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Does level of tobacco control relate to smoking prevalence in Canada: a national survey of public health organizations.
Hanusaik, Nancy ; Maximova, Katerina ; Kishchuk, Natalie 等
Appendix 1. Mean percentage decline in daily smoking
prevalence (CTUMS 1999 to 2009) among high- and
moderate-effort provinces based on % engagement and mean
involvement levels in tobacco control activities,
Canada (2004)
High-effort Provinces * Prevalence Daily Smokers
([dagger])
1999 2009 % decline
BC 16 12 25.0
NS 25 17 32.0
ON 19 12 36.8
QC 25 16 36.0
Mean 21.3 14.3 32.9
Moderate-effort Provinces
AB 22 14 36.4
SK 21 18 14.3
MB 19 15 21.1
NB 22 18 18.2
PE 21 14 33.3
NL 24 16 33.3
Mean 21.5 15.8 26.5
* Provinces for which both % engagement and mean involvement were high
in relation to the other provinces; ([dagger]) Canadian Tobacco Use
Monitoring Survey (CTUMS), Percentage daily smokers, by province, age
15+ years, Canada 1999 to 2009.
Table 1. Description of the Survey Items, Response Choices and Method
of Scoring for Analysis
Variable Description Survey Item
% Engagement Proportion of CDP In the last 3 years, has
[in tobacco organizations engaged in your organization
control] tobacco control. undertaken any chronic
disease prevention or
healthy lifestyle
promotion activities for
tobacco control?
Mean level of Mean amount of effort or Think about the last 3
involvement [in activity that engaged years. How would you
tobacco control CDP organizations had rate your organization's
activities] devoted to tobacco involvement in chronic
control as a proportion disease prevention/
of their total effort in healthy lifestyle
chronic disease promotion activities
prevention/healthy that address tobacco
lifestyle promotion. control?
Tobacco control Assessed using two Not applicable.
"effort" * indicators: i) %
engagement in tobacco
control; and ii) mean
level of involvement in
tobacco control
activities.
Involvement in How would you rate your
tobacco control organization's level of
across settings involvement in tobacco
control activities in
the following settings:
i) schools; ii) work-
places; iii) health care
settings; iv) community
at large.
Involvement in How would you rate your
tobacco control organization's level of
across strategies involvement in tobacco
control activities using
the following
strategies: individual-
or small-group focused
activities (i.e., group
development, public
education, skill
building at the
individual level,
facilitation of self-
help groups, service
provider skill building,
volunteer development),
and those targeted to
the population at large
(i.e., healthy public
policy development,
advocacy, community
mobilization, creating
healthy environments).
Level of involvement in
partnership building
(which can be viewed as
either an individual-or
population-focused
strategy) was also
measured.
Change in Using Canadian Tobacco Not applicable.
prevalence of Use Monitoring Survey
smoking score (CTUMS) data (Health
Canada, 2009), we ranked
each province from 1
(lowest prevalence) to
10 (highest prevalence)
according to the
prevalence of daily
smoking in 1999, and
then again ten years
later in 2009. Rank
order position in
prevalence in 2009 was
compared to rank order
position in 1999 (Table
4).
Variable Response Choices Scoring for Analysis
% Engagement Yes / No. Provinces ranked from 1
[in tobacco to 10 according to the
control] proportion of CDP
organizations engaged;
rank order >5
categorized as "high"
engagement (Table 3).
Mean level of 5-point Likert-type Provinces ranked from 1
involvement [in scale that ranged from to 10 according to mean
tobacco control "very low" (1) to "very level of involvement;
activities] high" (5). rank order >5
categorized as "high"
involvement (Table 3).
Tobacco control High/moderate effort. "High effort" = both
"effort" * engagement and
involvement categorized
as high. "Moderate
effort" = provinces
ranked low on both
indicators or had mixed
rankings (Table 3).
Involvement in 5-point Likert-type If no activities were
tobacco control scale that ranged from conducted in a
across settings "very low" (1) to "very particular setting,
high" (5). involvement was rated
"very low".
Involvement in 5-point Likert-type If no activities were
tobacco control scale that ranged from conducted using a
across strategies "very low" (1) to "very specific intervention
high" (5). strategy, involvement
was rated "very low".
Change in Not applicable. Score = number of rank
prevalence of order position points
smoking score gained or lost from 1999
to 2009. A positive
value represents an
improvement in 2009
prevalence standing over
the position held in
1999 (Table 4).
* This measure of "effort" reflects two dimensions (i.e.,
infrastructure and anti-tobacco programming) of the Strength of
Tobacco Control Index (14,15) by juxtaposing number or proportion of
public health organizations engaged in tobacco control and mean level
of involvement in tobacco control activities.
Table 2. Level of Involvement in Tobacco Control Activities in
Specific Settings and Using Specific Types of Intervention Strategies
According to Province, Canada, 2004-2005
Level of Involvement in Tobacco
Control, Mean (SD) *
TOTAL BC AB
Setting (n=172) (n=18) (n=12)
Community at large 4.0 (0.9) 3.7 (1.1) 3.8 (1.1)
Schools 3.5 (1.3) 3.6 (1.1) 3.3 (1.4)
Workplace 3.0 (1.2) 3.0 (1.2) 2.8 (1.5)
Health care 3.1 (1.2) 3.3 (1.4) 2.9 (1.3)
Intervention Strategy
Individual level
Public education 3.9 (1.0) 3.8 (1.0) 3.4 (1.2)
Group development 3.1 (1.1) 3.0 (1.3) 3.1 (0.9)
Skill building at the
individual level 3.2 (1.0) 3.7 (1.1) (f) 3.1 (0.9)
Facilitation of self-
help groups 2.4 (1.3) 2.6 (1.5) 1.7 (1.1) (g)
Service provider skill
building 2.9 (1.2) 3.1 (1.4) 2.7 (1.1)
Volunteer development 2.4 (1.2) 2.8 (1.2) 2.1 (0.9)
Population level
Healthy public policy
development 4.0 (1.2) 4.2 (0.9) 3.6 (1.2)
Advocacy 3.9 (1.1) 3.8 (1.1) 3.5 (1.4)
Community mobilization 3.6 (1.1) 3.6 (0.9) 3.4 (1.3)
Creating healthy
environments 3.9 (1.0) 3.8 (1.0) 3.6 (0.8)
Partnership building 3.8 (1.0) 4.1 (0.9) 3.7 (0.6)
Level of Involvement in Tobacco
Control, Mean (SD) *
SK MB
Setting (n=14) (n=10)
Community at large 3.9 (1.2) 3.3 (0.8) (a)
Schools 3.5 (1.0) 2.7 (1.3)
Workplace 2.7 (1.1) 2.4 (1.5)
Health care 3.1 (1.3) 3.0 (1.2)
Intervention Strategy
Individual level
Public education 3.7 (1.1) 3.1 (1.1) (d)
Group development 2.8 (1.0) 2.0 (0.7) (a,d)
Skill building at the
individual level 2.5 (1.1) (e,f) 2.6 (1.3)
Facilitation of self-
help groups 1.9 (1.1) 2.2 (0.9)
Service provider skill
building 2.5 (0.9) 2.8 (1.3)
Volunteer development 2.4 (1.3) 2.0 (1.3)
Population level
Healthy public policy
development 3.8 (1.4) 3.1 (1.5)
Advocacy 3.8 (1.3) 3.5 (1.3)
Community mobilization 3.4 (1.3) 2.5 (1.3) (a,d)
Creating healthy
environments 4.0 (1.1) 3.3 (1.1)
Partnership building 3.6 (1.3) 3.5 (1.3)
Level of Involvement in Tobacco
Control, Mean (SD) *
ON QC NB
Setting (n=172) (n=172) (n=172)
Community at large 4.2 (0.7) 3.4 (1.1) 4.0 (1.4)
Schools 3.6 (1.3) 2.5 (1.6) (b) 4.0 (1.4)
Workplace 3.1 (1.1) 2.9 (1.5) 2.8 (1.7)
Health care 2.7 (1.0) (c) 3.4 (1.2) 3.5 (1.3)
Intervention Strategy
Individual level
Public education 4.2 (0.9) (d) 4.0 (0.8) 3.7 (1.0)
Group development 3.2 (1.1) (d) 2.7 (1.1) (b) 3.7 (1.3)
Skill building at the
individual level 2.9 (1.0) (c) 3.7 (0.9) 3.0 (0.8)
Facilitation of self-
help groups 2.2 (1.1) (c) 2.4 (1.8) 2.7 (1.5)
Service provider skill
building 2.8 (1.0) 3.1 (1.7) 3.7 (1.9)
Volunteer development 2.3 (1.2) (c) 2.3 (1.4) 2.2 (1.5)
Population level
Healthy public policy
development 4.2 (1.0) (h) 3.0 (1.5) (b,h) 4.5 (1.0)
Advocacy 3.9 (1.1) 3.2 (1.4) 3.5 (1.9)
Community mobilization 3.9 (0.9) (d) 3.0 (1.1) 4.0 (1.4)
Creating healthy
environments 4.1 (0.9) 3.4 (1.2) 4.2 (1.0)
Partnership building 3.6 (1.0) 3.6 (1.2) 4.5 (1.0)
Level of Involvement in Tobacco
Control, Mean (SD) *
NS PE NL
Setting (n=172) (n=172) (n=172)
Community at large 4.5 (0.7) (a) 4.0 (0.9) 3.8 (0.7)
Schools 4.2 (0.8) (b) 3.6 (1.5) 3.3 (1.1)
Workplace 3.4 (1.0) 2.8 (1.6) 2.8 (1.3)
Health care 3.9 (0.9) (c) 3.4 (1.3) 3.3 (1.5)
Intervention Strategy
Individual level
Public education 4.1 (0.9) 3.9 (0.8) 3.8 (0.9)
Group development 4.1 (0.8) (a,b) 3.1 (1.1) 3.1 (1.2)
Skill building at the
individual level 3.9 (1.0) (c,e) 3.6 (0.9) 3.1 (0.7)
Facilitation of self-
help groups 3.4 (1.4) (c,g) 2.4 (1.2) 3.1 (0.9)
Service provider skill
building 3.5 (1.3) 3.0 (1.1) 2.9 (1.2)
Volunteer development 3.4 (1.3) (c) 2.4 (1.2) 2.5 (1.0)
Population level
Healthy public policy
development 4.5 (0.6) (b) 4.1 (1.2) 3.6 (0.8)
Advocacy 4.5 (0.6) 3.9 (1.1) 4.0 (0.7)
Community mobilization 4.2 (0.7) (a) 3.4 (1.1) 3.2 (0.8)
Creating healthy
environments 3.9 (1.0) 3.9 (1.0) 3.7 (0.7)
Partnership building 4.4 (0.5) 3.6 (0.9) 4.1 (0.9)
* Organizations with a multi-province mandate (n=6) were excluded from
provincial comparisons. Tukey-Kramer pairwise comparisons were
statistically significant (p< 0.05) between: NS and MB = (a); NS and
QC = (b); NS and ON = (c); MB and ON = (d); NS and SK = (e); SK and BC
= (f); NS and AB = (g); QC and ON = h.
([dagger]) Includes one organization with a multi-province mandate.
Table 3. Provincial Rank Order Classifications of Canadian Chronic
Disease Prevention Organizations According to % of Organizations
Engaged in Tobacco Control, Mean Level of Involvement in Tobacco
Control Activities Among Organizations That Were Engaged, and Tobacco
Control "Effort" (2004-2005)
Engagement * Involvement *
([dagger]) ([dagger])
Province % Rank Mean (SD) Rank
Total 88 -- 4.1 (1.0) --
BC 91 7 4.3 (0.8) 8.5
AB 71 2 4.1 (1.0) 5.5
SK 85 4 3.9 (0.7) 3.5
MB 100 10 3.2 (1.1) 1
ON 99 9 4.4 (0.9) 10
QC 93 8 4.1 (0.9) 5.5
NB 80 3 4.2 (1.5) 7
NS 89 6 4.3 (0.7) 8.5
PE 67 1 3.7 (0.9) 2
NL 88 5 3.9 (1.0) 3.5
Rank Order Classification
([double dagger])
Province Engagement Involvement Effort
Total -- -- --
BC High High High
AB Low High Moderate
SK Low Low Moderate
MB High Low Moderate
ON High High High
QC High High High
NB Low High Moderate
NS High High High
PE Low Low Moderate
NL Low Low Moderate
* Organizations with multi-province mandates excluded from provincial
results; ([dagger]) Ranked lowest to highest; ([double dagger]) %
Engagement and level of involvement rated "high" for provinces that
ranked >5; Tobacco control "effort" rated high if both % engagement
and level of involvement categorized as "high", otherwise rated
"moderate".
Table 4. Mean "Change in Prevalence of Smoking" Scores According to
Tobacco Control Effort (1999-2009)
Tobacco Control Effort Province Prevalence Rank 1999
Daily Smokers Prevalence
1999 (%) * ([dagger])
High BC 16 1
(High engagement/high ON 19 2.5
involvement) QC 25 9.5
NS 25 9.5
Moderate AB 22 6.5
(Low engagement/high NB 22 6.5
involvement)
Moderate SK 21 4.5
(Low engagement/low PE 21 4.5
involvement) NL 24 8
Moderate MB 19 2.5
(High engagement/low
involvement)
Tobacco Control Effort Province Prevalence Rank 2009
Daily Smokers Prevalence
2009 (%) * ([dagger])
High BC 12 1.5
(High engagement/high ON 12 1.5
involvement) QC 16 6.5
NS 17 8
Moderate AB 14 3.5
(Low engagement/high NB 18 9.5
involvement)
Moderate SK 18 9.5
(Low engagement/low PE 14 3.5
involvement) NL 16 6.5
Moderate MB 15 5
(High engagement/low
involvement)
Tobacco Control Effort Province Change in
Prevalence of
Smoking Score
([double dagger])
High BC -0.5
(High engagement/high ON +1.0
involvement) QC +3.0
NS +1.5
Mean score = +1.25
Moderate AB +3.0
(Low engagement/high NB -3.0
involvement) Mean score = 0
Moderate SK -4.0
(Low engagement/low PE +1.0
involvement) NL +1.5
Mean score = -0.5
Moderate MB -2.5
(High engagement/low Mean score = -2.5
involvement)
* Canadian Tobacco Use Monitoring Survey (CTUMS), Percentage daily
smokers, by province, age 15+ years, Canada 1999 to 2009; ([dagger])
Ranked lowest to highest prevalence; ([double dagger]) Positive values
represent an improvement in 2009 prevalence standing over the rank
position held in 1999. The actual value represents the number of
position points gained or lost.