| The Ontario Tobacco Research Unit (OTRU) was established in 1993 to foster and conduct research, monitoring and evaluation contributing to programs and policies to eliminate tobacco related health problems in Ontario. The Institute has worked with OTRU on a number of projects over the years. Knowledge, attitudes and behaviours regarding environmental tobacco smoke (ETS) have been the focus of two recent collaborations; a national study in 2001 and an earlier survey conducted in Ontario during 2000. This article describes the national survey and presents some of the findings reported by OTRU. A National Study of Environmental Tobacco Smoke in Canadian Homes was funded by the National Cancer Institute of Canada. It was led by OTRU Director, Dr. Roberta Ferrence, Ms Rachel Dioso the Project Director, Dr. Mary Jane Ashley of the Department of Preventive Medicine and Bio-statistics at the University of Toronto, OTRU Scientist, Dr. Joanna Cohen and David Northrup, ISR Associate Director, who also managed the data collection.
The research sought information about social norms with respect to smoking in households; information about the extent to which there are rules, understandings or agreements about smoking in households; what factors are associated with having or not having rules about smoking; the degree of association between rules and smoking status of respondents; and, the association between having or not having rules and knowledge of the health effects of ETS. Respondents were asked their views about the importance of ETS as a health issue, smoking behaviours of household members, reasons for quitting and relapse, restrictions on smoking in the workplace and public places, exposure to ETS, behaviours to reduce ETS in the home and socio-demographic information.
Structured, computer assisted telephone interviews with Canadian adults were carried out from June 2001 to January 2002. In total, 14,613 Canadian adults were contacted and 5,000 were interviewed at length. Since differences in smoking status among adults in the home and the presence or absence of children were factors of particular interest with respect to having or not having smoking restrictions in the home, the survey over sampled households with both smokers and non smokers as well as households with smokers and children. The analyses were weighted to account for over sampling of certain household types and the likelihood of selection.
In 64% of Canadian homes with at least one smoker, residents are exposed to ETS in the home. In 50% of Canadian homes with children, and at least one smoker, children are exposed to ETS in the home. By comparison, in 13% of households across Canada where there are no smokers, there is exposure to second hand smoke.
As Figure 1 shows, in homes with smokers, exposure to ETS varies considerably by region. Exposure is highest in Quebec where in 77% of homes with at least one smoker, residents are exposed. In 67% of homes in the Atlantic Provinces, where at least one person smokes, there is exposure to ETS. In the Prairies, the percentage of homes where residents are exposed to ETS is 61%. Exposure is lowest in Ontario and British Columbia. In 56% of Ontario homes with at least one smoker, residents are exposed to ETS and in British Columbia, the percentage is around 47%.
Exposure is highest in homes where everyone smokes and there are no children and lowest in homes where only some adults smoke and there are children. As Figure 2 shows, exposure ranges from 18% in British Columbia homes with children and some smokers to 93% in Quebec homes with all smokers and no children.
Having children in the home is associated with less exposure to ETS. Despite regional variation and regardless of the number of smokers in the home (some or all), the presence of children in the home is associated with less exposure to ETS. Having at least one non-smoker in the home is also associated with less exposure to ETS. The Ontario data offer an illustration. For Ontario households with all smokers, in homes with children, 64% are exposed to ETS compared to 79% in homes with no children. For Ontario households with only some smokers, in homes with children, 35% are exposed as opposed to 54% in homes with no children.
The OTRU study team believes that substantial progress is being made toward smoke free homes in Canada. However, more work is needed in this area. In particular, homes with children require renewed focus. Policy aimed at protecting children from ETS in the home would reduce exposure for both children and adults.
Homes with all adult smokers should receive special attention as well. Such households are less likely to ban or restrict smoking. Other research, not reported here, suggests that residents in such homes probably have more difficulty quitting and are more likely to relapse after quitting because everyone smokes. The research shows that most Canadian workplaces have restrictions on ETS, and most Canadian workers comply with these restrictions. In those workplaces, 32% said their smoking had gone down compared to 5% whose smoking had increased. A substantial proportion of workers do not smoke more outside of work to compensate for smoking restrictions in the workplace. It is anticipated that rules about smoking in the home will have similar effects. OTRU believes that continued efforts to support cessation in public places and workplaces should impact on reduction and cessation and ultimately smoking in homes. OTRU concludes that rules about smoking in households can reduce exposure to ETS in the home. Such household rules can also be important for smoking cessation and relapse. With respect to smoking cessation, restrictions on ETS can affect quitting and relapse in positive ways. Protecting others from ETS is an important reason for quitting. Seeing others smoke is a cue for smoking; restrictions in the home can protect against relapse. Smoking prevention, smoking cessation and protection from second hand smoke are inter-related.
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