Highlights
- The Cancer Risk Factors Atlas of Ontario provides neighbourhood-level risk factor data, which can help create targeted health policy planning.
- Using data from the atlas, an analysis of Hamilton showed that there was a significant increase in smoking prevalence with increased neighbourhood marginalization factors related to income and residential instability.
- The City of Hamilton has implemented strategies for local interventions to reduce inequities in smoking behaviours (e.g., targeted clinics and awareness campaigns, by-laws against smoking in parks, support of tobacco free policies in educational settings).
The recently launched Cancer Risk Factors Atlas of Ontario helps create targeted health policy planning by showing how risk factors related to cancer and other chronic diseases are distributed in local areas throughout Ontario. To identify and prioritize areas with increased risk factors, the atlas used Canadian Community Health Survey data from 2000 to 2014 to create local estimates for populations age 12 and older on 6 behavioural risk factors: alcohol consumption, excess body weight, inadequate physical activity, inadequate vegetable and fruit consumption, sedentary behaviour and tobacco smoking.
A unique feature of the atlas is that the data can be used with other sources of information, such as the Census of Canada, indicators of social determinants of health, or consumer data that may include product and media preferences (i.e., market segmentation data). This Cancer Fact explores relationships with social determinants of health using the Ontario Marginalization Index (ON-Marg), which provides 4 dimensions of indicators of social determinants of health (ethnicity, dependency, material deprivation and residential instability).[1]
An analysis using data from the atlas showed strong associations linking neighbourhood current smoking prevalence in Hamilton to neighbourhood material deprivation (e.g., proportion of the population considered low-income) and residential instability (e.g., proportion of the population living alone) (see figure).
As material deprivation and residential instability increased, the prevalence of current smoking increased significantly across all Hamilton neighbourhoods, which were grouped into 5 ranked categories of marginalization, called quintiles. For example, for material deprivation, the most marginalized neighbourhoods had an approximately 10% higher neighbourhood smoking prevalence compared to the least marginalized neighbourhoods (after adjusting for the other indicators of the social determinants of health). No strong associations were found linking neighbourhood current smoking prevalence in Hamilton to dependency (e.g., proportion of the population who are aged 65 and older) and ethnic concentration (e.g., proportion of the population who self-identify as a visible minority) (not shown in the figure).
The strong associations that smoking prevalence has to material deprivation and residential stability suggest that these indicators may be important contributors to current smoking prevalence in Hamilton neighbourhoods. Given the associations with income-related factors, these findings highlight opportunities for tobacco smoking prevention and cessation through taxation policies, which the World Health Organization identified as being effective in reducing smoking.[2] The findings also identify the need to focus programs on areas with increased residential instability, which is consistent with evidence showing the need for population-level interventions to address social, economic and physical components that influence health-related behaviours.[3][4]
Smoking increases the risk of lung, mouth, nasal, voice box (larynx), esophagus, stomach, pancreas, colon and rectum, liver, kidney, bladder, cervix and ovarian cancers.[5] Approximately 50% of cancers could be prevented if smoking, overweight and obesity (excess body weight), poor diet, excess alcohol consumption, inadequate physical activity, and harmful environmental and occupational exposures were reduced.[6][7][8] Cancer Care Ontario recognizes the complex social, economic and physical components that contribute to exposure to factors that lead to health inequities. These factors include social determinants of health, such as a lack of material resources (e.g., inadequate household income) and social support mechanisms.[9]
Identifying areas with increased prevalence of behavioural risk factors, such as tobacco smoking, can guide the direction of tailored health promotion programs and planning efforts that seek to prevent cancers and other chronic diseases. Hamilton Public Health Services has been implementing a number of local tobacco control strategies over the last several years to address smoking in its communities (see additional information on Hamilton’s tobacco control strategies in the highlights box).
To learn more about the atlas, go to Cancer Risk Factors Atlas of Ontario. For more information on the methods, which were developed by a team of investigators that included Cancer Care Ontario researchers, please visit Estimating micro area behavioural risk factor prevalence from large population-based surveys: a full Bayesian approach.
Hamilton’s Targeted Tobacco Control Strategies
The City of Hamilton is actively addressing social determinants of health and health inequities, particularly through its smoking cessation program.
Hamilton Public Health Services (HPHS) offers smoking cessation clinics in lower socio-economic status areas of the city, where smoking rates may exceed 40%. Additionally, the HPHS Tobacco Control Program provides access to tobacco cessation services through healthcare professionals and free nicotine replacement therapy to every person in Hamilton (visit Hamilton Quits Smoking).
HPHS has also focused on protecting Hamilton’s population from exposure to second-hand tobacco smoke and preventing people from starting to smoke. A substantial proportion of Hamilton’s non-smokers age 12 and older are exposed to second-hand smoke: 1 in 8 in Hamilton’s public places and 1 in 10 in the home. To enhance the quality and use of city property in all neighbourhoods of Hamilton, HPHS developed By-law No. 11-080 prohibiting smoking at city parks and recreation properties. In addition, HPHS worked with City Housing Hamilton to develop and approve a Smoke-Free Living Policy and Odour Mitigation to increase smoke-free housing options for 13,000 residents, 45% of whom are children.
Recognizing the prevalence of second-hand smoke exposure and that 78% of Hamiltonians who smoke start smoking between ages 12 and 19, HPHS actively supported the implementation of McMaster University’s new 100% Tobacco & Smoke Free policy (January 1, 2018). McMaster University is the first post-secondary institution in Ontario to go 100% smoke-free. Finally, since recent evidence indicates electronic cigarettes are likely a gateway to tobacco smoking among adolescents,[10][11] HPHS aims social media campaigns at the segments of Hamilton’s population (males and young adults ages 12 to 24) most likely to report using electronic cigarettes (compared to females and adults ages 25 to 64).