SURVEY HIGHLIGHTS
  The Magnitude of the Problem
  Getting Started and Kicking the Habit
  Secondhand Smoke
  Sifting Through Myths Around Tobacco Use

EXECUTIVE SUMMARY
Introduction

British Columbia

  Cigarette Smoking
  Social Demographic Variations in Cigarette Smoking
  Alternate Forms of Tobacco
  Social Demographic Variations in Alternate Tobacco Use
  Overall Tobacco use
  Environmental Tobacco Smoke (ETS)


Advanced Questionnaire

  Reasons For Using, Quitting and Never Using Tobacco
  Attitudes Towards Tobacco
  Segmentation Analysis

The Magnitude of the Problem

Tobacco adversely effects 37% of British Columbians – 23% use tobacco and another 14% are exposed to secondhand tobacco smoke daily or nearly daily. This percentage is 50% in Northern B.C. where 30% use tobacco and another 20% are exposed.

Among the 23% who use tobacco, cigarettes predominate at 22% – 21% smoke only cigarettes, 1% smoke cigarettes and an alternate form of tobacco. An additional 1% only use some form of alternate tobacco.

The prevalence of cigarette smoking among B.C. residents (15+) appears to be on a decline from 29% in 1991 to 25% in 1994 and 22% in 1997.

Those 19 to 24 are the most likely to be current smokers (31%) followed by those 25 to 44 (27%) and those 15 to 18 (25%).

Smokers want to quit – but have a hard time doing so. Nearly 56% of all current tobacco users made one or more quit attempts in the past year. Almost all smokers 12 to 18 have made a least one attempt to quit in the past year compared to only 1 in 2 of those 25 or older. Of those smokers who have tried to quit, younger smokers have made more quit attempts than older smokers.

Similarly, 18% of non-smokers are regularly exposed to secondhand smoke either at home, at work/school or in other indoor settings. In Northern B.C. this rises to 29%.

There is strong support for smoking bylaws – 86% of British Columbians (including 76% of smokers) believe that non-smokers should be provided with a smoke-free environment at work and 72% of British Columbians support a bylaw prohibiting smoking in all indoor public places.

There is a surprisingly low smoking rate amongst Asian men – only 14% of South East Asian men and 10% of South Asian men. Even in the 19 to 24 age category, only 12% of South East Asians and 20% of South Asians smoke.

The widespread use of tobacco among Aboriginal populations continues. Cigarette smoking rates in the Aboriginal population are 43% – nearly double the smoking rates for the province.

The survey of 18,000 residents determines the prevalence of tobacco use and the socio-demographic characteristics of those who use tobacco. Secondary objectives included measuring exposure to secondhand smoke and, for a random subset of residents completing the advanced questionnaire, identifying reasons for using or not using tobacco, attitudes towards tobacco, and psychographics.

Approximately 1,000 telephone interviews were conducted within each of the province’s 18 Regional Health Boards or Community Health Services Societies. For reporting purposes, the 18 RHBs/CHSSs were grouped into macro regions. These are the Lower Mainland, Island/Coast, Southern Interior and the North.

Three ethnic groups are mentioned throughout the course of this report – Aboriginals, South Asians, and South East Asians. In the case of South Asian and South East Asian residents, interviews were conducted in addition to those obtained randomly throughout the course of the survey for a total of 561 and 842 respondents respectively. Members of the South Asian population are defined as anyone who considers the ethnic/cultural background of their parents or grandparents to be from India, Pakistan, Bangladesh, Nepal, Sri Lanka or other similarly situated countries. Likewise, members of the South East Asian population are those whose parents or grandparents are from China, Japan, Korea, Philippines, Vietnam, Taiwan, Thailand, Laos, Cambodia/Kampuchea, Burma, Malaysia or other similarly situated countries. A total of 725 interviews were obtained randomly throughout the course of the survey with Aboriginal respondents. Aboriginal residents are defined as anyone who considers the ethnic/cultural background of their parents or grandparents to be Aboriginal which includes Inuit, Eskimo, Metis and First Nations groups. No distinction was made between status vs. non-status, or on-reserve vs. off-reserve.

This report is submitted by the Angus Reid Group to the Heart and Stroke Foundation of B.C. & Yukon. The findings contained in the report have been reviewed by an expert committee convened by the Foundation consisting of:

Ms. Linda Brigden, Senior Advisor, Tobacco Reduction Strategy, Ministry of Health and Ministry Responsible for Seniors

Ms. Linda Gee, Research Officer, Legislation, Evaluation and Project Management, Ministry of Health and Ministry responsible for Seniors

Ms. Lesley MacGregor, Director, Advocacy and Public Issues, Heart and Stroke Foundation of B.C. & Yukon

Dr. Shaun Peck, Deputy Provincial Health Officer, Province of British Columbia

Dr. Ken Prkachin, Chair, Psychology, University of Northern British Columbia, Board Member, Heart and Stroke Foundation of B.C. & Yukon

Mr. Richard Rees, Executive Director, Heart and Stroke Foundation of B.C. & Yukon

Dr. Richard Stanwick, Regional Medical Health Officer and Director of Clinical Information, Capital Health Region

The survey was undertaken by the Heart and Stroke Foundation of B.C. & Yukon with a grant from the Ministry of Health and Ministry Responsible for Seniors. The findings presented in this report reflect the responses to a survey of B.C. public opinion, and do not necessarily reflect the opinions of the Heart and Stroke Foundation of B.C. & Yukon or the Ministry of Health and Ministry responsible for Seniors.

Current cigarette smokers in British Columbia represent 22% of all residents, while former smokers represent 30% and never smokers 48%. Never smokers includes past experimenters (17%), beginners (1%) and lifetime abstainers (30%). The prevalence of current cigarette smoking varies by region from 20% in the Lower Mainland, to 22% on the Island/Coast, to 24% in the Southern Interior, to 28% in the North. A comparison with data from recent national health surveys suggests that the prevalence of cigarette smoking in B.C. may be continuing to decline through the 1990’s.

In looking at ethnic populations, the percentage of current smokers among Aboriginal residents (43%) is almost double the proportion for the province overall, while the proportion of Aboriginal residents who are former smokers is slightly lower (25%) than for the province overall. Contrary to Aboriginal residents, both the South Asian and South East Asian communities benefit from much lower proportions of current cigarette smokers than the provincial norm (7% and 9% respectively).

The vast majority of current cigarette smokers in B.C. are daily smokers (77%). Daily smokers average 16.6 cigarettes per day, while non-daily smokers average just 3.5. Male smokers and those aged 45 to 64 are more likely to smoke everyday, and to average more cigarettes per day.

On a provincial level, the average age of initiation for current daily smokers is 15.5, which is slightly lower than for current non-daily smokers (16.3), former daily smokers (16.3) and former non-daily smokers (17.1). Aboriginal residents have a lower age of initiation for both current and former cigarette smokers (14.0 and 15.2) whereas South East Asian residents have a higher age of initiation for both current and former cigarette smokers (17.7 and 19.1).

A number of socio-demographic characteristics are related to the cigarette smoking experience of B.C. residents (e.g., current vs. former vs. never).

Gender - Male and female residents of the province are equally likely to be current smokers, but males are more likely to be former smokers and females are more likely to have never smoked.

Age - The highest prevalence rate for current smoking is among residents aged 19 to 24 years. Prevalence rates for former smoking generally increase with age, while rates for never smoking decline with age.

Place of Birth - Residents who were born in Canada are more likely to be current smokers than those born outside of Canada.

Marital Status - Rates for current smoking are highest among separated or divorced residents, while rates for former smoking are highest among married and widowed residents.

Income Adequacy - The prevalence rate for current smoking declines considerably as the income adequacy of the resident’s household increases.

Education - Prevalence rates for current smoking are lowest among university graduates, while rates for never smoking are highest among university graduates and residents who have not finished high school.

Ethnicity - The prevalence rate for current smoking is much lower for South Asians and East Asians, but much higher for Aboriginal residents.

Labour Force Status - Rates for current smoking are noticeably higher among residents who are looking for/unable to work, in comparison to those who are working full or part-time.

The current prevalence of alternate tobacco use in B.C. is low – cigar/cigarillo (2%), pipe smoking (less than 0.5%) and smokeless tobacco use (1%). Among smokeless tobacco users 70% are daily users and 30% are non-daily users. Former users of these products are 7%, 6% and 2% respectively. It is almost exclusively males who consume alternate forms of tobacco. There is little or no variation in the current use of these alternate forms of tobacco by macro regions in the province or by ethnic origin. The average age of initiation for current users of alternate forms of tobacco is higher than that for cigarettes – cigars (21.6 yrs), pipes (22.8 yrs) and smokeless tobacco (19.0 yrs).

Because of the very low prevalence of cigar and pipe smoking, as well as smokeless tobacco use, they were combined for cross-tabulations with the social demographic characteristics of residents. Both current and former use of an alternate form of tobacco is considerably higher among male than female residents of the province (i.e., 4% vs. <1% for current use & 19% vs. 2% for former use). While there is generally little variation in the overall rate of 2% for the current use of least one form of these alternate tobaccos by most social demographic characteristics, rates for former use do show some noteworthy variations.

Age - Former use of alternate tobacco rises steadily with age and never use declines with age.

Marital Status - Rates for former use of alternate tobaccos are higher among residents who are either married or separated/divorced, and lowest among residents who are single.

Income Adequacy - Former use also tends to rise with the income adequacy of the resident’s household.

Education - Rates for former use of alternate tobaccos are somewhat higher among university graduates than among graduates of technical/community colleges.

Ethnicity - Lower rates for former use are found among South Asian and East Asian residents, while higher rates are found among British residents.

Labour Force Status - Former use of alternate tobaccos is considerably higher among retired residents than among residents who are either working full or part-time or looking for/unable to work.

A sizable minority (23%) of all B.C. residents currently use at least one form of tobacco: cigarettes only (21%), only cigars (1%), pipe only (<0.5%), smokeless tobacco only (<0.5%), two or more forms of tobacco (1%). The balance of the population is made up of former tobacco users (30%) and never users (47%). Never users includes past experimenters or beginners (21%) and lifetime abstainers (26%). The current prevalence for any form of tobacco use varies by region from 21% in the Lower Mainland, to 23% on the Island/Coast, to 25% in the Southern Interior, to 30% in the North. Prevalence of any form of tobacco use also varies by ethnic group with Aboriginal residents having the highest proportion of current tobacco users (45%) and South Asian and South East Asian having the lowest (8% and 10% respectively).

Almost two-thirds (63%) of non-smokers in the province report physical irritation to their eyes, breathing or throat due to ETS. Even 39% of current smokers acknowledged they are usually irritated by tobacco smoke. The proportion of non-smoking residents who are usually irritated by ETS does not vary appreciably depending on which region of the province they reside. However, some types of residents are more likely to be irritated by ETS – females, those 19 to 64, those with at least a high school education. Aboriginal, South Asian and South East Asian residents follow the provincial norm with approximately two thirds of non-smokers within each group reporting they are irritated by ETS. As well, the large minority of smokers among ethnic groups report irritation due to ETS.

Overall ETS Exposure - Collectively, these findings indicate that 18% of all non-smoking residents in the province are exposed to ETS everyday or almost everyday in at least one type of indoor environment (i.e., home, work/school or other indoor settings). This percentage is equivalent to 14% of all B.C. residents. In total, the health status of 37% of B.C. residents is being adversely affected by tobacco (23% through current tobacco use and 14% through exposure to ETS). Regional variations for the percentage of residents whose health status is being adversely affected by tobacco range from a low of 33% in the Lower Mainland, to 36% on the Island/Coast, to 41% in the Southern Interior, to a high of 51% in the North. In terms of ethnicity, Aboriginal residents are most adversely affected by tobacco (64%), while South Asian and South East Asian residents are the least affected (27% and 22% respectively).

ETS at Home - Amongst all non-smokers in the province, 83% report no ETS exposure at all in their homes. But for at least 10% of non-smokers (and 21% of Aboriginal non-smokers), there is everyday or almost everyday exposure to ETS in their own homes. Moreover, the average number of cigarettes smoked inside these homes on a typical day is 14.3. Daily or almost daily exposure to ETS at home is lowest for non-smokers in the Lower Mainland (7%) and highest for non-smokers in the Northern Interior (12%).

Daily or nearly daily exposure to ETS occurs in 18% of households with children aged 11 and under in B.C. This percentage is lowest for households with children in the Lower Mainland (15%) and highest in the Northern region (25%). Furthermore, province-wide the average number of cigarettes smoked inside these homes on a typical day is 18.2.

Non-smokers in the province are more likely to live in an ETS free home if: they reside in the Lower Mainland region, are aged 65 and over, were born outside of Canada, are married or widowed, are a university graduate, have the highest level of income adequacy, or are presently retired.

ETS At Work or School - Amongst all non-smokers in the province, 66% report no exposure to ETS at all while at work or school. Yet, at least 9% of non-smokers (16% of Aboriginal non-smokers) report they are exposed to ETS everyday or almost everyday while at school or work. This latter percentage is lowest among non-smokers working or attending school in the Lower Mainland region (8%) and highest among those working or attending school in the Northern region (15%).

Non-smokers in the province are more likely to report they are not exposed to ETS at all while at work or school if: they are female, aged 12 to 18 or over the age of 25, reside in the Lower Mainland region, are a university graduate, have the highest level of income adequacy, or are presently a student or keeping house.

ETS in Other Public Settings - The large majority (79%) of non-smoking residents in the province report some level of exposure to ETS in other indoor settings. Daily or nearly daily exposure in these settings is reported by 6% of all non-smokers in the province (12% for Aboriginal residents). This percentage is lowest for non-smokers residing in the Lower Mainland region (5%) and highest in the North (11%). Exposure to ETS is highest in restaurants, cafes, bars or nightclubs (86%) and in other people’s homes (51%) but is lower for entertainment events (36%), transportation (15%) and stores/shopping centres (16%).

The advanced survey expanded the investigation on tobacco use from that of the base questionnaire. The advanced survey results are based on a total of 1668 telephone interviews – 1501 randomly obtained throughout the course of the survey, plus an oversample of 167 cigarette smokers.

The majority of current tobacco users in the province say they smoke or use tobacco: out of habit, to relax or reduce stress, an addiction to nicotine, because they like it, or because they like to smoke in social situations. On the other hand, only a minority say they smoke or use tobacco: to combat boredom, because their family or friends are tobacco users, to control weight, or because of the low price.

Over half (56%) of all current tobacco users indicated they made one or more quit attempts in the past year (average of 5.4 quits). Female tobacco users and those under the age of 25 are more likely to report one or more quit attempts. The most common reasons for quitting or attempting to quit among both former and current users are: concern about future health effects, affects on current health, the cost of tobacco, and a dislike for the taste, smell or habit. The main reasons given for not starting are: not interested or didn’t want to; dislike for the smoke, taste or smell; harmful to one’s health; and filthy habit.

Tobacco Hazard - There is an extremely high degree of consensus among British Columbians that tobacco represents a health risk, not only to its users but also to others in the form of secondhand or environmental tobacco smoke (ETS). Nearly seven out of every eight respondents (85%) supported the practice of printing health warnings on cigarette packages. The connection between smoking and cancer is also a foregone conclusion for four out of five British Columbians (79%), and almost as many express concern about the health effects of secondhand smoke (72%).

Smoke Avoidance - These measures are especially interesting because they show how much of a marginalized or stigmatized behaviour smoking has become for British Columbians. There is a high acceptance of the idea that non-smokers have a right to a smoke free environment in their workplace (86%). There is correspondingly little evidence of any expectation that secondhand smoke is just something people should be prepared to "put up with" in everyday work and social situations. Barely a third (32%) of British Columbians said that they did not mind when other people smoked, and 9% went along with the idea that people should be able to smoke wherever they want.

Tobacco Control - The study revealed that the following set of attitudes represented a progression of increasingly hard-nosed approaches to dealing with the social costs of smoking. At the top of the list, more than eight out of every ten B.C. residents support the prohibition of tobacco sales to persons younger than 19 years of age. Close to two-thirds support special cigarette taxes to pay for treatment of smoking related diseases (68%) and agree with the argument that policies to discourage smoking will produce health care savings of benefit to all (61%). The only policy initiative that fails to gain majority support among the population is suing tobacco companies to recover the costs of treating tobacco related diseases (39%).

Corporate Distrust - The study also identified two items regarding the intentions of tobacco companies that are related in the eyes of most respondents. Nearly half agreed with the idea that tobacco companies deliberately target teenagers and children in their marketing strategies, while more than one-third of respondents felt that tobacco company sponsorship of sporting and cultural events was another way of encouraging people to smoke.

To arrive at a more complete appreciation of how tobacco users differ from the majority nonuser population, we conducted a segmentation analysis to group tobacco users and nonusers into groups that shared other traits beyond tobacco usage. The segments were identified using attitudes about smoking and a range of personal values and self images that might influence smoking related attitudes and behaviours. This analysis resulted in five segments, each of which are discussed below along with their relative size.

Adamant Smokers (11%) - This is a hard core smoking segment: the majority of this group are current smokers, and their attitude profile shows the least acknowledgment of smoking hazards or sympathy for smoking control measures. They represent an older segment whose attitudes about smoking have more in common with those of earlier decades when smoking was viewed as a socially acceptable and harmless activity.

Sociable Experimenters (16%) - This group has a higher than average concentration of smokers, but are a very young segment (nearly half of them are under age 24). Not surprisingly, they have a very distinctive psychographic profile which emphasizes experimentation rather than convention. For the moment, they are more devoted to an active social life and appear to accept smoking as just another lifestyle choice. As a young segment, their attitudes toward smoking are somewhat contradictory, just as their psychographic profile shows a mixture of anticipation and fatalism. They show some appreciation of smoking hazards, which might suggest good potential for future conversion to former smoker status. However, their attitudes on a number of key policy issues tend to have more in common with the Adamant Smokers than any other segment

Industrious Individualists (20%) - This is a young to middle aged group with above average education and upper middle incomes. They have a fair share of smokers in their midst, despite being in agreement with many of the hazards. While they are not apologists for smoking, they show little sympathy for some of the more activist smoking policies and have little suspicion about the motives of the tobacco industry.

Aging Abstainers (21%) - This group is older and more constrained in their economic prospects than the other groups. They have few current smokers in their midst and acknowledge all of the hazards of smoking and support smoking control initiatives. But they are not likely to be vocal supporters of any cause, given their limited resources and their low sense of personal efficacy and power.

Activist Antismokers (32%) - This group represents the outspoken elite that would support virtually any antismoking initiative. They are middle aged and older, highly educated and concentrated in the upper middle and upper income adequacy ranges. They are the most convinced of the hazards of smoking and most suspicious of tobacco companies. While this group has very few current smokers, it has a large proportion of former smokers as well as lifetime abstainers.