Neighborhood factors and quitting smoking in Ontario Presented by: Sarah Edwards * , Susan Bondy * , Russell Callaghan †,* , Robert Mann ‡,* * Dalla Lana School of Public Health, University of Toronto † University of Northern British Columbia ‡ Centre for Addiction and Mental Health, University of Toronto
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Neighborhood factors and quitting smoking in Ontario
Presented by: Sarah Edwards * , Susan Bondy * , Russell Callaghan †,* , Robert Mann ‡,* * Dalla Lana School of Public Health, University of Toronto † University of Northern British Columbia ‡ Centre for Addiction and Mental Health, University of Toronto. - PowerPoint PPT Presentation
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Neighborhood factors and quitting smoking in Ontario
Presented by: Sarah Edwards*, Susan Bondy*, Russell Callaghan†,*, Robert Mann‡,*
*Dalla Lana School of Public Health, University of Toronto† University of Northern British Columbia
‡ Centre for Addiction and Mental Health, University of Toronto
1 in 5 Ontarians smoke
Group Behaviour Therapy
Individual Counselling
Nicotine Replacement Therapies
0 10 20 30 40 50 60 70 80 90100% Increase in cessation with use
Ontario Tobacco Survey (OTS): Panel study of smokers
• 4500 Ontario smokers (2005-2008)• Representative telephone sample• Followed-up every 6 months for up to 3 years
• Current analysis: • Smoked at least 100 cigarettes (N = 4049)• Quit attempts at reported at each follow-up (N = 5481
in 2080 individuals)
Methods – Data Sources
OTS Postal Code
Outcome• Quit attempt – reported at least one serious quit
attempt or reported that they had stopped smoking for a period of time during follow-up (even if they do not identify it as an actual quit attempt) in the past 6 months– Assisted - reported using at least one of the following:• Nicotine patches, gum, chewing pieces, lozenges or inhalers• Zyban, bupropion, Wellbutrin, Champix or varenicline• Group counselling or group support• Specialized addiction counsellor
– Unassisted– did not report using any of the above
Analyses• Level of analysis individual, repeated measures• Neighbourhood measures ecological level• Analysis needs to take into account impact of non-
independence of data• Mixed-effects models were used to examine
relationship between neighborhood factors and quit outcomes
• Models were adjusted for clustering and potential individual-level confounders (age, sex, number of previous quit attempts, self-perceived addiction level)
Assisted Unassisted
57.2
42.844.0
56.0
Urban Rural
Quit Attempts
Wei
ghte
d %
The odds of quitting with assistance is 30% less for smokers living in rural versus urban areas in Ontario (adjusted p-value = 0.04).
Assisted Unassisted
49.1 50.7
66.9
33.0
Least Ethnic Concentration Most Ethnic Concentration
Quit Attempts
Wei
ghte
d %
The odds of quitting with assistance is 63% more for smokers living in areas with the least versus most ethnic concentration in
Conclusions• There is some evidence Ontario smokers living
in rural areas are less likely to quit with assistance (may be a function of access) and there are some ethnic differences in terms of use or non-use of assisted quitting methods
• Other area level measures were not significantly associated with type of quit attempt
Limitations
• Self-report quit attempts• Possible more than 1 quit attempt per 6
month period• Individual-level variables not available for
neighborhood-level variables using ecological measures
Next Steps• Examine additional social-environment
factors:– Occupation (blue versus white collar)– Access to care (including interactions with
rural/urban measure)– Social norms
Acknowledgements
The OTS is an initiative of Ontario Tobacco Research Unit which receives funding from the Ontario Ministry of Health and Long-Term Care.
My work is funded by the CIHR Training Grant in Population Intervention for Chronic Disease Prevention: A Pan-Canadian Program (Grant #: 53893).