Smoking and Income: Insights from the Canadian Community Health Survey

Earlier this summer, Statistics Canada released data files for the 2017-2018 Canadian Community Health Survey. This post is one of an occasional series which reviews this data for information on smoking patterns in Canada. Today's post is the first to look at the relationship between income and smoking behaviour. 

Inequities in income and smoking behaviour continue

In recent decades the relationship between economic disadvantage and smoking has been well established. A clear demonstration of this is in the smoking rates of each household income quintile (one-fifth of households). Those in the poorest households are 1.8 times as likely to smoke as those in the wealthiest: only 12% of Canadians in the highest group say they smoke cigarettes compared with 22% in the poorest.

The CCHS has reported on income quintiles since 2005. Although smoking rates have fallen in all household income groups over this period, the differences among them have not. In 2005, there was an 8 percentage point difference in smoking rates between lowest and highest income quintiles (27% vs 19%), while in 2017-2018, the gap was 9 percentage points (21% vs. 12%).  

Those in Canada's poorest one-fifth of families are 70% more likely to smoke than are those in Canada's one-fifth richest (RR=1.7).

This is is not because poorer Canadians are more likely to experiment with or become smokers. Canadians in all income levels are generally equally likely to have never smoked (this is less true for younger Canadians). Smokers in higher-income households, however, are more likely to quit than are those in poorer homes. For every 100 Canadians who have ever smoked more than 100 cigarettes, 70 in the highest income quintile will have quit, while only 57 in the lowest quintile will have done so.

Most smokers live in households with incomes over $60,000.

Although smoking rates are higher among poorer Canadians, it is not true that most smokers are poor. 

Statistics Canada provides information on household income brackets in increments of $20,000, with the highest category being "$80,000 or more". More than half (55%) of Canadian smokers live in families with household income over $60,000.

Families dealing with food insecurity are also affected by nicotine addiction. However, most smokers are not facing food insecurity. 

One signal that families are in economic distress is when they experience difficulties in obtaining enough food. The CCHS indicates when families have some difficulties accessing food ('marginal'), when they sometimes compromise quality or quantity of food consumed ('moderate') and when they have not had enough to eat regularly ('severe').

Slightly more than 1 in 10 Canadians (13%) live in families experiencing food insecurity, while more than 1 in 5 smokers (22%) do.

Canadians who are food secure smoke at half to one-third the rate of those who are facing moderate or severe food insecurity (14% vs 28% and 41%). Of the 2.5 million Canadians who live with moderate or severe food insecurity, one-third are  are smokers. 

Canadians living on social assistance are much more likely to smoke. However, the large majority of smokers are in the workforce.

In 2017-2018, the CCHS identified that the main source of income for three-quarters of survey participants (76%), were wages and earnings; that 15% relied on retirement benefits and that fewer than one in five (3%) were dependent on social assistance payments like employment insurance, welfare or workers compensation. Smoking rates in that last category were more than double those of the general population (38% vs 16%). Almost one in ten (8%) of smokers are in receipt of social assistance. 

About the CCHS

The Canadian Community Health Survey is an annual survey conducted by Statistics Canada. Every two years, the Public Use Micro File is made available with information based on surveys of the health behaviours and status of about 100,000 Canadians over the age of 12.

Links to data referred to in this post:

• CCHS 2017-2018: Smoking behaviour and income, source of income and food insecurity (by age and sex)
• CCHS 2017-2018: Smoking behaviour and household income quintiles (by age, sex and province)
• CCHS 2005 to 2017-2018: Historic data - Smoking behaviour and household income quintiles .
• Other reports or resources