Is There an Impact of Public Smoking Bans on Self-reported Smoking Status and Exposure to Secondhand Smoke?

Alisa B Naiman; Richard H Glazier; Rahim Moineddin

Disclosures

BMC Public Health. 2011;11 

In This Article

Methods

Ontario's population of 12.9 million makes it the most populous Canadian province, accounting for almost 40% of the national population.[5] The 15 largest municipalities based on the 2006 Canadian Census represent 78% of the Ontario population and were chosen for study (Figure 1).[6]

Figure 1.

Map of 15 Selected Ontario Municipalities.

In Ontario, smoke-free legislation was a municipal responsibility until the implementation of a province-wide smoking ban in May 2006. Each of the municipalities selected introduced smoke-free legislation from 1994 to 2004. A record of the introduction of municipal smoking bans for the 15 municipalities selected was created. Bans were classified as either partial or full. A ban was considered to be full if all public spaces were smoke-free. A ban was classified as partial if there was any exemption to the ban.[7] Figure 2 displays a historical record of the implementation of bans for the 15 Ontario municipalities selected from 1996 to 2006 Table 1.

Figure 2.

Historical Record of Smoking Ban Legislation by Municipality, Ontario, 1994–2006. Legend available in Table 1.

Municipalities within Ontario are structured in different ways.[8] This structure made it difficult in some locations to select one ban for an entire area, as different smoking bans could exist within the larger geographic area. In jurisdictions in which multiple bans existed, the introduction of the smoking ban for the area with the largest population was considered the start of the ban for the entire region.

The Canadian Community Health Survey (CCHS) is a cross-sectional survey conducted by Statistics Canada that collects information related to health status, health care utilization and health determinants of Canadians aged 12 years and older.[9] The survey is based on a sample of 65,000 respondents. The 2003 (2.1) and 2005 (3.1) public access CCHS were used and responses to questions about self-reported smoking prevalence and exposure to SHS were identified for the 15 municipalities. The 2.1 and 3.1 surveys were conducted through telephone interviews and ran between January and December of 2003 and 2005 respectively.[10] The information was captured at the level of the public health unit, as this level most closely resembles the geographic representation of municipalities. Five questions pertaining to smoking status were available in the 2.1 and 3.1 CCHS public access file.[11] These included questions about complete smoking restriction at home and at work; exposure to SHS at home, in public places, and in vehicles; and current and daily smoking. Additional file 1 includes survey questions that pertain to smoking. The 2006 Canada census was used for population composition and denominators.

This study employed a repeated cross-sectional design. Absolute and relative prevalence differences were calculated for questions on SHS exposure in public places and prevalence of complete workplace smoking restriction. To determine whether significant differences occurred for these two variables, 95% confidence intervals were calculated and compared across groups using the test statistic proposed by Carriere et al. This method is a nonparametric estimation and hypothesis-testing procedure for standardized rates of events. This test is applicable to both binary and non-binary events and recurrent or non-recurrent events. This procedure does not require any unrealistic or non-confirmable assumptions, such as a parametric distribution or an identical distribution for all observations. The variances are obtained using a simple measure of dispersion that applies to any type of event with no specific assumption as to the distribution; this measure is shown to be the usual estimator when the distribution is binomial, negative binomial, or normal.[12] Absolute prevalence differences between survey years were also calculated for the prevalence of SHS exposure at home and in vehicles, complete smoking restriction at home, and current number of smokers. Ethics approval was not required as public access files of the survey were used and no individual level information was available.

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