title: Community- and individual-level factors associated with smoking and heavy drinking among Aboriginal people in Canada.
abstract: OBJECTIVE
  1) To examine the association between place of residence (i.e., on- versus off-communities and between provinces) and daily smoking and heavy drinking among Aboriginal people in Canada; and 2) to identify community- and individual-level factors that may account for these associations.
  
  
  METHODS
  Data were from the Aboriginal Peoples Survey (2001). The sample included 52,110 Aboriginal people (≥ 15 years of age). Community-level variables included: place of residence, community socio-economic status (SES) and perceived community social problems. Individual-level variables included: age, sex, education, income, employment status, marital status, Aboriginal heritage and social support. Multilevel logistic regressions were conducted to analyze the data.
  
  
  RESULTS
  Living in First Nations communities (compared with living off-communities) was associated with daily smoking, and this association was accounted for by perceived community social problems. However, the association between Inuit communities and daily smoking remained after controlling for all covariates (odds ratio (OR) = 1.97, 95% confidence intervals (CI) = 1.44-2.70). Residence in First Nations communities was associated with heavy drinking (OR = 1.54, 95% CI = 1.17-2.04), however this risk became evident only after controlling for community SES, which was also positively associated with heavy drinking (OR = 1.46, 95% CI = 1.26-1.69). Compared with Saskatchewan, Aboriginal people in Atlantic Provinces (OR = 2.80, 95% CI = 2.08-3.78) or Territories (OR = 1.39, 95% CI = 1.01-1.92) were more likely to engage in heavy drinking.
  
  
  CONCLUSIONS
  Studies are needed to better understand the increased risk for smoking in Inuit communities and heavy drinking in First Nations communities, Atlantic Provinces and Territories, and to identify possible reasons for the positive association between community SES and heavy drinking among Aboriginal people.
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington. hmwekyu@uw.edu.
authors.forename: Hmwe Hmwe
authors.initials: HH
authors.lastname: Kyu
authors.forename: Katholiki
authors.initials: K
authors.lastname: Georgiades
authors.forename: Harriet L
authors.initials: HL
authors.lastname: MacMillan
authors.forename: Michael H
authors.initials: MH
authors.lastname: Boyle
mesh_terms: D000428:Alcohol Drinking / Q000208:ethnology*; D002170:Canada / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D007198:Indians, North American / Q000523:psychology* / Q000706:statistics & numerical data; D004930:Inuit / Q000523:psychology* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D055361:Multilevel Analysis; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012907:Smoking / Q000208:ethnology*; D012940:Social Problems / Q000523:psychology; D012944:Social Support; D012959:Socioeconomic Factors
keywords: Aboriginal people; heavy drinking; place of residence; smoking