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Trends in smoking in Canada from 1950 to 2011: progression of the tobacco epidemic according to socioeconomic status and geography

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Abstract

Purpose

Smoking has declined in Canada in recent years. However, it is not clear whether differences in current smoking by socioeconomic status have increased, decreased, or remained unchanged in Canada.

Methods

We examined rates of current smoking by sex, education, and province from 1950 to 2011. Differences in current smoking, initiation, and cessation were summarized using relative and absolute measures.

Results

Between 1950 and 2011, the prevalence of current smoking (including daily and non-daily) among adults aged 20 years and older decreased steadily in men from 68.9 % (95 % CI 63.9–73.3) to 18.6 % (14.9–22.1) but in women increased slightly from 38.2 % (32.3–42.2) in 1950 to 39.1 % (36.4–41.2) in 1959 before declining to 15.4 % (11.9–18.9) in 2011. Among men, there was an inverse association between educational attainment and smoking which was consistent from 1950 to 2011. A similar gradient emerged in the mid-1960s in women. Absolute differences in rates of smoking across levels of education increased despite overall declines in smoking across all levels of education. Rates of smoking in women and men were higher in the Atlantic Provinces and Quebec, although in men these differences have declined since the 1990s. In a subset of data from 1999 to 2011, those with lower levels of education had higher levels of smoking initiation and lower levels of cessation.

Conclusions

Smoking rates have fallen over time but socioeconomic differences have increased. Smoking prevalence peaked later in lower socioeconomic status (SES) groups, and rates of decline in lower SES groups and certain provinces have been less steep. This suggests that SES gradients emerge rapidly in later stages of the tobacco epidemic and may have increased through greater efficacy of tobacco control policies in reducing smoking among those of higher SES compared to those of lower SES. Tailored approaches may be required to reduce smoking rates in those of lower SES and narrow SES differences.

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Notes

  1. The relative change in the ratio of smoking prevalence between low- and high-SES groups was calculated for each study as follows. First, SES ratios were defined for the first and final study years as the rates of smoking in low-SES groups divided by the rates in high-SES groups. Next, the relative change in the ratio was calculated as the difference in these ratios divided by the ratio in the first study year and expressed as a percentage. For example, in Barnett (first row of Table 1), the SES ratio was 1.9 in the final year and 1.6 in the first year, yielding a relative change in the ratio of (1.925–1.58)/1.58 = 21.8 %. Note ratios in the table have been rounded to 1 decimal place.

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Acknowledgments

Part of the work presented in this paper was conducted by DJC while a doctoral student at McMaster University and the Population Health Research Institute (Hamilton, ON, Canada). The authors acknowledge the support of the McMaster University Research Data Centre for assistance with accessing the survey data files used in this research.

Author information

Authors and Affiliations

  1. Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA

    Daniel J. Corsi

  2. Department of Psychiatry and Behavioural Neurosciences and Offord Centre for Child Studies, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada

    Michael H. Boyle

  3. Simon Fraser University, Vancouver, BC, Canada

    Scott A. Lear

  4. George Institute for Global Health, University of Sydney, Sydney, NSW, Australia

    Clara K. Chow

  5. Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada

    Koon K. Teo

  6. Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA

    S. V. Subramanian

Authors
  1. Daniel J. Corsi
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  2. Michael H. Boyle
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  3. Scott A. Lear
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  4. Clara K. Chow
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  6. S. V. Subramanian
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Corresponding author

Correspondence to Daniel J. Corsi.

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Corsi, D.J., Boyle, M.H., Lear, S.A. et al. Trends in smoking in Canada from 1950 to 2011: progression of the tobacco epidemic according to socioeconomic status and geography. Cancer Causes Control 25, 45–57 (2014). https://doi.org/10.1007/s10552-013-0307-9

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  • DOI: https://doi.org/10.1007/s10552-013-0307-9

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