Neighborhood factors and quitting smoking in Ontario
Presented by: Sarah Edwards*, Susan Bondy*, Russell Callaghan†,*, Robert Mann‡,*
*Dalla Lana School of Public Health, University of Toronto† University of Northern British Columbia
‡ Centre for Addiction and Mental Health, University of Toronto
1 in 5 Ontarians smoke
Group Behaviour Therapy
Individual Counselling
Nicotine Replacement Therapies
0 10 20 30 40 50 60 70 80 90100% Increase in cessation with use
ObjectiveTo examine the association between cessation strategies used in attempts to quit and neighborhood factors.
?
Neighborhood DeprivationSmoking associated with: • Neighborhood deprivation • Neighborhoods with low socioeconomic status
Use of cessation supports?
Urban-rural continuum
Does use of cessation strategy differ by rural/urban location?
Measure urban-rural continuum from Statistics Canada
Ontario Tobacco Survey (OTS): Panel study of smokers
• 4500 Ontario smokers (2005-2008)• Representative telephone sample• Followed-up every 6 months for up to 3 years
• Current analysis: • Smoked at least 100 cigarettes (N = 4049)• Quit attempts at reported at each follow-up (N = 5481
in 2080 individuals)
Methods – Data Sources
OTS Postal Code
Outcome• Quit attempt – reported at least one serious quit
attempt or reported that they had stopped smoking for a period of time during follow-up (even if they do not identify it as an actual quit attempt) in the past 6 months– Assisted - reported using at least one of the following:• Nicotine patches, gum, chewing pieces, lozenges or inhalers• Zyban, bupropion, Wellbutrin, Champix or varenicline• Group counselling or group support• Specialized addiction counsellor
– Unassisted– did not report using any of the above
Analyses• Level of analysis individual, repeated measures• Neighbourhood measures ecological level• Analysis needs to take into account impact of non-
independence of data• Mixed-effects models were used to examine
relationship between neighborhood factors and quit outcomes
• Models were adjusted for clustering and potential individual-level confounders (age, sex, number of previous quit attempts, self-perceived addiction level)
Assisted Unassisted
57.2
42.844.0
56.0
Urban Rural
Quit Attempts
Wei
ghte
d %
The odds of quitting with assistance is 30% less for smokers living in rural versus urban areas in Ontario (adjusted p-value = 0.04).
Assisted Unassisted
49.1 50.7
66.9
33.0
Least Ethnic Concentration Most Ethnic Concentration
Quit Attempts
Wei
ghte
d %
The odds of quitting with assistance is 63% more for smokers living in areas with the least versus most ethnic concentration in
Ontario (adjusted p-value = 0.004).
No Significant Differences
Neighborhood level• Deprivation• Instability• Dependency
Conclusions• There is some evidence Ontario smokers living
in rural areas are less likely to quit with assistance (may be a function of access) and there are some ethnic differences in terms of use or non-use of assisted quitting methods
• Other area level measures were not significantly associated with type of quit attempt
Limitations
• Self-report quit attempts• Possible more than 1 quit attempt per 6
month period• Individual-level variables not available for
neighborhood-level variables using ecological measures
Next Steps• Examine additional social-environment
factors:– Occupation (blue versus white collar)– Access to care (including interactions with
rural/urban measure)– Social norms
Acknowledgements
The OTS is an initiative of Ontario Tobacco Research Unit which receives funding from the Ontario Ministry of Health and Long-Term Care.
My work is funded by the CIHR Training Grant in Population Intervention for Chronic Disease Prevention: A Pan-Canadian Program (Grant #: 53893).