An update on smoking from the 2005 Canadian Community Health Survey

by Margot Shields

Sharpest declines for youth
No provincial/territorial increases
Lowest rates in Ontario and British Columbia
Household bans on the rise
Bans in work places also up
Bans and reduced consumption
Exposure to second-hand smoke declines
Youth at increased risk
Concluding remarks
Data source
Definitions
References

The prevalence of smoking in Canada continues to decline, according to the latest results from the Canadian Community Health Survey (CCHS). The 2005 CCHS estimated that 5.9 million people, or 21.8% of the population aged 12 or older, were smokers. This was a slight decline from the 23% estimated using the 2003 CCHS, and was even lower than the 2000/01 CCHS estimate of 26%. In 1994/95, the National Population Health Survey (NPHS) estimated that 29% of Canadians smoked.

Sharpest declines for youth

Declines in smoking prevalence were observed for both sexes and across all age groups, although the rates among seniors seem to be stabilizing (Chart 1, Table 1). The sharpest declines were among youth aged 12 to 17, with the rate declining from 14% in 2000/01 to 10% in 2003, and to 8% in 2005. In 2000/01, seniors had the lowest smoking rates, but by 2005, rates were lowest among 12- to 17-year-olds.

The youth smoking rate has declined because increasing numbers of young people never start to smoke. In 2000/01, 73% of youth reported that they had never smoked cigarettes (Chart 2). By 2005, the proportion had increased to 82%. This finding is particularly relevant because smoking initiation usually occurs before age 18, and it is relatively rare for adults to take up smoking⁸. As a result, further declines in smoking rates among older age groups may be observed in the future as today’s youth move through adulthood.

Top of Page

No provincial/territorial increases

Between 2003 and 2005, smoking rates declined significantly in the provinces of New Brunswick , Quebec , Ontario and Manitoba , and in the territory of Nunavut (Chart 5). In the remaining provinces and territories, 2005 rates were similar to 2003 rates.

Lowest rates in Ontario and British Columbia

In 2005, smoking rates were significantly below the national figure of 22% in British Columbia (18%) and Ontario (21%) (Table 2, Chart 5). These two provinces also had comparatively low rates in 2003 and 2000/01. The 2005 rate was also low in Manitoba (20%), but the difference from the national rate only approached statistical significance (p=0.07). In the remaining provinces, rates were between 22% and 24%.

Smoking rates in the three territories were fairly high: 30% in Yukon Territory , and 36% in Northwest Territories . Although Nunavut had the country’s highest rate, at 53%, it also underwent the sharpest decline between 2003 and 2005: a 12-percentage point drop.

Smoking rates at the health region level are presented in Table 2. As in previous years, the health region of Richmond in British Columbia had the country’s lowest smoking rate at 12.6%.

Top of Page

Household bans on the rise

In 2005, close to two-thirds (64%) of people aged 12 or older lived in households where smoking was completely restricted, meaning that smokers are asked to refrain from smoking in the house (Chart 6). This was up 7 percentage points from 2003.

Not surprisingly, living in a household with a smoking ban was more common among non-smokers. The percentage of non-smokers who resided in homes with a ban rose from 57% in 2000/01 to 63% in 2003; by 2005, the figure had risen an additional 8 percentage points to 71%. Even smokers became more likely to face a smoking ban at home: the percentage rose form 34% in 2003 to 41% in 2005.

Between 2003 and 2005, the percentage of the population living in a household where smoking was banned rose significantly in all 10 provinces, as well as in Northwest Territories and Nunavut (Chart 7). In Yukon Territory , the rate remained stable at 62%.

In 2005, compared with the national rate of 64%, the percentage of people living in homes where smoking was banned was significantly higher in Nova Scotia (66%), Ontario (71%), Manitoba (68%), Alberta (72%) and British Columbia (77%). By contrast, the rate was particularly low in the province of Quebec (43%).

Top of Page

Bans in work places also up

A higher percentage of non-smokers reported workplace smoking bans. In 2005, 73% of non-smokers worked at a location where smoking was prohibited, compared with 54% of smokers.

Since 2000/01, the percentage of the employed population reporting workplace smoking bans rose in all provinces and territories, but in many cases, a significant increase occurred in only one of the two periods (2000/01 to 2003 or 2003 to 2005) (Chart 9). This likely reflects the varying dates when legislation to restrict smoking in workplaces and in public places was introduced across the country (Health Canada 2006b; Health Canada 2006a)^{2, 3}.

In 2005, 71% of the employed population in Ontario and 76% in Manitoba reported workplace smoking bans; both figures are significantly higher than the national average (68%). Percentages were even higher in the three territories: Yukon Territory, 79%; Northwest Territories, 83%; and Nunavut, 92%—the highest rate in the country. Workplace bans were less common in Nova Scotia (64%), Quebec (67%), Saskatchewan (65%), and Alberta (61%).

Table 4 shows, by health region, the percentage of workers employed at places where smoking was prohibited.

Top of Page

Bans and reduced consumption

Household and workplace smoking restrictions were associated with reduced tobacco consumption among smokers. In 2005, smokers aged 12 or older living in households where smoking was completely banned smoked an average of 9 cigarettes per day, 6 fewer than those living in homes where they could smoke (Chart 10). Employed smokers who faced total smoking bans at work smoked an average of 11 cigarettes daily, compared with 14 for those who could smoke at work.

The combination of bans at home and at work yielded even lower levels of tobacco consumption among employed smokers. Those facing such restrictions smoked 9 cigarettes per day, on average, compared with 16 for those who could smoke at home and at work (Chart 11). These findings are particularly relevant given that reduced cigarette consumption is associated with a higher probability of quitting, and higher cigarette consumption is associated with increased health risks ⁹.

Top of Page

Exposure to second-hand smoke declines

As smoking bans became more widespread, exposure to second-hand smoke among non-smokers declined. In 2005, 9% of non-smokers reported that they were regularly exposed to second-hand smoke at home (i.e., every day or almost every day), down from 11% in 2003 (Chart 12). Over the same period, regular exposure to second-hand smoke in private vehicles fell from 10% to 8%. In 2005, the most common location for exposure to second-hand smoke was public places, reported by 15% of non-smokers. However, this was also the setting in which the exposure rate declined the most, down from 20% in 2003. When the three venues are considered together, in 2005, 23% of the non-smokers reported regular exposure to second-hand smoke in at least one location, down from 29% in 2003.

Top of Page

Youth at increased risk

For all three locations considered, the likelihood of being exposed to second-hand smoke diminished at successively older ages. In 2005, 40% of non-smokers aged 12 to 17 reported being regularly exposed to second-hand smoke in at least one location. This compares with 31% for those aged 18 to 34, 19% for those aged 35 to 64, and 11% among seniors aged 65 or older (Chart 13). This pattern may partially reflect the higher percentage of elderly people who live alone (i.e., decreased likelihood of living with a smoker), as well as changes in activities across the lifespan. In some cases, exposure to second-hand smoke may be a choice; in other cases, it may be unavoidable⁵. Although exposure declined for all age groups between 2003 and 2005 (Chart 14), the high rate among youth is of particular concern since they likely have the least amount of control over their exposure to second-hand smoke.

Exposure rates to second-hand smoke in public places varied considerably by province and territory in 2003 and 2005, reflecting the different dates when legislation was introduced to restrict smoking in these venues (Chart 15)^{2, 3}. Between 2003 and 2005, rates fell by at least 10 percentage points in New Brunswick , Manitoba , and Saskatchewan , and in all three territories. In 2005, exposure rates were highest in Quebec (23%) and Alberta (18%). It is likely, however, that these rates will continue to drop, given that legislation restricting smoking in public places will become effective in both provinces in 2006.

Table 5 shows, at the health region level, exposure rates to second-hand smoke in public places among non-smokers.

Top of Page

Concluding remarks

Between 2003 and 2005, there was a small but significant decline in the percentage of Canadians aged 12 or older who were smokers: from 23% to 21.8%. The sharpest decrease was among youth aged 12 to 17.

Over the same period, the percentage of people living in homes where smoking was completely banned increased, and non-smokers’ exposure to second-hand smoke, particularly in public places, decreased.

Exposure rates to second-hand smoke will likely continue to decline, given that new restrictions on smoking in public places will come into effect in several provinces in 2006. These trends are encouraging in light of the serious health effects of smoking and exposure to second-hand smoke^{4, 10, 11}. Nonetheless, high exposure to second-hand smoke among 12- to 17-year-olds—at home, in private vehicles and in public places—remains an area of concern.

Top of Page

Data source

Estimates in this article are based on data from the 2005, 2003 and 2000/01 Canadian Community Health Survey (CCHS), conducted by Statistics Canada. The CCHS covers the population aged 12 or older living in private households. It does not include residents of Indian reserves, institutions, and some remote areas; full-time members of the Canadian Armed Forces; and civilian residents of military bases .

The first cycle (cycle 1.1) of the CCHS began in September 2000 and continued over 14 months. The response rate was 84.7%, yielding a sample of 131,535 respondents.

Cycle 2.1 began in January 2003 and ended in December that year. The response rate was 80.6%, yielding a sample of 135,573 respondents.

Cycle 3.1 was conducted between January and December of 2005. The response rate was 79% yielding a sample of 132,947 respondents. A description of the CCHS methodology is available in a published report¹ .

All estimates in this article were weighted to be representative of the household population aged 12 or older in 2005, 2003 and 2000/01. Differences between estimates were tested to ensure statistical significance, which was established at the 0.05 level. To account for survey design effects, standard errors and coefficients of variation were estimated using the bootstrap technique^{6, 7}.

Top of Page

Definitions

In the 2000/01, 2003 and 2005 Canadian Community Health Survey, respondents were asked, “At the present time, do you smoke cigarettes daily, occasionally or not at all?” Those who said they smoked daily or occasionally were defined as current smokers.

Household smoking bans were measured using two questions: “Are there any restrictions against smoking cigarettes in your home?” Those who responded “yes” were asked, “How is smoking restricted in your home? The choices read to the respondents were:

• Smokers are asked to refrain from smoking in the house.
• Smoking is allowed in certain rooms only.
• Smoking is restricted in the presence of young children .
• Other restriction.

Respondents were defined as residing in homes where smoking is completely restricted if they said that smokers were asked to refrain from smoking in the house. In 2000/01 (cycle 1.1), these questions were only asked of non-smokers.

Respondents aged 15 or older who were employed were asked, “At your place of work, what are the restrictions on smoking?” The choices read to the respondents were:

1. Restricted completely.
2. Allowed in designated areas.
3. Restricted only in certain places.
4. Not restricted at all.

Respondents who indicated the first choice were defined as being employed where smoking is completely restricted.

The questions on exposure to second-hand smoke differed somewhat between cycle 1.1 compared with cycle 2.1 and 3.1; therefore, only the latter two cycles were used in this report. In cycles 2.1 and 3.1 non-smokers were asked the following questions in order to measure regular exposure to second-hand smoke in the home, private vehicles and public places:

1. “Including both household members and regular visitors, does anyone smoke inside your home every day or almost every day?” (Yes/No)
2. “In the past month, were you exposed to second-hand smoke every day or almost every day in a car or other private vehicle?” (Yes/No)
3. “In the past month, were you exposed to second-hand smoke every day or almost every day in public places (such as bars, restaurants, shopping malls, arenas, bingo halls, bowling alleys)?” (Yes/No)