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Modifiable Risk Factors – Tobacco Smoking

Key findings

Tobacco smoking rates in Ontario have been declining for at least 2 decades.[1] In 2017, however, nearly one-fifth (17%) of Ontarians ages 20 years and older reported that they were daily or occasional smokers. Smoking rates were significantly higher in men than women, rural residents than urban residents, Canadian-born people than immigrants, lower household income than higher household income, and those with high-school or lower education compared with post-secondary graduates.

Why is this important to Ontarians?

  • Modifiable risk factors are behaviours and exposures that can lower or raise a person’s risk of cancer and that can be changed. Evidence confirms strong associations between tobacco smoking and the risk of nearly 20 types of cancer, including lung and colorectal cancers.[2] 
  • In Ontario, 71.0% of lung cancer cases and 10.7% of colorectal cancer cases can be attributed to smoking tobacco in 2009.[3]
  • Reporting on risk factor prevalence in Ontario is important to effectively monitor trends over time, support the development of health promotion and disease prevention strategies, and evaluate outcomes of provincial interventions.

See Modifiable Risk Factors Methodology for technical information.

Report date: April 2019
Data source: Canadian Community Health Survey, 2015–2017 (Statistics Canada)
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Population Health and Prevention)
Notes:

  1. Estimates are adjusted to the age distribution of the 2011 Canadian population.
  2. Current smoking (adults ages 20 years and older): individuals who are daily or occasional smokers.

 

Report date: April 2019
Data source: Canadian Community Health Survey, 2015–2017 (Statistics Canada)
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Population Health and Prevention)
Notes:

  1. Estimates are adjusted to the age distribution of the 2011 Canadian population.
  2. Current smoking (adults ages 25 years and older): individuals who are daily or occasional smokers.
  3. Secondary graduate category includes those with some post-secondary education.
Data Table 1. Percentage of Ontario adults (ages 20 and older) who reported current tobacco smoking, by sex, 2015 to 2017
  2015 Estimate (%) 2015 Lower 95% Confidence Interval (%) 2015 Upper 95% Confidence Interval (%) 2016 Estimate (%) 2016 Lower 95% Confidence Interval (%) 2016 Upper 95% Confidence Interval (%) 2017 Estimate (%) 2017 Lower 95% Confidence Interval (%) 2017 Upper 95% Confidence Interval (%)
Both sexes 18.5 17.4 19.6 17.5 16.5 18.6 17.0 15.9 18.0
Male 21.7 19.9 23.5 21.3 19.5 23.1 20.5 18.7 22.2
Female 15.4 14.0 16.8 13.9 12.6 15.1 13.6 12.4 14.9

Report date: April 2019
Data source: Canadian Community Health Survey, 2015–2017 (Statistics Canada)
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Population Health and Prevention)
Notes:

  1. Estimates are adjusted to the age distribution of the 2011 Canadian population.
  2. Current smoking (adults ages 20 years and older): individuals who are daily or occasional smokers.

 

Data Table 2. Percentage of Ontario adults (ages 25 and older) who reported current tobacco smoking, by selected socio-demographic factors, 2015 to 2017 combined
  Tobacco smoking, Estimate (%) Tobacco smoking, Lower 95% Confidence Interval (%) Tobacco smoking, Upper 95% Confidence Interval (%)
Residence - rural 22.1 20.5 23.8
Residence - urban 17.4 16.6 18.1
Household income quintile - Q1 (lowest) 26.5 24.7 28.3
Household income quintile - Q2 19.1 17.3 20.8
Household income quintile - Q3 17.9 16.3 19.5
Household income quintile - Q4 15.3 13.9 16.6
Household income quintile - Q5 (highest) 12.6 11.3 13.8
Education status - less than secondary 35.3 32.0 38.6
Education status - secondary graduate 26.1 24.4 27.8
Education status - post-secondary graduate 13.7 13.0 14.5
Immigration status - <=10yrs in Canada 9.2 6.8 11.6
Immigration status - >10yrs in Canada 13.3 11.8 14.9
Immigration status - Canadian born 20.9 20.1 21.8

Report date: April 2019
Data source: Canadian Community Health Survey, 2015–2017 (Statistics Canada)
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Population Health and Prevention)
Notes:

  1. Estimates are adjusted to the age distribution of the 2011 Canadian population.
  2. Current smoking (adults ages 25 years and older): individuals who are daily or occasional smokers.
  3. Secondary graduate category includes those with some post-secondary education.
  4. Bolded estimates are significantly different from the rates in: urban areas for analyses by urban/rural residence; income quintile 5 (Q5) for analyses by income quintile; post-secondary graduate for analyses by education status; and Canadian born for analyses by immigration status.
Table 1: International Comparisons: Percentage of adults who reported current tobacco smoking, by sex
Country Estimates, both sexes (percentage) Estimates, men (percentage) Estimates, women (percentage)
New Zealand[4] 14.9 16.4 13.3
United States[5] 17.1 18.8 15.3
United Kingdom[6] 17.3 19.2 15.5
Ireland[7] 20 22 17

Notes:

  1. Current tobacco smoking is defined as current daily or occasional smokers.
  2. There are slight differences in the year, age groups, and/or definitions for each region’s data:
    • New Zealand (2017 to 2018 data of individuals ages 15 and older who smoked more than 100 cigarettes in lifetime)
    • United States (2017 data of individuals ages 18 and older who smoked more than 100 cigarettes in lifetime)
    • United Kingdom (2017 data of individuals ages 16 and older)
    • Ireland (2018 data of individuals ages 15 and older)

 

Results

  • The proportion of Ontario adults ages 20 and older who self-reported tobacco smoking remained stable from 2015 (18.5%) to 2017 (17.0%). Men were significantly more likely to be smokers than women.
  • From 2015 to 2017, rates of tobacco smoking in Ontario adults ages 25 and older were higher in:
    • rural residents (22.1%) compared with urban residents (17.4%)
    • the lowest income quintile (26.5% in Q1) than the highest income quintile (12.6% in Q5)
    • those with less secondary education and secondary graduates (35.3% and 26.1% respectively) than in post-secondary graduates (13.7%)
    • Canadian-born residents (20.9%) compared with immigrants who came more than 10 years ago and recent immigrants (13.3% and 9.2% respectively)

Comparisons

Getting comparable data and measures from multiple jurisdictions is a challenge. Be aware of the different data definitions, methodologies and years used in indicators measured outside Ontario. Jurisdictional comparison is still useful to provide a rough indication of how well Ontario is doing relative to other provinces and countries.

  • The prevalence of tobacco smoking in Ontario is higher than the rate in New Zealand (14.9%), and is similar to those in the United States (17.1%) and United Kingdom (17.3%).[4] [5] [6] However, Ontario’s tobacco smoking rate is lower than Ireland’s (20%).[7] 

Opportunities

  • Exposure to some risk factors is higher in particular social, economic or geographic populations. Populations facing health inequities experience higher incidence and mortality rates for certain cancers.
  • The Ontario government has made significant progress in reducing tobacco use through Smoke-Free Ontario. The program aims to prevent youth from starting to smoke, protect people from second-hand smoke and help smokers quit. In 2017, the Ministry of Health and Long-Term Care established the Executive Steering Committee for the Modernization of Smoke-Free Ontario to update the Smoke-Free Ontario strategy. Among the committee’s recommendations was a strategy to work towards reducing the prevalence of tobacco use in the province to less than 5% by 2035. To date, the report’s recommendations have not been implemented.[8]
  • Many groups facing health inequities continue to smoke at much higher rates than the rest of the population.[9]
  • Universal and targeted interventions are also needed to reduce tobacco use.
  • Evidence shows that healthy public policy and community-wide programs are more effective to reduce the prevalence of modifiable risk factors at a population-level than those that focus on changing individuals’ behaviours.
  • The Prevention System Quality Index is a series of reports that monitor population-level policies and programs that can reduce cancer risk factors and exposures in the Ontario population. The reports include evidence-based recommendations to strengthen cancer prevention in Ontario.[9]

References

  1. Ialomiteanu, A. R., Hamilton, H. A., Adlaf, E. M., & Mann, R. E. (2018). CAMH Monitor e-Report: Substance Use, Mental Health and Well-Being Among Ontario Adults [Internet]. 1977–2017 (CAMH Research Document Series No. 48). Toronto, ON: Centre for Addiction and Mental Health [cited 2019 May 10]. Available from: http://www.camh.ca/camh-monitor
  2. International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans. Volume 100E. A review of human carcinogens. Part E: Personal habits and indoor combustions. Lyon, FR: International Agency for Research on Cancer; 2012.
  3. Cancer Care Ontario. Cancer Risk Factors in Ontario: Tobacco. Toronto, Canada; 2014.
  4. New Zealand Health Survey [Internet]. 2017/18 [cited 2019 May 17]. Ministry of Health, New Zealand. Available from: https://minhealthnz.shinyapps.io/nz-health-survey-2017-18-annual-data-explorer/_w_1754510c/_w_45c47951/#!/explore-indicators (login required)
  5. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. Chronic Disease Indicators (CDI) Data [Internet]. 2016 [cited 2019 May 17]. Available from: https://nccd.cdc.gov/cdi.
  6. Health Survey for England [Internet]. 2017 [cited 2019 May 17]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2017#resources
  7. Healthy Ireland Survey 2018: Summary of Findings [Internet; cited 2019 May 17]. Ipsos MRBI. Available from: https://health.gov.ie/wp-content/uploads/2018/10/Healthy-Ireland-Survey-2018.pdf
  8. Executive Steering Committee for the Modernization of Smoke-Free Ontario. Smoke-Free Ontario modernization: report of the Executive Steering Committee. Toronto: Queen's Printer for Ontario; 2017.
  9. Cancer Care Ontario. Prevention System Quality Index: health equity. Toronto: Queen's Printer for Ontario; 2018.