Alcohol consumption: a different kind of Canadian mosaic.

Paradis, Catherine ; Demers, Andree ; Picard, Elyse 等

In Can j Public Health 2010;101(4):275-80. n Canada, health and social problems resulting from alcohol consumption are becoming a concern. Over the last decade, both the annual volume of consumption and high-risk drinking have increased. (1-4) Consequently, in order to avoid a proliferation of alcohol-related damages, effective recommendations are needed. While commonly reported numeric measures of alcohol consumption are accurate predictors of various problems, they are limited in their scope to help understand the drinking act and its relationships to alcohol-related harm. (5,6) Yet, this could be improved if more thought were given to the qualitative dimensions of drinking such as the types of beverages consumed and the circumstances surrounding the drinking act.

Drinking occasions, characterized by relational, temporal, circumstantial and locational dimensions, represent a distinct social world that has its own norms and, as such, influence drinking outcome. (7-10) For instance, the probability for heavy drinking is generally higher in bars, discos or taverns than in restaurants or homes. (11-16) Accordingly, drinking in a bar is associated with acute social consequences such as suicide, violence, motor vehicle and other accidents. (17,18) By contrast, light drinking with meals may be associated with improved cardiac functioning and reduced risk of heart attack. (19)

While damages from alcohol are strongly related to total volume of alcohol consumed and heavy drinking episodes, some studies have shown that beverage choices can also be associated with drinking outcomes. Beer drinkers are more often involved in alcohol-related accidents than other types of drinkers, (20) whereas wine drinkers have a lesser risk of alcohol-related problems, (21) morbidity and mortality from all causes. (22,23) While these differences can be explained by the health-promoting components of different alcoholic beverages, (22,24-27) they might also be an artifact of the qualitative ways a standard dose of alcohol is taken, (6) the personality of the drinker and his lifestyle, (28-32) or the circumstances in which drinkers find themselves. (33,34) Beverage choice is also a significant indicator of social status, a fact that may also impact on drinking consequences. (10)

To develop effective alcohol recommendations, alcohol consumption needs to be considered as a social behaviour and each and every dimension of the drinking act must be analyzed. Hence, this paper's key questions are:

1) What are Canadians' drinking patterns in terms of drinking amounts as well as beverage and drinking context preferences?

2) Are Canadians' drinking patterns similar across provinces?

This paper aims to be a first step toward finding out whether Canadians share a drinking culture.

METHODS

Survey

The GENACIS* survey was developed to study the influence of social and cultural variation on gender differences in alcohol use. Between January 2004 and January 2005, telephone interviews were performed and responses from 14,067 Canadians between the ages of 18 and 76 originating from ten provinces were collected. The overall response rate was 53%. Although provinces with smaller populations were over-sampled to allow provincial comparisons, there were still an insufficient number of respondents from the Maritime provinces to carry out the present analyses. Consequently, these provinces were grouped together as preliminary analyses revealed that they shared very similar drinking practices.

The analytical sample includes 10,466 current drinkers (5,743 women and 4,723 men). The age distribution of respondents was not statistically different across provinces. Data were not weighted, in accordance with the GENACIS technical report's suggested protocol when comparing provinces.35

Measures

Analyses are based on the annual frequency of drinking, the occurrence of a binge drinking occasion (5+ drinks on one occasion), the usual daily quantity and the annual volume. We further calculated the percentage of the total volume due to each type of beverage as well as the percentage of the annual frequency attributable to specific drinking contexts, by dividing beverage-specific/context-specific responses by the general ones. Details about variables and relevant questions are shown in Appendix 1.

Analyses

Analyses were conducted to reveal drinking patterns and verify whether these patterns vary across provinces. Descriptive analyses and pairwise comparisons based on estimated marginal means were performed using SPSS 12.0. Analyses were stratified according to gender and were conducted separately for each drinking measure, each beverage type and each drinking context. Level of significance was set at p[less than or equal to]<0.05.

RESULTS

Men's drinking amounts and drinking patterns

On average, a Canadian male drinker has 432 drinks a year. This average varies from 486 drinks in the Maritimes to 318 drinks in

Manitoba and these two extremes are significantly different from one another. The average annual drinking frequency for Canadian men is 95 occasions. The highest number is observed in Quebec where men report 109 drinking occasions, i.e., significantly more occasions than the number reported in the Maritimes (84), Alberta (82), Saskatchewan (78) and Manitoba (71). Canadians' usual daily quantity is 3.3 drinks whereas Maritimers' intake is significantly higher than that observed in every other province, with a usual daily quantity of 4.1 drinks. Accordingly, while 64% of Canadians binge drink at least once a year, 73% of Maritimers do so--a significantly greater proportion than everywhere else in Canada except Alberta (64%) and Saskatchewan (64%).

Men's beverages and context preferences

Beer--the preferred alcoholic beverage in every province--accounts for 51% of men's annual volume, though the annual intake of Maritimers is significantly more (59%) than in any other province except Quebec (53%). While wine constitutes 26% of Canadian men's annual volume, Quebecers have a distinct preference for this beverage. More than one third (36%) of Quebecers' annual volume is wine, a proportion that is significantly greater than in all other provinces. Spirits constitute 19% of Canadians' annual volume, but these beverages are significantly more appreciated in the Prairies. In Saskatchewan, the annual volume attributable to spirits (32%) is significantly higher than in the Maritimes (24%), British Columbia (19%), Ontario (19%) and Quebec (8%). Notably, Quebecers' percentage of the annual intake consisting of spirits is significantly lower than everywhere else in Canada. Finally, coolers are not popular among men. Yet, Ontarians (5%) drink significantly more coolers than both Quebecers (2%) and Maritimers (2%).

With regards to drinking contexts, results indicated provincial differences. Drinking during a meal is more prevalent in Quebec (58%) than in Alberta (45%), Saskatchewan (41%) and the Maritimes (40%). Drinking at a restaurant is less frequent in the Maritimes (23%) than in Alberta (30%) and Ontario (29%). Drinking at a party is significantly more popular in Manitoba (46%) than in BC (37%) and Quebec (37%). Finally, Quebecers report significantly less drinking occasions at a bar (24%) than men from other provinces except BC and Ontario. Quebecers also report less drinking with friends (37%) than drinkers from Alberta (44%), Manitoba (48%) and Ontario (42%).

Women's drinking amounts and drinking patterns

On average, a Canadian female drinker has 183 drinks annually. It is in British Columbia that women drink the most (207 drinks), followed by women from Ontario (190), and those numbers are significantly higher than that observed in Saskatchewan where women drink the least (134). The average annual drinking frequency of Canadian women is 62 occasions. The highest number is observed in BC where women report 71 drinking occasions, i.e., significantly more occasions than that reported by women in Alberta (56), Manitoba (51), the Maritimes (45) and Saskatchewan (39). While Canadian women usually have 2.2 drinks per day, the highest average is found in the Maritimes where women usually have 2.5 drinks per day, i.e., significantly more than in Quebec (2.2), British Columbia (2.1), Alberta (2.1) and Ontario (2.1). Finally, 37% of women report binge drinking at least once a year. This proportion is largest in the Maritimes (43%) and significantly higher than that observed in Ontario (35%) and Quebec (35%).

Women's beverages and context preferences

Among women, wine is the preferred beverage (47%) and the proportion of the annual intake that is attributable to this beverage is significantly higher in Quebec (59%) than in every other province. Beer constitutes 20% of Canadian women's annual intake and again, it is in Quebec that we observed the largest proportion of the intake attributable to this beverage (25%)--a significantly larger proportion than in the Maritimes (19%), BC (18%), Ontario (18%) and Manitoba (17%). Spirits are preferred in the Prairies. Manitoba women report that 31% of their annual intake consists of spirits. This proportion is significantly higher than in every other province except Saskatchewan (31%). Finally, while coolers represent 13% of Canadian women's annual intake, in the Maritimes they represent 18%, i.e., significantly more than everywhere else in Canada except Manitoba (15%).

With regards to drinking contexts, data indicate that drinking during a meal is more prevalent in Quebec (70%) than in Saskatchewan (56%), Manitoba (53%) and the Maritimes (51%). It is in Alberta (41%) that the highest percentage of drinking in a restaurant is observed and this number is significantly higher than that observed in the Maritimes (28%) where women drink significantly less in a restaurant than women from every other province except Manitoba. Maritime women drink significantly more often during a party (57%) than women in Ontario (49%), BC (48%), Alberta (48%) and Quebec (47%). Women from Quebec report significantly fewer drinking occasions at a bar (18%) than women from other provinces, and they also report the lowest proportion of drinking occasions with friends (44%), one that is significantly lower than in the Maritimes (52%) and Ontario (50%).

DISCUSSION

In the alcohol field, it is commonplace to treat nation states and their drinking culture as congruent. However, by looking beyond drinking amounts and paying attention to the qualities of the drinking act, present analyses reveal that in Canada, a large country with ten provinces, there may not be just one single way of consuming alcohol. Preliminary analyses presented in this paper suggest the possibility of three main patterns among Canadian drinkers.

At one end of the spectrum, Maritimers tend to drink more per occasion and report more binge drinking, and Maritime men largely prefer beer. Men and women from the Maritimes drink less often during a meal than elsewhere in the country.

A second way of drinking is observed in the Prairies where men and women tend to drink less, to drink less often and to strongly favour spirits--a type of beverage that constitutes one third of their annual intake.

Finally, there is a way of drinking typified by Quebecers and to a lesser extent by male and female drinkers from Ontario and British Columbia. Actually, given the pronounced preference of Quebecers for wine--a preference which impacts the proportion of volume associated with every other beverage--we could justify putting Quebecers in an exclusive category. However, recent longitudinal data indicate that the value of wine sales increased more noticeably in BC and Ontario than in Quebec3 and therefore, we expect that in the future, drinking practices in these three provinces will grow even more similar. Overall, drinkers from Quebec, Ontario and BC show a drinking style that is closer to the Mediterranean culture, i.e., men and women in these provinces drink more often, drink more wine, drink less spirits, and drink during a meal more often than drinkers from the other provinces.

Overall, this paper prepares the ground for further development of a Canadian alcohol consumption typology, as we were able to identify three distinct ways of consuming alcohol in Canada. We argue that awareness about these three subgroups of Canadian drinkers could be taken into account in the development of alcohol recommendations. This knowledge can be used to strengthen the links between alcohol-related problems and prevention strategies such as low-risk drinking guidelines, which in turn can contribute to increasing the legitimacy of alcohol policies in general.

Appendix 1. Relevant survey questions on drinking patterns, beverage preferences and drinking context preferences

Four dimensions of drinking patterns were studied: the annual frequency, the prevalence of five drinks or more per occasion, the usual daily quantity and the annual volume.

For the annual frequency of drinking, respondents were asked: "During the last 12 months, how often did you usually have any kind of drink containing alcohol?" Possible responses were 1) every day, 2) five or six days a week, 3) three or four days a week, 4) once or twice a week, 5) one to three days a month, 6) less than once a month, or 7) never. Those categories were recoded into absolute average numbers, i.e., 365, 286, 182, 78, 24, 6 or 0 annual drinking days. The same procedure was used for the annual frequency of 5 drinks or more per occasion.

The usual daily quantity is a continuous variable where respondents were asked the following question: "In the past 12 months, on those days when you had any kind of beverage containing alcohol, how many drinks did you usually have?"

The annual volume is a continuous variable derived from multiplying the annual frequency of drinking by the usual daily quantity.

Questions regarding the annual volume were then asked again but specifically for each type of beverage (wine, beer, spirits, coolers). Afterward, proportions of the total volume due to each type of beverage were calculated.

Regarding drinking contexts, respondents were asked how often they drank in various circumstances, i.e., during a meal, at a party, at home, with friends, at work, at a bar/pub/disco/nightclub, at a restaurant, alone. Again, the percentage of the annual frequency of drinking that occurred in each of those contexts was calculated.

Acknowledgements: Funding for this research was provided through an operations grant from the Canadian Institutes of Health Research (CIHR) (Kate Graham (PI) and Demers (Co-PI)). We are grateful to the staff at the Institute for Social Research (ISR) at York University and to Jolicoeur for their assistance in implementing the survey, especially David Northrup and Renee Elspett-Koeppen of ISR for their contributions to the design of the survey. This research was conducted as part of the GENACIS project, a collaborative multinational project led by Sharon Wilsnack and affiliated with the Kettil Bruun Society for Social and Epidemiological Research on Alcohol.

Received: September 8, 2009

Accepted: April 5, 2010

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Catherine Paradis, MSc, [1] Andree Demers, PhD, [1] Elyse Picard, MSc [2]

Author Affiliations

[1.] Departement de sociologie, GRASP, Universite de Montreal, Montreal, QC

[2.] GRASP, Universite de Montreal, Montreal, QC Correspondence: Catherine Paradis, GRASP, Pavillon 7077 av. du Parc, Universite de Montreal, C.P. 6128, succursale Centre-ville, Montreal (Quebec) H3C 3J7, Tel: 514343-6193, E-mail: catherine_paradis@yahoo.ca

Conflict of Interest: None to declare.

* GENder Alcohol and Culture: an International Study

Table 1. Men's Average Drinking Amounts and Drinking Patterns, by
Provinces and Results of Pairwise Comparisons between Provinces

             Annual Volume of                Annual Frequency
             Standard Drinks                   of Drinking

      Mean        Signif. Different   Mean        Signif. Different
      (CI)        from:               (CI)        from:

CDN   432                             95
      (414-452)                       (92-98)

BC    431                             99          SK MB
      (375-489)                       (91-107)

AB    404                             82          ON QC
      (346-463)                       (74-90)

SK    384                             78          BC ON QC
      (310-458)                       (68-87)

MB    318         QC ATL              71          BC ON QC
      (269-367)                       (61-81)

ON    432                             100         AB SK MB ATL
      (410-463)                       (95-106)

QC    465         MB                  109         AB SK MB ATL
      (422-508)                       (103-116)

ATL   486         MB                  84          ON QC
      (419-553)                       (77-91)

          Usual Daily Quantity         % Reporting Binge Drinking
           in Standard Drinks             at Least Once a Year

      Mean        Signif. Different   Mean        Signif. Different
      (CI)        from:               (CI)        from:

CDN   3.3                             64%
      (3.2-3.4)                       (63-66)

BC    2.9         ATL                 60%         ATL
      (2.8-3.2)                       (56-64)

AB    3.3         ATL                 64%
      (3.0-3.6)                       (60-69)

SK    3.3         ATL                 64%
      (2.9-3.6)                       (59-70)

MB    3.4         ATL                 62%         ATL
      (3.0-3.8)                       (56-68)

ON    3.2         ATL                 63%         ATL
      (3.1-3.3)                       (61-66)

QC    3.2         ATL                 64%         ATL
      (3.1-3.4)                       (62-67)

ATL   4.1         BC AB SK MB         73%         BC MB ON QC
      (3.8-4.4)   ON QC               (69-76)

Note: In the Signif. different from: columns, we included the name of
each province whose mean is statistically different at the 0.05 level
from the mean of the province in the first column of the table.

Table 2. Men's Average Beverage-specific Proportions of Annual Volume
and Men's Average Context-specific Proportions of Annual Drinking
Frequency, by Provinces and Results of Pairwise Comparisons between
Provinces

             Beer's                Wine's               Spirits'
           Proportion            Proportion            Proportion
             of the                of the                of the
          Annual Volume         Annual Volume         Annual Volume

       Mean      Signif.     Mean      Signif.     Mean      Signif.
       (CI)      Different   (CI)      Different   (CI)      Different
                 from:                 from:                 from:

CDN    51%                   26%                   19%
       (50-52)               (25-27)               (18-20)

BC     47%       ATL QC      30%       AB SK MB    19%       AB SK MB
       (44-50)               (27-32)   QC ATL      (17-21)   QC ATL

AB     50%       ATL         21%       BC ON       26%       BC SK
       (46-53)               (18-24)   QC          (23-29)   ON QC

SK     50%       ATL         16%       BC ON       32%       BC AB ON
       (46-54)               (13-19)   QC          (29-35)   QC ATL

MB     45%       QC ATL      21%       BC QC       29%       BC ON
       (41-49)               (18-25)               (25-32)   QC

ON     50%       ATL         26%       AB SK       19%       AB SK MB
       (49-52)               (25-28)   QC ATL      (18-20)   QC ATL

QC     53%       BC MB       36%       BC AB       8%        BC AB SK
       (51-56)               (34-38)   MB ON       (7-9)     MB ON
                                       ATL                   ATL

ATL    59%       BC AB SK    16%       ON QC       24%       BC SK
       (56-62)   MB ON       (14-18)               (21-26)   ON QC

            Coolers'          Proportion of the     Proportion of the
           Proportion         Annual Frequency      Annual Frequency
             of the              of Drinking           of Drinking
          Annual Volume       Occurring during         Occurring at
                                   a Meal              a Restaurant

       Mean      Signif.     Mean      Signif.     Mean      Signif.
       (CI)      Different   (CI)      Different   (CI)      Different
                 from:                 from:                 from:

CDN    4%                    51%                   27%
       (3-4)                 (50-52)               (26-28)

BC     4%        QC          55%       AB SK ATL   28%
       (3-6)                 (52-59)               (25-30)

AB     4%                    45%       BC ON       30%       ATL
       (3-5)                 (41-49)   QC          (27-34)

SK     3%                    41%       BC MB       26%
       (2-4)                 (36-46)   ON QC       (22-30)

MB     5%                    52%       SK ATL      31%
       (3-6)                 (47-56)               (26-35)

ON     5%        QC ATL      53%       AB SK       29%       ATL
       (4-5)                 (51-55)   ATL         (27-31)

QC     2%        BC ON       58%       AB SK       26%
       (2-3)                 (55-60)   ATL         (24-28)

ATL    2%        ON          40%       BC MB       23%       AB ON
       (2-3)                 (36-43)   ON QC       (20-26)

        Proportion of the     Proportion of the     Proportion of the
        Annual Frequency      Annual Frequency      Annual Frequency
           of Drinking           of Drinking           of Drinking
           Occurring at          Occurring at          Occurring at
            a Party                 a Bar             with Friends

       Mean      Signif.     Mean      Signif.     Mean      Signif.
       (CI)      Different   (CI)      Different   (CI)      Different
                 from:                 from:                 from:

CDN    41%                   28%                   41%
       (39-42)               (27-29)               (40-42)

BC     37%       AB MB       29%                   40%
       (34-40)               (26-32)               (37-44)

AB     45%       BC QC       33%       QC          44%       QC
       (41-49)               (30-37)               (40-48)

SK     43%                   34%       QC          44%
       (38-47)               (30-39)               (39-48)

MB     46%       BC QC       32%       QC          48%       QC
       (42-51)               (27-37)               (43-53)

ON     41%                   27%                   42%       QC
       (39-44)               (25-29)               (40-44)

QC     37%       AB MB       24%       AB SK       37%       AB MB ON
       (35-39)               (21-26)   MB ATL      (35-39)

ATL    41%                   30%       QC          42%
       (38-44)               (27-33)               (38-45)

Note: In the Signif. different from: columns, we included the name of
each province whose mean is statistically different at the 0.05 level
from the mean of the province in the first column of the table.

Table 3. Women's Average Drinking Amounts and Drinking Patterns, by
Provinces and Results of Pairwise Comparisons between Provinces

            Annual Volume of                Annual Frequency
            Standard Drinks                   of Drinking

      Mean        Signif. Different   Mean        Signif. Different
      (CI)        from:               (CI)        from:

CDN   183                             62
      (176-191)                       (59-64)
BC    207         SK                  71          AB SK MB ATL
      (184-229)                       (65-78)
AB    185                             56          BC
      (156-215)                       (49-63)
SK    134         BC ON               39          BC ON QC
      (112-156)                       (33-46)
MB    157                             51          BC ON
      (134-180)                       (43-58)
ON    190         SK                  68          SK MB ATL
      (176-203)                       (64-72)
QC    187                             65          SK ATL
      (174-201)                       (61-70)
ATL   164                             45          BC ON QC
      (140-189)                       (40-50)

          Usual Daily Quantity          % Reporting Binge Drinking
           in Standard Drinks              at Least Once a Year

      Mean        Signif. Different   Mean        Signif. Different
      (CI)        from:               (CI)        from:

CDN   2.2                             37%
      (2.1-2.2)                       (36-38)
BC    2.1         ATL                 37%
      (1.9-2.2)                       (34-41)
AB    2.1         ATL                 40%
      (2-2.3)                         (36-44)
SK    2.2                             38%
      (2-2.3)                         (33-44)
MB    2.3                             38%
      (2.1-2.4)                       (33-43)
ON    2.1         ATL                 35%         ATL
      (2-2.1)                         (33-38)
QC    2.2         ATL                 35%         ATL
      (2.1-2.2)                       (33-38)
ATL   2.5         BC AB ON QC         43%         ON QC
      (2.3-2.6)                       (39-46)

Note: In the Signif. different from: columns, we included the name of
each province whose mean is statistically different at the 0.05 level
from the mean of the province in the first column of the table.

Table 4. Women's Average Beverage-specific Proportions of Annual
Volume and Women's Average Context-specific Proportions of Annual
Drinking Frequency, by Provinces and Results of Pairwise
Comparisons between Provinces

            Beer's                Wine's               Spirits'
          Proportion            Proportion            Proportion
            of the                of the                of the
         Annual Volume         Annual Volume         Annual Volume

      Mean      Signif.     Mean      Signif.     Mean      Signif.
      (CI)      Different   (CI)      Different   (CI)      Different
                from:                 from:                 from:

CDN   20%                   47%       SK MB       20%
      (20-21)               (46-48)   QC ATL      (19-21)
BC    18%       SK QC       47%       SK ON       22%       SK MB
      (16-19)               (44-49)   QC          (20-24)   QC
AB    21%                   41%       BC AB       24%       SK MB
      (18-23)               (37-44)   ON QC       (22-27)   QC
SK    25%       BC MB       32%       BC ON       31%       BC AB ON
      (21-28)   ON          (28-36)   QC          (28-35)   QC ATL
MB    17%       SK QC       36%       AB SK MB    31%       BC AB ON
      (14-20)               (32-40)   QC ATL      (27-34)   QC ATL
ON    18%       SK QC       47%       BC AB SK    20%       SK MB
      (17-20)               (45-48)   MB ON       (19-21)   QC
QC    25%       BC MB       59%       ATL         10%       BC AB SK
      (23-26)   ON ATL      (57-61)   BC ON       (9-11)    MB ON
                                                            ATL
ATL   19%       QC          38%       QC          24%       SK MB
      (17-22)               (36-41)               (21-26)   QC

            Coolers'         Proportion of the     Proportion of the
          Proportion          Annual Frequency      Annual Frequency
            of the              of Drinking           of Drinking
         Annual Volume        Occurring during        Occurring at
                                  a Meal              a Restaurant

      Mean      Signif.     Mean      Signif.     Mean      Signif.
      (CI)      Different   (CI)      Different   (CI)      Different
                from:                 from:                 from:

CDN   13%                   61%                   35%
      (12-13)               (60-62)               (34-36)
BC    14%       QC ATL      61%       QC ATL      37%       ATL
      (12-15)               (58-64)               (35-40)
AB    14%       QC ATL      60%       QC ATL      39%       ATL
      (12-16)               (57-64)               (36-43)
SK    12%       QC ATL      56%       QC          39%       ATL
      (10-14)               (51-61)               (34-43)
MB    15%       QC          53%       QC          35%
      (13-18)               (49-58)               (31-39)
ON    15%       QC ATL      60%       QC ATL      35%       ATL
      (14-16)               (58-62)               (33-37)
QC    7%        BC AB SK    70%       BC AB SK    34%       ATL
      (6-8)     MB ON       (68-72)   MB ON       (32-36)
                ATL                   ATL
ATL   18%       BC AB SK    51%       BC AB       27%       BC AB SK
      (16-20)   ON QC       (47-54)   ON QC       (25-30)   ON QC

       Proportion of the     Proportion of the     Proportion of the
        Annual Frequency      Annual Frequency      Annual Frequency
          of Drinking           of Drinking           of Drinking
          Occurring at          Occurring at          Occurring at
            a Party                a Bar              with Friends

      Mean      Signif.     Mean      Signif.     Mean      Signif.
      (CI)      Different   (CI)      Different   (CI)      Different
                from:                 from:                 from:

CDN   50%                   25%                   48%
      (49-51)               (24-26)               (47-49)
BC    48%       ATL         27%       QC          48%
      (45-51)               (24-30)               (45-51)
AB    48%       ATL         32%       ON QC       49%
      (45-52)               (29-36)               (45-52)
SK    54%                   33%       ON QC       50%
      (49-58)               (28-38)               (45-55)
MB    53%                   27%       QC          50%
      (48-57)               (23-32)               (46-54)   QC
ON    49%       ATL         24%       AB SK       50%
      (47-51)               (22-26)   QC ATL      (48-52)   ON ATL
QC    47%       ATL         18%       BC AB SK    44%
      (45-50)               (16-20)   MB ON       (42-56)
                                      ATL
ATL   57%       BC AB       31%       ON QC       52%       QC
      (54-60)   ON QC       (28-34)               (49-56)

Note: In the Signif. different from: columns, we included the name of
each province whose mean is statistically different at the 0.05 level
from the mean of the province in the first column of the table.