Prince Edward Island; QC Quebec; SK Saskatchewan.
Figure 5
Figure 5. Odds ratios for current smoking for a one-category increase in the level of education and occupation across Canadian provinces.
BC British Columbia; PEI Prince Edward Island.
Figure 6
Figure 6. Odds ratios for quitting for a one-category increase in the level of education and occupation across Canadian provinces.
BC British Columbia; PEI Prince Edward Island.
See this image and copyright information in PMC

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