title: Socioeconomic and geographic patterning of smoking behaviour in Canada: a cross-sectional multilevel analysis.
abstract: OBJECTIVE
  To describe the socioeconomic and geographic distribution of smoking behaviour in Canada among 19,383 individuals (51% women) aged 15-85 years.
  
  
  METHODS
  Current smoking and quitting were modeled using standard and multilevel logistic regression. Markers of socioeconomic status (SES) were education and occupation. Geography was defined by Canadian Provinces.
  
  
  RESULTS
  The adjusted prevalence of current smoking was 20.2% (95% confidence interval [CI]: 18.8-21.7) and 63.7% (95% CI: 61.1-66.3) of ever smokers had quit. Current smoking decreased and quitting increased with increasing SES. The adjusted prevalence of current smoking was 32.8% (95% CI: 28.4-37.5) among the least educated compared to 11.0% (95% CI: 8.9-13.4) for the highest educated. Among the least educated, 53.0% (95% CI: 46.8-59.2) had quit, rising to 68.7% (95% CI: 62.7-74.1) for the most educated. There was substantial variation in current smoking and quitting at the provincial level; current smoking varied from 17.9% in British Columbia to 26.1% in Nova Scotia, and quitting varied from 57.4% in Nova Scotia to 67.8% in Prince Edward Island. Nationally, increasing education and occupation level were inversely associated with current smoking (odds ratio [OR] 0.64, 95% CI: 0.60-0.68 for education; OR 0.82, 95% CI: 0.77-0.87 for occupation) and positively associated with quitting (OR 1.27, 95% CI: 1.16-1.40 for education; OR 1.20, 95% CI: 1.12-1.27 for occupation). These associations were consistent in direction across provinces although with some variability in magnitude.
  
  
  CONCLUSIONS
  Our findings indicate that socioeconomic inequalities in smoking have persisted in Canada; current smoking was less likely and quitting was more likely among the better off groups and in certain provinces. Current prevention and cessation policies have not been successful in improving the situation for all areas and groups. Future efforts to reduce smoking uptake and increase cessation in Canada will need consideration of socioeconomic and geographic factors to be successful.
authors.affiliation: Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, United States of America. djcorsi@hsph.harvard.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Corsi
authors.forename: Scott A
authors.initials: SA
authors.lastname: Lear
authors.forename: Clara K
authors.initials: CK
authors.lastname: Chow
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.forename: Michael H
authors.initials: MH
authors.lastname: Boyle
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003625:Data Collection; D004522:Educational Status; D005260:Female; D005843:Geography / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009790:Occupations / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000706:statistics & numerical data; D012923:Social Class; D055815:Young Adult