The community placement of interest is located in the Whitehaven-Queensway Terrace North neighbourhood in West Ottawa. This community is bound by Carling Avenue (north), Highway 417 (south), Woodroffe Avenue (east), and Roseview and Dumaurier Avenues (west) (Ottawa Neighbourhood Study [ONS], 2017). This neighbourhood has many outdoor parks and activities (ONS, 2017). There are no grocery stores but there are convenience stores, restaurants and fast food stores (ONS, 2017). The epidemiological data presented in Appendix B demonstrates that there is a higher percentage of immigrants, visible minorities, and people living with lower income in this community (ONS, 2017). In addition, there is a lower percentage of people that have post-secondary education when compared to the average Ottawa neighbourhood (ONS, 2017). In the environmental scan (see Appendix A), it was noted that smoking is a predominant health concern for Whitehaven-Queensway Terrace North.
Within the City of Ottawa, 15.5% of the population are daily or occasional smokers according to Statistics Canada (2013). In 2012, Ottawa Public Health (OPH) released their most current report regarding tobacco smoking in Ottawa. This report stated that the current smoking rate was 15% and the daily smoking rate was 12% in 2011 (Ottawa Public Health [OPH], 2012). This OPH report also noted that, “in the last ten years, the proportions of current and daily smokers have been significantly higher among adults in the lowest household income bracket compared to those in the highest income bracket” (2012). This indicates that adults with lower income are more likely to be smokers than those with higher income. Since Whitehaven-Queensway Terrace North is a lower income area, this provides insight as to why smoking was seen as prevalent health concern in the environmental scan conducted.
Smoking and The Population Health Promotion Model
The first step of the Population Health Promotion Model (PHPM) is to look at the foundations or evidence based-data which explain why we are taking action (Public Health Agency of Canada [PHAC], 2001). The OPH report of 2012 measured the amount of hospitalizations attributable to smoking and the amount of hospitalizations attributable to non-smoker exposure to second-hand smoke. OPH stated that “from 2008 to 2010, there were an estimated 2,900 acute hospitalizations per year in Ottawa attributable to smoking, 2,800 hospitalizations attributable to current or former cigarette smoking and 100 hospitalizations attributable to passive smoking exposure in residents” (2012). Some of the health effects listed were respiratory diseases, cardiovascular diseases, and cancers (OPH, 2012). Using this information, it is evident that there is a direct link between smoking and negative health effects that require hospital care.
The second step in the PHPM is the determinants of health or explaining on what we should take action (PHAC, 2001). According to Braveman and Gottlieb (2014), in their article about the social determinants of health, income, wealth and education are important aspects that influence people’s health and wellbeing. Whitehaven-Queensway Terrace North is a lower income area and a lower percent of this population has completed post-secondary education compared to other Ottawa neighbourhoods (ONS, 2017). Therefore, income status and education are the determinants of health of concern. OPH has reported that there is a correlation between lower-income status and smoking prevalence (2012). In 2013, Thakur et al. released an article that looked at tobacco consumption in India. One of their conclusions was that tobacco smoking was higher in the poorest regions compared to the richest regions in India (Thakur et al., 2013). In 2014, the World Health Organization (WHO) released a systematic review of countries around the world demonstrating that current smoking is higher among low income populations. The review by the WHO (2014) did not go into great detail of the reasons why this association exists. However, according to an article on the WHO’s website (2017), when people of low income buy tobacco they have less money to spend on necessities like food, education, and health related activates. Therefore, with less money for food, education, and health, tobacco leads to malnutrition, higher illiteracy rates, and higher-health costs (WHO, 2017). This article mentions that premature death related to smoking correlates with lower education level (WHO, 2017). Looking at the evidence from Ottawa Public Health and the WHO, the determinants of health of concern are income status and education.
The third step in the PHPM is levels of action or deciding with whom we should act and the fourth step is action strategies or how we should take action (PHAC, 2001). Ontario (2017) has implemented a society-wide intervention for the province through their Smoke-free Ontario Strategy. This strategy has many regulations that decrease smoking in Ontario including reducing the public places where people can smoke or buy cigarettes (Ontario, 2017). However, there still continue to be smokers and negative health related effects causing hospitalization as mentioned earlier in the 2012 OPH report.
There are campaigns that target the individual such as the “Leave the Pack Behind” and the Canadian Cancer Society’s “Break it Off” that raise awareness of the negative effects of smoking and encourage people to quit on their websites (2016; n.d.). However, these websites are mostly written and if the education level of the individual is low enough for them to have difficulty reading, this could be a deterrent to using these website campaigns.
Ottawa Public Health has many strategies on their website to help the individual once they have decided to quit smoking. OPH (2017) has workshops throughout the city, including the west end near Whitehaven-Queensway Terrace North; smoking cessation groups; community drop-ins; and many other resources. However, these recourses are useful once a person has decided to quit smoking but not as effective if the individual has not decided to quite yet.
The Pinecrest-Queensway Community Health Centre (PQCHC), which is located just outside the boundaries of the community of interest but still serves this community, has a smoking cessation program targeting the individual level (Collation of Community Health and Resource Centres of Ottawa, 2017). However, this community centre is far away from parts of this neighbourhood and there are no community centres to address this issue within the community itself (ONS, 2017).
In order to increase the smoking cessation within the Whitehaven-Queensway Terrace North community, there are different interventions at the individual level that could be put in place. First of all, video computer tailoring, smoking cessation interventions given through videos on the individual’s computer, could be a new and more effective way to increase smoking cessation (Stanczyk, N., Bolman, C., Adrichem, M. V., Candel, M., Muris, J., & Vries, H. D., 2014). Stanczyk et. al released a study in 2014 that looked at using video computer tailoring as an intervention to improve smoking cessation. This study found that video computer tailoring did improve smoking cessation and was even successful for smokers who had a “low readiness to quit smoking” (Stanczyk et. al., 2014). As long as people within this community have access to a computer, smoking cessation video computer tailoring would be beneficial for them.
Another strategy to increase smoking cessation within the community of interest would be to add a financial incentive for individuals to be motivated to quit. In an article released in May 2015, Halpern, French, & Small looked at four different financial incentive programs, two types of financial incentives and each divided into a group and individual intervention, to increase smoking cessation. The two types of financial incentives were reward (get a sum of money at the end) and deposit (get a refundable deposit back plus more money if successful) programs. The authors found that reward-based programs were more successful than deposit-based programs and had “higher rates of sustained abstinence from smoking” (Halpern, S., French, B., & Small, D., 2015). Considering the Whitehaven-Queensway Terrace North community has a high rate of low income people within the population (ONS, 2017), a financial incentive program would help to increase the smoking cessation within the community. The Canadian Cancer Society’s Break It Off (n.d.) campaign has many incentives to help increase smoking cessation, one incentive presented on their website is a contest to win a Flight Centres gift card. However, it might be more beneficial for this community to have a government-based incentive program in which someone quitting smoking who is under a certain income threshold would get a grant from the government or have to pay less in taxes for a period of time once they quit smoking.
In conclusion, Whitehaven-Queensway Terrace North is a community of lower income and lower level of education (ONS, 2017), which inversely correlates with increased smoking rates as explained by OPH (2012) and the WHO (2014). In order to treat this health concern witnessed in the environmental scan, the province of Ontario (2017) has implemented legislation, there are many Canada-wide campaigns, OPH has different several programs and resources, and the PQCHC has a smoking cessation program. However, it would be beneficial for this community to implement video computer tailoring interventions and more government-based financial incentive programs. These programs would lead to a decreased rate of smoking and a healthier population in Whitehaven-Queensway Terrace North.