Community- and individual-level factors associated with smoking and heavy drinking among Aboriginal people in Canada.
Kyu, Hmwe Hmwe ; Georgiades, Katholiki ; MacMillan, Harriet L. 等
Health disparities are a major public health concern in Canada
today. Alarming disparities exist in the health status and behaviours of
Aboriginal compared to nonAboriginal people. (1-5) For example, a
population-based study in Manitoba reported that the life expectancy for
registered First Nations people is about eight years shorter than all
other Manitobans. (5) Rates of daily smoking are more than twice as high
among Aboriginal compared to non-Aboriginal people: 46.0% for on-reserve
First Nations, 41.5% for off-reserve Aboriginal people, and 22.1% for
non-Aboriginal people. (6) The proportion of First Nations people
(16.0%) who report heavy drinking (i.e., having five or more drinks on
one occasion on a weekly basis) is double that of the general population
(7.9%). (7) Both smoking and heavy drinking have been linked to many
types of cancer, cardiovascular disease and other chronic diseases. (8)
Indeed, rates of cardiovascular disease, diabetes, and chronic health
conditions among Aboriginal people are at least twice those of the
general population. (4) Thus, preventing or reducing tobacco and alcohol
use represents an important opportunity to reduce the burden of disease
among Aboriginal people.
When studying health outcomes and risk behaviours among Aboriginal
people, it is important to consider 'place of residence'. The
Aboriginal population is faced with high rates of poverty, unemployment
and poor living conditions, and these disadvantages are more pronounced
in certain Aboriginal communities, including First Nations communities
(also known as reserves) and Inuit communities. (6) However, the extent
to which risk behaviours and health outcomes differ between Aboriginal
people living on-versus those living off-communities has not been
studied. Moreover, substantial interprovincial differences in smoking
and heavy drinking have been documented in the general Canadian
population, (9,10) but little is known as to whether this variation
applies to Aboriginal people.
Among non-Aboriginal populations, previous studies have shown that:
i) socio-economic status (SES) disadvantage at the community level is
associated with higher levels of crime; (11) ii) high crime
neighbourhoods are associated with increased rates of substance use;
(12,13) and iii) community SES disadvantage is linked to increased risk
for smoking. (14-16) However, evidence for the association between
community SES and alcohol use is mixed. Studies have shown both positive
(17,18) and negative (19) associations between alcohol use and higher
SES at the community level.
In addition to community-level factors, individual-level
characteristics (e.g., SES, Aboriginal heritage, and social support)
could also account for between-community differences. In general, First
Nations and Inuit are likely to be socioeconomically worse off than
Metis. (6) First Nations have a historic tradition of using tobacco in a
sacred pipe, which is believed to be an important way of communicating
with a spirit, but the Inuit have no such practice. (20)
The protective effects of social support on health have been well
established. (21-23) Lower levels of perceived social support have also
been linked to daily smoking and heavy use of alcohol among the
non-Aboriginal population. (24,25) Few studies have examined the
association between social support and alcohol and tobacco use among
Aboriginal people.
The objectives of this study were to examine: 1) differences in the
prevalence of daily smoking and heavy drinking by place of
residence-specifically, on-communities versus off-communities and
between provinces among Aboriginal people in Canada; 2) the extent to
which community-level SES and perceived community social problems
account for these differences; and 3) the extent to which individual
SES, demographic factors, Aboriginal heritage groups and social support
account for these differences. The availability of data from the 2001
Aboriginal People's Survey (APS) provides a unique opportunity to
address these research objectives. It is the most recent dataset where
data from Aboriginal people living on-reserve are available and it has
been analyzed rarely.
METHODS
We obtained data from the 2001 APS of individuals ([greater than or
equal to]15 yrs of age) who identified themselves as Aboriginal or being
of Aboriginal ancestries in the 2001 Census. The detailed methodology
has been published elsewhere (26) and a brief description is provided
here. The APS covered Aboriginal people living on-community and
off-community across Canada. The term "on-community" refers to
123 First Nations communities/reserves, 53 Inuit communities in Arctic
regions and 43 other communities (28 of them have a large density of
Metis people). The on-reserve sample comprised large reserves in each
province and was not designed to be representative of all on-reserve
populations. The term "off-community" excludes all communities
mentioned above and includes all other off-reserve rural and urban
areas. Aboriginal people living off-community were selected using a list
of enumeration areas or primary sampling units (PSU) as the sampling
frame. In each selected PSU, all Aboriginal people who got a long-form
census form were selected. The overall response rate of the survey was
84.1%.
Daily smoking and heavy drinking
The dependent variables (based on respondents' self-report)
included dully smoking (0, no; 1, yes) and heavy drinking, defined as
having 5 or more drinks on a single occasion at least once a week in the
12 months prior to the survey (0, no; 1, yes).
Community-level factors
In this study, census subdivision (CSD) was selected as the
community-level variable because reserves constitute separate CSDs. A
CSD is "the general term for municipalities or areas treated as
municipal equivalents for statistical purposes (e.g., an Indian
reserve)". (27)
Community SES was measured by the Community Well-being (CWB) Index,
(28) which combines measures of income, education, housing conditions
(housing quality and housing quantity), and labour force characteristics
(participation and employment rates). Data used to construct the CWB
index were from the 2001 Census profile, except for the housing quantity
variable (% population whose dwelling contains no more than 1 person per
room), which we created by aggregating individual-level data from the
APS up to the CSD level. A higher score of the CWB index indicates
higher SES.
Perceived community social problems included 6 items: suicide,
unemployment, family violence, sexual abuse, drug abuse and alcohol
abuse. Respondents were asked whether each of these was a problem in
their community. A response of "yes" to each question was
coded as 1, while responses of "no" and "don't
know" were coded as 0. All 6 items were summed to obtain a total
perceived community social problems score, ranging from 0 to 6. The
score was aggregated up to the CSD level by summing the scale and then
taking a mean for each CSD. This scale demonstrated high internal
consistency reliability (Cronbach's alpha = 0.88).
Place of residence
Community of residence was classified as First Nations communities,
Inuit communities, other communities and off-communities. In the 2001
APS, information was available as to whether a respondent was living
on-community or off-community. Information on whether a respondent was
residing in a First Nations or Inuit community was also available.
Respondents who were living on-community but not resident in either
First Nations or Inuit communities were classified as 'other
communities' (about 65% of other communities included high
concentrations of Metis people). The "off-community" category
excludes all communities mentioned above and includes all other
off-reserve rural and urban areas.
Province of residence. Dummy variables were created for each
province except for the Atlantic Provinces (Table 1). Because of the
very small sample size, New Brunswick, Prince Edward Island, Nova
Scotia, and Newfoundland and Labrador were categorized together as
Atlantic Provinces.
Individual-level factors
These included age, sex, education, individual income, employment
status, marital status, Aboriginal heritage and social support (Table
1). Respondents were asked to rate the availability of social support on
a 4-point scale, ranging from 0, all of the time, to 3, almost none of
the time. Sample items include availability of someone who shows the
respondent love and affection, someone to have a good time with, etc.
All items were reverse coded and summed to obtain a social support
score, ranging from 0 to 24, with higher scores representing higher
levels of social support. Internal consistency reliability
(Cronbach's alpha) was 0.92.
Data analysis
In our descriptive analyses (Table 1), standardized sample weights
were used and the results were rounded according to the guidelines of
Statistics Canada. Weighted multilevel logistic regression models were
constructed using the statistical software MLwiN 2.24 (29) to run
two-level random intercept models with individuals nested in CSDs
(Tables 2 and 3). The models began by examining the age-and sex-adjusted
associations between place of residence (i.e., on-community versus
off-community and between provinces) and smoking and heavy drinking,
separately (Model 1). Next, community SES and perceived community social
problem variables were included in Model 2, followed by individual-level
variables in Model 3.
Sample for analysis
A total of 60,499 Aboriginal people completed an interview. Census
subdivisions (CSDs) with fewer than 10 Aboriginal people in the study
were dropped from the analysis to avoid statistical overlap between
variables measured at the individual level and the same variables
aggregated to the CSD level (n = 4,590 individuals were excluded).
Information on individual age, sex, education, marital status, income,
employment status and Aboriginal heritage was missing and excluded for
about 2% of respondents. About 6% and 8% of the items used to measure
perceived community social problems and social support respectively were
missing and imputed using an iterative Markov chain Monte Carlo method
in PASW 18. Five imputed datasets were generated and we randomly
selected one for use in all analyses. Individuals with missing data on
the dependent variables [smoking (2.5%) and heavy drinking (8.7%)], and
individuals with missing CSD-level data (2%) were excluded. The final
samples for analyses include 52,110 and 47,990 individuals for smoking
and heavy drinking respectively. Excluded individuals were more likely
to be younger, male, never married and to have lower levels of income
and education.
RESULTS
Table 1 presents the sample characteristics. There were 700 CSDs
and an average of 124 individuals in each one. Daily smoking was most
prevalent in Inuit communities (62.7%) and least prevalent in
off-communities (35.7%). The prevalence of heavy drinking did not vary
much across communities (11.0% in Inuit communities versus 7.3 to 8.1%
in the remaining communities).
Table 2 presents fixed effects for daily smoking (i.e., odds ratios
(ORs) associated with study variables) and random effects (i.e.,
estimates for variation in smoking between CSDs). Between-CSD variation
in smoking was 10.9% (Null Model). In Model 1, compared with individuals
living off-community, those living on-community (Inuit, First Nations or
other community) were more likely to smoke daily after adjusting for
age, sex and province of residence. Compared with Aboriginal people in
Saskatchewan, those in British Columbia and Atlantic Provinces were less
likely to smoke daily. The variables in Model 1 explained about 50% of
between-CSD variation in smoking (the variance decreased from 10.9% in
the Null Model to 5.5% in Model 1). In Model 2, the increased risk for
smoking in First Nations and other communities was explained by
perceived community social problems. In Model 3, after including
individual-level variables, the association between Inuit communities
and daily smoking remained, although the OR decreased from 2.87 in Model
2 to 1.97 in Model 3. The negative association between living in British
Columbia and smoking also remained but the association for Atlantic
Provinces was accounted for by individual-level variables. Higher levels
of perceived community social problems, being an Inuit or having more
than one Aboriginal identity were associated positively while social
support was associated negatively with daily smoking.
In Table 3, between-CSD variation in heavy drinking was 15.1% (Null
Model). In Model 1, there was no statistically significant difference in
heavy drinking between those living on-community versus those living
off-community. Compared with Aboriginal people living in Saskatchewan,
those in all other provinces (except Alberta) and Territories were more
likely to engage in heavy drinking. In Model 2, after including
community-level covariates, the associations between heavy drinking and
residence in First Nations communities and other communities became
statistically significant. The increased risk for heavy drinking in some
provinces (Quebec, Ontario, Manitoba and British Columbia) was accounted
for by community-level covariates in Model 2. In Model 3, after
including individuallevel variables, there was still a significant
positive association between First Nations communities and heavy
drinking (OR = 1.54, 95% CI = 1.17-2.04) but this was not the case for
other communities. The significant associations between residence in
Atlantic Provinces (OR = 2.80, 95% CI = 2.08-3.78) and Territories (OR =
1.39, 95% CI = 1.01-1.92) and heavy drinking persisted in Model 3.
Higher levels of community SES and perceived community social problems
were associated positively while social support was associated
negatively with heavy drinking.
DISCUSSION
This is the first study to examine differences in daily smoking and
heavy drinking behaviours depending on place of residence among Canadian
Aboriginal people, and to identify communityand individual-level factors
that account for these differences. Place of residence along with
community SES and social problems appear to exert different influences
on smoking and heavy drinking. First, residing in an Inuit community was
associated with elevated risk for smoking while living in a First
Nations community was associated with increased risk for heavy drinking.
Second, there was no community SES effect for smoking but there was a
strong, statistically significant positive association between community
SES and heavy drinking. This suggests that community affluence has a
role in heavy drinking. Third, in contrast, perceived community social
problems were associated with both smoking and heavy drinking.
The increased risk for smoking in Inuit communities was only
partially accounted for by covariates. In this study, being an Inuit and
living in Inuit communities were both associated with daily smoking.
Future studies should explore possible reasons for these increased
risks. The elevated risk for smoking in First Nations communities and
other Aboriginal communities was accounted for by perceived community
social problems. This finding is consistent with previous findings among
non-Aboriginal populations which have reported increased rates of
substance use (12,13) in high crime neighbourhoods.
In this study, residence in First Nations communities was
associated with heavy drinking, however this risk became evident only
after controlling for community SES and social problems. A separate
analysis (adding community SES and social problems one at a time in the
model) showed that this increased risk was due to community SES, which
was also positively associated with heavy drinking. In many First
Nations reserves, prohibition of alcohol has resulted in smuggling of
alcohol into communities, where it is sold at high prices. (30)
Wealthier communities may be more likely to access smuggled alcohol,
which might in turn influence heavy drinking, but we can only speculate
at this time due to the lack of data regarding access to alcohol in
communities. Two previous studies involving non-Aboriginal populations
have also reported a positive association between living in
socio-economically better-off communities and alcohol abuse, (17,18) but
one other study (19) reported a negative association between higher
community SES and alcohol use. Further studies are necessary to better
understand the positive association between higher level of community
SES and heavy drinking among Aboriginal people.
The pattern of association between province of residence and
smoking/heavy drinking among Aboriginal people is consistent with that
among the general Canadian population. This study found that Aboriginal
people living in British Columbia were less likely to smoke daily. The
reason for this decreased risk is unknown, but British Columbia also has
the lowest rate of smoking among provinces in the general Canadian
population, possibly due to its extensive tobacco control policies
(e.g., high tobacco taxes, smoking bans) and programs (e.g., smoking
prevention/quitting programs). (31) In this study, Aboriginal people
residing in Atlantic Provinces and Territories were more likely to
engage in heavy drinking. Consistently, age-standardized percentages of
heavy drinking among the general population were also significantly
higher than the overall Canadian percentage in most of the Atlantic
Provinces, Northwest Territories, and the Yukon. (10)
At the individual level, there was a negative association between
income and daily smoking-a finding consistent with results from a
general population study in Canada. (32) The protective effect of social
support for both smoking and heavy drinking is consistent with the
results of previous investigations. (24,25)
This study has some limitations. One, the on-reserve sample is
selective for larger reserves (i.e., First Nations communities) and only
those who participated in the Census were included in the APS: as a
result, it is not representative of the entire on-reserve population.
Two, the relocation rate among the off-reserve Aboriginal population is
high: about 41% of First Nations, 39% of Metis and 41% of Inuit had
moved at least once in the 5 years prior to the 2001 APS. (33) Mobility
was not controlled for in the current study and could have an influence
on social support, individual income and other factors. Three, the
measurement of perceived community social problems was assessed based on
the respondents' awareness of the presence of problems and may not
reflect the actual level of problems in the community. Four, in our
analyses, we were unable to control for personal past history of trauma,
a known risk factor for substance use. However, this should not alter
the results significantly because it is unlikely that there is
substantial difference in trauma history across communities or
provinces. Finally, causal associations between the study variables and
outcomes could not be established because of the cross-sectional nature
of the study.
In conclusion, there were differences in smoking and heavy drinking
behaviours among Aboriginal people in Canada, depending on place of
residence. The increased risk for smoking in First Nations communities
and other communities was accounted for by perceived community social
problems. However, the association between Inuit communities and daily
smoking remained after controlling for all covariates. The increased
risk for heavy drinking in First Nations communities became evident only
after controlling for community SES, which was also positively
associated with heavy drinking. Aboriginal people in Atlantic Provinces
or Territories were also more likely to engage in heavy drinking. Our
study raises the following unanswered questions: i) what are the factors
that account for the increased risk of smoking in Inuit communities and
heavy drinking in First Nations communities, Atlantic Provinces and
Territories? ii) Are there phenomena that explain the positive
association between higher level of community SES and heavy drinking
among Aboriginal people? The high rate of smoking and heavy drinking
among Aboriginal people, and the serious health outcomes associated with
them, provide a strong rationale for addressing these questions in
future studies.
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Received: July 3, 2014
Accepted: October 27, 2014
Hmwe Hmwe Kyu, PhD, [1] Katholiki Georgiades, PhD, [2] Harriet L.
MacMillan, MD, FRCPC, [2] Michael H. Boyle, PhD [2]
Author Affiliations
[1.] Institute for Health Metrics and Evaluation, University of
Washington, Seattle, WA
[2.] Department of Psychiatry and Behavioural Neurosciences,
McMaster University and Offord Centre for Child Studies, Hamilton, ON
Correspondence: Hmwe Hmwe Kyu, Institute for Health Metrics and
Evaluation, University of Washington, 2301 5th Avenue, Seattle, WA
98121, Tel: *^206-897-2800, E-mail: hmwekyu@uw.edu
Acknowledgements: This study was approved by the Social Sciences
and Humanities Research Council of Canada. Kyu. was supported by a
Lawson Postdoctoral Fellowship. Georgiades was supported by a Canadian
Institutes of Health Research New Investigator Award and the David R.
(Dan) Offord Chair in Child Studies. MacMillan was supported by the
Chedoke Health Chair in Child Psychiatry. Boyle was supported by a
Canada Research Chair in the Social Determinants of Child Health, which
also provided graduate student support to Kyu.
Conflict of Interest: None to declare.
Table 1. Sample characteristics
Level 2, CSD (n) 700
Number of individuals per CSD Mean (SD) 124.4 (218.2)
Community SES Mean (SD) 0.71 (0.04)
Community problem score Mean (SD) 2.4 (1.2)
Provinces (% individuals)
Saskatchewan 11.1
Quebec 9.1
Ontario 20.3
Manitoba 15.1
Alberta 17.9
British Columbia 16.5
Other provinces 6.5
Territories 3.6
Level 1, individuals (n) 52,110
Age, years (%)
15-19 14.3
20-29 22.7
30-39 24.3
[greater than or equal to] 40 38.7
% Male 46.8
% Employed 53.1
Income Mean (SD) 19,000 (22,000)
% Education
[less than or equal to] Grade 8 13.0
Grade 9-10 18.3
Grade 11-13 or trades certificates 26.4
College 26.9
University 15.4
% Marital status
Married 33.3
Separated/divorced/widowed 15.8
% Aboriginal identity
First Nations 54.7
Metis 21.1
Inuit 3.1
> 1 identity 2.2
Not identified as Aboriginal 18.9
Social support score Mean (SD) 19.2 (5.5)
% Smoke daily
Off-community 35.7
Inuit communities 62.7
First Nations communities 43.0
Other communities 45.2
% Heavy drinking (n = 47,990)
Off-community 7.3
Inuit communities 11.0
First Nations communities 7.8
Other communities 8.1
Table 2. Multilevel logistic regressions of daily smoking among
Aboriginal peoples on all covariates
Null Model Model 1
OR (95% CI)
Fixed effects
Age, years
15-19 1.06 (0.98-1.16)
20-29 1.49 (1.37-1.63)
30-39 1.45 (1.36-1.56)
[greater than Ref.
or equal to] 40
Male 1.00 (0.95-1.05)
Level 2
Community of residence
Off-community Ref.
Inuit community 3.12 (2.61-3.73)
First Nations 1.34 (1.21-1.49)
community
Other community 1.22 (1.06-1.40)
Province of residence
Saskatchewan * Ref.
Quebec 0.91 (0.74-1.12)
Ontario 0.86 (0.74-1.00)
Manitoba 0.93 (0.81-1.07)
Alberta 0.92 (0.78-1.08)
British Columbia 0.54 (0.47-0.63)
Atlantic Provinces 0.71 (0.60-0.86)
Territories 1.04 (0.87-1.24)
Community SES
Community problem
Level 1
Employed
Income ([dagger])
Education
[less than or
equal to] Grade 8
Grade 9-10
Grade 11-13
College
University
Marital status
Never married
Married
Divorced/widowed
Aboriginal identity
Metis ([double
dagger])
First Nations
Inuit
> 1 identity
Not identified
as Aboriginal
Social support
Random effects
Between CSD 0.40 (0.03) 0.19 (0.02)
Variance (SE)
Between CSD 10.9 5.5
Variances
expressed as a %
Model 2 Model 3
OR (95% CI) OR (95% CI)
Fixed effects
Age, years
15-19 1.07 (0.98-1.16) 0.72 (0.65-0.80)
20-29 1.49 (1.37-1.63) 1.21 (1.10-1.33)
30-39 1.45 (1.36-1.56) 1.37(1.28-1.47)
[greater than Ref. Ref.
or equal to] 40
Male 1.00 (0.95-1.05) 0.99 (0.94-1.04)
Level 2
Community of residence
Off-community Ref. Ref.
Inuit community 2.87 (2.37-3.49) 1.97(1.44-2.70)
First Nations 1.11 (0.93-1.33) 1.10 (0.91-1.32)
community
Other community 1.11 (0.97-1.27) 1.04 (0.91-1.19)
Province of residence
Saskatchewan * Ref. Ref.
Quebec 0.93 (0.76-1.14) 0.98 (0.80-1.19)
Ontario 0.94 (0.80-1.10) 0.94 (0.80-1.10)
Manitoba 0.99 (0.86-1.13) 0.99 (0.86-1.13)
Alberta 0.94 (0.80-1.10) 0.94 (0.80-1.10)
British Columbia 0.55 (0.47-0.64) 0.54 (0.46-0.63)
Atlantic Provinces 0.78 (0.65-0.94) 0.86 (0.71-1.03)
Territories 1.02 (0.85-1.22) 1.00 (0.83-1.19)
Community SES 0.96 (0.88-1.06) 1.02 (0.92-1.12)
Community problem 1.12 (1.07-1.18) 1.09(1.04-1.15)
Level 1
Employed 1.05 (0.99-1.11)
Income ([dagger]) 0.94 (0.93-0.96)
Education
[less than or Ref.
equal to] Grade 8
Grade 9-10 1.39(1.29-1.50)
Grade 11-13 1.29(1.19-1.38)
College 1.31 (1.22-1.42)
University 0.73 (0.65-0.83)
Marital status
Never married Ref.
Married 0.69 (0.64-0.73)
Divorced/widowed 0.97 (0.90-1.04)
Aboriginal identity
Metis ([double Ref.
dagger])
First Nations 0.98 (0.91-1.07)
Inuit 1.44(1.07-1.93)
> 1 identity 1.32(1.16-1.49)
Not identified 0.67 (0.59-0.76)
as Aboriginal
Social support 0.99 (0.98-0.99)
Random effects
Between CSD 0.18 (0.02) 0.18 (0.02)
Variance (SE)
Between CSD 5.2 5.1
Variances
expressed as a %
* Saskatchewan was used as the reference for provinces because it
has the largest sample size.
([dagger]) Income was rescaled for the purposes of analyses so
that 1 unit increase refers to $10,000.
([double dagger]) Those having Metis identity were used as the
reference because Metis are socio-economically better off than
First Nations and Inuit.6
Table 3. Multilevel logistic regressions of heavy drinking among
Aboriginal peoples on all covariates
Null Model Model 1
OR (95% CI)
Fixed effects
Age, years
15-19 1.14 (0.99-1.32)
20-29 1.67 (1.48-1.89)
30-39 1.53 (1.37-1.72)
[greater than Ref.
or equal to] 40
Male 2.67 (2.43-2.93)
Level 2
Community of residence
Off-community Ref.
Inuit community 0.68 (0.42-1.10)
First Nations community 1.16 (0.98-1.36)
Other community 1.23 (0.96-1.59)
Province of residence
Saskatchewan * Ref.
Quebec 1.48 (1.05-2.09)
Ontario 1.40 (1.07-1.84)
Manitoba 1.38 (1.03-1.85)
Alberta 0.98 (0.75-1.27)
British Columbia 1.52 (1.21-1.90)
Atlantic Provinces 2.31 (1.74-3.08)
Territories 1.55 (1.11-2.17)
Community SES
Community problem
Level 1
Employed
Income ([dagger])
Education
[less than or
equal to] Grade 8
Grade 9-10
Grade 11-13
College
University
Marital status
Never married
Married
Divorced/widowed
Aboriginal identity
Metis ([double
dagger])
First Nations
Inuit
> 1 identity
Not identified
as Aboriginal
Social support
Random effects
Between CSD 0.59 (0.07) 0.57 (0.08)
Variance (SE)
Between CSD 15.1 14.8
Variances
expressed as a %
Model 2 Model 3
OR (95% CI) OR (95% CI)
Fixed effects
Age, years
15-19 1.14 (0.99-1.33) 0.74 (0.62-0.88)
20-29 1.67 (1.48-1.89) 1.21 (1.06-1.39)
30-39 1.53 (1.36-1.72) 1.35 (1.19-1.52)
[greater than Ref. Ref.
or equal to] 40
Male 2.67 (2.43-2.94) 2.62 (2.37-2.89)
Level 2
Community of residence
Off-community Ref. Ref.
Inuit community 0.82 (0.52-1.31) 0.73 (0.42-1.27)
First Nations community 1.57 (1.19-2.08) 1.54 (1.17-2.04)
Other community 1.30 (1.01-1.67) 1.20 (0.93-1.54)
Province of residence
Saskatchewan * Ref. Ref.
Quebec 1.30 (0.93-1.82) 1.29 (0.92-1.80)
Ontario 1.24 (0.93-1.64) 1.25 (0.94-1.65)
Manitoba 1.29 (0.96-1.74) 1.30 (0.98-1.74)
Alberta 0.84 (0.65-1.09) 0.85 (0.66-1.10)
British Columbia 1.23 (0.97-1.56) 1.21 (0.95-1.53)
Atlantic Provinces 2.49 (1.84-3.37) 2.80 (2.08-3.78)
Territories 1.46 (1.05-2.02) 1.39 (1.01-1.92)
Community SES 1.37 (1.18-1.58) 1.46 (1.26-1.69)
Community problem 1.13 (1.04-1.24) 1.09 (1.002-1.20)
Level 1
Employed 1.08 (0.98-1.20)
Income ([dagger]) 0.98 (0.95-1.00)
Education
[less than or Ref.
equal to] Grade 8
Grade 9-10 1.10 (0.94-1.29)
Grade 11-13 1.25 (1.08-1.45)
College 1.18 (1.03-1.36)
University 0.79 (0.65-0.95)
Marital status
Never married Ref.
Married 0.44 (0.39-0.49)
Divorced/widowed 0.85 (0.74-0.97)
Aboriginal identity
Metis ([double Ref.
dagger])
First Nations 0.97 (0.85-1.11)
Inuit 1.05 (0.70-1.56)
> 1 identity 1.02 (0.77-1.36)
Not identified 0.69 (0.54-0.89)
as Aboriginal
Social support 0.97 (0.97-0.98)
Random effects
Between CSD 0.53 (0.08) 0.51 (0.08)
Variance (SE)
Between CSD 13.9 13.4
Variances
expressed as a %
* Saskatchewan was used as the reference for provinces because it
has the largest sample size.
([dagger]) Income was rescaled for the purposes of analyses so
that 1 unit increase refers to $10,000.
([double dagger]) Those having Metis identity were used as the
reference because Metis are socio-economically better off than
First Nations and Inuit.6
