The extent of tobacco consumption in the Indigenous population in association with pulmonary diseases in Canada

Abstract

Objectives: (1) To explore the prevalence of and characteristics associated with tobacco consumption in the overall Indigenous population and within specific demographic groups (e.g. age, sex, etc.). (2) To explore the association between tobacco consumption and COPD and asthma, in the Indigenous population, through the lens of the Integrated Life Course and Social Determinants Model of Aboriginal People's Health framework. Methods: This cross-sectional study utilizes data from the Aboriginal People’s Survey (2017), with a sample of 20,849 self-identified Indigenous people living off-reserves across Canada aged 15 or older. Results: The overall prevalence of smoking was 34.7%. The highest prevalence of smoking was seen in groups of people who drank 3+ drinks/week or every day (37.9%), had 3+ chronic diseases (37.3%). Individuals between 25-34 years old were 2.37 times more likely to be smokers (95%C.I 2.04- 2.75), those who experienced in-home smoking were 5.01 times more likely to smoke (95%, C.I 4.59- 5.47), people who feel a sense of belonging were 2.38 times more likely to smoke (95% C.I 2.18- 2.60), and individuals who consume alcoholic beverages three or more times a week or drink every day had a 23% higher likelihood of smoking (95% C.I 1.07- 1.41). Overall, 13.2% of the study population reported having asthma, and 5.0% reported having COPD. Most of the participants with COPD were 55 years or older (11.4%) more individuals experienced in-home smoking (8.2%), 6.9% of smokers reported having COPD, and 22.6% had 3+ diseases. Smokers had a 52% higher likelihood of having COPD (95% CI: 1.31-1.76), participants 55+ years were 13 times more likely to have COPD (95% C.I: 7.94 -22.31), being female was associated with a 25% higher likelihood (95% C.I: 1.08-1.42), and in-home smoking was associated with a 59% higher likelihood (95% C.I: 1.36-1.9). Fifteen percent (15%) of the participants who reported having asthma were female (15.2%), with 14% between the ages of 15-18, and 15% experiencing in-home smoking. Thirteen percent (13%) of people who reported asthma were smokers, and 14% reported three or more chronic conditions. Females had 49% higher likelihood of having asthma (95% C.I. 1.37-1.63), in-home smoking had a prevalence of asthma 25% higher (95% C.I: 1.11- 1.41), those who started smoking prior to 11 years old had a 50% higher prevalence of asthma (95% C.I: 1.06- 3.95). Conclusions: This study found age and sex to have a significant relationship with smoking habits; women and people aged 25-44 years were more likely to partake in smoking. This highlights the need for a more targeted tobacco cessation program in this group to mitigate the impact of smoking-related adverse health effects for this group. In-home smoking very consistently has a significant association with the likelihood of individuals smoking themselves, as well as the likelihood of individuals having asthma or COPD. This emphasizes the need for policies targeting smoke-free homes to reduce the risk of diseases, particularly for young children within the Indigenous population.