Abstract
Objective
Smoking prevalence in the Saskatoon Health Region (SHR) went from 23.9% in 2003 to 23.3% in 2005 to 26.2% in 2007. The prevalence of smoking within the SHR Aboriginal population is substantially higher than the rest of the population. The purpose of the current study was to determine the independent effects of Aboriginal cultural status and income status on daily smoking status.
Methods
Data from three cycles of the Canadian Community Health Survey (2001, 2003, 2005) were merged with identical data collected by the SHR in 2007. All four cycles were random telephone survey samples.
Results
5948 participants (81.1% response rate) completed the survey. After cross-tabulation, Aboriginal cultural status and income were strongly associated with daily smoking status. Using logistic regression, the odds of daily smoking for residents of Aboriginal cultural status was reduced substantially from the initial odds of 3.43 to 2.26 after adjusting for income alone, and reduced further to 1.57 after full multivariate adjustment.
Conclusion
Given the association between smoking status and income status, future policies to reduce smoking prevalence should include generic policies to reduce income disparity as well as targeted strategies to improve the social conditions of Aboriginal people.
Key words: Ethnology, social class, income, smoking
Résumé
Objectif
La prévalence du tabagisme dans la région sanitaire de Saskatoon (RSS) a reculé de 23,9 % en 2003 à 23,3 % en 2005, puis augmenté à 26,2 % en 2007. La prévalence du tabagisme dans la population autochtone de la RSS est considérablement plus élevée que dans le reste de la population. Notre étude visait à déterminer les effets indépendants du statut culturel autochtone et du revenu sur l’usage quotidien du tabac.
Méthode
Nous avons fusionné les données de trois cycles de l’Enquête sur la santé dans les collectivités canadiennes (2001, 2003, 2005) avec des données identiques recueillies par la RSS en 2007. Les quatre cycles utilisaient des échantillons aléatoires d’enquêtes téléphoniques.
Résultats
5 948 participants ont répondu aux enquêtes (taux de réponse de 81,1 %). Une tabulation en croix a mis au jour de fortes corrélations entre le statut culturel autochtone et le revenu et l’usage quotidien du tabac. L’analyse de régression logistique a toutefois considérablement réduit la probabilité pour les résidents de statut culturel autochtone d’être des fumeurs quotidiens: cette probabilité est passée de 3,43 (initialement) à 2,26 après rajustement selon le revenu, et à 1,57 après rajustement multivarié.
Conclusion
Étant donné l’association entre l’usage du tabac et le revenu, les futures politiques de réduction de la prévalence du tabagisme devraient inclure des politiques générales pour réduire l’écart dans les revenus, ainsi que des stratégies ciblées pour améliorer les conditions sociales des Autochtones.
Mots clés: ethnologie, classe sociale, revenu, tabagisme
Footnotes
At time of submission of manuscript. Current affiliation is Saskatoon Tribal Council, Saskatoon, SK
References
- 1.Health Canada. Building and sustaining partnerships. A resources guide to address non-traditional tobacco use. Ottawa, ON: First Nations and Inuit Branch, Health Canada; 2003. [Google Scholar]
- 2.Tjepkema M. The health of the off-reserve Aboriginal population. Health Rep. 2002;13:1–15. [Google Scholar]
- 3.Statistics Canada. Canadian Community Health Survey, cycle 2.1. Ottawa: Statistics Canada; 2003. [Google Scholar]
- 4.Statistics Canada. Canadian Community Health Survey, cycle 3.1. Ottawa: Statistics Canada; 2005. [Google Scholar]
- 5.Statistics Canada. Canadian Community Health Survey, cycle 4.1. Ottawa: Statistics Canada; 2007. [Google Scholar]
- 6.Saskatchewan Health. Healthier places to live, work and play: A population health promotion strategy for Saskatchewan. Regina, SK: Saskatchewan Health; 2004. [Google Scholar]
- 7.U.S. Department of HealthHuman Services. Tobacco use among U.S. racial/ethnic minority groups — African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, Hispanics: A report of the Surgeon General 1998. Atlanta, GA: U.S. Department of Health and Human Services; 1998. [PubMed] [Google Scholar]
- 8.Novotny TE, Warner KE, Kendrick JS, Remington PL. Smoking by Blacks and Whites: Socioeconomic and demographic differences. Am J Public Health. 1988;78(9):1187–89. doi: 10.2105/AJPH.78.9.1187. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Statistics Canada. Canadian Community Health Survey — Methodological overview. Health Rep. 2002;13(3):1–6. [PubMed] [Google Scholar]
- 10.Lemstra M, Neudorf C, Opondo J. Health disparity by neighbourhood income. Can J Public Health. 2006;97:435–39. doi: 10.1007/BF03405223. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Rothman KJ, Greenland S. Modern Epidemiology. 2. Philadelphia, PA: Lip-pincott Williams and Wilkins; 1998. [Google Scholar]
- 12.Hosmer DW, Lemeshow S. Applied Logistic Regression. New York, NY: Wiley; 1989. [Google Scholar]
- 13.Lantz PM, House JS, Lepkowski JM, Williams DR, Mero RP, Chen J. Socio-economic factors, health behaviors, and mortality: Results from a nationally representative prospective study of US adults. JAMA. 1998;279(21):1703–8. doi: 10.1001/jama.279.21.1703. [DOI] [PubMed] [Google Scholar]
- 14.Pomerleau J, Pederson LL, Østbye T, Speechley M, Speechley KN. Health behaviours and socio-economic status in Ontario, Canada. Eur J Epidemiol. 1997;13(6):613–22. doi: 10.1023/A:1007339720807. [DOI] [PubMed] [Google Scholar]
- 15.Winkleby MA, Jatulis DE, Frank E, Fortmann SP. Socioeconomic status and health: How education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health. 1992;82(6):816–20. doi: 10.2105/AJPH.82.6.816. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Laaksonen M, Prättälä R, Helasoja V, Uutela A, Lahelma E I. ncome and health behaviours. Evidence from monitoring surveys among Finnish adults. J Epidemiol Community Health. 2003;57:711–17. doi: 10.1136/jech.57.9.711. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Huisman M, Kunst AE, Mackenbach JP. Inequalities in the prevalence of smoking in the European Union: Comparing education and income. Prev Med. 2005;40:756–64. doi: 10.1016/j.ypmed.2004.09.022. [DOI] [PubMed] [Google Scholar]
- 18.van Lenthe FJ, Mackenbach JP. Neighbourhood and individual socioeconomic inequalities in smoking: The role of physical neighbourhood stressors. J Epidemiol Community Health. 2006;60:699–705. doi: 10.1136/jech.2005.043851. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Mykletum A, Overland S, Aaro LE, Liabo HM, Stewart R. Smoking in relation to anxiety and depression: Evidence from a large population survey: The HUNT study. Eur Psychiatry. 2008;23(2):77–84. doi: 10.1016/j.eurpsy.2007.10.005. [DOI] [PubMed] [Google Scholar]
- 20.Miller M, Hemenway D, Bell NS, Yore MM, Amoroses PJ. Cigarette smoking and suicide: A prospective study of 300,000 male active duty Army soldiers. Am J Epidemiol. 2000;151:1060–63. doi: 10.1093/oxfordjournals.aje.a010148. [DOI] [PubMed] [Google Scholar]
- 21.Eaton WW, Muntaner C. Socioeconomic stratification and mental disorder. In: Horwitz AV, Scheid TL, editors. A Handbook for the Study of Mental Health: Social Contexts, Theories and Systems. New York: Cambridge University Press; 1999. [Google Scholar]
- 22.Frohlich KL, Ross N, Richmond C. Health disparities in Canada today: Some evidence and a theoretical framework. Health Policy. 2006;79:132–43. doi: 10.1016/j.healthpol.2005.12.010. [DOI] [PubMed] [Google Scholar]
- 23.Jarvis MJ. Why people smoke. BMJ. 2004;328:277–79. doi: 10.1136/bmj.328.7434.277. [DOI] [PMC free article] [PubMed] [Google Scholar]