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

Corsi DJ, Lear SA, Chow CK, Subramanian SV, Boyle MH, Teo KK - PLoS ONE (2013)

Bottom Line: Current smoking decreased and quitting increased with increasing SES.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.

View Article: PubMed Central - PubMed

Affiliation: Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, United States of America. djcorsi@hsph.harvard.edu

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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Related in: MedlinePlus

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.
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pone-0057646-g004: 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.

Mentions: We examined geographic variation in current smoking and quitting between provinces using a multilevel modeling approach. In this approach, provinces were treated as a random sample and between provincial differences in current smoking and quitting were assumed to come from a distribution estimated in the model. Compared to treating provinces as a fixed classification, the multilevel model yielded similar provincial-level estimates although the differences between provinces were found to be 2.2% narrower (6.0% vs 8.2%) for current smoking and 3.2% narrower (7.2% vs 10.4%) for quitting. The fixed effects estimates for each province, compared to the multilevel model estimates are shown for current smoking in Figure 4A and quitting in Figure 4B. The ordering of provinces was generally consistent in the two approaches. For current smoking, the provinces with lower than average rates of smoking (British Columbia, Ontario, and Prince Edward Island) in the fixed effects model also emerged as lower than average in the multilevel model, indicating the reliability of these estimates. The multilevel model tends to ‘shrink’ less reliable provincial estimates towards the national average; this is apparent in the quit rate model where a smaller range in the multilevel estimates for quitting was observed compared to the fixed effects approach (Figure 4B).


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

Corsi DJ, Lear SA, Chow CK, Subramanian SV, Boyle MH, Teo KK - PLoS ONE (2013)

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.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3585192&req=5

pone-0057646-g004: 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.
Mentions: We examined geographic variation in current smoking and quitting between provinces using a multilevel modeling approach. In this approach, provinces were treated as a random sample and between provincial differences in current smoking and quitting were assumed to come from a distribution estimated in the model. Compared to treating provinces as a fixed classification, the multilevel model yielded similar provincial-level estimates although the differences between provinces were found to be 2.2% narrower (6.0% vs 8.2%) for current smoking and 3.2% narrower (7.2% vs 10.4%) for quitting. The fixed effects estimates for each province, compared to the multilevel model estimates are shown for current smoking in Figure 4A and quitting in Figure 4B. The ordering of provinces was generally consistent in the two approaches. For current smoking, the provinces with lower than average rates of smoking (British Columbia, Ontario, and Prince Edward Island) in the fixed effects model also emerged as lower than average in the multilevel model, indicating the reliability of these estimates. The multilevel model tends to ‘shrink’ less reliable provincial estimates towards the national average; this is apparent in the quit rate model where a smaller range in the multilevel estimates for quitting was observed compared to the fixed effects approach (Figure 4B).

Bottom Line: Current smoking decreased and quitting increased with increasing SES.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.

View Article: PubMed Central - PubMed

Affiliation: Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, United States of America. djcorsi@hsph.harvard.edu

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.

Show MeSH
Related in: MedlinePlus