Socio-economic status and smoking in Canada, 1999-2006: has there been any progress on disparities in tobacco use?

OBJECTIVES Comprehensive tobacco control policies implemented in Canada have succeeded in lowering overall smoking prevalence; however, the extent to which they have impacted socio-economic disparities in tobacco use is not known. This study examined smoking rates and related measures across socio-economic groups over a 7-year period in Canada. METHODS Regression analyses tested associations between smoking-related outcomes (prevalence, frequency, consumption, quit intentions and attempts, quit ratios), education level and time, using data from adults 25 years and older who completed the 1999 to 2006 waves of the Canadian Tobacco Use Monitoring Survey (CTUMS), a repeated cross-sectional survey with nationally representative samples (n = 86,971). RESULTS Between 1999 and 2006, smoking prevalence, daily smoking, and cigarette consumption decreased, while the proportion of smokers who planned to quit increased, as did the proportion of ever-smokers who had quit. However, significant educational differences were observed: Canadians with less education had greater odds of current smoking (prevalence approximately doubled between the most and least educated groups) and daily smoking, and consumed more cigarettes, compared to university graduates. Highly-educated ever-smokers were also more likely to have quit smoking. These disparities remained stable over the time period studied. Intentions and attempts to quit were not consistently associated with education. CONCLUSIONS The decline in smoking among Canadians between 1999 and 2006 represents a major public health achievement. However, considerable smoking-related disparities exist between socio-economic groups, and have changed very little. Therefore, while recent programs and policies have succeeded in reducing overall tobacco use, they have not addressed socio-economic disparities.