SMOKING BEHAVIOUR OF CANADIANS
A National Alcohol and
Other Drugs Survey Report
The opinions expressed herein are those of the authors, and do not necessarily reflect the point of view of Health and Welfare Canada.
Health and Welfare Canada (1988).
The Smoking Behaviour of Canadians:
A National Alcohol and Other Drugs
Survey (1989) Report.
Prepared by Marc Eliany and Jean‑René Courtemanche
(c) Department of Supply and Services Canada, 1991
Également disponible en français sous le titre
"L'usage du tabac au Canada : un rapport de
l'Enquête nationale sur l'alcool et les autres
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . vii
List of text figures . . . . . . . . . . . . . . . . . . . . . . . viii
List of text tables . . . . . . . . . . . . . . . . . . . . . . . ix
Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Smoking status . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Age and sex . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Language spoken . . . . . . . . . . . . . . . . . . . . . . . . . 5
Ethnic origin . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Religion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Daily cigarette consumption . . . . . . . . . . . . . . . . . . . 6
Age and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Language spoken . . . . . . . . . . . . . . . . . . . . . . . . . 7
Ethnic origin . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Religion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Changes in smoking behaviour . . . . . . . . . . . . . . . . . . . 9
Proportion of smokers . . . . . . . . . . . . . . . . . . . . . . 9
Daily consumption . . . . . . . . . . . . . . . . . . . . . . . . 9
Alcohol and tobacco consumption . . . . . . . . . . . . . . . . . 11
International comparisons . . . . . . . . . . . . . . . . . . . . 12
Sales trends . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Studies of smoking behaviour . . . . . . . . . . . . . . . . . . 12
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
NATIONAL ALCOHOL AND OTHER DRUGS SURVEY
THE SMOKING BEHAVIOUR OF CANADIANS
This report is the second in a series concerning the results of the National Alcohol and Other Drugs Survey. It contains estimates of tobacco consumption among Canadians age 15 and over. Statistics Canada carried out the survey on behalf of Health and Welfare Canada in March of 1989. The survey covered a total of 11,634 Canadians age 15 and over, who answered many questions concerning their consumption of alcohol, tobacco and other drugs, in particular the quantities involved, habits of consumption and the circumstances and atmosphere surrounding consumption. Other questions dealt with health problems and with the social and economic problems caused by the abuse of alcohol, prescription and over‑the‑counter drugs and illegal drugs. The survey also asked people what could and should be done to prevent such problems. All respondents were given the assurance that they would remain totally anonymous and that their answers would be confidential.
The results of the survey provide a solid basis which will be used to assess the importance of the problem caused by alcohol and other drugs among Canada's adults.
The information contained in this report should be taken into account in developing programs and measures in Canada. It should foster dialogue and debate among people working in the field, provide a basis for other research and above all give Canadians the facts they need to make judicious decisions regarding the consumption of alcohol, tobacco and other drugs.
Although the National Alcohol and Other Drugs Survey is impressive in scope, it does have its limitations. For example, the survey excludes some groups, such as teenagers under 15, the homeless and people in institutions. Moreover, it was only possible to study a small number of the thousands of psychotropic drugs and other substances that are currently available in Canada. Various surveys relating to these important issues will be undertaken in order to complete the general picture.
Research in drug abuse in Canada is in its infancy, and proper documentation on the nature and extent of the problem is still lacking. This Survey fills many of the gaps in our information, and prepares the way for the development of effective measures in the long term.
The National Drug Strategy
The National Alcohol and Other Drug Survey is part of the program of the National Drug Strategy and of the National Strategy to Reduce Tobacco Use in Canada.
The National Drug Strategy, initiated in 1987, has been developed through extensive consultations among the federal, provincial and territorial governments, non‑governmental organizations and toxicologists.
The federal government has committed $ 210 million over five years to improve existing programs and to fund the activities of five federal departments.
The objective of the National Drug Strategy is to reduce the harmful effects of addiction on families and communities by taking a balanced approach to the problems of supply and demand in a Canadian context.
The National Drug Strategy is based on a proper balance between educational and preventive measures on the one hand, and actions of interdiction and coercion on the other. Its underlying assumption is that the best way to reduce the incidence of drug addiction in the long term is to attack the problem at its source: supply. Seventy per cent of National Drug Strategy resources are devoted to priority areas.
When the National Drug Stategy was launched, five federal departments received financial support to take steps for which Health and Welfare Canada assumes general responsibility. However, the overall strategy calls upon several federal departments. Some programs, which were already under way when the Strategy was first implemented, have not received additional funding. Other anti‑drug programs have since been set up or are under development. All are partners in the National Drug Strategy on the same basis as the provinces, the territories and agencies that receive federal assistance to carry on the war against drugs.
At the present time, the partners of the National Drug Strategy include 14 departments and agencies of the federal government, all the provinces and territories and hundreds of non‑governmental organizations.
National Strategy to Reduce Tobacco Use in Canada
Smoking is the major avoidable cause of disease, disability and death in Canada. Every year, more than 35,000 Canadians die of diseases associated with tobacco use.
The National Strategy to Reduce Tobacco Use in Canada is based on the principle that actions taken to combat smoking will be more effective if all levels of government and non‑governmentalal organizations work together.
In May of 1985, the federal Minister of Health and Welfare and all the provincial ministers of Health in Canada agreed on the need to adopt a comprehensive approach if the real desire is to fight against tobacco use in Canada. Eight national organizations working in the health field also endorsed this approach.
The position paper of the National Strategy to Reduce Tobacco Use in Canada lists seven major ways of dealing with the issue of smoking: legislation; access to information; accessibility of services and programs; dissemination of anti‑smoking messages; support for community‑based initiatives; and coordination of policies and research.
The National Strategy is intended to create a feeling of solidarity in dealing with the many initiatives that are currently being implemented to fight smoking throughout Canada, and to take advantage of the excellent programs already in place, in order to give more scope to the initiative.
The National Alcohol and Other Drugs Survey is the result of very extensive collaboration among scientists from all parts of Canada, who have pooled their efforts and their skills.
This report has been prepared by Marc Eliany of the Health Promotion Studies Unit, with the assistance of Jean‑René Courtemanche, a coop student from the University of Sherbrooke.
The team responsible for the National Survey was composed of the following members: Marc Eliany, National Survey Project Director; Norman Giesbrecht, of the Ontario Addiction Research Foundation, who acted as principal consultant; Mike Nelson, Special Advisor to the Health Studies Promotion Branch.
All members of the team wish to express their thanks to the managers of the Health Promotion Branch, and in particular to the staff of the Tobacco Programs Unit and of the Health Studies Promotion Unit. We specially wish to thank Tariq Bhatti, Reg Warren, Paul Melia, Ellan Bobet and Lyn Taylor for the advice they gave us during the writing of this report. We also thank Roberta Ferrence, Lucia Farinon and Tom Stephens for their contribution to the revision of this report.
The survey team also wishes to thank the many other revisers for the help they gave us at various stages in the process. In particular, we would like to mention the help we received from Thomas Stephens , who prepared the study "Canadians and Smoking: an update" and the example given by Wayne J. Millar  in his report, "Smoking Behaviour of Canadians, 1986", which preceded this report. Special thanks are also due to the staff of the Special Surveys Division at Statistics Canada who conducted the interviews and supplied the data tapes, especially Gary Catlin and Anne Haining; and to the staff of the Program Planning and Information Branch of Health and Welfare Canada for their invaluable assistance in data processing, in particular Bill Bradley, Prem Khosla, John Hancock and Paul Boulé.
LIST OF TEXT FIGURES
1 Cigarette smokers age 15 and over, by age and sex, Canada, 1989
2 Cigarette smokers age 15 and over, by province and sex, Canada, 1989
3 Cigarette smokers age 15 and over, by education and sex, Canada, 1989
4 Cigarette smokers age 15 and over, by sector of employment and sex, Canada, 1989
5 Percentage of smokers age 15 and over, Canada, 1965‑1990
6 Percentage of smokers age 15 to 24, Canada, 1979‑1989
7 Percentage of current drinkers, by smoking behaviour, Canada, 1989
8 Average number of drinks consumed per week, by smoking behaviour, Canada, Canada, 1989
9 Percentage of drinkers having consumed five or more drinks on 15 or more occasions last year, by smoking behaviour, Canada, 1989
«field1» LIST OF TEXT TABLES
«field2»1 Percentage distribution of the population 15 years of age and over, by smoking behaviour, age and sex, Canada, 1989
«field3»2a Percentage of smokers in the population 15 years of age and over, by region, province, age and sex, Canada, 1989
«field4»2b Percentage of the population 15 years of age and over who have never smoked, by region, age and sex, Canada, 1989
«field5»2c Percentage of non‑smokers in the population 15 years of age and over, by region, age and sex, Canada, 1989
«field6»3 Percentage of smokers in the population 15 years of age and over, by education, age and sex, Canada, 1989
«field7»4 Percentage of smokers in the population 15 years of age and over, by occupation, age and sex, Canada, 1989
«field8»5 Percentage of smokers in the population 15 years of age and over, by sector of employment and sex, Canada, 1989
«field9»6 Percentage of smokers in the population 15 years of age and over, by income, age and sex, Canada, 1989
«field10»7 Percentage of smokers and of individuals who have never smoked in the population 15 years of age and over, by language spoken, age and sex, Canada, 1989
«field11»8 Percentage of smokers in the population 15 years of age and over, by ethnic origin, age and sex, Canada, 1989
«field12»9 Percentage of smokers and of individuals who have never smoked in the population 15 years of age and over, by religion, age and sex, Canada, 1989
«field13»10 Percentage of smokers in the population 15 years of age and over, by number of cigarettes smoked per day, age and sex, Canada, 1989
«field14»11 Percentage of smokers in the population 15 years of age and over, by number of cigarettes smoked per day, region and sex, Canada, 1989
«field15»12 Percentage of smokers in the population 15 years of age and over, by number of cigarettes smoked per day, education and sex, Canada, 1989
«field18»13 Percentage of smokers in the population 15 years of age and over, by number of cigarettes smoked per day and occupation, Canada, 1989
«field19»14 Percentage of smokers in the population 15 years of age and over, by number of cigarettes smoked per day and household income, Canada, 1989
«field20»15 Percentage of smokers in the population age 15 years of age and over, by number of cigarettes smoked per day and language spoken, Canada, 1989
«field21»16 Percentage of smokers in the population 15 years of age and over, by number of cigarettes smoked per day and ethnic origin, Canada, 1989
«field22»17 Percentage of smokers in the population aged 15 years of age and over, by number of cigarettes smoked per day, religion and sex, Canada, 1989
«field23»18 Percentage of current cigarette smokers in the population 15 years of age and over, Canada, 1965‑1990
«field24»19 Percentage of current cigarette smokers in the population 15 years of age and over, by age and sex, Canada, 1979‑1989
«field25»20 Percentage of regular smokers in the population 15 years of age and over, by number of cigarettes smoked per day, age and sex, Canada, 1966‑1989
«field26»21 Types of drinkers 15 years of age and over and number of drinks consumed in the week preceding the survey, by smoking behaviour and sex, Canada, 1989
«field27»22 Number of occasions where 5 or more drinks are consumed in the population 15 years of age and over, by smoking behaviour and sex, Canada, 1989
«field28»23 Sale of tobacco in millions of units for selected years
«field29»24 Percentage of male and female adult smokers, in various countries
. In 1989, approximately 6.5 million Canadians, or 32 % of the population 15 years of age or over, were cigarette smokers. About 33 % of men and 31 % of women were smokers.
. The highest rates of tobacco consumption, namely 35 % and 37 %, are found in the 20‑54 age group. Rates are lower among teenagers (23 %) and among older Canadians (19 %).
. In the 15‑34 age group, women consume tobacco as much as men, but the rate of consumption among older individuals is higher for men.
. Tobacco use is higher in Quebec (35 %) and in the Maritimes (33 %), and lower in British Columbia (28 %). For men, rates of consumption vary considerably from region to region, but for women there is little regional variation except in Quebec, where the rate is high.
. The rate of tobacco use decreases as the level of education increases. Individuals who have a high school diploma or less are more likely to smoke than people with a university education.
. The rate of consumption among those earning $ 60,000 or more per year is one third lower than among those who earn less than $ 30,000.
. Managers, students and retirees are less likely to smoke (23 % to 29 %). The highest smoking rates are found among blue collar workers and people looking for work (41 % and 42 %).
. For young adults and for older individuals, tobacco consumption is higher among Francophones and lower among those whose first language is neither English nor French. There are no differences by language for smokers in the 35‑54 age bracket.
. In general, one quarter of Canadians smoke 1 to 10 cigarettes per day, 62 % 11 to 25 cigarettes, and 10 % smoke 26 or more cigarettes. Men between 34 and 54 years of age are the biggest consumers of tobacco. Women are more likely than men to smoke 1 to 10 cigarettes per day.
. When we look at trends over the years, we find that the predominant use of tobacco has gradually declined since 1965. The greatest declines have taken place primarily among young people 15 to 19 years of age. Teenagers, both boys and girls, are now less likely to smoke than they were in the past.
. From 1966 to 1988, the proportion of those who smoke the largest number of cigarettes increased, but in 1989 it declined. The greatest decline is again found among young people.
There is much evidence to suggest that the abuse of alcohol and other drugs is directly harmful to a large number of Canadians, and indirectly harmful to even more. Among these drugs, tobacco is one of the major causes of health problems in Canada.
In earlier research efforts, such as the work done in connection with the Health Promotion Survey of 1985, the data collected on the consumption of alcohol and other drugs proved useful to researchers and practitioners. This showed the need for a databank that people would be able to consult in carrying out more detailed studies of issues relating to alcohol and drugs.
Since 1965, Health and Welfare Canada has been gathering information on the smoking habits of Canadians, through supplements to the Labour Force Survey. The Canadian Labour Force Survey (LFS) is the most extensive ongoing survey of households conducted by Statistics Canada.
The development of this databank was one of the priorities of the National Drug Strategy, which Health and Welfare Canada inaugurated on May 27, 1987 in order to reduce the harm that drug abuse causes to individuals, families and communities.
The National Alcohol and Other Drug Survey is the first large Canada‑wide study to deal specifically with the problems associated with alcohol and other drugs. The major focus of the survey was to study the alcohol consumption habits of Canadians. A second aim was to examine the use of presription or over‑the‑counter drugs, of tobacco and of illegal drugs like marijuana.
In the National Alcoohol and Other Drugs Survey, Canadians were contacted by telephone and asked whether they smoked cigarettes, at what age they began smoking, if they had smoked in the past but quit, and how many cigarettes they smoked a day.
In this report, the main purpose of our analysis is to determine the national and regional characteristics of smokers, and trends smoking status from 1965 to 1989.
Age and sex
In 1989, some 6.5 million Canadians, or 32 % of the population 15 years of age and over, smoked cigarettes. About 3.3 million men and 3.2 million women (33 % and 31 % respectively) were current smokers¹ (Table 1). The percentage of current smokers gradually declined from 19865 to 1989 (from 50 % to 32 %)(see Table 18). However, this rate is one of the highest in the world (see Tables 23 and 24).
Table 1 and Figure 1 present more detailed data on the distribution of the population by smoking status. Among people under 35 years of age, consumption rates are similar for men and for women. For those 35 and over, men's smoking rates are slightly higher, by 3 to 5 percentage points.² Consumption rates are higher among adults in the 20‑54 age group (35% to 37 %), and are lower among teenagers and older Canadians (23 % to 19 %).
[Figure 1 here]
Sixty‑eight per cent of Canadians are non‑smokers. This category includes both former smokers (26 %) and those who have never smoked (42 %). Because of historical differences between men and women in regard to tobacco use, the proportion of former smokers is higher among men (30 %) than among women (22 %). Among men, the proportion of former smokers increases with age, while for women, it increases up to the 35‑44 age group, and then gradually declines (Table 1).
The category of people who have never smoked is important because it may reflect social pressures on people not to start smoking. Approximately
¹ The category of "current smokers" includes both daily and occasional smokers. Since only 1 per cent of people were occasional smokers in 1989, we have combined the two categories. In this study, current smokers will be described simply as "smokers".
² Throughout the report, differences in responses are expressed in percentages, namely in relation to total response rather than to the number of individuals answering the question. For example, a decline from 30 to 20 per cent is considered to be a drop of 10 percentage points (30 ‑ 20 = 10), rather than a decline of 33 per cent (10/30 x 100 = 33). These differences have not been analyzed for the statistical value, and in general, remarks are only made on differences of 3 to 4 per cent or more. Such differences are likely significant in a sample of this size. (See Table C of Appendix B.)
42 % of the adult population state that they have never smoked (about 37 % of men, compared to 48 % of women). The percentage of adult males who have never smoked decreases with age, and a higher percentage of women have never smoked. Sixty‑three per cent of women 65 years of age or older have never smoked, compared to 24 % of men in this age group (Table 1).
Smoking status varies from region to region, although these differences are becoming smaller. In 1989, Newfoundland and Quebec had the largest proportions of smokers in Canada (36 % and 35 % respectively), while British Columbia had the smallest (28 %)(see Table 2 and Figure 2).
[Figure 2 here]
If we compare the smoking status of men in the different provinces, we find that consumption rates are highest in Prince Edward Island, Newfoundland and New Brunswick (38 % to 40 %). Rates observed in Manitoba and British Columbia are lower (27 % and 29 % respectively).
Quebec and Newfoundland have the highest proportion of women who smoke (34 %), while New Brunswick has the smallest percentage of women smokers (23 %). In all provinces except British Columbia, tobacco use is more widespread among men. In British Columbia, the proportion of women smokers is 2 percentage points higher than that of men, while in the other provinces, the consumption rate for men is 1 to 7 points higher than for women. The ratio of men to women who smoke varies from 1.0 to 1.7. Prince Edward Island and New Brunswick have the greatest differences in tobacco use by sex. In New Brunswick, the rate of consumption for men is 17 percentage points higher than the rate for women, and in Prince Edward Island, the difference is 10 percentage points. In these two provinces, the ratio of male to female smokers is 1.7 and 1.3 respectively.
The relationship between education and tobacco use is important because it facilitates identification of target groups for public education initiatives. Most previous surveys showed an inverse relationship between number of years of formal education and tobacco use, and this survey is no exception.
Consumption of tobacco is closely linked to level of education. Table 3 and Figure 3 present comparative data on cigarette consumption by level of education. The ratio of smokers with a high school diploma to university graduates who smoke is 1.8. The difference for women is 17 percentage points, and is 14 points for men. The percentage of smokers decreases as the level of formal education increases. It should be noted that these comparisons are not age‑adjusted.
[Figure 3 here]
It is important to know the extent of tobacco use in various occupational categories, both for epidemiological reasons and to facilitate the development of health promotion programs. Tobacco use associated with other hazardous substances in the workplace may have a synergistic effect more pathogenic than the combined effect of the two particular types of exposure [U.S. Department of Health and Human Services, 1984]. The quantities of tar, nicotine and carbon monoxide that cigarettes emit into the ambient air are much higher than they are in the smoke inhaled by smokers [Rickert et al., 1984]. Consequently, workers who do not smoke but who are involuntarily exposed to cigarette smoke may run some of the same health risks as smokers [Dosman, 1985 and Wigle et al, 1987]. In other words, they can develop the same kinds of diseases as smokers. A recent Canadian study of data on the composition of tobacco smoke and on health risks associated with passive smoking suggests that there is no safe level of exposure [Collishaw et al, 1984].
As Table 4 shows, the highest rates of tobacco use have been found among people looking for work (42 %). blue collar workers (41 %) and white collar workers (37 %). Those groups that had the lowest rates include students (23 %) and retired people (24 %). Managers and people at home fall between these two extremes, with rates of 29 % and 30 % respectively. When tobacco use is compared according to the sex of the respondents, we find that men are generally more inclined to smoke than women unless they are students, blue collar workers or managers, all groups where the proportion of smokers is higher among women than among men. If we look at the data in terms of employment sectors (Table 5 and Figure 4), we find the highest proportion of smokers in the transportation sector (44 %), followed by manufacturing (41 %) and the sales and service sector (37 %).
[Figure 4 here]
Table 6 shows the distribution of smokers by household income. Tobacco use is closely tied to personal income and tends to decrease as income increases. For example, it is 36 % among those earning less than $ 10,000 per year, but only 25 % for people making $ 60,000 or more. Tobacco consumption rates for men and for women differ greatly among those earning less than $ 10,000, but similar for people who earn $ 10,000 or more.
Smoking status varies according to the language spoken by individuals. Table 7 shows that the proportion of smokers is greater among Francophones (35 %) than among Anglophones (31 %), for all age groups and for both sexes. The lowest percentage of smokers (27 %) is found among people whose first language is neither English nor French. Furthermore, 81 % of women in this category say that they have never smoked.
Table 8 contains data on tobacco use by ethnic origin. It shows that the largest proportion of smokers, namely 37 %, is found among individuals whose origin is both Canadian and French. Moreover, those who are Canadians only or French only have the second highest percentage, namely 35 % in both cases. Rates of tobacco use are lower among other Europeans (29 %) and among people of other origins (26 %). The greatest difference between the sexes in regard to smoking is found among people of both Canadian and French origin, the discrepancy being 6 percentage points (40 % among men compared to 34 % for women), and among people of other ethnic origins (where the difference is 9 percentage points).
Tobacco use is closely associated with the religion of individuals (Table 9). People who say they have no religion, Roman Catholics and members of the United Church are the heaviest smokers, each group having a consumption rate of about 34 %. Next in order come the Anglicans (31 %) and other Protestants (29 %). The lowest proportion of smokers (24 %) is found among people who belong to other religions. This category also contains the largest percentage of people who have never smoked, namely more than half.
¹ See note on Table 8 for a definition of "ethnic origin".
DAILY CIGARETTE CONSUMPTION
Mortality risks vary according to smoking status and degree of exposure to risk factors. People who currently smoke cigarettes are much more likely to suffer diseases associated with tobacco use and to die of them than former smokers or people who have never smoked. It has been established that tobacco‑related risk depends upon the number of cigarettes smoked per day, the tar and nicotine content of the cigarettes smoked, the habit of inhaling smoke, and the duration of tobacco use. This report contains information on the frequency of tobacco use.
Data on the distribution of smokers by number of cigarettes smoked per day in 1989 (Table 10) indicate that 26 % of Canadian smokers consumed 1 to 10 cigarettes per day, 64 % smoked 11 to 25 cigarettes and 10% had more than 25 cigarettes per day. Some Canadian manufacturers have recently marketed packs of 30 cigarettes. If this trend catches on, the proportion of smokers consuming more than 25 cigarettes per day could further increase.
Age and sex
Table 10 shows that in general, men are heavier smokers. About 13 % of male smokers consume more than 25 cigarettes per day, compared to 6 per cent of women smokers. The proportion of smokers consuming more than 25 cigarettes per day increases with age for both men and women, up to the 45‑54 age group. The highest percentage of smokers consuming less than 10 cigarettes per day, namely about half (50 %), is found in the 15‑19 age group. They are followed by the group of people 65 years of age and over, where the corresponding figure is nearly 34 % (Table 10).
The proportion of individuals who regularly smoke more than 25 cigarettes per day varies by region. Table 11 shows that the highest proportion of such smokers is in Quebec (14 %), followed by British Columbia (12 %). The Atlantic provinces are close to the national average, with 10 %, and the lowest percentages are in Ontario (8 %) and in the Prairie provinces (5 %). In all regions, women generally smoke fewer cigarettes than men.
Table 12 indicates that more smokers with between zero and eight years of formal education smoke more than 25 cigarettes per day. The consumption habits of men were largely responsible for this particular configuration of data in the overall population. Approximately 15 % of men with less than eight years of schooling consumed more than 25 cigarettes per day. Men smoke more than women in general, but for both sexes, the proportion of smokers consuming less than 10 cigarettes per day becomes progressively larger as the level of education rises. In the group of women with the most education, for example, 43 % of smokers consumed fewer than 10 cigarettes per day. These results are similar to those of Table 3, which shows that tobacco use decreases as the level of education increases.
Table 13 indicates that among smokers, students have the lowest rate of daily cigarette consumption. Half of student smokers consume between one and 10 cigarettes per day. This rate is more than 21 percentage points above the rates for the groups of managers and of retired people, which follow with 30 % each. Blue collar workers seem to be the heaviest smokers, 12 % of them smoking more than 25 cigarettes per day. The largest percentages of average smokers (consuming between 11 and 25 cigarettes per day) are found among white collar workers (70 %), blue collar workers (69 %) and people at home (68 %). Similar results are recorded in Table 4 in regard to frequency of tobacco use.
Table 14 gives the distribution of smokers by income. Tobacco use is highest among people who earn between $ 30,000 and $ 59,999 (11 % smoke more than 25 cigarettes per day). Those who have an income of less than $ 10,000 have the highest percentage of smokers consuming less than 10 cigarettes per day (31%). They are followed by those who earn between $ 10,000 and $ 29,900 and by people earning more than $ 60,000, both of these groups having a proportion 0f 27 %.
Table 15, which gives the distribution of smokers by number of cigarettes smoked per day and by language spoken, shows that as a group, people who speak neither French nor English have the highest percentage of smokers consuming less than 10 cigarettes per day (38 %). Francophones are more inclined than Anglophones to smoke more than 25 cigarettes per day, the percentages for these groups being 13 % and 8 % respectively. Similar results are recorded in Table 7 in regard to frequency of tobacco use.
Tobacco use varies according to ethnic origin, as Table 16 shows. People who have identified themselves as being of Canadian and French origin seem to have the largest proportion of smokers consuming more than 25 cigarettes per day (15 %). On the other hand, the highest percentage of smokers who have less than 10 cigarettes per day (34 %) is found among people whose origin is other than Canadian, French, English or European. This model agrees with the distribution of types of smokers (Table 8).
We have seen above that religion has an influence on the consumption of tobacco (Table 9). Table 17 shows the effect of religion on the number of cigarettes smoked per day. People who do not adhere to any specific religion have the highest percentage of smokers of 25 more more cigarettes per day (13 %). This percentage is 10 % or less for each of the other categories of religion. Members of the United Church and Anglicans are more inclined than other groups to smoke between 11 and 25 cigarettes per day (69 % and 68 % respectively), while people whose religion is other than those mentioned in the table show the lowest daily consumption, with 34 % who smoke between one and 10 cigarettes per day.
CHANGES IN SMOKING BEHAVIOUR
Proportion of smokers
Changes have occurred in the consumption of cigarettes since 1965. Figure 5 shows that the percentage of smokers has steadily declined over the last 25 years, from 50 % in 1965 to 32 % in 1989 (see Table 18).
[Figure 5 here]
Among young people, smoking has dropped off considerably since 1979. Figure 6 shows that the percentage of young smokers (15 to 19 years of age) has decreased more than the percentage of smokers aged 20 to 24. It is too early to determine whether there is a long‑term levelling off among young people (see Table 19).
[Figure 6 here]
In general, this decline has been much more pronounced among men than among women, the figures for the two sexes being 21 and 3 percentage points respectively. It should, however, be noted that in 1966, the proportion of regular smokers among men was much higher than among women, the difference being 22 percentage points (54 % for men compared to 32 % for women). Today, however, the percentages for the two sexes are much closer together than they were in 1966. In 1989, indeed, the proportion of regular smokers was 33 % for men and 31 % for women (Table 1). Furthermore, while there are more men than women 25 years of age and over who smoke every day, men and women have similar rates in the under‑25 age group. Another point that should be stressed is that while among men, the percentages of regular smokers are lower than they were in 1989 for every age group, some age groups of women show an incrase in regular smokers in comparison with 1966. For example, among women 65 years of age and over, the proportion of regular smokers has risen from 8 % in 1966 to 16 % in 1989. This change is primarily attributed to aging of the smokers' group, and to replacement of the oldest cohort of non‑smokers as the years went by. This development, then, is probably a temporary phenomenon.
Smokers are today thought to be more aware than they were in the past of dangers caused by cigarette smoking. Canadians have seen steep tax increases on tobacco products, and now face greater restrictions of smoking in public and in the workplace. Smokers have responded to these pressures by reducing their daily consumption of cigarettes. Although the percentage of smokers has not changed much since 1986, Table 20 shows that changes have occurred in the daily consumption of smokers, namely in the number of people who smoke every day. We find in fact that between 1986 and 1989, the proportion of people who smoke 26 or more cigarettes per day has declined by 3 per cent. We also find a drop of 4 per cent in the proportion of average smokers, namely those who smoke between 11 and 25 cigarettes per day. The result of these changes is an increase of 6 per cent in the number of people who smoke few cigarettes (1 to 10 per day).
The percentage of smokers consuming 26 or more cigarettes per day grew somewhat from 1966 to 1981 (from 8 to 13 %), and has since been on the decrease. The proportion of smokers in this category has decreased for both men and women, by 2 and 3 percentage points respectively (Table 20).
The proportion of people who smoke less than 10 cigarettes per day has grown since 1981. The largest increase in this category, from 38 % to 51 %, occurred in the 15‑19 age group. This great change is largely attributable to women, who recorded a 24 percentage point increase during this period (Table 20).
ALCOHOL AND TOBACCO CONSUMPTION
In Canada, cigarette smokers have a greater tendency to consume alcohol than those who have never smoked (see Figure 7). They are also more likely to take more drinks per week (see Figure 8), and to have consumed five or more drinks at least 15 times during the previous year (see Figure 9). Eighty‑three per cent of regular and former smokers drink at least "occasionally", compared to 70 % of those who have never smoked (see Table 30). On the average, regular smokers have 5.2 drinks per week, compared to former smokers (3.9) and those who have never smoked (2.4).
The proportion of heavy drinkers (namely those who have had 5 or more drinks at least 15 times during the previous year) is twice as high among regular smokers (18 %) and it is among former smokers (9 %) or those who have never smoked (7 %)(see Table 31).
Table 23 gives tobacco sales figures for some industrialized and developing countries.
Although short‑term trends may show fluctuations, some long‑term trends do emerge. For most countries, the record year came in the early 1980s, while in some European countries, tobacco sales were declining since the 1970s. There were only six countries in which sales were at their highest level in 1983, the last year for which figures were available.
Sales figures are expressed in millions of product units manfactured. Tobacco sales are governed by number of factors: taxes above all of course, the economic situation, advertising and the existence or lack of programs and restrictions to reduce tobacco use. Periodic tax increases generally result in a substantial drop in sales.
Studies of smoking behaviour
Studies of smoking behaviour are a useful source of information, because they enable us to draw a profile of smokers and their behaviour. These studies provide valuable information on public health, making it possible, for example, to identify populations at risk. Table 24 gives an overview of smoking rates among adults 15 years of age and over, based on reliable probability surveys conducted around the world.
The definitions of "smokers", "non‑smokers" and "former smokers" may differ slightly. They are, however, generally based on self‑declared information. We encourage the reader to exercise caution before drawing conclusions about the classification of countries on the basis of data contained in this work [WHO, 1986]. However, the figures do show that on a worldwide basis, men were more likely to be smokers than women, at least in the early 1980s, and that smoking rates in Canada for both sexes were similar to those of other developed countries.
Since 1966, tobacco consumption seems to have gradually decreased, and the proportion of Canadians who smoke has declined considerably. Moreover, tobacco consumption habits are changing among those who still smoke, and regular smokers were smoking much less in 1989 than they had in previous years.
It is interesting to note that the changes that have occurred show a convergence in the smoking behaviour of men and women. This increasing similarity in the smoking habits of both sexes is due to the fact that men have reduced their smoking more than women. It is also important to note that differences in tobacco use rates continue to be recorded in different regions and socioeconomic groups.
In general, tobacco use is one of the major causes of health problems in Canada. More than 38,000 Canadians die each year of diseases associated with the consumption of tobacco [Collishaw and Leahy, 1991]. An evaluation of prevention and treatment studies indicates that reduction in tobacco use and in its attendent problems is possible when all the parties concerned work together to encourage optimal use of resources and to create a climate conducive to making changes in standards and behaviour.
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