Alain P. Gauthier PhD Susan J. Snelling PhD Michael King MSc

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1 Thinking Outside the Pack: Examining Physically Active Smokers and Implications for Practice among Ontario Residents Alain P. Gauthier PhD Susan J. Snelling PhD Michael King MSc

2 Tobacco Use It is estimated that tobacco use kills more than 5 million people annually; it is the leading cause of preventable deaths (1). Tobacco use increases the risk of (2): Multiple types of cancers Heart disease Strokes Emphysema Chronic obstructive pulmonary disease Osteoporosis Diabetes Infertility In 2007/08, the rate of current smokers in Ontario was 19% (slightly below the national average of 20%).

Smoke-Free Ontario A) discouraging youth from smoking (e.g., bans on displaying tobacco products ) B) protecting Ontarians from secondhand and side-stream smoke (e.

3 Smoke-Free Ontario A) discouraging youth from smoking (e.g., bans on displaying tobacco products ) B) protecting Ontarians from secondhand and side-stream smoke (e.g., bans on smoking in enclosed public places, vehicles, and workplaces) C) providing programs to help smokers quit (e.g., helplines) (4)

4 What do we know? Researchers have found that physical activity seems to partially mitigate the consequences of smoking (5-8). Physically active smokers are more likely to attempt cessation (9) Physical activity interventions have been found to aid in the success of cessation programs (10, 11). Physically active smokers are more likely to be young, single, and male (9) when compared to inactive smokers.

5 What don t we know? How do physically active smokers differ from physically active non-smokers? Socio-demographic predictors Types of physical activity

6 Purpose The purpose of this study was to profile physically active smokers in order to inform intervention strategies.

7 Methods Research Questions Socio-demographic characteristics of physically active smokers (Ontario) Do these differ from physically inactive smokers? Do these differ from physically active nonsmokers? Types of leisure-time physical activities practiced among active Ontario smokers Do these differ from active non-smokers?

8 Methods Data Source Canadian Community Health Survey (CCHS) Cross-sectional survey in which information is collected in relation to health status, health care utilization and health determinants for the Canadian population (10). Sharing File - Ontario Sample: 41,800 respondents aged 12 and over

9 Defining Variables Grouping Variables Physical Activity Status Smoking Status Methods Demographic Characteristics Smoking Related Variables Cessation Attempt within the past Year Stages of Change Type of Leisure-Time Physical Activity (N x D x Mets)/365

10 Results- Descriptive Statistics Ontario Sample Active (26%) Smokers (20.5%) Active Non- Smokers (21.4%) Active Smokers (4.5%) Inactive Smokers 6603 (15.8%)

11 Results- Descriptive Statistics Descriptive Statistics for Attempted Cessation by Activity Status 80.00% 60.00% 40.00% 20.00% 0.00% Didn t Try to Quit Tried to Quit Active Smokers 45.50% 54.50% Inactive Smokers 57.60% 42.40% p<0.001

12 Results- Descriptive Statistics Descriptive Statistics for Stages of Change 60.00% 40.00% 20.00% 0.00% Active Smoker Inactive Smoker Pre-Contemplation 34.20% 41.70% Contemplation 39.40% 44.40% Preparation 26.40% 14.80% p<0.001

Results- Active Smokers vs. Inactive Smokers Physically Active Smokers Physically Inactive Smokers Total Number n=1882 n=4647 Individuals, % 4.5% 11.1% Gender, %*** Men Women 62.

13 Results- Active Smokers vs. Inactive Smokers Physically Active Smokers Physically Inactive Smokers Total Number n=1882 n=4647 Individuals, % 4.5% 11.1% Gender, %*** Men Women 62.5% 37.5% 55.0% 45.0% Age, Years, Mean *** Marital Status, %*** Married or Common Law Formerly Married Single 46.8% 10.0% 43.2% 57.3% 16.5% 26.3% *p<.05; **p<.01; ***p<.001

Results- Active Smokers vs. Active Non- Smokers Physically Active Smokers Physically Active Non-Smokers Total Number n=1882 n=8963 Individuals, % 4.5% 21.4% Gender, %*** Men Women 62.5% 37.5% 55.

14 Results- Active Smokers vs. Active Non- Smokers Physically Active Smokers Physically Active Non-Smokers Total Number n=1882 n=8963 Individuals, % 4.5% 21.4% Gender, %*** Men Women 62.5% 37.5% 55.8% 44.2% Age, Years, Mean (SD)** Marital Status, %*** Married or Common Law Formerly Married Single Education, %*** Less than Sec. School Graduation Sec. School Graduation Some Post-Sec. School Post-Sec. School Graduation Income, %*** Below LICO Above LICO Missing *p<.05; **p<.01; ***p< % 10.0% 43.2% 20.1% 20.6% 11.2% 48.1% 14.2% 58.6% 27.2% 50.4% 7.9% 41.8% 26.9% 12.2% 7.7% 53.2% 8.8% 64.2% 27.0%

Results- Active Smokers vs. Active Non- Smokers Physically Active Smokers Physically Active Non- Smokers Total Number n=1882 n=8963 Walking for exercise*** 0.37 0.33 Gardening or yard work*** 0.22 0.

15 Results- Active Smokers vs. Active Non- Smokers Physically Active Smokers Physically Active Non- Smokers Total Number n=1882 n=8963 Walking for exercise*** Gardening or yard work*** Bicycling** Home exercises*** Ice Hockey*** Ice Skating** In-Line Skating or Rollerblading* Weight-Training* Fishing* Volleyball*** Soccer*** *p<.05; **p<.01; ***p<.001

16 Discussion Physical activity interventions for smokers need to be tailored to their activity types/preferences Low cost Low intensity Solitary

17 Conclusion We urge health promotion programmers to consider integrating physical activity into their tobacco control strategies Consider ways to promote physical activity to smokers -- their PA patterns are different from non-smokers but they can be active

18 Research Funds Acknowledgements Louise Picard Health Research Grant

19 References 1. World Health Organization. WHO Report on the Global Tobacco Epidemic, 2009; Implementing Smoke-Free Environments. Geneva: World Health Organization, Mackay J, Eriksen M. The Tobacco Atlas. Geneva: World Health Organization; Ontario Tobacco Research Unit. Indicators of Smoke-Free Ontario Progress. Monitoring and Evaluation Series, Vol. 14/15, No. 2. Toronto: Ontario Tobacco Research Unit, Special Report, January Government of Ontario. Smoke Free Ontario Act: S.O. 1994, Chapter 10. Toronto, Ontario. Last Amendment July 1, Ferrucci, L., Izmirlian, G., Leveille, S., Phillips, C., L, Corti, M., Brock, D., B, et al. (1999). Smoking, Physical Activity and Active Life Expectancy. American Journal of Epidemiology, 149(7), Garcia-Aymerich, J., Lange, P., Benet, M., Schnohr, P., & Anto, J., M. (2007). Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: A populationbased cohort study. American Journal of Respiratory and Critical Care Medicine, 175, Mahabir, S., Leitzmann, M., F, Pietinen, P., Albanes, D., Virtamo, J., & Taylor, P., R. (2004). Physical activity and renal cell cancer risk in a cohort of male smokers. International Journal of Cancer, 108, Manson, J., E, Hu, F., B, Rich-Edwards, J., W, Colditz, G., A, Stampfer, M., J, Willett, W., C, et al. (1999). A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. The New England Journal of Medicine, 341(9), de Ruiter W, Faulkner G, Cairney J, Veldhuizen S. Characteristics of Physically Active Smokers and Implications for Harm Reduction. Research and Practice. 2008;98(5): Ussher M, Aveyard P, Coleman T, Straus L, West R, Marcus B, et al. Physical activity as an aid to smoking cessation during pregnancy: Two feasibility studies. BMC Public Health. 2008;8(328). 11. Prapevassis H, Cameron L, Baldi J, C, Robinson S, Borrie K, Harper T, et al. The effects of exercise and nicotine replacement therapy on smoking rates in women. Addictive Behaviors. 2007;32: Canadian Community Health Survey Cycle 4.1 ( ). Master Microdata File User Documentation. Ottawa, Ontario: Statistics Canada: 2009.

SMOKING STAGES OF CHANGE KEY MESSAGES

SMOKING STAGES OF CHANGE KEY MESSAGES KEY MESSAGES In Peel among current daily or occasional smokers: o 19% are not thinking are not thinking about quitting (pre-contemplation stage) in the next six months; o 21% are thinking about quitting