2002 Youth Smoking Survey - Technical Report

Tobacco Access

Caroline C. Murphy, BSc
Department of Health Care and Epidemiology
University of British Columbia

Chris Y. Lovato, PhD
Department of Health Care and Epidemiology
University of British Columbia

Murray J. Kaiserman, PhD
Tobacco Control Programmme
Health Canada

Acknowledgements: The authors thank Alan Diener (Health Canada), Ana Florescu (University of Toronto) and Jean Forster (University of Minnesota) who reviewed an earlier draft of this chapter and provided helpful commentary.

Highlights

• The majority of students obtained cigarettes from social sources; 75% of students reported buying, receiving, or taking cigarettes from family and friends.
• About half of students who attempted to purchase cigarettes in a store were asked their age and to show ID. More than half of students who attempted to purchase cigarettes in a store were refused the sale.
• About half of students who reported obtaining cigarettes from retail outlets do nothing special in their attempts to purchase cigarettes.
• 60% of students who smoked usually smoked the same brand, and 52% reported they do so because they like the taste.
• Students in the 2002 YSS faced more challenges in their attempts to purchase cigarettes than did students in the 1994 YSS. In the 1994 YSS, students were less likely to report someone had refused to sell them cigarettes.
• Banning point of sale displays, implementing product labelling legislation, increasing the number of smoke-free spaces, and further enforcement of restrictions on the sale of tobacco to minors will be important strategies for preventing tobacco access and use among young people.

Methods

This section covers definitions and sample issues specific to this chapter. For detailed methods on the entire 2002 Youth Smoking Survey refer to Chapter 2. 

Definitions

Categories of Smokers

The definitions used to categorize smokers in the 2002 Youth Smoking Survey (YSS) are described in Chapters 2 and 3. Some of the analyses related to tobacco access and smoking behaviour were conducted using the five category derived variable (Never Smoker who has Never Seriously Thought About Smoking; Never Smoker who has Seriously Thought About Smoking; Puffer; Smoked Beyond Puffing, Not Daily Smoker; and Daily Smoker). However, in most cases only the final two categories (Smoked Beyond Puffing, Not Daily Smoker; and Daily Smoker) are reported. Analyses of the behaviours of Puffers, Never Smokers who have Seriously Thought About Smoking, and Never smokers who have Never Seriously Thought About Smoking would be irrelevant because they are unlikely to regularly access cigarettes.

Source of Cigarettes

All students were asked, "Where do you usually get your cigarettes?" (Y_Q25). Response choices included various retail and/or social sources and the response, "I don't smoke." Retail sources included buying cigarettes from: 1) a vending machine, 2) a small grocery/corner store, 3) another kind of store, and 4) buying cigarettes on the Internet. Social sources included receiving cigarettes from: 1) a brother/sister, 2) mother/father and 3) a friend or someone else. Other social sources included taking cigarettes from a family member or buying cigarettes from a friend or someone else. Findings are reported for students who were categorized as smokers according to the above definitions.

Attempts to Purchase Cigarettes

All students were asked, "Have you ever been asked your age when buying cigarettes in a store for yourself or for someone else?" (Y_Q27), "Have you ever been asked for an ID when trying to buy cigarettes?" (Y_Q28), and "Has anyone in a store ever refused to sell you cigarettes?" (Y_Q29).

The findings on purchasing behaviours apply only to those students who have ever bought cigarettes in a store. These results should be interpreted with caution, because the questions asked about lifetime experiences and not recent experiences. There is a higher probability that older students who have purchased cigarettes have "ever" been asked their age as compared to younger students, since they are likely to have made more purchase attempts in their lifetime. In contrast, older students may be less likely to remember they had "ever" been asked their age if this had not occurred in the recent past.

Strategies Used to Purchase Cigarettes

Students were asked about the strategies they used when buying cigarettes from a store (Y_Q26). Findings are reported for both smoked beyond puffing, not daily smokers and daily smokers. It is important to note that this item was an open-ended question and respondents were able to provide personal responses. Qualitative response results are not available and detailed responses were grouped into an "other" category. Students were also asked, "Have you ever asked a stranger to buy you cigarettes?" (Y_Q30). Findings are reported for all students, regardless of smoking category.

Purchase of Single Cigarettes

All students were asked, "Do you sometimes buy single cigarettes?" (Y_Q31a). Respondents who answered 'yes' were then asked, "Where do you buy them?" (Y_Q31b). Response choices included: 1) at a small grocery/corner store, 2) in another kind of store, and 3) I buy them from a friend or someone else.

Usual Brand and Type of Cigarettes

Students were asked, "Do you usually smoke the same brand of cigarettes?" (Y_Q22a). Those answering "yes" were then asked for more information regarding the brand and type of cigarettes they usually smoke (Y_Q22b), reasons for smoking certain brands (Y_Q23), and whether or not they switched brands during the 12 months preceding the survey (Y_Q24).

Cigarette brand names were suppressed after the data were collected, as well as other sensitive or identifying information. Information regarding the usual brand and type of cigarettes smoked is reported using the derived variables ( DVSMOKE) ( strength of cigarettes smoked) and (DVLOWTAR) ( the tar content range of cigarettes).

Sample and Response

Much of this chapter refers to information obtained from two subsamples of students surveyed; those categorized as ever smokers and those who ever purchased cigarettes. Some subgroup sizes are small thus affecting the reliability of the estimates and preventing detailed comparisons. All estimates with a high variability (coefficient of variation of 33% or greater) or sample size less than 30 were suppressed.

Statements about differences betweens subgroups are based on the 0.05 level of confidence calculated using coefficient of variation tables. Assessment of significance was undertaken by employing the Coefficient of Variation Tables from Chapter 2. Missing data were excluded from percentage total calculations and "don't know" answers were included as valid responses.

Of particular importance to note is that comparisons across provincial subpopulations were often unreportable. Given the low prevalence of smoking among students, provincial sample sizes were generally very small and the data highly variable.

Comparisons to the 1994 YSS

Where possible, data from the 1994 and 2002 YSS were compared. Several questions regarding youth tobacco purchasing and tobacco company sponsorship and marketing in the1994 YSS were not repeated in the 2002 YSS. The excluded questions addressed brand recognition and perceived attractiveness of cigarette packages, and knowledge of cigarette corporation-sponsored events and advertisements.

Findings

Source of Cigarettes

In the 2002 YSS smokers (smoked beyond puffing, not daily smokers and daily smokers) most often reported usually obtaining cigarettes from social sources; 75% of students reported buying, receiving, or taking cigarettes from family or friends (Table 9-A). Friends were key providers of cigarettes; 29% were given cigarettes by a friend or someone else and 24% usually bought cigarettes from a friend (Figure 9-A). Family members were also an important source of cigarettes; 13% of these smokers reported a family member usually gives them cigarettes and 8% responded they usually "take" them from a family member. Of the one quarter (25%) of students who reported their usual source for obtaining cigarettes was purchasing at a retail outlet (Table 9-2a), more reported they usually purchased cigarettes at a small grocery/corner store (20%) than at other stores (3%).

Table 9-A Usual Source of Cigarettes, by Grade, Sex and Category of Smoker, Canada, Youth Smoking Survey 2002

	Where Do You Usually Get Cigarettes? (%)
Grade	Retail Source	Social Source
Total, 5-9	25.2	74.8
Males, 5-9	31.6	68.5
Females, 5-9	19.9	80.1
Smoked Beyond Puffing, 5-9 (a)	18.3	81.7
Daily Smokers, 5-9	40.5	59.5

(a) Smoked Beyond Puffing, Not Daily Smoker

Figure 9-A - Usual Place Cigarettes Obtained, by Students who Smoke*, Grades 5-9, Canada, Youth Smoking Survey 2002, 1994

*Includes Smoked Beyond Puffing, Not Daily Smokers and Daily Smokers

Note: In 1994, students were not asked whether or not they usually take cigarettes from family members.

It was not possible to compare differences regarding the social availability of cigarettes between older (grades 7-9) and younger students (grades 5-6), and behaviours of students in each of grades 7, 8, and 9 were similar. Both male and female students reported a heavy reliance on social sources to obtain cigarettes; differences were not statistically significant (Table 9-2a).

Not surprisingly, daily smokers were less reliant on social sources for obtaining cigarettes, and their usual sources differed from smoked beyond puffing, not daily smokers. Eighty-two percent (82%) of smoked beyond puffing, not daily smokers usually obtained cigarettes from social sources, whereas only 60% of daily smokers did (Table 9-A). While both groups were equally likely to buy cigarettes from friends, daily smokers were less reliant on friends to give them cigarettes than smoked beyond puffing, not daily smokers (11% and 37%, respectively), and significantly more likely to buy cigarettes at a corner store (35%) than smoked beyond puffing, not daily smokers (13%) (Table 9-B). Daily smokers were more likely to obtain cigarettes from family members (23%) than smoked beyond puffing, not daily smokers (9%). However, an additional 10% of smoked beyond puffing, not daily smokers said they took cigarettes from a family member. Thus, families may be an equally important source of cigarettes for both daily and smoked beyond puffing, not daily smokers. This is an interesting finding given that young people are more likely to smoke if someone else in their home also smokes (Table 9-B). Please refer to Chapters 5 and 10 for a full discussion on social influences and restrictions on smoking.

Table 9-B - Usual Place Cigarettes Obtained, by Grade and Category of Smoker, Canada , Youth Smoking Survey 2002

	Where do you usually get cigarettes? (% )
	Retail Sources		Social Sources
Grade	Corner Store	Other Store	Buy from Friend/Other	Family	Friend Gives	Take from Family
Total, 5-9	19.6	2.8*	24.1	13.3	29.2	8.3*
Smoked Beyond Puffing, 5-9 (a)	12.9	#	25.2	8.9*	37.3	10.4*
Daily Smokers, 5-9	34.6	#	21.7*	23.0	11.0*	#

# Data suppressed due to high sampling variability
* Moderate sampling variability; interpret with caution
(a) Smoked Beyond Puffing, Not Daily Smokers

It is not possible to compare provincial findings due to high variability of the data (Table 9-4).

Compared to the findings of the 1994 YSS (Figure 9-A and Table 9-2b), two significant changes were noted in the 2002 YSS with regard to where smokers reported usually obtaining cigarettes; 1) social sources have become more important, and 2) within the social environment, regular sources of cigarettes are different. Fewer smokers reported purchasing cigarettes in retail environments (22.4% in the 2002 YSS and 39.4% in the 1994 YSS), and they were more likely to purchase, rather than receive cigarettes from friends (29% in the 2002 YSS and 16% in the 1994 YSS). In the 2002 YSS, 20% and 3% of students purchased cigarettes at a corner store or other store, respectively; in contrast, 29% and 11% of students in the 1994 YSS usually obtained cigarettes at a corner store or other store, respectively. Several changes were also evident in the distribution of cigarettes through social sources. In the 2002 YSS, students reported receiving cigarettes from friends less often than in the 1994 YSS (29% versus 37%, respectively). In contrast, more students reported buying cigarettes from friends in the 2002 YSS than in the 1994 YSS (24% versus 16%, respectively) (Table 9-2b).

Attempts to Purchase Cigarettes

Among students in the 2002 YSS who attempted to purchase cigarettes in stores, approximately half (53%) had been asked their age, 44% had been asked to show identification, and 61% had been refused the purchase of cigarettes (Figure 9-B). Experiences for male and female students were similar (Figure 9-B and Table 9-5a). The data do not allow for grade comparisons. Also, comparisons of provincial findings are not possible due to high variability of the data. Please refer to Chapter 10 for a description and discussion of students' knowledge of legal age to purchase cigarettes.

Figure 9-B - Attempts to Purchase Cigarettes, by Students who Smoke*, Canada, Youth Smoking Survey 2002

*Smoked Beyond Puffing, Not Daily Smokers and Daily Smokers

In the 1994 YSS, students were asked whether they had ever been asked their age or ever been refused purchase when trying to buy cigarettes. Reports of being asked their age in the 2002 and 1994 YSS were similar (53% and 48%, respectively). In the 1994 YSS fewer students reported someone had refused to sell them cigarettes (51%), compared to such reports in the 2002 YSS (61%) (Table 9-5b).

Strategies Used for Purchasing Cigarettes

When asked about how they go about buying cigarettes from a store, approximately half (53%) of smoked beyond puffing, not daily smokers and daily smokers reported they do not buy cigarettes from stores, and 19% reported they do nothing special. Other strategies were to ask an older person (12%) or to ensure they know the clerk (11%) before attempting the purchase. A small proportion of students reported they try to look older (6%) (Table 9-6).

Strategies used to purchase cigarettes were similar for males and females. Younger students (grades 5-6) were more likely to report they do not buy cigarettes from stores (72%) than older students (52%) (grades 7-9). Two thirds of smoked beyond puffing, not daily smokers reported they do not buy cigarettes from stores (66%) compared to only one quarter (26%) of daily smokers. Daily smokers were more likely than smoked beyond puffing, not daily smokers to report that they do nothing special (28% and 15%, respectively) or ask an older person to purchase cigarettes for them (23% and 7%, respectively). Additionally, daily smokers were more likely than smoked beyond puffing, not daily smokers to ensure they know the clerk before buying cigarettes in a store (16% and 8%, respectively) (Table 9-6).

Given the small sample sizes, a provincial comparison of strategies used by students to purchase cigarettes in stores is not possible. However, the majority of grades 5-9 students in all provinces reported they do not buy cigarettes from stores (Table 9-7).

All students, including students who do and do not smoke, were asked whether they had ever asked a stranger to purchase cigarettes for them; few students ever had (5%) (Table 9-8). Males and females reported similar behaviours (4% and 5%, respectively); however, older students (grades 7-9) were more likely to ask a stranger (7%) than were students in grades 5-6 (1%).

Daily smokers were significantly more likely to report they had ever asked a stranger to buy cigarettes for them (75%) than all other smokers (Table 9-9). One quarter (25%) of smoked beyond puffing, not daily smokers had asked a stranger to buy cigarettes for them. Provincial differences were minimal; students living in Quebec were most likely to report they had asked a stranger to buy cigarettes for them (10%) (Table 9-10).

Attempts to Purchase Single Cigarettes

In the 2002 YSS a very small proportion of smoked beyond puffing, not daily smokers and daily smokers reported purchasing single cigarettes (3%) (data not shown). Of those who reported purchasing single cigarettes, an overwhelming majority of both males and females bought them from friends (88%). Few reported they had purchased single cigarettes at a small grocery or corner store (16%). Grade differences are unreportable due to high variability of the data.

Usual Brand and Type of Cigarettes Smoked

In the 2002 YSS the majority of both male and female students who smoked in the 30 days preceding the survey reported they usually smoke the same brand of cigarettes (60%) (Table 9-11a). Daily smokers were more likely to report usually smoking the same brand than smoked beyond puffing, not daily smokers (74% and 54%, respectively). In the 1994 YSS (Table 9-11b) these smokers were more likely than those in 2002 to report they usually smoked the same brand (81% and 60%, respectively).

Among those students who reported usually smoking the same brand of cigarettes in the 2002 YSS, 66% reported smoking "regular" and 28% reported smoking "light/mild" cigarettes (Table 9-11a). Seven percent (7%) of students reported they smoke "ultra/extra mild" cigarettes. Similar proportions of males and females reported they smoke regular and light/mild cigarettes; differences across grades are unreportable.

While 35% of smokers smoked beyond puffing, not daily smokers and daily smokers) claimed they smoke a "light/mild" or "ultra/extra light/mild" brand of cigarettes, evidence of this is not present in the corresponding tar levels; almost all smokers (97%) reported smoking brands with tar levels of 10 mg or greater (Table 9-11a). There is a lack of correspondence between tar delivery and product descriptor; tar delivery is a function of cigarette engineering while the descriptor is a marketing tool. The data seem to indicate that youth are choosing cigarettes designed to deliver nicotine with minimum effort; such cigarettes are designed so that smokers may easily adjust their nicotine uptake upwards.

There were no significant differences between males and females regarding the strength or the tar levels of cigarettes smoked (Table 9-11a). Provincial comparisons were not possible due to insufficient sample sizes, and thus highly variable data (Table 9-12).

Approximately half of both male and female smokers (52% each) reported their choice of usual brand of cigarettes is largely determined by taste (Table 9-13a). One quarter (24%) of students reported they smoke the cigarette they do because it is the same brand that friends smoke, and 15% of smokers responded their usual brand is the same brand their parents smoke. Eleven percent (11%) of students reported they smoke the brand they do because they are the only cigarettes available. Daily smokers were more likely to report their brand preference was determined by taste (68%) than were smoked beyond puffing, not daily smokers (42%), whereas smoked beyond puffing, not daily smokers were more likely to choose a cigarette brand because their friends smoke the same brand (32%, smoked beyond puffing, not daily smokers and 12%, daily smokers). Provincial comparisons were not possible due to insufficient sample sizes, and thus highly variable data.

Smokers (smoked beyond puffing, not daily smokers and daily smokers) in the 1994 YSS were more likely to report their brand preference was determined by taste, compared to similar smokers in the 2002 YSS (62% and 52%, respectively) (Table 9-14b). Similar proportions of students in the 1994 and 2002 YSS reported their brand choice was determined by the availability of cigarettes (10%) (Tables 9-13a, b). Among those students who usually smoked the same brand of cigarettes, similar proportions in the 1994 and 2002 YSS reported switching brands in the year preceding the survey (39% and 42%, respectively) (Tables 9-14a,b).

Discussion

Since the 1994 YSS, several tobacco control policies have been implemented in an effort to reduce tobacco consumption. Examples include the Tobacco Sales to Young Persons Act (1994) , making it illegal to sell or provide tobacco products to a person under the age of 18, the Act to Amend the Tobacco Act (1998) calling for a ban of tobacco sponsorship promotions, and the introduction of graphic health warning messages on cigarette packages (2000). Additionally, both provincial and federal taxes on tobacco products have steadily increased since the smuggling-induced tax rollback in 1994. Combined, such initiatives and other potential influences in the social and physical environment have led to a decrease in youth smoking prevalence, yet access to tobacco products remains relatively easy.

Overview of 2002 YSS Findings

Findings of the 2002 YSS provide evidence regarding sources for and strategies used by Canadian students to obtain cigarettes. Male and female youth smokers most often acquired cigarettes through social sources, from both family and friends. Daily smokers were less reliant on social sources for accessing cigarettes, and more than one third usually purchased cigarettes at small grocery/corner stores. About half of youth who buy cigarettes in stores reported doing nothing special in their attempts, and were not always asked their age, to show identification, or refused purchase.

The majority of all grades 5-9 students usually reported smoking the same brand of cigarettes. These students reported brand preference is largely determined by taste, although some smoke the brands smoked by friends and family members. Thirty-five percent (35%) reported they smoked "light/mild" or "ultra/extra light/mild" cigarettes, and 39% switched brands during the year preceding the survey.

Comparison to the 1994 YSS

Students in both the 1994 and 2002 YSS were most likely to report obtaining cigarettes through social sources; however, important changes were noted in the proportion of students who receive cigarettes from friends and who access cigarettes through retail outlets. In 1994, students were more likely to report purchasing cigarettes in retail outlets and faced fewer challenges in their attempts to purchase cigarettes. These students were also less likely to report that someone had refused to sell them cigarettes.

Data from both surveys are similar regarding the proportion of students who regularly smoked the same brand of cigarettes and reasons for choosing specific brands.

Implications for Regulation and Legislation

Tobacco Sales

In Canada , it is against the law to sell or provide tobacco products to persons under the age of 18. Under the Tobacco Act, passed in 1997, it is illegal to furnish "a tobacco product to a young person in a public place or in a place to which the public reasonably has access." Additional legislation in the provinces of British Columbia , Ontario , Nova Scotia , New Brunswick , Newfoundland and Labrador, and Prince Edward Island prohibits the sale of tobacco to people under 19 years. Despite such legislation, one quarter of Canadian youth in grades 5-9 who smoked beyond puffing, not daily or daily reported they usually purchase cigarettes in retail environments. The entire sample was too young to legally purchase cigarettes, yet only 61% of youth reported that anyone had refused to sell them cigarettes. These findings correspond with evidence from other Canadian studies suggesting that it is far too easy for minors to obtain cigarettes. A report of retailers' behaviour towards youth access-to-tobacco restrictions indicated that only 68% of retailers refused to sell cigarettes to underage Canadians¹.

Youth access laws make it more difficult for most youth to obtain cigarettes, yet laws alone are not enough to impact youth smoking behaviour. Oftentimes, youth seek and find retailers who will sell cigarettes to them. However, even full compliance is not sufficient to prevent youth access; youth are able to obtain cigarettes from social sources.

Be that as it may, restrictions on the sale of tobacco to minors remain an important strategy for preventing tobacco use among youth. Social sources do not substitute access to cigarettes through commercial sources; instead, they may mitigate the impact of sales bans and restrictions. Youth who purchase cigarettes in retail environments are likely to give them away or sell them to others². American studies show that teens increasingly rely on non-commercial sources, including friends, other underage youth and adults, to purchase or give cigarettes to them³. In Minnesota in 2000, 60% of current smokers in middle school and 71% of current smokers in high school reported social sources were their primary means of obtaining cigarettes⁴. In a study examining the correlates of social exchange of cigarettes, 90% of students surveyed had obtained a cigarette from another teen, while 75% had provided cigarettes to others⁵. Provision of cigarettes by social sources depends on commercial access; strong legislation and retailer compliance limit the ability of adolescents to purchase and provide cigarettes.

To achieve sustained compliance, enforcement of tobacco access laws is essential. Rather than simply educating retailers about youth tobacco access laws, effective enforcement activities include regular compliance checks, warnings, assigning appropriate penalties and mobilising community support⁶.

Point of Sale Displays

Retail display of tobacco products has become the most important advertising strategy to the tobacco industry in the wake of restrictions on tobacco promotion. In 2002, $77 million was paid to retailers by tobacco manufacturers to display tobacco products⁷ and in 2003, 42% of all Canadian tobacco retailers employed point of sale advertising with counter top displays being the most prominent format (33% of stores)¹. These are effective advertising tools because they reach the entire population and situate tobacco beside other common products, sending the message to youth that tobacco use is as socially acceptable as candy consumption.

In June 2001, the province of Saskatchewan became the first jurisdiction in Canada to ban the display of tobacco products in places accessible to people under the age of 18. While the legislation received unanimous approval in the Legislature and strong support from the public, the tobacco industry was quick to challenge its constitutionality. The tobacco industry claimed that point of sale displays and advertising have no effect on youth smoking, despite the strong evidence that advertising increases tobacco use⁸.

On January 19, 2005 the Supreme Court upheld Saskatchewan 's legislation prohibiting the display of tobacco products in any retail premise accessible by minors. Similar legislation has been tabled in other Canadian provinces including Manitoba , Prince Edward Island and Ontario. 

Product Regulation

Although approximately one third of smokers (smoked beyond puffing, not daily smokers and daily smokers) claimed they smoked a "light/mild" or "ultra/extra light/mild" brand of cigarettes, evidence of this was not present in corresponding tar values. The majority of students who smoked reported they usually smoked a brand of cigarettes with tar levels greater than 10 mg and over one third reported smoking cigarettes with tar values greater than 15 mg. There is a lack of correspondence between tar delivery and product descriptors; tar delivery is a function of cigarette engineering, while the descriptor is a marketing tool.

The choice of high tar delivery cigarettes by youth who are beginning to smoke is not unusual or surprising. These cigarettes are designed to be easy to use while providing maximum levels of nicotine with minimum effort. Additionally, smokers may increase the delivery of nicotine by increasing the amount of smoke inhaled⁹. For youth who smoke fewer cigarettes, and who are becoming addicted to nicotine, such products are ideal; youth may experiment with their nicotine intake at a minimum cost.

For this group of smokers, and cigarette manufacturers, the engineering of the cigarette and marketing go hand in hand. Internal tobacco industry documents suggest that in addition to advertising and promotional activities targeting youth, cigarettes were designed to be more palatable, easier to smoke, and more addictive¹⁰. Among those students with a usual brand, approximately half (51%) reported their choice was based on taste. In addition to the possibility of being confused by the descriptor ("regular," "light," or "mild") which is irrelevant to the physiological response, youth are also influenced by taste and other nicotine delivery properties. Consideration of regulation regarding cigarette design is necessary; engineering of cigarettes so they are less palatable and very difficult to smoke, and reducing the amount of available nicotine are key issues to address.

Implications for Education and Message Promotion

Findings of the 2002 YSS provide clear evidence that youth are increasingly reliant on social sources to obtain cigarettes. It is important to recognize, however, that social acquisition and provision of cigarettes are highly related, and depend heavily on a hospitable social environment⁵. There are fewer opportunities for youth to purchase and smoke cigarettes in an environment where smoking is unacceptable. Attempts to modify the social environment include tobacco industry denormalization strategies. Such campaigns can be used to reduce the social acceptability of smoking by highlighting the tobacco industry's manipulative and unethical activities , and their overt attempts to increase the social acceptability of smoking¹¹. Promotion and education efforts to reduce youth tobacco access need to address all aspects of the social environment that allow or promote youth tobacco use, including social and retail sources of cigarettes, a lack of smoke-free spaces, and marketing of tobacco and other tobacco industry practices (e.g. disinformation strategies). 

Source of Cigarettes

The increasing dependence upon social sources, revealed by the comparison of findings from the 1994 and 2002 YSS, suggest that current enforcement and compliance activities are having an effect. However, one quarter of youth continued to purchase cigarettes from retail sources, indicating a need for implementing strategies that discourage non-compliant retailers from selling cigarettes to youth. To ensure compliance and limit youth purchasing ability, retailers and the general public need to understand both the law restricting sales to minors and the purpose behind the law. Both groups need to be made aware of how the regulations are enforced, and the potential consequences of selling or providing tobacco to underage youth.

Given that the majority of students usually obtained cigarettes through social sources, activities discouraging social sources from supplying cigarettes are also necessary.

Education programs are essential that both discourage retailers from selling to youth and discourage adult smokers from providing cigarettes to underage/beginning smokers.

Smoke-Free Spaces

Social exchange of cigarettes among youth is influenced by parental behaviour and community norms about smoking⁵. Strong, comprehensive smoke-free laws covering public places and workplaces can promote cessation among adults, reduce cigarette consumption among those who continue to smoke, and create social norms against smoking. Thus, educational campaigns promoting both the health benefits of smoke free spaces and the potential to reduce youth tobacco consumption are an important strategy for reducing youth access to tobacco.

Restrictions on smoking at work and home are associated with reduced daily smoking rates and increased cessation in adults¹². As smoking restrictions become more pervasive, smoking is likely to be perceived as more socially unacceptable and inconvenient . Parents who enforce rules restricting smoking in private settings limit opportunities for social exchange of cigarettes by youth, reinforce negative expectations about smoking, and send a clear message to youth regarding the unacceptability of smoking. Evidence suggests when smoking restrictions in public places and at home are enforced, fewer youth begin smoking, and fewer of those who do begin smoking transition from experimentation to advanced smoking¹³. Additionally, public smoking restrictions limit the number of spaces that young people have to smoke, making social acquisition and sharing more difficult. 

Tobacco Industry Products

Education campaigns may be used to create public awareness of tobacco industry marketing efforts and increase interest and participation in tobacco control. One example is to alert the public to the fact that tobacco companies are spending increasing sums on point of purchase displays. Effective campaigns will inform smokers there are insignificant differences between most cigarette brands sold in Canada with respect to exposure to carcinogens and toxins, and "light" and "mild" descriptors are nothing more than a marketing strategy of tobacco companies.

Implications for Future Monitoring and Further Research

The 2002 YSS provides useful information regarding youth access to tobacco, but this information is only a fraction of what is needed to monitor youth tobacco use in relation to tobacco access.

Research is necessary to understand effective strategies for decreasing the social availability of cigarettes to youth, and factors influencing sharing behaviours. Between 1994 and 2002, the proportion of students who received cigarettes from friends increased considerably, as did the price of cigarettes. Higher prices can reduce the availability of cigarettes through social sources; fewer young smokers have cigarettes to share and those who have cigarettes may be less willing to give them away because of the higher costs of obtaining them¹⁴. This relationship creates a need to better understand the reciprocal nature of the social exchange of cigarettes among adolescents. For example, it is unclear how the price of cigarettes contributes to smokers' generosity, and at what price threshold an individual's propensity to give away cigarettes would be limited. Given the current practice of sharing cigarettes, it will be easier to increase retailer compliance with tobacco access laws than it will be to prevent youth from accessing cigarettes through social sources. None-the-less, interventions aimed at diminishing social sources should be explored.

Evaluating the implementation, enforcement, and impact of legislation banning point of sale tobacco displays is necessary to understand the influence of such advertising on youth tobacco access and retailer compliance with youth access restrictions. Additionally such research could provide the support needed to impose similar legislation in other jurisdictions.

There are some limitations to the degree to which the YSS is a good vehicle to study youth tobacco access in Canada. Underage smokers may use multiple sources to obtain cigarettes and may have a variable rate of success when attempting to make purchases. The YSS asked a limited number of questions about attempts to buy cigarettes and may not capture the complexity of this behaviour. The survey instrument may need to be expanded to deal with such issues.

More notably, due to low smoking prevalence and small sample sizes, the ability to compare youth tobacco access across provinces was limited. Tobacco use behaviour is highly influenced by environmental and sociocultural factors. The inability to make comparisons across provinces did not permit the examination of the environmental and social factors affecting tobacco access and smoking behaviours in each province. However, small sample sizes are representative of decreased youth smoking prevalence and the overall success of tobacco control efforts. In the future, provinces may wish to augment the sample in order to fully explore environmental and sociocultural differences.

References

1. Final Report of Findings: 2003. Evaluation of Retailers' Behaviour Towards Certain Youth Access-to-Tobacco Restrictions. February 2004. AC Nielsen. Prepared for: Health Canada , Tobacco Control Programme. Healthy Environments Branch.

2. Wolfson M, Forster JL, Claxton AM et al. Adolescent smokers' provision of tobacco to other adolescents. American Journal of Public Health 1997; 87; 649-51.

3. DiFranza J, Coleman M. Sources of tobacco for youths in communities with strong enforcement of youth access laws. Tobacco Control 2001; 10:323-328.

4. Center for Health Statistics, Minnesota Department of Health. Teens and Tobacco in Minnesota - Results from the Minnesota Youth Tobacco Survey 2000.

5. Forster J, Chen V, Blaine T, Perry C, Toomey T. Social exchange of cigarettes by youth. Tobacco Control 2003; 12:148-154.

6. Stead LF, Lancaster T. Interventions for preventing tobacco sales to minors (Systematic Review). Cochrane Tobacco Addiction Group. Cochrane Database of Systematic Reviews . 2, 2004.

7. Cunningham R. Banning Retail Displays and Signage. Presented at the Ontario Tobacco Control Conference, 2004. May 6, 2004. Toronto Ontario.

8. Lovato C, Linn G, Stead LF, Best A. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. [Systematic Review] Cochrane Tobacco Addiction Group Cochrane Database of Systematic Reviews. 2, 2004 .

9. Benowitz NL. Compensatory Smoking of Low Yield Cigarettes. In, Smoking and Tobacco Control Monographs 13: Risks Associated with Smoking Cigarettes with Low Machine-Measured Yields of Tar and Nicotine . National Cancer Institute, 2001.

10. Wayne GF, Connolly GN. How cigarette design can affect youth initiation into smoking: Camel cigarettes 1983-93. Tobacco Control 2002; 11(Suppl 1):I32-I39.

11. Lavack AM. Tobacco Industry Denormalization Campaigns - A Review and Recommendations. July 17, 2001. http://www.hc-sc.gc.ca/hecs-sesc/tobacco/roundtable/denorm_campaigns.html Accessed August 13, 2004.

12. Farkas AJ, Gilpin EA, Distefan JM, Pierce JP. The effects of household and workplace smoking restrictions on quitting behaviours. Tobacco Control 1999; 8:261-265.

13. Wakefield MA , Chaloupka FJ, Kaufman NJ, Orleans CT , Barker DC, Ruel EE. Effect of restrictions on smoking at home, at school, and in public places on teenage smoking: cross sectional study. British Medical Journal 2000; 321:333-337.

14.Chaloupka FJ. Contextual factors and youth tobacco use: policy linkages. Addiction 2003; 98(Suppl 1): 147-149.

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Table 9-1 - Usual Source of Cigarettes, by Grade, Sex and Category of Smoker, Canada, Youth Smoking Survey 2002

Table 9-2a - Usual Place Cigarettes Obtained Among Students who Smoke**, by Grade and by Sex, Canada, Youth Smoking Survey 2002

Table 9-2b - Usual Place Cigarettes Obtained among Students who Smoke, by Grade, Sex and Category of Smoker, Canada, Youth Smoking Survey 1994

Table 9-3 - Usual Place Cigarettes Obtained, by Grade and Category of Smoker, Canada, Youth Smoking Survey 2002

Table 9-4 - Usual Place Cigarettes Obtained among Students who Smoke**, by Province Smokers, Canada, Youth Smoking Survey 2002

Table 9-5a - Attempts to Purchase Cigarettes Among Students Who Smoke**, by Sex and Grade, Canada, Youth Smoking Survey 2002

Table 9-5b - Attempts to Purchase Cigarettes among Students who Smoke**, by Sex and Grade, Canada, Youth Smoking Survey 1994

Table 9-6 - Strategies for Purchasing Cigarettes from Stores by Category of Smoker, by Grade, Sex, and Type of Smoker, Canada, Youth Smoking Survey 2002

Table 9-7 - Strategies for Purchasing Cigarettes from Stores Among Students Who Smoke**, by Province, Canada, Youth Smoking Survey 2002

Table 9-8 - Attempts to ask a Stranger to Purchase Cigarettes, All Students by Sex and Grade, Canada, Youth Smoking Survey 2002

Table 9-9 - Attempts to Ask a Stranger to Purchase Cigarettes, by Category of Smoker and Grade, Canada, Youth Smoking Survey 2002

Table 9-10 - Attempts to Ask a Stranger to Purchase Cigarettes, All Students by Province, Canada, Youth Smoking Survey 2002

Table 9-11a - Brand, Strength, and Tar Levels of Cigarettes Usually Smoked, by Grade, Sex and Category of Smoker, Canada, Youth Smoking Survey 2002

Table 9-11b - Students* With a Usual Brand, by Sex and Grade, Canada, Youth Smoking Survey 1994

Table 9-12 - Brand, Strength, and Tar Levels of Cigarettes Usually Smoked**, by Province, Canada, Youth Smoking Survey 2002

Table 9-13a - Reasons for Smoking Certain Brands Among Smokers With a Usual Brand, by Sex, Grade, and Category of Smoker, Canada, Youth Smoking Survey 2002

Table 9-13b - Reasons for Smoking Certain Brands Among Smokers** With a Usual Brand, by Grade and Sex, Canada, Youth Smoking Survey 1994

Table 9-14a - Brand Switching Among Smokers With a Usual Brand, by Sex, Grade, and Category of Smoker, Canada, Youth Smoking Survey 2002

Table 9-14b - Brand Switching Among Smokers With a Usual Brand, by Sex, Grade, and Category of Smoker, Canada, Youth Smoking Survey 1994