The economic consequences of obesity and overweight among adults in Quebec.

OBJECTIVES: This article presents the first study of the economic consequences of obesity and overweight in the Canadian province of Quebec. The article examines three types of direct costs: hospitalizations, medical visits and drug consumption; and one type of indirect cost: productivity loss due to disability. METHODS: The National Population Health Survey, conducted in all Canadian provinces by Statistics Canada between 1994 and 2011, provides self-reported longitudinal data for body mass index and the frequency of health care utilization and disability. RESULTS: When we compared obese adults in Quebec to those with a normal weight at the beginning of the follow-up period, we observed that the former had significantly more frequent visits to the physician, more frequent hospital stays and higher consumption of drugs between 1994 and 2011. We estimated the annual cost of the excess health care utilization and excess disability at more than CAD $2.9 billion in 2011. CONCLUSION: The results confirm that, similar to what had been found elsewhere in Canada and abroad, there are important economic consequences associated with overweight and obesity in Quebec.

Predictors of Cigarette Smoking Initiation in Early, Middle, and Late Adolescence.

PURPOSE: Little is known about age-related differences in risk factors for cigarette smoking initiation. We identified predictors of initiation in early, middle, and late adolescence from among sociodemographic factors, indicators of smoking in the social environment, psychological characteristics, lifestyle indicators, and perceived need for cigarettes. METHODS: Data were drawn from a longitudinal study of 1,801 children recruited at age 10-11 years from 29 elementary schools in Montreal, Canada. Multivariable logistic regression within a generalized estimating equations framework was used to identify predictors among never smokers across three 2-year windows: age 11-13 years (n = 1,221); age 13-15 years (n = 737); and age 15-17 years (n = 690). RESULTS: Among the 18 risk factors investigated, two differed across age. Friends' smoking, a strong risk factor in early adolescence (odds ratio [95% confidence interval] = 5.78 [3.90-8.58]), lost potency in late adolescence (1.83 [1.31-2.57]). Depressive symptoms, a risk factor in early and middle adolescence (1.60 [1.26-2.02] and 1.92 [1.45-2.54], respectively), were inversely associated in late adolescence (.76 [.58-1.00]). Sex, TV viewing, and weight-related goals were not associated with initiation at any age. All other factors were significant in two or three age groups. CONCLUSIONS: Most risk factors for smoking initiation were stable across age. Tobacco control interventions may be robust for risk factors across age groups and may not need adjustment. At all ages, interventions should focus on eliminating smoking in the social environment and on reducing the availability of tobacco products.