Neighborhood factors and quitting smoking in Ontario

1. 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 Neighborhood factors and quitting smoking in Ontario

2. 1 in 5 Ontarians smoke

4. Objective To examine the association between cessation strategies used in attempts to quit and neighborhood factors. ?

5. Neighborhood Deprivation • Smokingassociated with: • Neighborhood deprivation • Neighborhoods with low socioeconomic status Use of cessation supports?

7. Urban-rural continuum Does use of cessation strategy differ by rural/urban location? Measure  urban-rural continuum from Statistics Canada

8. 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)

9. Methods – Data Sources Postal Code OTS

10. 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

11. 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)

12. The odds of quitting with assistance is 30% less for smokers living in rural versus urban areas in Ontario (adjusted p-value = 0.04).

13. The odds of quitting with assistance is 63% more for smokers living in areas with the least versus most ethnic concentration in Ontario (adjusted p-value = 0.004).

14. No Significant Differences Neighborhood level • Deprivation • Instability • Dependency

15. 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

16. 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

17. Next Steps • Examine additional social-environment factors: • Occupation (blue versus white collar) • Access to care (including interactions with rural/urban measure) • Social norms

18. Acknowledgements My work is funded by the CIHR Training Grant in Population Intervention for Chronic Disease Prevention: A Pan-Canadian Program (Grant #: 53893). The OTS is an initiative of Ontario Tobacco Research Unit which receives funding from the Ontario Ministry of Health and Long-Term Care.

19. Questions