Why Do Fewer People Smoke in Vancouver Than in Montreal?

The smoking gap between British Columbia and Quebec is not new. According to the Canadian Community Health Survey (CCHS) data from 2007/08 to 2017/18, Quebec has consistently had higher smoking prevalence .

• 2007/08: Quebec 25% of adults 15+ smoked vs. 22% in other provinces (including BC) [citation:4].
• 2017/18: Quebec 18% vs. other provinces 16% — gap narrowed but persisted [citation:4].
• Youth initiation (2015-2018): BC 4% vs. Quebec 10% — a 2.5x difference [citation:1].
• Vancouver CMA (2003): 16.4% current smokers vs. Montreal CMA 26.7% — a striking 10-point gap [citation:2].

British Columbia has the highest proportion of foreign-born residents in Canada (excluding territories). This demographic fact has a direct impact on smoking rates because:

• Immigrants smoke less than Canadian-born individuals: Research shows that being born in Canada is strongly associated with smoking initiation. Among youth, Canadian-born adolescents are significantly more likely to start smoking than immigrants [citation:1].
• Cultural norms vary: Many source countries for BC immigrants (China, India, Philippines, Hong Kong) have lower smoking prevalence among women and sometimes among men compared to Canadian-born populations.
• Language and social integration: Immigrant communities may have different social networks and cultural practices around tobacco use.
• Quebec’s population: Quebec has a smaller proportion of foreign-born residents, and its immigrant population comes from different source countries (France, North Africa, Haiti) with different smoking norms.

Speaking French is a significant risk factor for smoking initiation, independent of province of residence [citation:1]. This helps explain Quebec’s higher rates.

• Historical tobacco industry targeting: Until the 1990s, tobacco companies heavily marketed to French-speaking Quebecers with distinct campaigns, sponsorships, and cultural events.
• Different media environment: French-language media in Quebec was less exposed to early English-language anti-smoking campaigns, delaying norm shifts.
• Social acceptability: Smoking has remained more socially acceptable in certain French-speaking social circles, particularly in café and bar culture.
• Comparative data: A 2022 study of young adults aged 17-20 in Quebec found that 82.9% of participants self-identified as French-Canadian — a demographic group with higher smoking rates than other ethnicities [citation:5].

Perhaps the most important factor is provincial investment in tobacco control. The 2022 study concludes that “reprioritizing tobacco control and public health funding are likely key in attaining the ‘tobacco endgame’ across provinces” [citation:1].

• BC’s proactive approach: British Columbia implemented aggressive tobacco control measures earlier than most provinces, including bans on flavoured tobacco, plain packaging, and extensive cessation programs.
• Quebec’s slower adoption: Quebec’s tobacco control funding has historically been lower per capita than BC’s, and some policies (like the ban on smoking in cars with children) came later.
• The 9-metre rule: Quebec has the strictest outdoor smoking distance law (9 metres from entrances), but enforcement has varied.
• Anti-tobacco campaign effectiveness: BC’s long-running “QuitNow” campaign is considered one of Canada’s most successful cessation initiatives.

The same 2022 study identified that “not living in a two-parent household, being in the lowest household income quintile, having parents without postsecondary education, living in rented accommodation” were all associated with smoking initiation [citation:1].

• Quebec has higher rates of single-parent households: Particularly in Montreal’s poorer neighbourhoods, family structure differences contribute to initiation risk.
• Income inequality: While both cities have high inequality, Montreal’s poverty is more concentrated in specific boroughs with less social mobility.
• Educational attainment: BC has a slightly higher proportion of adults with postsecondary education, which is protective against smoking initiation in children.
• However, these factors only explain 3-9% of the gap: The study found that controlling for demographic and socioeconomic characteristics “attenuated the AME of residing in another province compared with Quebec by between 3% and 9%” — meaning most of the gap is explained by other factors like policy and culture [citation:1].

The timing of key tobacco control policies explains part of the gap:

• Workplace smoking bans: BC banned smoking in all public places and workplaces in 2000 (with a 6-month grace period ending March 31, 2000). Quebec followed in 2006.
• Smoking in cars with children: BC banned smoking in cars with children under 16 in 2009. Quebec’s ban came later in 2016.
• Flavoured tobacco ban: BC was among the first provinces to ban flavoured tobacco, including menthol, in 2016. Quebec followed with the federal ban in 2017.
• Plain packaging: Both provinces implemented federal plain packaging simultaneously in 2019.
• These 6-10 year lags matter: A decade of lower youth exposure to policy-protected environments created a cultural gap that persists today.

Beyond policy, cultural differences play a role:

• Montreal’s café and terrace culture: Montreal has a strong European-style café culture where smoking on terraces was historically common. Until Quebec banned smoking on patios in 2016, outdoor smoking was widely normalized.
• Vancouver’s wellness ethos: Vancouver’s culture emphasizes “healthy living,” outdoor recreation, and wellness. Smoking is stigmatized more heavily than in Montreal.
• Film and arts scenes: Montreal’s film and arts communities have historically glamorized smoking more than Vancouver’s.
• Peer effects: Lower smoking rates create a self-reinforcing cycle — fewer smokers means less normalization among youth.

A crucial 2021 study by Pelekanakis et al. asked: is Quebec’s higher prevalence due to more people starting or fewer people quitting? The answer: initiation [citation:4].

• No difference in cessation: Past-year cessation among adults aged 25+ was approximately 8% in both Quebec and the rest of Canada, with no change over time [citation:4].
• No difference in young adult initiation: Among those aged 18-24, initiation was similar in Quebec (6%) and other provinces (7%) [citation:4].
• The gap is entirely from youth (12-17): Quebec’s youth initiation rate (5-9% over time) has consistently exceeded other provinces (3-7%) [citation:4].
• Implication: To close the gap, Quebec needs to focus on preventing youth from starting, not just helping adults quit.