Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
Am J Prev Med. 2012 Dec;43(6):601-10. doi: 10.1016/j.amepre.2012.08.023.
The extent to which the prevalence of smoking in Canada varies across geographic areas independently of individual characteristics has not been quantified.
To estimate the extent and potential sources of geographic variation in smoking among communities, health regions, and provinces/territories in Canada.
Data are from the Canadian Community Health Surveys conducted between 2001 and 2008 (n=461,709). Current cigarette smoking among adults (aged ≥18 years) was the primary outcome. Individual-level markers of SES were education, household income, and occupation. Contextual variables potentially related to smoking considered were provincial cigarette taxes, workplace smoking bans, and collective family norms discouraging smoking in communities. A multilevel logistic regression analysis was conducted to model variation in smoking at the geographic scale of communities, health regions, and provinces.
Overall, the contribution of geography as a percentage of the total variation in smoking was 8.4%, with 2.4% attributable to provinces, 1.2% attributable to health regions, and 4.8% attributable to communities after adjusting for age, gender and survey period. In models that accounted for socioeconomic and demographic characteristics in addition to age and gender, the contribution of geography to the total variation in smoking was attenuated to 4.1%; with 2.0% at the province level, 0.4% at the health region level, and 1.7% at the community level. Within provinces/territories, the community variation in smoking ranged from 2.4% in Prince Edward Island to 9.1% in British Columbia. Nationally, 71% of community and 21% of provincial differences in smoking were explained by individual, socioeconomic, and demographic factors alone; the inclusion of contextual covariates explained an additional 27% of the variation among communities. Collective family norms discouraging smoking in a community was the strongest contextual predictor of individual smoking; provincial cigarette taxes and workplace bans were only modestly related to individual smoking behavior.
Geographic variation in smoking remained after accounting for individual, socioeconomic, and demographic characteristics, suggesting the importance of place, at the level of provinces and communities in Canada. Remaining community variation in smoking was largely attenuated after accounting for collective family norms discouraging smoking. Area-level influences such as the social and/or environmental conditions of provinces and communities may be important sources of variation in smoking and therefore need to be considered if rates of smoking are to be modified.
在加拿大，吸烟的流行程度在多大程度上独立于个体特征而在地理区域之间存在差异，尚未得到量化。
评估加拿大社区、卫生区域和省/地区吸烟的地理差异程度及其潜在来源。
数据来自 2001 年至 2008 年期间进行的加拿大社区健康调查（n=461,709）。主要结局为成年人（年龄≥18 岁）当前吸烟情况。个体社会经济地位的标志物为教育、家庭收入和职业。考虑了与吸烟有关的潜在情境变量包括省级香烟税、工作场所禁烟令以及社区中反对家庭吸烟的集体规范。采用多水平逻辑回归分析模型来对社区、卫生区域和省的吸烟地理尺度的变异进行建模。
总体而言，地理因素对吸烟总变异的贡献为 8.4%，其中 2.4%归因于省份，1.2%归因于卫生区域，4.8%归因于社区，调整年龄、性别和调查期后。在考虑了年龄和性别以外的社会经济和人口特征的模型中，地理因素对吸烟总变异的贡献减弱至 4.1%；在省级水平上为 2.0%，在卫生区域水平上为 0.4%，在社区水平上为 1.7%。在各省/地区内，吸烟的社区差异范围从爱德华王子岛的 2.4%到不列颠哥伦比亚省的 9.1%。在全国范围内，71%的社区和 21%的省级吸烟差异可仅通过个体、社会经济和人口因素来解释；纳入情境协变量可额外解释社区差异的 27%。社区内反对家庭吸烟的集体规范是个体吸烟的最强情境预测因素；省级香烟税和工作场所禁烟令与个体吸烟行为仅有适度的关系。
在考虑了个体、社会经济和人口特征后，吸烟的地理差异仍然存在，这表明在加拿大，省级和社区层面的地点重要性。在考虑了反对家庭吸烟的集体规范后，吸烟的社区差异在很大程度上减弱了。省级和社区的环境条件等区域层面的影响可能是吸烟差异的重要来源，如果要改变吸烟率，就需要考虑这些因素。
