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Health Behaviours – Smoking

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1 May 2014

Smoking is an independent risk factor for several diseases that affect a great many Canadians, and the associated health costs have long posed a significant burden on Canadian health systems and the economy more broadly. Compared to the previous decade, fewer Canadians are smoking now and fewer people have taken up the habit in recent years. However there is still some reason for concern in that the proportion of Canadians giving up smoking has remained relatively stagnant since the beginning of this century.

Smoking is on the decline in Canada. In 2011-12, 20.0% of respondents to the Canadian Community Health Survey (CCHS) indicated that they were either daily or occasional smokers, compared to 25.9% in 2000-01 – a decrease of 22.8% in the span of a decade. When only daily smokers are considered, this decline is even steeper, with the proportion of respondents identifying as daily smokers dropping from 21.5% in 2000-01 to 15.2% in 2011-12 – a decrease of 29.3%.

Starting and Quitting Smoking

Since 2000-01, smoking has declined across all age groups, with the least decline being observed among those between the ages of 50 and 59 (4.8%), and the most among those between the ages of 15 and 19 (48.1%). The observed decline in smoking among teenagers is particularly noteworthy as the vast majority of present and former smokers (75.8%) indicated that they began smoking daily while aged 19 or younger.

Indeed, the observed decline in smoking since 2000-01 is primarily explained by the fact that fewer people have taken up smoking in recent years, and not that more people are quitting. Between 2000-01 and 2011-12, the proportion of current daily smokers to have only begun smoking in the past five years decreased by 28% from 13.2% to 10.2%, while the proportion of CCHS respondents indicating that they were former smokers remained virtually unchanged (36.8% in 2000-01, compared to 37.2% in 2011-12).

Demographic Trends

There are pronounced regional differences across Canada in the prevalence of smoking. The proportion of smokers is highest in the territories – where 37.6% identify as either daily or occasional smokers – and lowest in British Columbia – where only 15.1% smoke.

Notably, smoking is higher within provinces in eastern Canada than it is in the west. With the exception of PEI, every province east of Ontario exhibits a higher proportion of daily and occasional smokers than the four provinces west of Ontario – with Ontario itself ranking as the province with the second lowest percentage of smokers in the country, behind British Columbia.

Additionally, men are 22.9% more likely than women to smoke, as 22.7% of men identify as daily or occasional smokers, compared to only 17.5% of women. In regard to socioeconomic characteristics, individuals with an annual household income of $20,000 or less are over 90% more likely to smoke as those with household incomes of $80,000 or more – 30.6% compared to 16.1% – and are 37.6% more likely to smoke than all other income groups combined.

Smoking and Self-Perceived Health

The self-perceived health of CCHS respondents was recorded along a five-point scale, where 1 represents “Excellent” and 5 “Very Poor”. Looking at respondents below the age of fifty, the mean response was 2.42 among current smokers, 2.15 among former smokers, and 2.08 among those that had never smoked. For respondents aged fifty and over, the mean response was 2.74 among current smokers, 2.52 among former smokers, and 2.52 among those that had never smoked. Thus, both above and below the age of fifty, smokers feel significantly less healthy than those that had never smoked, and those that had given up smoking feel healthier than present smokers. Specifically, only 55.4% of current smokers under fifty and 43.4% above fifty rate their health as either excellent or very good, compared to 67.9% among former daily smokers under fifty and 51.9% above, and 71.0% among those that never smoked under fifty and 51.1% above.

Smoking and Disease

Unsurprisingly, data from the CCHS also show that, with varying degrees, the prevalence of several diseases for which smoking has been identified as an independent risk factor is markedly higher among current and former smokers than among those that have never smoked. As the table below illustrates, among those both under and above the age of 50, COPD, heart disease and cancer affect current and former smokers in significantly greater proportion than those that have never smoked.

Disease Prevalence, by Type of Smoker (2011-12)
Under 50Over 50
Current or Former SmokerNever SmokedCurrent or Former SmokerNever Smoked
Diagnosed with COPD2.30%1.40%6.80%2.70%
Diagnosed with heart disease1.30%0.70%11.20%9.10%
Has had cancer2.00%0.80%9.80%7.40%
Suffers the effects of stroke0.30%0.20%2.40%2.30%
Has diabetes2.20%1.50%12.60%13.20%

Yet, perhaps more troubling is that many of those affected by these diseases continue to smoke despite their diagnosis. Specifically, 35.1% with COPD indicate that they currently smoke, as do 16.5% of those with heart disease, 18.8% that have had cancer, 13.9% that currently have cancer, 20.1% that have had a stroke, and 15.3% of those with Type 2 diabetes. Particularly among individuals with COPD or who have had a stroke, the proportion of current smokers is at least equal to or higher than among the total population.

Policy Implications

Evidence from the CCHS demonstrates that far fewer Canadians are smoking and taking up smoking now than at the beginning of the last decade. Yet, despite these positive trends, there is still some reason for concern. In particular, the rate of current smokers abandoning the habit has remained relatively stagnant since 2000-01, and many that have been diagnosed with diseases that have been directly linked to smoking have not given up smoking. These results may indicate a need for increased efforts and awareness aimed at persuading current smokers to quit.

While access to telephone “quit-lines” is provided throughout the country, not all provincial health systems provide the same degree of support for those wishing to stop smoking. In fact, according to the HSI’s own Canadian Diabetes Policy Database, we find that those three provinces with the highest proportion of present smokers (Newfoundland and Labrador, Nova Scotia, and New Brunswick) are also the only Canadians provinces that do not provide coverage for the cost of smoking cessation aids and medications under the provincial drug plan.

Despite the apparent successes of efforts to dissuade young people from starting smoking, it is evident that governments and public health officials throughout Canada must continue to pursue new policy approaches aimed at providing smokers with the assistance they need to overcome this harmful habit.

Unless otherwise noted, all data contained herein is drawn from the Canadian Community Health Survey (CCHS) 2000/01-2011/12. The CCHS is a joint effort of Health Canada, the Public Health Agency of Canada, Statistics Canada, and the Canadian Institute for Health Information (CIHI).