Abstract

Smoking continues to be a major public health issue worldwide. It is associated with elevated rates of potential years of life lost, mortality, reduced life expectancy and chronic diseases. This dissertation contains three essays on the consequences and control of tobacco in Canada.

Essay one (Chapter 2) used the 2009/10 Canadian Community Health Survey (CCHS) to examine the prevalence and the factors associated with smoking behavior during pregnancy. Results from multivariable logistic regression revealed that the odds of smoking during pregnancy were decreased with increasing age, having a regular family doctor, and having highest level of family income. Mothers who reported poor or fair self-perceived health and those who had at least one mental illness had greater odds of smoking during pregnancy.

Essay two (Chapter 3) used data from the 2012/13 Canadian Youth Smoking Survey to estimate the elasticity of smoking initiation and intensity. We found that a 1% increase in price leads to a 1.13% reduction in initiation and a 1.02% reduction in intensity; while 1% increase in income leads to a 0.07% increase in initiation and a 0.06% increase in intensity. The effects of pocket money are much smaller in magnitude than the response of smoking to the price of cigarettes.

Essay three (Chapter 4) used data from the 2015 Canadian Community Health Survey to examine whether smoking status is associated with a reduction in health related quality of life (HRQoL) as measured by the Health Utility Index (HUI3); to calculate the overall loss of HRQoL over a lifetime and economic burden of loss; and to compare smoking related losses in HRQoL by age and gender. The results demonstrated that smoking was significantly and negatively associated with HRQoL loss and also is associated with substantial individual and societal economic cost.

In summary, the findings from this research not only can guide public healthcare providers to promote health within the target population, but also has important implications for tobacco control policies. Enhanced tobacco prevention will not only improve HRQoL but also will generate returns on investment from smoking cessation programs.