cancer risk factors in ontario · • in 2011, current smoking prevalence was significantly higher...

Cancer Risk Factors in OntarioAdults

Cancer Risk Factors in Ontario: Tobacco 15

2. Adults

2.1 Overview: current, fOrmer And never-smOkers

Figure 3. Smoking status of Ontario adults (aged 20+), by sex, 2011

Notes: Estimates are age-standardized to the 2006 Canadian population. represent 95% confidence intervals.

Current smokers: adults who reported that they presently smoke cigarettes “daily” or “occasionally.” See Appendix B for more details.Former smokers: adults who reported that they presently do not smoke cigarettes but they had smoked at least 100 cigarettes in their lifetime. Never-smokers: adults who reported that they presently do not smoke cigarettes and that they had smoked less than 100 cigarettes in their lifetime.

Source: Canadian Community Health Survey, 2011 (Statistics Canada)

• In2011,approximately2millionOntarioadultsaged20yearsandolder(20.6%after

adjustingforage)smokedcigarettesdailyoroccasionally,whileanadditional2.6million

(25.7%)wereformerdailyoroccasionalsmokers(basedonself-reports)(seesupplementary

table S1).

• AlargerproportionofadultmalesthanfemalesinOntariowerecurrent(dailyor

occasional)smokersandformersmokers,whiletheproportionwhohadneversmokedwas

significantlyhigherinfemalesthanmales(Figure 3):

◦ Amongmales,24.2%werecurrentsmokers,28.8%wereformersmokersand46.9%were

never-smokers.

◦ Amongfemales,theprevalenceofcurrent,formerandnever-smokingwas17.1%,23.1%

and59.8%,respectively.

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16 Cancer Risk Factors in Ontario: Tobacco

• Dailysmokingwasmuchmorecommonthanoccasionalsmokingformenandwomen;17.9%

ofmalesand13.2%offemalesweredailysmokers,while6.3%ofmalesand3.9%offemales

wereoccasionalsmokers.

• Occasionalsmokersareindividualswhoreportedthatthey“smokecigarettesoccasionally”

atthepresenttime.Ontario’soccasionalsmokersareaheterogeneousgroupofpersistent

occasionalsmokersandofformerdailysmokersatriskofreturningtodailysmoking.15

Figure 4. Prevalence of former smokers among Ontario adults (aged 20+), by time since quitting, 2011

Notes: Estimates are age-standardized to the 2006 Canadian population.represent 95% confidence intervals.


• Tobacco-associatedcancerriskgenerallydecreasesasthetimesincequittingincreases.For

somecancers,suchaslung,riskdeclinesrapidlybutremainselevatedcomparedtonever-

smokersformanyyears,whileforothers,suchasoralcancer,theriskisnearlythesameas

fornever-smokersaround10yearsaftercessation.3,4

• Amongadultsaged20yearsandover,5.5%wereformersmokerswhohadstoppedsmoking

withinthelastfiveyears,3.3%hadquitfivetonineyearsago,5.5%wereformersmokers

whoquit10to19yearsago,and10.7%wereformersmokerswhohadnotsmokedforatleast

20years(Figure 4).Significantlymoremaleshadquitsmoking10to19yearsagoandfor20

yearsormorethanfemales(seesupplementarytable S2).

• Thehigherproportionofformersmokerswhoquitlessthanfiveyearsago,comparedwith

fivetonineyearsago,mayreflectthefactthatthisgroupincludespeoplewhohaverecently

quitsmokingandareatahighriskofrelapsing.

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2.2 current smOking

Figure 5. Trends in current smoking prevalence among Ontario adults (aged 20+), 2003–2011

Notes: Estimates are age-standardized to the 2006 Canadian population.First year of data is 2003 because of a change in the method of administering the survey after the 2000/2001 CCHS cycle, which affected some smoking estimates.

Source: Canadian Community Health Survey, 2003, 2005, 2007–2011 (Statistics Canada)

• Theoverallprevalenceofcurrentsmoking(dailyoroccasional)amongOntarioadultsaged

20yearsandolderdecreasedsignificantlybetween2003and2011(seesupplementarytable S3),continuingadeclineseenforseveraldecades.16Thisdeclineislargelyduetodecreasesintheprevalenceofdailyratherthanoccasionalsmoking.17

• Theprevalenceofcurrentsmokingremainedconsistentlyhigherinmalesthaninfemales

between2003and2011;thisissimilartoearlierperiods.Theproportionoffemaleadults

whoweredailyoroccasionalsmokersdecreasedsignificantly,from20.3%in2003to17.1%

in2011,althoughtherateappearstohavestabilizedsince2009.Smokingratesformales

remainedstableforthe2003–2011period(Figure 5).

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• Despitelong-termdeclinesinsmokingrates,asizeablenumberofOntarioadultssmoke

andthisnumbercanbeexpectedtoriseinfutureyears,evenifthesmokingrateremains

stable,becauseofongoingpopulationgrowth.Therecentstabilizationofsmokingrates,

particularlyinmales,followingalong-termdeclinesuggestsaneedforadditionalstrategies

topromotecessationandpreventuptaketore-startthisdownwardtrend.

Figure 6. Current smoking prevalence in Ontario adults (aged 20+), by sex and age group, 2011

Notes: represent 95% confidence intervals. Source: Canadian Community Health Survey, 2011 (Statistics Canada)

• In2011,theage-specificprevalenceofcurrentdailyoroccasionalsmokingamongboth

malesandfemaleswashighestinthe20–29(males28.2%,females21.4%)and30–44

(males32.3%,females19.0%)agegroups.Prevalencewassignificantlyloweratages65and

older(males9.2%,females8.8%)(Figure 6;supplementarytable S4).Itshouldbenotedthatdespitelowerpercentages,theolderagegroups30yearsanduprepresentmoreOntarians

andthushigheractualnumbersofsmokersthanthe20–29-year-oldgroup.

• Lowerprevalenceintheolderagegroupslikelyreflectsacombinationofhigherratesof

successfulquittingamongever-smokersintheseagegroupsandgreatertobacco-related

mortalityassmokersage.

• Similartothepatternforallagescombined,malesyoungerthanage65hadasignificantly

higherprevalenceofcurrentsmokingthanfemales.Malesandfemalesaged65andolder

hadsimilarratesofcurrentsmoking(Figure 6).

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Figure 7. Current smoking prevalence in Ontario adults (aged 30+), by selected socio-demographic factors, 2011


Interpret estimates denoted with diagonal lines with caution due to high sampling variability. Source: Canadian Community Health Survey, 2011 (Statistics Canada)

• Theprevalenceofcurrentsmokingdifferssignificantlyacrosslevelsofseveralsocio-

demographicfactors.Socio-demographiccharacteristicswereanalyzedforadultsaged

30andovertorestrictthesampletothosewhohavelikelycompletedtheireducationand

reachedtheiradultsocio-demographicstatus.

• In2011,currentsmokingprevalencewassignificantlyhigheramongadults(aged30+)

livinginrural(23.0%)comparedtourbanareas(19.3%),amongthosewithlessthana

secondaryschooleducation(32.1%)comparedtopost-secondaryschoolgraduates(15.7%),

andamongthelowestincomegroup(27.8%)comparedwiththehighest(14.2%)(Figure 7).

• Consistentwithahealthyimmigranteffect,Canadian-bornadultshadsignificantlyhigher

smokingrates(23.1%)thanimmigrants.

• Similardifferencesincurrentsmokingprevalencebyeducation,incomeandimmigrant

statuswereseenformalesandfemales(seesupplementarytable S5).

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• Adultsmokers(ages18+),comparedtonon-smokers,arelesslikelytobefoodsecure,havea

familydoctor,owntheirdwellingandbeapost-secondarygraduate,andaremorelikelyto

bewhite,Canadian-born,male,haveunhealthyeatinghabitsandexceedlow-riskdrinking

guidelines.7

Figure 8. Current smoking prevalence in Ontario adults (aged 20+), by Local Health Integration Network, 2011


*Estimate is significantly higher/lower than the Ontario estimate.Source: Canadian Community Health Survey, 2011 (Statistics Canada)

• Ontariohassignificantregionalvariationincurrentsmokingrates,withthelowestrates

generallyobservedinthecentralpartoftheprovinceandthehighestratesgenerallyinthe

north.

• Comparedtothe2011provincialestimateof20.6%,theWaterlooWellington,NorthEast

andNorthWestLocalHealthIntegrationNetworks(LHINs)hadsignificantlyhigherage-

adjustedrateofcurrentsmoking,whiletheCentralWestLHINhadasignificantlylower

smokingrate(Figure 8;seeAppendix DformapshowingLHINboundaries).

• CurrentsmokingprevalenceamongOntario’s14LHINsrangedfromalowof16.7%inthe

CentralWestLHINtoahighof28.4%intheNorthEastLHIN.

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• ThevariationincurrentsmokingprevalenceacrossLHINsappearstobelargelyinfluenced

byvariationinLHIN-specificfemaleratesofcurrentsmoking(seesupplementarytable S6).

• In2011,theprevalenceofcurrentsmokingamongOntario’s36publichealthunits(PHUs)

rangedfromalowof15.1%intheWindsor-EssexPHUtoahighof33.6%inthePorcupine

PHU(Figure 9andsupplementarytable S7).

• Comparedtotheprovincialestimateof20.6%,thePorcupine,Oxford,Lambton,North

BayParrySound,WaterlooandThunderBayPHUshadsignificantlyhigherprevalenceof

currentsmoking,whiletheWindsor-Essex,OttawaandTorontoPHUshadsignificantly

lowersmokingprevalence.

• GreaterregionalvariationincurrentsmokingprevalencewasapparentatthePHUlevel

thanattheLHINlevel,withmarkedvariationbetweensomePHUswithinthesameLHIN.

WithintheErieSt.ClairLHINatthesouthwesttipofOntario,forexample,currentsmoking

ratesrangedfromaslowas15.1%intheWindsor-EssexPHUtoashighas31.0%inthe

LambtonPHU;thesedifferencesareaveragedoutattheLHINlevelresultinginasmoking

estimatethatissimilartoallOntario.Likewise,smokingprevalenceinnorthernOntario

wasnotuniformlyhigherthantheprovincialaverage,astheLHINratesimply(seeAppendix DformapshowingLHINandPHUboundaries).


FIGURE 9. Current smoking prevalence in Ontario adults (aged 20+) by public health unit, 2011

Notes: † Estimates are age-standardized to the 2006 Canadian population.

Sources: Canadian Community Health Survey, 2011 (Statistics Canada); 2006 Census Boundaries (Statistics Canada)

18.9–22.515.1–18.8

Current smoking prevalence†(%) Ontario = 20.6

26.3–29.922.6–26.2 30.0–33.6

High sampling variability 0 50

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100km

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SOUTH ONTARIO

NORTH ONTARIOStatistical significance

Lower than Ontario

Higher than Ontario


2.3 cigArette cOnsumptiOn

Figure 10. Median cigarette consumption among adult (aged 20+) daily smokers in Ontario, by sex and by age group, 2011

Notes: represent 95% confidence intervals. Source: Canadian Community Health Survey, 2011 (Statistics Canada)

• In2011,themediannumberofcigarettesconsumedbydailysmokerswas11.8(mean14.5)

cigarettesperday(CPD)(Figure 10;supplementarytable S8).

• Maleshadasignificantlyhighermediancigaretteconsumption(14.2CPD)comparedto

females(10.0CPD).

• Dailycigaretteconsumptionvariedsignificantlyacrossagegroups.In2011,median

consumptionwaslowestamongadultsaged20–29(9.6CPD),higherinthe30–44agegroup

(11.6CPD),higherstillinthe45–64agegroup(14.5CPD),andslightlyloweramongadults

aged65yearsandolder(12.7CPD).

• AlthoughhalfofdailysmokersinOntariosmokedwellbelow20cigarettes(onepack)per

day,32.4%reportedsmoking20ormorecigarettesperdayandcanbeconsidered“heavy

smokers.”Theproportionofdailysmokerssmokingheavilyappearstohavedeclinedsince

atleast2003,butnonethelessremainshigh(datanotshown).

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2.4 use Of Other tObAccO prOducts

Figure 11. Prevalence of other tobacco product use in Ontario adults (aged 20+), by age group and by type of product, 2011

Notes: Estimates for overall and by type are age-standardized to the 2006 Canadian population. represent 95% confidence intervals.

Interpret estimates denoted with diagonal lines with caution due to high sampling variability. Source: Canadian Community Health Survey, 2011 (Statistics Canada)

• In2011,4.8%ofOntarioadultsusedtobaccoproductsotherthancigarettes,suchascigars,

pipesandchewingtobacco,inthepastmonth(Figure 11;supplementarytable S9).

• Theuseofothertobaccoproductsofalltypeswas10.4timeshigherinmales(8.9%)thanin

females(0.9%)(seesupplementarytable S9).

• Othertobaccousewasmostcommonamongadultsaged20–29(11.1%)andgenerally

decreasedwithincreasingage;theprevalenceofothertobaccoproductsinthe65+age

groupwaslessthanonepercent.

• Cigarswerethemostcommonlyusedalternateformoftobacco,with4.2%ofOntarioadults

reportingsmokingatleastoneinthepastmonth.Amuchsmallerproportionofadults

reportedusingpipes(0.7%)andsnufforchewingtobacco(0.4%).

• Currentcigarettesmokersweremorelikelytouseothertobaccoproductsthanadultswho

donotsmokecigarettes(datanotshown).

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PipesCigarAges 65+

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• Inadditiontothetobaccoproductsconsideredhere,moreinformationonother

products,suchascigarillosandflavouredtobaccoproducts,isimportantforacomplete

understandingoftheburdenoftobaccouseintheOntariopopulation.Dataonsuch

productsarenotavailableintheCanadianCommunityHealthSurvey(CCHS);however,

theCanadianTobaccoUseMonitoringSurvey(CTUMS)suggeststhatin2011nearly2%of

Ontariansaged19+hadusedalittlecigarorcigarillointhepastmonth.18

2.5 smOking cessAtiOn

Tobaccocontroleffortsaimtoincreasetheproportionofsmokerswhohavesuccessfullyquit

smokingandtosupportsuccessfulquitterstoremainabstinentoverthelongterm.Smoking

cessationisacomplexprocessinfluencedbyanumberoffactors,suchaspastquitattempts,

motivation,levelofdependenceandbansonsmokinginsidethehome.Whilefactorssuchas

sex,ageandmeasuresofsocioeconomicstatusmayalsoplayarole,thesehavebeenreported

inconsistentlyintheliterature.19

• AmongOntarioadultswhohaveeverbeensmokers,overhalf(53.1%)havenowquit(data

notshown).

• In2011,25%ofcurrentsmokersintendedtoquitinthenext30daysandoverhalfintended

toquitinthenextsixmonths.7

• Thepercentageofrecentsmokers(i.e.,currentsmokersandrecentquitters)whohadquit

smokinginthepastyearandweresmoke-freeatthetimeofinterviewin2011was7.1%

(6.5%formalesand8.0%forfemales).Resumingregularsmokingiscommonamongrecent

quitters;datafromtheOntarioTobaccoSurveysuggeststhat79%oftheserecentquitters

willrelapseinthesubsequentyear.7

• Roughlyhalf(50.8%)ofever-smokingadultssurveyedinOntarioin2011hadsuccessfully

quitsmokingforatleastoneyear(Figure 12).Thislong-termquittingindicatorprovides

amorerobustestimateoftrendsinsmokingcessationthananestimateincludingmore

recentquitters,giventhehighrateofrelapseexperiencedinthefirstyearofquitting

(ShawnO’Connor,OntarioTobaccoResearchUnit,personalcommunication).


Figure 12. Prevalence of long-term quitters among Ontario ever-smokers (aged 20+), by sex and by age group, 2011

Notes: Estimates for overall and by sex are age-standardized to the 2006 Canadian populationrepresent 95% confidence intervals.

Long-term quitters: adult former smokers who reported that they quit smoking at least 1 year ago.Source: Canadian Community Health Survey, 2011 (Statistics Canada)

• Alargerproportionofever-smokingfemales(53.4%)thanmales(48.6%)hadsuccessfully

quitsmokingatleastoneyearago(Figure 12;supplementarytable S10).

• Theproportionofever-smokerswhosuccessfullyquitsmokingatleastoneyearagowas

significantlyhigherwithincreasesinage,from25.9%amongadultsaged20–29to81.5%

amongadultsaged65yearsandolder.

• Ahigherrateofsuccessfullong-termquittingwithincreasingageisconsistentwiththe

lowerratesofcurrentsmokinginthesegroups.Oldersmokershavehadmoretimetotryto

quitandmostsmokersattempttoquitsmokingseveraltimesbeforesucceeding.20

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Figure 13. Prevalence of long-term quitters among Ontario ever-smokers (aged 30+), by socio-demographic factors, 2011



• Theprevalenceofever-smokingOntarioadultswhohavesuccessfullyquitsmokingforat

leastoneyearvariessignificantlyacrosslevelsofseveralsocio-demographicfactors.

• In2011,ever-smokerswiththehighestlevelofeducation(61.7%)andthoseinthehighest

incomequintile(66.8%)weresignificantlymorelikelytohavesuccessfullyquitsmokingfor

atleastoneyear,comparedwiththeleasteducated(44.4%)andthoseinthelowestincome

quintile(43.5%)(Figure 13;supplementarytable S11).

• Long-termquittingdidnotdifferbetweenurbanandruralareasorbetweenCanadian-born

adultsandimmigrantstoCanada,regardlessoftimesinceimmigration.

• Theseresults,togetherwiththecurrentsmokingresultsbysocio-demographicfactors,

highlightsignificantincome-andeducation-relateddisparitiesintobaccouseinOntario;

adultswiththelowestlevelofeducationandinthelowestincomegrouparemorelikelyto

smokeandlesslikelytoquitsmokingoverthelongterm.

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• Socio-demographicdisparitiesinsmokingcessationhavebeenreportedpreviouslyin

Canada21andmaybepartiallyrelatedtodifferencesinhealth-seekingbehaviours,as

wellasawarenessofandaccess(includingavailabilityanduptake)tosmokingcessation

assistancemethods(e.g.,stop-smokingmedications)andothersourcesofcessationsupport

intheprovince.21

Figure 14. Prevalence of long-term quitters among Ontario ever-smokers (aged 20+), by Local Health Integration Network, 2011


*Estimate is significantly lower than Ontario’s estimate.Source: Canadian Community Health Survey, 2011 (Statistics Canada)

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• In2011,theproportionofever-smokerswhohadsuccessfullyquitsmokingforatleast

oneyearinOntario’s14LHINsrangedfrom43.4%intheCentralWestLHINto56.5%in

theChamplainLHIN.TheCentralWestLHINwas,however,theonlyLHINthatdiffered

significantlyfromtheOntarioestimateof50.8%(Figure 14;supplementarytable S12).ThisLHINhasthelowestrateofcurrentsmoking,andtheremainingsmokersmaybethosewho

findithardesttoquit.

• TheSmoke-FreeOntarioStrategyincludesavarietyofinitiativestohelpsmokersquit,

althoughthereachofthesemaybetoonarrowandtoorecenttoexplainthevariation

incessationratespresentedhere.TheGovernmentofOntarioprovidesfundingfor

theprovincial,population-levelquit-lineoperatedbytheCanadianCancerSocietyand

alsofundssmokingcessationprescriptionmedicationsforeligibleOntariansthrough

theOntarioDrugBenefit(ODB)program.Throughitsrenewedcommitmenttothe

Smoke-FreeOntarioStrategy,theGovernmentofOntarioisalsoworkingonexpanding

theavailabilityofsmokingcessationsupportinclinicalandcommunitysettings.A

recommendationtofurtherextendeffortstocreateanintegratedandcoordinatedtobacco

cessationsysteminOntariowaspartofthe2012Taking Action to Prevent Chronic

Disease: Recommendations for a Healthier Ontario report.2

• Electroniccigarettes(e-cigarettes)willbeimportantfortheOntariogovernmentto

consider.E-cigarettesheatnicotinesolutionintovapoursinhaledbytheuser22andare

gainingpublicinterestasapotentialharmreductionandsmokingcessationaid.23,24Little

researchhasbeenconductedtodateontheireffectivenessascessationaids.


2.6 expOsure tO secOnd-hAnd smOke

Exposuretosecond-handsmokemayoccurinseverallocales,includingthehome,vehicles,

workplacesandpublicplaces,suchasbars,restaurantsandoutdoorpublicspaces.Asmoke-free

homepolicynotonlybenefitsthenon-smokersinsideahousehold,buthasalsobeenfoundtohelp

smokersreducetheircigaretteconsumptionandquitsmokingcompletely.19,25

Figure 15. Trends in second-hand smoke exposure among non-smoking adults (aged 20+) in Ontario, 2003–2011

Notes: Estimates are age-standardized to the 2006 Canadian population.Source: Canadian Community Health Survey, 2003, 2005, 2007–2011 (Statistics Canada)

• Between2003and2011,theproportionofOntarionon-smokersreportingthattheywere

regularlyexposedtosecond-handsmokeathome,inpublicplacesandinvehiclesgenerally

declined(Figure 15).

• In2011,11.8%ofnon-smokerswereexposedtosecond-handsmokeinpublicplaces,down

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from16.6%in2003.Thedeclinewasmostapparentbetween2003and2005,andappears

tohavesincelevelledoffafteranapparentbutnotstatisticallysignificantincreasebetween

2009and2011.Theearlierdeclineslikelyreflectsmokingbansinbarsandrestaurantsin

severallargemunicipalitiesintheyearspriortotheimplementationoftheSmoke-Free

Ontario Actin2006.

• Second-handsmokeexposureinvehiclesdeclinedsignificantlyfrom7.8%in2003to5.5%

in2011,althoughitappearsthatrateshavestabilizedsince2007.Exposureathomealso

declinedsignificantly,from7.5%in2003to3.8%in2011(seesupplementarytable S13).

• Declinesinsecond-handsmokeexposureinthehomeandinvehicleshavelikelyresulted

fromincreasedawarenessofthehealthhazardsassociatedwithtobaccoexposure,

increasednon-smokingsocialnorms,theincreasedadoptionofvoluntarynon-smoking

policiesathome,andtheSmoke-Free Ontario Actbanonsmokinginvehicleswhen

childrenunderage16arepresent.

Figure 16. Prevalence of second-hand smoke exposure among non-smoking adults (aged 20+) in Ontario, by sex, 2009–2011 combined

Notes: Estimates are age-standardized to the 2006 Canadian population.Data from CCHS cycles 2009, 2010, and 2011 combined to increase sample size for analyses of second-hand smoke exposure.

represent 95% confidence intervals. Source: Canadian Community Health Survey, 2009–2011 (Statistics Canada)

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• During2009–2011,theproportionofnon-smokersregularlyexposedtosecond-handsmoke

inpublicplaces(11.4%)wassignificantlyhigherthantheproportionregularlyexposedin

avehicle(5.7%)andathome(4.2%)(seesupplementarytable S14).Thiswastrueformales

andfemales(Figure 16).

• Malenon-smokershadasignificantlyhigherprevalenceofregularexposuretosecond-hand

smokeinapublicplace(13.0%)andinavehicle(6.5%)thanfemalenon-smokers(10.0%

and5.1%,respectively).Thesexesweresimilarintheproportionexposedtosecond-hand

smokeathome(4.6%males,3.8%females).

• Theyoungestgroupofadults,aged20–29years,hadthehighestprevalenceofsecond-hand

smokeexposureathome(7.3%),inavehicle(11.3%)andinpublicplaces(20.1%),andthese

generallydecreasedacrosstheolderagegroups(seesupplementarytable S15).

• Highprevalenceofsecond-handsmokeexposureamongyoungadultsaged20–29may

bedue,inpart,toahighprevalenceofcurrentsmokinginthisagegroupandthereforea

greaterlikelihoodofexposureamongnon-smoking20–29year-oldsfromtheirfriendsand

acquaintances.

• Therelativelyhighprevalenceofexposuretosecond-handsmokeinpublicplacesin

OntarioislikelyduetoexposureinsettingsnotcoveredbytheSmoke-Free Ontario

Act(e.g.,uncoveredpatios,entrancewaystomostbuildings,parksandotheroutdoor

spaces).DatafromtheCTUMSdemonstratesmuchhigherprevalenceofsecond-hand

smokeexposureonpatiosthananyotherpublicplace.7Toaddressthissourceofexposure,

Taking Action to Prevent Chronic Disease: Recommendations for a Healthier Ontario

recommendsexpandingtheSmoke-Free Ontario Acttoincludeunenclosedbarand

restaurantpatios.2

• Therelativelylowprevalenceofregularexposuretosecond-handsmokeathomeamong

Ontarioadultnon-smokerslikelyreflectshighadoptionofvoluntarybansonsmoking

withinthehome.In2011,86.4%ofallOntariohouseholdsreportedthatsmokingisnot

allowedinsidetheirhomeandeventhemajority(61.9%)ofcurrentsmokersreported

livingina“smoke-freehome”(datanotshown).Itis,however,likelythattheestimatesof

exposuretosecond-handsmokeathomereportedhereunderestimatethetrueprevalence

ofexposurebecauseindividualslivinginmulti-unitdwellingswherenoonesmokesinside

theirhomemaystillbeexposedtosmokecomingfromotherunitswithinthesamebuilding

andbecausetheCCHSdoesnotaskaboutregularexposurethatdoesnotoccur“everyday”

or“almosteveryday.”


Figure 17. Prevalence of second-hand smoke exposure in Ontario adults (aged 30+), by selected socio-demographic factors, 2009–2011 combined

A) Second-hand smoke exposure at home

B) Second-hand smoke exposure in vehicles

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C) Second-hand smoke exposure in public places


Interpret estimates denoted with diagonal lines with caution due to high sampling variability. Source: Canadian Community Health Survey, 2009–2011 (Statistics Canada)

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• During2009–2011,theprevalenceofexposuretosecond-handsmokeathomewassimilar

inurban(3.4%)andrural/smalltown(3.8%)areasofresidence.Exposuretosecond-hand

smokeinavehicle,was,however,significantlyhigheramongnon-smokingadultslivingin

rural/smalltownareas(5.5%)thanthoseinurbanareas(4.4%),whilesecond-handsmoke

exposureinpublicplaceswassignificantlyhigherinurbanareas(9.7%urbanvs.7.9%

rural)(Figure 17A, B, C;supplementarytable S16).

• Higherratesofexposuretosecond-handsmokeinpublicplacesinurbanareasmayreflect

agreaterlikelihoodoffrequentingmoredenselypopulatedpublicplaceswheresmoking

maybeallowed,includingoutdoorspaces,suchaspublicparks.

• Exposuretosecond-handsmokeathomeandinavehiclewassignificantlyhigheramong

non-smokingadultswithlessthanasecondaryschooleducation(6.3%athomeand8.5%in

avehicle)thanpost-secondaryschoolgraduates(2.7%athomeand4.0%inavehicle).The

prevalenceofsecond-handsmokeexposureinpublicplacesdidnot,however,differbythe

highestlevelofeducation.

• Non-smokingadultsinthelowestincomequintileshadsignificantlyhigherprevalenceof

second-handsmokeexposureathome(4.7%),inavehicle(6.1%forQ1)andinpublicplaces

(12.9%)thanthoseinthehighestincomequintile(2.3%athome,3.5%inavehicle,8.3%in

publicplaces).

• Thedecreasinggradientsintheprevalenceofsecond-handsmokeexposureathome

andinavehicleacrossincreasinglevelsofeducationandincreasingincomequintiles

areconsistentwiththeeducation-andincome-relatedinequalitiesincurrentsmoking

prevalenceseeninOntario.

• Theprevalenceofexposuretosecond-handsmokeathomedidnotdifferaccordingto

immigrantstatus.However,non-smokingimmigrantswhohadbeeninCanadaformore

than10yearshadasignificantlylowerprevalenceofsecond-handsmokeexposureina

vehicle(3.2%)andasignificantlyhigherprevalenceofsecond-handsmokeexposurein

publicplaces(10.4%)thannon-smokingCanadian-bornadults.Higherexposureinpublic

placesamongimmigrantsmayreflectthefactthattheyarelikelytoliveinurbanareas.

• During2009–2011,therewaslittlevariationinsecond-handsmokeexposureathomeorin

avehicleamongOntario’sLHINs,whiletheprevalenceofsecond-handsmokeexposurein

publicplacesrangedfrom7.7%to18.0%(seesupplementarytable S17).

cancer risk factors in ontario · • in 2011, current smoking prevalence was significantly higher...

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