Printer Friendly

Community- and individual-level factors associated with smoking and heavy drinking among Aboriginal people in Canada.

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.

REFERENCES

(1.) Tjepkema M, Wilkins R. Remaining life expectancy at age 25 and probability of survival to age 75, by socio-economic status and Aboriginal ancestry. Health Reports/Statistics Canada, Canadian Centre for Health Information 2011;22(4):31.

(2.) Tjepkema M, Wilkins R, Pennock J, Goedhuis N. Potential years of life lost at ages 25 to 74 among Status Indians, 1991 to 2001. Health Reports 2011;22(1):25.

(3.) Wilkins R, Uppal S, Fines P, Senecal S, Guimond E, Dion R. Life expectancy in the Inuit-inhabited areas of Canada, 1989 to 2003. Health Reports 2008; 19(1):7-19.

(4.) Frohlich KL, Ross N, Richmond C. Health disparities in Canada today: Some evidence and a theoretical framework. Health Policy 2006;79(2-3):132-43.

(5.) Martens P, Bond R, Jebamani L, Burchill C, Roos N, Derksen S, et al. The Health and Health Care Use of Registered First Nations People Living in Manitoba: A Population-Based Study. Winnipeg, MB: University of Manitoba, 2002.

(6.) Reading CL, Wien F. Health Inequalities and Social Determinants of Aboriginal Peoples' Health: National Collaborating Centre for Aboriginal Health, 2009. Available at: http://www.nccah-ccnsa.ca/docs/social%20determinates/nccah-loppie-wien_report.pdf (Accessed May 5, 2014).

(7.) Health Canada. First Nations, Inuit and Aboriginal Health. A Statistical Profile on the Health of First Nations in Canada: Determinants of Health, 1999 to 2003, 2009. Available at: http://www.hc-sc.gc.ca/fniah-spnia/pubs/ aborig-autoch/2009-stats-profil/08-health-hyg-eng.php (Accessed May 21, 2014).

(8.) National Institute on Alcohol Abuse and Alcoholism. Alcohol and tobacco 2007. Available at: http://pubs.niaaa.nih.gov/publications/AA71/AA71.htm (Accessed July 1, 2014).

(9.) Reid JL, Hammond D, Burkhalter R, Ahmed R. Tobacco Use in Canada: Patterns and Trends. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo, 2012.

(10.) Statistics Canada. Heavy drinking. Available at: http://www.statcan.gc.ca/ pub/82-229-x/2009001/deter/hdx-eng.htm (Accessed May 5, 2014).

(11.) Wallace M, Wisener M, Collins K. Neighbourhood Characteristics and the Distribution of Crime in Regina. Crime and Justice Research Paper Series, Statistics Canada 2006 (Catalogue no. 85-561-MIE-No. 008).

(12.) Burlew A, Johnson C, Flowers A, Peteet B, Griffith-Henry K, Buchanan N. Neighborhood risk, parental supervision and the onset of substance use among African American adolescents. J Child Fam Stud 2009;18(6):680-89. doi: 10.1007/s10826-009-9273-y.

(13.) Kulis S, Marsiglia FF, Sicotte D, Nieri T. Neighborhood effects on youth substance use in a Southwestern city. Sociol Perspect 2007;50(2):273-301.

(14.) Datta GD, Subramanian SV, Colditz GA, Kawachi I, Palmer JR, Rosenberg L. Individual, neighborhood, and state-level predictors of smoking among US Black women: A multilevel analysis. Soc Sci Med 2006;63(4):1034-44. doi: 10.1016/j.socscimed.2006.03.010.

(15.) Kleinschmidt I, Hills M, Elliott P. Smoking behaviour can be predicted by neighbourhood deprivation measures. J Epidemiol Community Health 1995;49(Suppl 2):S72-77. doi: 10.1136/jech.49.Suppl_2.S72.

(16.) Reijneveld SA. The impact of individual and area characteristics on urban socioeconomic differences in health and smoking. Int J Epidemiol 1998;27(1):33-40. doi: 10.1093/ije/27.1.33.

(17.) Galea S, Ahern J, Tracy M, Vlahov D. Neighborhood income and income distribution and the use of cigarettes, alcohol, and marijuana. Am J Prev Med 2007;32(6 Suppl):S195-202. PMID: 17543711. doi: 10.1016/j.amepre.2007. 04.003.

(18.) Pollack CE, Cubbin C, Ahn D, Winkleby M. Neighbourhood deprivation and alcohol consumption: Does the availability of alcohol play a role?. Int J Epidemiol 2005;34(4):772-80. PMID: 15737966. doi: 10.1093/ije/dyi026.

(19.) Hill TD, Angel RJ. Neighborhood disorder, psychological distress, and heavy drinking. Soc Sci Med 2005;61(5):965-75.

(20.) Health Canada. First Nations, Inuit and Aboriginal Health. Tobacco, 2007. Available at: http://www.hc-sc.gc.ca/fniah-spnia/substan/tobac-tabac/indexeng.php (Accessed May 5, 2014).

(21.) Richmond CA, Ross NA, Egeland GM. Social support and thriving health: A new approach to understanding the health of indigenous Canadians. Am J Public Health 2007;97(10):1827-33.

(22.) Daniel M, Cargo MD, Lifshay J, Green LW. Cigarette smoking, mental health and social support: Data from a northwestern First Nation. Can J Public Health 2004;95(1):45-49.

(23.) Kawachi I, Colditz GA, Ascherio A, Rimm EB, Giovannucci E, Stampfer MJ, et al. A prospective study of social networks in relation to total mortality and cardiovascular disease in men in the USA. J Epidemiol Community Health 1996;50(3):245-51.

(24.) Hussong AM, Hicks RE, Levy SA, Curran PJ. Specifying the relations between affect and heavy alcohol use among young adults. J Abnorm Psychol 2001;110(3):449-61. PMID: 11502088. doi: 10.1037/0021-843X.110.3.449.

(25.) Averna S, Hesselbrock V. The relationship of perceived social support to substance use in offspring of alcoholics. Addict Behav 2001;26(3):363-74. PMID: 11436928. doi: 10.1016/S0306-4603(00)00112-X.

(26.) Statistics Canada. Aboriginal Peoples Survey 2001: Concepts and Methods Guide 2003. Available at: http://www5.statcan.gc.ca/access_acces/archive. action?loc=/pub/89-591-x/89-591-x2003001-eng.pdf (Accessed May 3, 2014).

(27.) Statistics Canada. 2006 Census Dictionary. Available at: http://www12.statcan.ca/ census-recensement/2006/ref/dict/geo012-eng.cfm (Accessed May 3, 2014).

(28.) McHardy M, O'Sullivan E. First Nations Community Well-Being in Canada: The Community Well-Being Index (CWB), 2001. Ottawa: Strategic Research and Analysis Directorate, Indian and Northern Affairs Canada, 2004.

(29.) Rasbash J, Charlton C, Browne WJ, Healy M, Cameron B. MLwiN Version 2.1: Centre for Multilevel Modelling. Bristol, UK: University of Bristol, 2009.

(30.) Banning booze won't solve problems on reserves: Chiefs 2008. Available at: http://www.cbc.ca/news/canada/manitoba/banning-booze-won-t-solveproblems-on-reserves-chiefs-1.705400 (Accessed May 3, 2014).

(31.) British Columbia Ministry of Health Tobacco Control Program. Available at: http://www.health.gov.bc.ca/tobacco/ (Accessed August 18, 2014).

(32.) Qi V, Phillips SP, Hopman WM. Determinants of a healthy lifestyle and use of preventive screening in Canada. BMC Public Health 2006;6:275.

(33.) O'Donnell V, Ballardin A. Aboriginal Peoples Survey 2001-Provincial and territorial reports: Off-reserve Aboriginal population. 2006 Contract No.: Catalogue no. 89-618-XIE.

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
COPYRIGHT 2015 Canadian Public Health Association
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2015 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:QUANTITATIVE RESEARCH
Author:Kyu, Hmwe Hmwe; Georgiades, Katholiki; MacMillan, Harriet L.; Boyle, Michael H.
Publication:Canadian Journal of Public Health
Article Type:Report
Geographic Code:1CANA
Date:Jan 1, 2015
Words:5700
Previous Article:Demographic and behavioural characteristics predict bacterial STI reinfection and coinfection among a cross-sectional sample of laboratory-confirmed...
Next Article:Correlates of physical activity in First Nations youth residing in First Nations and northern communities in Canada.
Topics:

Terms of use | Privacy policy | Copyright © 2019 Farlex, Inc. | Feedback | For webmasters