Smoking in Context

A Multilevel Analysis of 49,088 Communities in Canada

This article examines the extent to which smoking prevalence varies across geographic areas, specifically communities, health regions, and provinces/territories in Canada, independent of individual characteristics.

Using data from the Canadian Community Health Surveys conducted between 2001 and 2008, researchers examined current cigarette smoking among adults aged 18 years and older. The final sample included 461,709 adults in 49,088 communities. Independent variables of income, education, and occupation were included as measures of socioeconomic status (SES).  Contextual variables considered included provincial cigarette taxes, workplace smoking banks, and collective family norms discouraging smoking in communities.

Key Findings:

  • Geography contributed to the total variation in smoking at 8.4 percent: 2.4 percent was attributable to provinces; 1.2 percent attributable to health regions; and 4.8 percent attributable to communities.
  • Considering socioeconomic and demographic characteristics, in addition to age and gender, brought the geographic contribution to 4.1 percent of the total variation in smoking.
  • Variation in smoking ranged from 2.4 percent in Prince Edward Island to 9.1 percent in British Columbia.

After accounting for individual, socioeconomic, and demographic characteristics, geographic variation remained. This indicates the importance of place, and suggests that area-level influences should be considered in working to decrease rates of smoking.