Smoking frequency, prevalence and trends, and their socio-demographic associations in Alberta, Canada.

Li, Feng Xiao ; Robson, Paula J. ; Ashbury, Fredrick D. 等

Tobacco smoking is one of the most important yet preventable causes of diseases and deaths in the world. (1-5) Despite substantial declines over the past few decades in Canada, (6) one-fifth of Canadians still smoked in 2006. (7) In 2007, the Canadian Federal Tobacco Control Strategy set a new target to further reduce the smoking rate to 12% by 2011. (8) Although the strategy has been articulated at a federal level, the provincial/territorial health authorities have an important role to play in achieving this national goal.

In Alberta, regional health authorities (RHAs) have been responsible for making and implementing local public health policies, including those relevant to cigarette smoking. While there are data describing the smoking trends in Alberta, (9) there is a paucity of published information concerning the numbers of smokers, and smoking prevalence and trends at the RHA level. Furthermore, the socio-demographic factors that may be associated with smoking in Alberta have not been examined.

The aims of this study were to determine the smoking frequency, prevalence and trends at the RHA level, and to examine their socio-demographic associations in Alberta. Such information will help guide policy-makers in facilitating resource planning and in evaluating the effectiveness of smoking control programs.

METHODS

Three Canadian Community Health Surveys (CCHS: Cycle 1.1, 2000/01; Cycle 2.1, 2002/03; Cycle 3.1, 2004/05) were carried out by Statistics Canada between 2000 and 2005. The surveys collected self-reported health information from a representative sample of Canadians aged 12 years and older, with the exclusion of the population on Indian reserves and Canadian forces bases, in institutions and in some remote areas. The three surveys were designed to provide reliable health estimates at the RHA level across Canada. The sample sizes were, respectively, 130,880, 134,072 and 132,221 for Canada, and 14,456, 13,871 and 11,800 for Alberta. The response rates ranged from 78.9% to 84.7% for Canada and from 81.5% to 85.1% for Alberta. The survey methodology has been published widely (6,10,11) and can also be found on the Statistics Canada website. (12)

During CCHS 1.1, there were 17 RHAs in Alberta. The 17 RHAs were collapsed into nine RHAs by Alberta Health and Wellness in 2003. To facilitate comparisons over time, the 17 RHAs were regrouped into the nine corresponding RHAs using a 2006 Postal Code Translation File (prepared by Alberta Finance). This contains information on both postal codes and RHA designations, and can be merged with the postal codes in the CCHS 1.1 dataset to redefine the RHAs. To characterize the urban/rural status of the nine RHAs, the 2006 Census urban/rural population for Alberta census subdivisions13 was matched to the census subdivisions of the nine RHAs in the Postal Code Translation File. An urban area was defined by the Census as a minimum population of 1,000 and a population density of at least 400 persons/km2. On the basis of this definition, the percent urban population (PUP) for the nine RHAs ranged from 46% to 93%, with an average of 82%. A map outlining the 2008 RHA boundaries is presented in Figure 1.

In the CCHS surveys, a variable known as "type of smoker" was derived. For the purposes of this analysis, respondents defined as "current daily smokers" or "occasional smokers" were combined into a single group (smokers), and all other respondents were combined into a "non-smoker" group. The missing values (i.e., "don't know" or "refusal"), accounting for less than 6% of the responses in each survey, were excluded from the analysis. The respondents' sex, age, educational level, household income and immigration status were also extracted to examine their association with smoking.

The estimated numbers of smokers and smoking prevalence were first determined by survey, sex and RHAs, and then by the sociodemographic and urban/rural status of the population using the final and Bootstrap weights. The final weight was used to adjust the sample into the appropriate population distribution. The Bootstrap weight was used in variance estimation to account for the complex sample design of the surveys. The association between smoking and socio-demographic factors was further examined using logistic regression. The likelihood ratio test was used to retain the significant predictors of smoking by means of backward elimination. For all significance tests performed, a p-value of <0.05 was considered statistically significant. The analyses were performed using SAS 9.1 (SAS Institute Inc., Cary, NC, US) and STATA 9.2 (Stata Corporation, College Station, TX, US).

[FIGURE 1 OMITTED]

RESULTS

Table 1 presents the smoking prevalence and numbers of smokers by survey and sex for the nine RHAs and for the entire province of Alberta. The smoking prevalence in the nine RHAs ranged from 18.5% to 36.1% among men and from 15.5% to 32.5% among women during the 6-year period. Over the three surveys, smoking was more prevalent among men than women in Alberta as a whole. However, in each survey, the smoking prevalence varied widely by RHA. In addition to the weighted prevalence, Table 1 also presents the estimated number of smokers in each RHA. While Calgary ranked lowest or second lowest for smoking prevalence in each of the three surveys for both men and women, the size of the smoking population was much greater than in any of the other RHAs, with the exception of Capital Health.

On the basis of the PUP, the nine RHAs were grouped into three categories: major urban RHAs, including Calgary and Capital Health (PUP: 93%, 91%); minor urban RHAs, including Palliser, Northern Lights and Chinook (PUP: 76%, 73%, 72%); and rural RHAs, including David Thompson, Peace County, East Central and Aspen (PUP: 60%, 58%, 50%, 46%). The weighted number of smokers and the prevalence were further cross-tabulated against the socio-demographic variables and urban/rural status of the three surveys (Table 2). As shown, both the smoking prevalence and the number of smokers were higher among men than women, in middle-aged groups (20-39 and 40-59 years) than in younger (12-19 years) and older (>60 years) groups, and among Canadian-born people than immigrants to Canada. The smoking prevalence tended to 1) increase with the increasing rurality of the RHAs, 2) decrease over the three surveys, 3) be inversely proportional to educational level and 4) be inversely proportional to household income. However, when examined in terms of numbers of smokers in the three surveys, the smoking population was the largest in the major urban RHAs and among those who reported the highest educational achievement and highest household income.

The above associations were further examined using logistic regression (Table 3). As shown, the odds of being a smoker were significantly lower in women than men and about four times higher in those aged 20-39 and 40-59 years than in those aged 12-19 years and 60 years or older. The odds of being a smoker in Canadian-born participants were approximately twice as high as those observed in immigrants to Canada. The odds of being a smoker increased with increasing rurality of the RHAs and decreased with increasing educational level and household income. The odds of being a smoker were significantly lower during the second and third survey than during the first survey.

DISCUSSION

Tobacco smoking was essentially a male habit about half a century ago (14) but became more common among women after World War II. (15) In 1965, the smoking prevalence among Canadian women aged 15 years and older reached 38%, compared with 61% among men. (16) Over the past 30 years, tobacco use, especially among male Canadians, has decreased significantly, so much so that in 2005 the smoking prevalence among Canadian men and women aged 12 years and older was 24% and 20%, respectively. (9) Smoking has been widely reported to be more prevalent in the lower socio-economic classes, (17-19) and among Canadian-born people than Canadian immigrants. (20) The socio-demographic distributions of the smoking rates, as observed by this study, are consistent with the previous findings.

Several Canadian studies have examined the urban/rural variation in smoking rates. (21,22) According to Mitura and Bollman, (22) smoking prevalence was significantly higher in small towns, rural areas and northern regions of Canada. Our finding that smoking prevalence was positively associated with the rurality of the RHAs is consistent with these findings. It has been suggested that the differences may be associated with the fewer smoking restrictions in rural areas. This may be compounded by an over-representation of blue-collar jobs in rural areas relative to urban areas. Previously, smoking rates among those performing manual labour have been observed to be higher than those in non-manual occupations. (23,24) Our finding of higher smoking rates in the lower socio-economic groups does appear to support these findings. (5,19)

It should be noted that we also observed a negative association between the immigrant population and the rurality of the RHAs, immigrants accounting for an average of 22%, 12% and 7% (data not shown) of the population of the major urban, minor urban and rural RHAs, respectively, during the six years. The proportionately greater immigrant population in the urban RHAs may have contributed to the lower smoking prevalence in those regions. However, this potential contribution did not substantially change the urban/rural smoking difference when immigration status was modelled as a covariate.

Studies from European countries have yielded different results with respect to smoking prevalence in urban areas. (25,26) It has been suggested that life in urban areas is more stressful than in rural areas, (27,28) and this explains the higher smoking rate in urban areas. According to a health behaviour model, people under stress are more likely to engage in behaviours that are detrimental to their health. (29) This model has been repeatedly supported by previous studies in the context of low socio-economic class in relation to smoking. (30,31) These results support our findings in the sense that the proportion of Albertans with low socio-economic status was higher in rural areas than in urban areas. For example, the per capita income and educational level in rural Alberta was lower than in urban Alberta. (32,33) How much other stressful events (e.g., stress at work or home) might contribute to the urban/rural smoking difference in Alberta is not known and may be worth further investigation.

Our finding that the smoking prevalence has been declining in Alberta coincides with the smoking trends observed for all of Canada. However, it should be noted that although the smoking prevalence among men fell over time, the number of Alberta men defined as smokers did not decrease substantially over time. Furthermore, in Capital Health, although the smoking prevalence among men dropped from 30% to 28%, the weighted number of smokers rose, because the number of smokers is a function of both smoking prevalence and population size. These findings illustrate that smoking prevalence should not be examined in isolation from absolute numbers of smokers.

Alberta is currently establishing new tobacco legislation to prevent initiation of tobacco use and to increase motivation to quit, by increasing tobacco taxes, restricting smoking in public places and prohibiting tobacco retail displays. (34) Although such strategies have been shown to be effective in decreasing smoking prevalence in other jurisdictions, (34,35) our findings suggest that additional strategies may have to be employed if the numbers of smokers in the large urban RHAs are to be reduced. Given that the smokers in these regions tend to have higher income, it is conceivable that financial penalties associated with the new tobacco legislation may have less impact in such regions than in the regions of lower socioeconomic status. Smoking control programs targeting these regions may lead to more effective reduction of the smoking population and the overall smoking prevalence in Alberta.

This study was conducted using data from three consecutive surveys that had high response rates and consistent methodology, making the data highly comparable across these surveys. Since the surveys depended on respondents' self-report of their smoking status, a potential for misclassification of information exists. Such misclassification, if it exists, is likely to be consistent across the three surveys and should have minimal impact on the smoking trends examined.

CONCLUSIONS

Although the new tobacco legislation being introduced in Alberta in 2009 may have a positive impact on smoking reduction, targeted interventions tailored to the regions or groups with the largest numbers of smokers may help further reduce the smoking population and the overall smoking prevalence in Alberta.

Acknowledgements: We wish to express our gratitude to Statistics Canada for granting our access to the Research Data Centre (RDC), where this data analysis was conducted. We also thank Ms. Shirley Loh at the RDC for her full support and assistance when the data analysis was conducted.

The research and analysis are based on data from Statistics Canada, and the opinions expressed do not represent the views of Statistics Canada.

* See page 478 for a letter to the editor updating the information in this article.

Received: March 9, 2009

Accepted: July 30, 2009

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Feng Xiao Li, PhD, [1] Paula J. Robson, PhD, [2] Fredrick D. Ashbury, PhD, [3,4] Juanita Hatcher, PhD, [1] Heather E. Bryant, MD, PhD [5]

Author Affiliations

[1.] Surveillance, Health Promotion, Disease and Injury Prevention--Cancer Bureau, Population and Public Health, Alberta Health Services, Edmonton, AB

[2.] Population Health Research, Alberta Health Services--Cancer Care, Edmonton, AB

[3.] PICEPS Consultants, Inc., Ajax, ON

[4.] Division of Preventive Oncology, Department of Oncology, University of Calgary, AB

[5.] Canadian Partnership against Cancer, Toronto, ON

Correspondence: Feng Xiao Li, Surveillance, Health Promotion, Disease and Injury Prevention--Cancer Bureau, Population and Public Health, Alberta Health Services, 14th Floor, Sun Life Building, 10123 99 St, Edmonton, AB T5J 3H1, Tel: 780-643-4357, Fax: 780-643-4380, E-mail: [email protected]

Table 1. Numbers of Smokers and Smoking Prevalence by Survey,
Sex and Regional Health Authority, sorted by PUP *

                                 2000/01

Men                    n            n         Prev (95% CI)
                   ([dagger])   ([double       ([section])
                                dagger])

Calgary                391       123,353    27.7 (24.7-30.7)
Capital                385       117,377    30.0 (26.4-33.5)
Palliser               115        11,376    29.3 (23.9-34.8)
Northern Lights        161          7627    34.0 (28.0-40.1)
Chinook                112        17,275    28.9 (22.8-35.0)
David Thompson         287        35,252    30.8 (26.7-35.0)
Peace County           250        16,915    32.5 (28.5-36.5)
East Central           136        16,920    36.1 (29.9-42.4)
Aspen                  295        23,824    34.1 (29.5-38.7)
Alberta               2132       369,919    29.8 (28.1-31.5)

Women
Calgary                359       101,778    23.0 (20.5-25.5)
Capital                367       102,955    26.2 (22.7-29.6)
Palliser               109        10,731    26.9 (21.2-32.6)
Northern Lights        138          5913    29.3 (24.1-34.5)
Chinook                104        13,090    21.9 (17.6-26.2)
David Thompson         282        30,743    27.6 (24.5-30.6)
Peace County           234        14,701    30.7 (26.5-34.9)
East Central           132        15,190    32.5 (27.0-38.0)
Aspen                  264        18,899    28.3 (24.6-32.1)
Alberta               1989       313,999    25.5 (24.0-27.0)

                                 2002/03

Men                    n            n         Prev (95% CI)
                   ([dagger])   ([double       ([section])
                                dagger])

Calgary                304       107,013    22.6 (19.5-25.7)
Capital                329        98,374    24.1 (20.8-27.3)
Palliser                96        12,416    29.8 (22.2-37.3)
Northern Lights        130          8979    32.9 (27.0-38.7)
Chinook                 92        15,261    24.9 (19.5-30.4)
David Thompson         249        34,144    28.1 (24.2-32.0)
Peace County           163        15,570    29.3 (23.6-34.9)
East Central            84        10,438    22.9 (17.0-28.9)
Aspen                  223        20,475    30.0 (25.3-34.8)
Alberta               1670       322,670    24.8 (23.1-26.5)

Women
Calgary                298        84,198    18.1 (15.6-20.6)
Capital                326        91,239    22.3 (18.8-25.8)
Palliser               100        10,724    26.5 (21.1-31.9)
Northern Lights        106          6736    27.8 (22.6-33.1)
Chinook                 77          9527    15.5 (11.1-20.0)
David Thompson         267        32,248    26.9 (23.2-30.5)
Peace County           152        10,295    20.7 (16.4-25.1)
East Central            91        10,315    22.6 (16.7-28.6)
Aspen                  219        17,121    26.1 (21.9-30.2)
Alberta               1636       272,403    21.2 (19.7-22.8)

                                 2004/05

Men                    n            n         Prev (95% CI)     PUP *
                   ([dagger])   ([double       ([section])
                                dagger])

Calgary                312       110,582    22.2 (19.4-25.0)     93%
Capital                317       118,935    28.1 (24.4-31.8)     91%
Palliser               130        14,353    33.8 (28.3-39.2)     76%
Northern Lights        111          9513    32.6 (26.5-38.6)     73%
Chinook                103        11,389    18.5 (13.7-23.3)     72%
David Thompson         171        30,853    25.7 (21.7-29.6)     60%
Peace County           132        16,911    31.3 (25.5-37.0)     58%
East Central           109        13,136    27.6 (22.1-33.0)     50%
Aspen                  127        18,858    27.2 (22.0-32.3)     46%
Alberta               1512       344,530    25.6 (23.9-27.3)     82%

Women
Calgary                262        86,876    17.6 (15.0-20.2)     93%
Capital                281        81,124    18.9 (16.1-21.7)     91%
Palliser                98        10,220    24.3 (18.4-30.1)     76%
Northern Lights         85          7132    28.1 (22.0-34.2)     73%
Chinook                132        13,220    21.6 (17.2-26.1)     72%
David Thompson         166        29,731    25.3 (20.8-29.8)     60%
Peace County           136        12,471    24.8 (18.5-31.1)     58%
East Central            98        10,195    22.0 (17.5-26.5)     50%
Aspen                  120        15,497    23.5 (18.9-28.2)     46%
Alberta               1378       266,466    20.0 (18.6-21.4)     82%

* Percent urban population

([dagger]) Unweighted number of respondents who were
current daily or occasional smokers

([double dagger]) Weighted number of respondents who
were current daily or occasional smokers

[section]) Weighted prevalence in percent
(95% confidence interval)

Table 2. Numbers of Smokers and Smoking Prevalence by
Socio-demographic Factors, Survey and Urban/Rural Status
of the Regional Health Authorities

                                    2000/01

Variable     Category                Major Urban

Sex          Male                          776 *
                                         240,730
                                      ([dagger])
                                28.7 (26.3-31.1)
                               ([double dagger])
             Female                          726
                                         204,733
                                24.5 (22.3-26.6)
Age group    12-19                           147
(years)                                   40,108
                                17.9 (14.7-21.0)
             20-39                           644
                                         203,649
                                32.2 (29.4-34.9)
             40-59                           546
                                         164,617
                                29.4 (26.5-32.3)
             [greater than                   165
             or equal to] 60              37,089
                                14.4 (11.9-17.0)
Education    <Secondary                      381
level        graduation                  110,571
                                26.7 (24.0-29.4)
             Secondary                       338
             graduation                  104,538
                                33.8 (30.5-37.1)
             Some post-                      172
             secondary                    51,790
                                30.2 (25.2-35.2)
             Post-secondary                  593
             graduation                  174,192
                                22.8 (20.5-25.0)
Household    <$30,000                        346
income                                    79,991
                                31.9 (28.3-35.5)
             $30,000-                        288
             $49,999                      86,300
                                31.0 (27.4-34.5)
             $50,000-                        322
             $79,999                     104,383
                                27.3 (24.3-30.4)
             [greater than                   546
             or equal to]                174,789
             $80,000            22.9 (20.5-25.3)
Immigrant    Yes                             187
status                                    66,597
                                17.5 (14.7-20.3)
             No                             1296
                                         371,750
                                29.3 (27.3-31.2)

                                                2000/01

Variable     Category                Minor Urban                Rural

Sex          Male                            388                  968
                                          36,278               92,911
                                30.0 (26.2-33.7)     32.8 (30.4-35.2)
             Female                          351                  912
                                          29,733               79,533
                                24.8 (21.8-27.8)     29.1 (27.3-31.0)
Age group    12-19                            58                  167
(years)                                     6887               15,491
                                18.9 (13.4-24.4)     18.3 (15.4-21.2)
             20-39                           341                  812
                                          30,106               81,689
                                34.3 (30.1-38.4)     40.9 (37.7-44.2)
             40-59                           285                  684
                                          24,308               59,403
                                32.6 (27.8-37.3)     33.4 (30.9-35.9)
             [greater than                    55                  217
             or equal to] 60                4710               15,861
                                 11.3 (7.2-15.3)     16.9 (13.9-19.9)
Education    <Secondary                      216                  648
level        graduation                   18,595               56,116
                                23.6 (19.9-27.4)     29.8 (27.2-32.5)
             Secondary                       150                  397
             graduation                   14,519               38,225
                                31.0 (26.0-35.9)     36.1 (32.4-39.7)
             Some post-                       60                  145
             secondary                      5865               15,558
                                29.1 (21.6-36.7)     36.1 (30.5-41.7)
             Post-secondary                  295                  625
             graduation                   25,573               56,790
                                28.3 (25.1-31.5)     27.6 (25.3-29.8)
Household    <$30,000                        131                  365
income                                    10,432               26,400
                                32.0 (26.8-37.1)     31.8 (27.9-35.7)
             $30,000-                        121                  335
             $49,999                      11,386               30,325
                                27.2 (22.2-32.2)     33.5 (29.8-37.3)
             $50,000-                        156                  425
             $79,999                      14,489               40,011
                                28.0 (22.8-33.1)     31.5 (28.3-34.7)
             [greater than                   331                  755
             or equal to]                 29,704               75,707
             $80,000            25.9 (22.4-29.5)     29.6 (27.1-32.1)
Immigrant    Yes                              54                   83
status                                      4447                 5984
                                15.3 (10.6-20.1)     15.9 (11.3-20.6)
             No                              680                 1787
                                          61,087              165,841
                                29.1 (26.1-32.0)     32.3 (30.5-34.1)

                                                2002/03

Variable     Category                Major Urban          Minor Urban

Sex          Male                            633                  318
                                         205,387               36,656
                                23.3 (21.0-25.6)     28.1 (24.2-32.1)
             Female                          624                  283
                                         175,437               26,987
                                20.0 (17.9-22.1)     21.4 (18.3-24.5)
Age group    12-19                           109                   67
(years)                                   27,960                 6552
                                 12.2 (8.8-15.6)     17.0 (12.4-21.7)
             20-39                           552                  253
                                         184,615               26,211
                                27.8 (24.9-30.7)     28.3 (23.9-32.6)
             40-59                           439                  217
                                         133,600               25,655
                                22.5 (19.6-25.5)     31.0 (26.2-35.9)
             [greater than                   157                   64
             or equal to] 60              34,562                 5225
                                12.8 (10.1-15.4)      12.3 (9.2-15.4)
Education    <Secondary                      262                  166
level        graduation                   71,188               16,773
                                20.0 (16.6-23.3)     21.8 (18.1-25.6)
             Secondary                       303                  154
             graduation                   92,284               17,067
                                28.9 (25.0-32.8)     34.9 (29.0-40.8)
             Some post-                      137                   67
             secondary                    47,088                 7025
                                28.9 (22.9-34.8)     26.5 (18.4-34.7)
             Post-secondary                  521                  198
             graduation                  156,790               20,704
                                17.9 (15.8-20.0)     20.9 (17.4-24.5)
Household    <$30,000                        224                   97
income                                    44,101                 8084
                                26.5 (22.0-31.1)     29.0 (22.2-35.5)
             $30,000-                        238                   71
             $49,999                      57,237                 7216
                                26.6 (22.5-30.7)     24.3 (17.9-30.7)
             $50,000-                        279                   95
             $79,999                      82,740               10,419
                                23.0 (19.8-26.1)     23.0 (16.5-29.5)
             [greater than                   516                  338
             or equal to]                196,746               37,924
             $80,000            19.4 (17.3-21.5)     24.7 (21.7-27.8)
Immigrant    Yes                             159                   50
status                                    57,283                 7229
                                15.0 (11.8-18.3)     21.9 (14.3-29.5)
             No                             1088                  530
                                         321,007               54,599
                                23.7 (22.0-25.4)     25.4 (22.6-28.2)

                                    2002/03              2004/05

Variable     Category                      Rural          Major Urban

Sex          Male                            719                  629
                                          80,627              229,517
                                27.9 (25.6-30.3)     24.9 (22.6-27.2)
             Female                          729                  543
                                          69,979              168,001
                                24.9 (22.7-27.1)     18.2 (16.4-20.1)
Age group    12-19                           168                   73
(years)                                   15,026               25,328
                                17.1 (13.8-20.5)      10.7 (7.7-13.6)
             20-39                           540                  511
                                          66,793              180,336
                                34.7 (31.6-37.8)     27.0 (24.5-29.5)
             40-59                           536                  426
                                          54,475              154,408
                                28.9 (25.9-32.0)     23.9 (20.9-26.8)
             [greater than                   204                  162
             or equal to] 60              14,399               37,446
                                14.2 (11.9-16.5)     12.8 (10.4-15.3)
Education    <Secondary                      490                  250
level        graduation                   47,461               83,999
                                26.0 (23.4-28.5)     22.9 (19.7-26.2)
             Secondary                       144                  242
             graduation                   35,907               80,731
                                31.9 (28.2-35.6)     28.4 (24.5-32.4)
             Some post-                      101                  121
             secondary                    13,783               40,891
                                31.7 (24.8-38.5)     26.0 (21.2-30.8)
             Post-secondary                  471                  539
             graduation                   47,924              184,525
                                22.3 (19.9-24.7)     18.5 (16.5-20.5)
Household    <$30,000                        252                  250
income                                    20,970               50,896
                                30.3 (26.2-34.4)     30.4 (25.9-35.0)
             $30,000-                        207                  204
             $49,999                      19,052               50,953
                                27.6 (23.4-31.9)     24.5 (20.4-28.6)
             $50,000-                        276                  209
             $79,999                      31,684               76,534
                                29.3 (25.2-33.5)     23.5 (19.8-27.2)
             >$80,000                        713                  509
                                          78,900              219,135
                                24.4 (22.3-26.5)     19.2 (17.3-21.1)
Immigrant    Yes                              63                  161
status                                      7401               55,296
                                19.9 (13.8-26.1)     14.4 (11.7-17.1)
             No                             1353                  996
                                         140,086              336,351
                                26.8 (25.1-28.5)     23.5 (21.7-25.3)

                                                2004/05

Variable     Category                Minor Urban                Rural

Sex          Male                            344                  539
                                          35,255               79,758
                                26.5 (23.3-29.6)     27.4 (24.7-30.0)
             Female                          315                  520
                                          30,572               67,894
                                23.8 (20.7-26.9)     24.2 (21.8-26.7)
Age group    12-19                            59                   66
(years)                                     5693                 8179
                                15.6 (11.4-19.8)       9.6 (7.1-12.2)
             20-39                           276                  433
                                          30,158               63,024
                                32.9 (28.9-36.9)     33.8 (30.3-37.3)
             40-59                           245                  396
                                          24,778               61,207
                                28.1 (24.1-32.2)     30.7 (26.9-34.5)
             [greater than                    79                  164
             or equal to] 60                5197               15,243
                                 11.4 (8.6-14.3)     15.1 (12.5-17.8)
Education    <Secondary                      162                  274
level        graduation                   15,980               34,348
                                24.5 (20.5-28.6)     21.8 (18.8-24.8)
             Secondary                       144                  225
             graduation                   15,386               35,913
                                33.5 (27.8-39.1)     35.9 (30.5-41.3)
             Some post-                       57                   80
             secondary                      5876               10,917
                                23.6 (16.7-30.4)     22.8 (16.6-28.9)
             Post-secondary                  280                  454
             graduation                   26,996               62,409
                                22.4 (19.3-25.4)     24.5 (21.9-27.1)
Household    <$30,000                        116                  195
income                                      7907               19,867
                                27.2 (21.9-32.5)     32.9 (27.9-38.0)
             $30,000-                         76                  156
             $49,999                        7347               19,736
                                26.9 (20.7-33.2)     30.1 (25.1-35.0)
             $50,000-                        116                  192
             $79,999                      12,116               28,635
                                23.8 (18.6-29.0)     29.0 (24.5-33.5)
             [greater than                   351                  516
             or equal to]                 38,457               79,413
             $80,000            24.9 (21.9-27.9)     22.9 (20.6-25.2)
Immigrant    Yes                              48                   47
status                                      4776                 6385
                                16.1 (10.5-21.7)     18.0 (11.3-24.8)
             No                              599                  993
                                          59,833              138,057
                                26.2 (23.9-28.6)     26.2 (24.3-28.1)

* Unweighted number of respondents who were current
daily or occasional smokers

([dagger]) Weighted number of respondents who were
current daily or occasional smokers

([double dagger]) Weighted prevalence in percent
(95% confidence interval)

Table 3. Socio-demographic Predictors of Smoking in
Alberta--Final Weighted Logistic Regression Model

Variable          Category                 n *     n ([dagger])

Sex               Male                    5128       1,037,119
                  Female                  4842         852,869
Age group         12-19                    898         151,224
  (years)         20-39                   4219         866,581
                  40-59                   3643         702,451
                  [greater than           1210         169,732
                    or equal to]
                    60
Urban/rural       Major urban RHAs        3831       1,223,805
  RHAs            Minor urban RHAs        1922         195,481
  ([section])     Rural RHAs              4217         470,702
  Education       <Secondary            2816         455,031
    level           school
                    graduation
                  Secondary               2276         434,570
                    school
                    graduation
                  Some                     932         198,793
                    post-secondary
                    school
                  Post-secondary          3946         755,903
                    school
                    graduation
Household         <$30,000                1945         268,648
  income          $30,000-$49,999         1679         289,552
                  $50,000-$79,999         2045         401,011
                  [greater than           4301         930,775
                    or equal to]
                    80,000
Immigration       Immigrant                836         215,398
  status          Canadian-born           9134       1,648,611
Year of           2001/02                 3986         683,918
  survey          2003/04                 3158         595,073
                  2005/06                 2826         610,997

Variable          Category              OR (95 CI)       p Value
                                     ([double dagger])

Sex               Male               Ref
                  Female             0.84 (0.80-0.88)    <0.001
Age group         12-19              Ref
  (years)         20-39              4.09 (3.73-4.49)    <0.001
                  40-59              3.62 (3.30-3.97)    <0.001
                  [greater than      1.08 (0.98-1.19)     0.14
                    or equal to]
                    60
Urban/rural       Major urban RHAs   Ref
  RHAs            Minor urban RHAs   1.03 (0.97-1.10)     0.319
  ([section])     Rural RHAs         1.06 (1.00-1.11)     0.038
  Education       <Secondary         Ref
    level           school
                    graduation
                  Secondary          0.90 (0.84-0.97)     0.006
                    school
                    graduation
                  Some               0.69 (0.62-0.75)    <0.001
                    post-secondary
                    school
                  Post-secondary     0.50 (0.47-0.54)    <0.001
                    school
                    graduation
Household         <$30,000           Ref
  income          $30,000-$49,999    0.82 (0.75-0.89)    <0.001
                  $50,000-$79,999    0.65 (0.60-0.70)    <0.001
                  [greater than      0.60 (0.57-0.65)    <0.001
                    or equal to]
                    80,000
Immigration       Immigrant          Ref
  status          Canadian-born      2.08 (1.92-2.25)    <0.001
Year of           2001/02            Ref
  survey          2003/04            0.82 (0.77-0.86)    <0.001
                  2005/06            0.88 (0.83-0.93)    <0.001

* Unweighted number of smokers of the three surveys

([dagger]) Weighted number of smokers of the three surveys

([double dagger]) Odds ratio (95% confidence interval)

([section]) Regional health authorities