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).

Questions