Neighborhood factors and quitting smoking in Ontario 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

1 in 5 Ontarians smoke

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

Neighborhood Deprivation Smoking associated with: Neighborhood deprivation Neighborhoods with low socioeconomic status Use of cessation supports?

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

Ontario Tobacco Survey (OTS): Panel study of smokers 4500 Ontario smokers ( ) 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)

Methods – Data Sources OTS Postal Code

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

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)

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

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).

No Significant Differences Neighborhood level Deprivation Instability Dependency

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

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

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

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

Questions