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ARCHIVED - 2002 Youth Smoking Survey - Technical Report

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2002 Youth Smoking Survey - Technical Report Image

2005
ISBN: 0-662-40683-4 (PDF Version)
Cat. No.: H46-1/44-2002E (PDF Version)

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Table of Contents

Preface

This report of the 2002 Youth Smoking Survey provides national and provincial results of this important Canada-wide survey based on over 19,000 questionnaires completed by young Canadians in grades 5-9 and interviews with almost 18,000 of their parents. It complements and builds from the 1994 Youth Smoking Survey Technical Report. It describes smoking practices and related knowledge, beliefs, and attitudes as well as social influences, restrictions on smoking and reports on drug and alcohol use.

This report presents findings for every major topic covered in the survey, and, for most chapters, provides detailed findings classified by grade, sex and province of residence. The report is considered "technical" only because of this level of detail, not because of any requirement for statistical sophistication to read it. Indeed, the intended readership consists primarily of individuals in public, voluntary, and private agencies which are responsible for developing policies and programs to combat youth smoking. Epidemiologists and other researchers may find many issues in this report worthy of further examination. Survey data in electronic form are available for this purpose from Statistics Canada or their Regional Data Centres.

List of Figures

Chapter 1

  • 1-A
    Smoking Prevalence by Province, Grade 7, Canada, 1994-2002
  • 1-B
    Smoking Prevalence by Province, Grade 9, Canada, 1994-2002
  • 1-C
    Smoking Behaviour and Social-Cognitive-Policy Influences Covered in YSS 2002

Chapter 3

  • 3-A
    Comparison of Smoking Categories by Year, Canada, Youth Smoking Survey 2002 and Youth Smoking Survey 1994
  • 3-B
    Percentage of Never Smokers Who Had Seriously Thought About Smoking by Grade, Canada, Youth Smoking Survey, 2002, 1994
  • 3-C
    Age at Smoking First Whole Cigarette Among Grade 9 Respondents, Canada, Youth Smoking Survey 2002
  • 3-D
    Ever Smoker by Grade, Canada, Youth Smoking Survey 2002 and 1994
  • 3-E
    Mean Number of Cigarettes Smoked Per Day by Those Who Smoked in Previous Seven Days, by Grade, Canada, Youth Smoking Survey 2002 and 1994
  • 3-F
    Ever Smoker Category by Province, Canada, Youth Smoking Survey 2002 and 1994
  • 3-G
    Percentage of Youth Who Ever Smoked by Parental Education, Canada, Youth Smoking Survey 2002 and 1994
  • 3-H
    Weekly Income Available by Category of Smoker, Canada, Youth Smoking Survey 2002
  • 3-I
    Smoking Category by Self-Perceived Academic Performance, Canada, Youth Smoking Survey 2002
  • 3-J
    Self Esteem by Smoking Category and Sex, Canada, Youth Smoking Survey 2002
  • 3-K
    Preferred Weight by Smoking Category, Females, Canada, Youth Smoking Survey 2002

Chapter 5

  • 5-A
    Category of Smoker, by Number of Close Friends Who Smoke, Grades 5-9, Canada, Youth Smoking Survey 2002
  • 5-B
    Category of Smoker, by Number of Smokers Inside the Home, Grades 5-9, Canada, Youth Smoking Survey 2002

Chapter 6

  • 6-A
    Doctor Ever Asked About Tobacco Product Use by Sex and Smoking Category, Grades 5-9, Canada, Youth Smoking Survey 2002
  • 6-B
    Doctor Ever Talked About Health Risks from Tobacco Product Use by Sex and Grade, Canada, Youth Smoking Survey 2002
  • 6-C
    Dentist Ever 'Asked About Tobacco Product Use' or 'Talked About Health Risks from' Tobacco Product Use by Grade, Grades 5-9, Canada, Youth Smoking Survey 2002
  • 6-D
    Dentist Ever Talked About Health Risks from Tobacco Product Use by Sex and Grade, Grades 5-9, Canada, Youth Smoking Survey 2002

Chapter 7

  • 7-A
    Health Beliefs by Category of Smoker, Canada, Youth Smoking Survey 2002
  • 7-B
    Percentage of Students Who Believe that Smoking is Responsible for More Deaths than AIDS, Drugs, Murders, Accidents, Suicides, and Alcohol, Canada, Youth Smoking Survey 2002
  • 7-C
    Estimates of Numbers of Deaths Due to Smoking by Grade, Canada, Youth Smoking Survey 2002

Chapter 8

  • 8-A
    Received Education about Smoking and Health, by Province, Youth Smoking Survey 2002 and 1994

Chapter 9

  • 9-A
    Usual Place Cigarettes Obtained, by Students who Smoke, Grades 5-9, Canada, Youth Smoking Survey 2002, 1994
  • 9-B
    Attempts to Purchase Cigarettes, by Students who Smoke, Canada, Youth Smoking Survey 2002

Chapter 10

  • 10-A
    Knowledge of Legal Purchase Age for Cigarettes, by Province and Actual Purchase Age, Grades 5-9, Canada, Youth Smoking Survey 2002
  • 10-B
    Reported School Smoking Restrictions, by Type of Restriction and Province, Grades 5-9, Canada, Youth Smoking Survey 2002
  • 10-C
    Weekly Smoking Pattern, by School Smoking Restrictions, Last 30 days Smokers, Grades 7-9, Canada, Youth Smoking Survey 2002
  • 10-D
    Weekly Smoking Pattern, by School Smoking Restrictions, Last 30 days Smokers, Grades 7-9, Canada, Youth Smoking Survey 1994
  • 10-E
    Mean Number of Cigarettes Smoked per day by Reported School Smoking Restrictions, Last 30 days Smokers in Grades 7-9, Canada, Youth Smoking Survey 2002

List of Tables

Chapter 1

  • 1-A
    Smoking Attributable Economic Costs, Canada, 1991 and 1996
  • 1-B
    Per Capita Funding for Tobacco-Control (2002-2003) by Territories, Provinces in Canada and Selected US States
  • 1-C
    2002 & 1994 YSS Questionnaire Content
  • 1-1
    Health Behaviour Surveys, Grades 5-9, Canada
  • 1-2
    Health Behaviour Surveys, Grades 10-12, Canada

Chapter 2

  • 2-A
    Number of Classes for Which Consent was Given (After Replacement) by Province, Canada, 2002 Youth Smoking Survey
  • 2-B
    Student Participation Rates by Province, Canada, 2002 Youth Smoking Survey
  • 2-C
    Definitions of Categories of Smoking Behaviour, Youth Smoking Survey 2002
  • 2-1a
    Approximate Population Total Required in the Smaller of Two Groups for Significance (p<0.05) when Comparing Two Proportions in Canada for the 2002 Youth Smoking Survey
  • 2-1b
    Approximate Population Total Required in the Smaller of Two Groups for Significance (p<0.05) when Comparing Two Proportions in Canada for the 1994 Youth Smoking Survey
  • 2-1c
    Approximate Population Total Required in the Smaller of Two Groups for Significance (p<0.05) when Comparing Two Proportions in Canada: One From the 1994 Youth Smoking Survey and One From the 2002 Youth Smoking Survey

Chapter 3

  • 3-A
    Percentage of Ever and Never Smokers Participating In Extracurricular Activities, Canada, Youth Smoking Survey 2002
  • 3-1
    Amount Smoked in the Last 30 Days on Days When Smoking Occurred, Canada, Youth Smoking Survey 2002 and 1994
  • 3-2a
    Prevalence of Ever Use of Tobacco Products Other than Cigarettes, by Sex and by Grade, Canada, Youth Smoking Survey 2002
  • 3-2b
    Prevalence of Ever Use of Tobacco Products Other than Cigarettes, by Sex and by Grade, Canada, Youth Smoking Survey 1994
  • 3-3a
    Percentage of Never Smokers Who Might Try Smoking in Next Month, by Grade and Sex, Canada, Youth Smoking Survey 2002
  • 3-3b
    Percentage of Never Smokers who Might Try Smoking in Next Month, by Grade and Sex, Canada, Youth Smoking Survey 1994
  • 3-4
    Perceived Easy Access to Cigarettes among Never Smokers by Province, Canada, Youth Smoking Survey 2002 and 1994
  • 3-5a
    Smoking Category by Province and Grade, Canada, Youth Smoking Survey 2002
  • 3-5b
    Smoking Category by Province and Grade, Canada, Youth Smoking Survey 1994
  • 3-6a
    Smoking Category by Sex and Grade, Canada, Youth Smoking Survey 2002
  • 3-6b
    Smoking Category by Sex and Grade, Canada, Youth Smoking Survey 1994
  • 3-7
    Mean Number of Cigarettes Smoked Per Day in Last 7 Days - By Those Who Reported Any Smoking in Last 7 Days - by Province, Canada, Youth Smoking Survey 2002 and 1994
  • 3-8a
    Ever Used Other Tobacco Products, by Province, Canada, Youth Smoking Survey 2002
  • 3-8b
    Ever Used Other Tobacco Products, by Province, Canada, Youth Smoking Survey 1994
  • 3-9a
    Smoking Category by Language Usually Spoken at Home and Grade, Canada, Youth Smoking Survey 2002
  • 3-9b
    Smoking Category by Language Usually Spoken at Home and Grade, Canada, Youth Smoking Survey 1994
  • 3-10a
    Parental Education by Smoking Category, Canada, Youth Smoking Survey 2002
  • 3-10b
    Parental Education by Smoking Category, Canada, Youth Smoking Survey 1994
  • 3-11
    Smoking Category by Aboriginal Status, Canada, Youth Smoking Survey 2002
  • 3-12a
    Smoking Category by Aboriginal Status in the Prairie Provinces and British Columbia, Youth Smoking Survey 2002
  • 3-12b
    Smoking Category by Aboriginal Status in the Prairie Provinces and British Columbia, Youth Smoking Survey 1994
  • 3-13
    Full Agreement with Self Esteem Items, by Never/Ever Smoker Category, Canada, Youth Smoking Survey 2002

Chapter 4

  • 4-A
    Ever Seriously Thought About Quitting by Category of Smoker, Grade, and Sex, Canada, Youth Smoking Survey 2002
  • 4-B
    Ever Tried To Quit by Category of Smoker, Grade, and Sex, Canada, Youth Smoking Survey 2002
  • 4-C
    Tried to Quit in the Last Six Months by Category of Smoker, Grade, and Sex (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002
  • 4-D
    Tried to Quit in the Last Six Months by the Number of Cigarettes Smoked per Day and Sex (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002 and Youth Smoking Survey 1994
  • 4-E
    Tried to Quit in the Last Six Months by Province (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002
  • 4-1
    Mean, Median And Range Of Number Of Lifetime Quit Attempts by Type Of Smoker and Sex (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002 and Youth Smoking Survey 1994
  • 4-2
    Longest Length of Time (Days) Successfully Stopped Smoking by Category of Smoker and Sex (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002
  • 4-3
    Tried to Quit in the Last Six Months by Socio-Demographic Factors (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002
  • 4-4
    Tried to Quit in the Last Six Months According to Selected Beliefs About Smoking and Sex (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002
  • 4-5
    Tried to Quit in the Last Six Months by Selected Indicators of the Social And Physical Environment (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002
  • 4-6
    Tried to Quit in the Last Six Months by Other Selected Indicators of Behaviour (Among Students, Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002
  • 4-7
    Tried to Quit in the Last Six Months by Other Potential Correlates (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002

Chapter 5

  • 5-A
    Number of Close Friends Who Smoke, by Type Category of Smoker, and Grade, Canada, Youth Smoking Survey 2002
  • 5-B
    Ever Smoked at Home, by Grade, Sex, and Category of Smoking Behaviour, Canada, Youth Smoking Survey 2002
  • 5-1a
    Number of Close Friends Who Smoke, by Grade, Sex, and Category of Smoker, Canada, Youth Smoking Survey 2002
  • 5-1b
    Number of Close Friends Who Smoke, by Grade, Sex, and Category of Smoker, Canada, Youth Smoking Survey 1994
  • 5-2a
    Father Smokes, by Category of Smoker, Grade, and Sex, Canada, Youth Smoking Survey 2002
  • 5-2b
    Father Smokes, by Category of Smoker, and Father's Education Level, Canada, Youth Smoking Survey 2002
  • 5-2c
    Father Smokes, by Category of Smoker, Grade, and Sex, Canada, Youth Smoking Survey 1994
  • 5-3
    Father's Opinion of His Child's Smoking, by Grade, Sex, and Category of Smoking Behaviour, Canada, Youth Smoking Survey 2002
  • 5-4a
    Mother Smokes, by Category of Smoker, Grade, and Sex, Canada, Youth Smoking Survey 2002
  • 5-4b
    Mother Smokes, by Category of Smoker, and Mother's Education Level, Canada, Youth Smoking Survey 2002
  • 5-4c
    Mother Smokes, by Category of Smoker, Grade, and Sex, Canada, Youth Smoking Survey 1994
  • 5-5
    Mother's Opinion of Her Child's Smoking, by Grade, Sex, and Category of Smoking Behaviour, Canada, Youth Smoking Survey 2002
  • 5-6a
    Combined Influence of Both Parents Smoking, by Grade, Sex, and Category of Smoker, Canada, Youth Smoking Survey 2002
  • 5-6b
    Combined Influence of Both Parents Smoking, by Grade, Sex, and Category of Smoker, Canada, Youth Smoking Survey 1994
  • 5-7a
    Number of Smokers Inside the Home, by Grade, Sex, and Category of Smoker, Canada, Youth Smoking Survey 2002
  • 5-7b
    Number of Smokers Inside the Home, by Grade, Sex, and Category of Smoker, Canada, Youth Smoking Survey 1994

Chapter 6

  • 6-1
    'Doctor Ever Asked About' or 'Doctor Ever Talked About Health Risks from Tobacco Product Use' by Sex and Grade, Canada, Youth Smoking Survey 2002
  • 6-2
    'Doctor Ever Asked About' or 'Doctor Ever Talked About Health Risks from Tobacco Product Use' by Province, Canada, Youth Smoking Survey 2002
  • 6-3
    'Doctor Ever Talked About Health Risks from Tobacco Product Use' by Sex, Smoking Category and Grade, Grades 5-9, Canada, Youth Smoking Survey 2002
  • 6-4
    'Doctor Ever Talked About Health Risks from Tobacco Product Use' by Province and Smoking Category, Canada, Youth Smoking Survey 2002
  • 6-5
    'Dentist Ever Asked About' or 'Dentist Ever Talked About Health Risks from Tobacco Product Use' by Province, Canada, Youth Smoking Survey 2002

Chapter 7

  • 7-A
    Attitudes Toward Smoking, By Category of Smoker, Canada, Youth Smoking Survey 2002, 1994
  • 7-B
    Attitudes Toward Smoking by Proportion of Friends Who Smoke and Proportion of Smokers in the Household, Canada, Youth Smoking Survey 2002
  • 7-C
    Beliefs About Cigarette Package Health Warning Messages by Type of Smoker, Canada, Youth Smoking Survey 2002, 1994
  • 7-1a
    Beliefs About Harms of Tobacco and Quitting (% Yes) by Sex, Category of Smoker and Grade, Canada, Youth Smoking Survey 2002
  • 7-1b
    Beliefs About Harms of Tobacco and Quitting (% Yes) by Sex, Category of Smoker and Grade, Canada, Youth Smoking Survey 1994
  • 7-2a
    Beliefs About Perceived Benefits of Smoking by Sex, Category of Smoker and Grade, Canada, Youth Smoking Survey 2002
  • 7-2b
    Beliefs About Perceived Benefits of Smoking by Sex, Category of Smoker and Grade, Canada, Youth Smoking Survey 1994
  • 7-3
    Perceptions that Smoking Causes More Death than Other Causes by Sex, Category of Smoker and Grade, Canada, Youth Smoking Survey 2002
  • 7-4
    Health Beliefs by Province, Canada, Youth Smoking Survey 2002
  • 7-5
    Health Beliefs by Language Spoken at Home, Perceived Class Standing Relative to Peers, and Percentage of Friends who Smoke, Percentage in the Household who Smoke, Canada, Youth Smoking Survey 2002
  • 7-6a
    Attitudes Toward Smoking by Category of Smoker, Sex and Grade, Canada, Youth Smoking Survey 2002
  • 7-6b
    Attitudes Toward Smoking by Sex, Category of Smoker, and Grade, Canada, Youth Smoking Survey 1994
  • 7-7
    Attitudes Toward Smoking by Category of Smoker, Canada, Youth Smoking Survey 2002, 1994
  • 7-8
    Attitudes Toward Smoking by Proportion of Friends Who Smoke and Proportion of Smokers in the Household, Canada, Youth Smoking Survey 2002
  • 7-9a
    Perceived Reasons Youth Start Smoking by Sex, Category of Smoker, and Grade, Canada, Youth Smoking Survey, 2002
  • 7-9b
    Perceived Reasons Youth Start Smoking (% yes) by Sex, Category of Smoker, and Grade, Canada, Youth Smoking Survey 1994
  • 7-10
    Perceived Reasons Youth Start Smoking by Language Spoken at Home, Perceived Class Standing Relative to Peers, and Percentage of Friends who Smoke, Percentage in the Household who Smoke, Canada, Youth Smoking Survey 2002
  • 7-11
    Beliefs About Cigarette Package Health Warning Messages by Category of Smoker, Canada, Youth Smoking Survey 2002, 1994
  • 7-12
    Percent Who Believe Cigarette Package Health Warning Messages by Frequency of Looking at Health Warning Messages and Category of Smoker, Canada, Youth Smoking Survey 2002

Chapter 8

  • 8-A
    Categories and Coding Scheme for Health Problems Recalled, Youth Smoking Survey 2002
  • 8-B
    Categories and Coding Scheme for Cigarette Package Health Warning Messages Recalled, Youth Smoking Survey 2002
  • 8-C
    Recall of Health Problem, by Recall of Cigarette Package Health Warning Message Canada, Youth Smoking Survey 2002
  • 8-D
    Recall of Health Problem, by Recall of Cigarette Package Health Warning Message, Canada, Youth Smoking Survey 1994
  • 8-1a
    Ever Received Education about Smoking-related Health Problems in School, by Sex and Grade, Canada, Youth Smoking Survey 2002
  • 8-1b
    Ever Received Education about Smoking-related Health Problems in School, by Sex and Grade, Canada, Youth Smoking Survey 1994
  • 8-2a
    Ever Received Education About Smoking-Related Health Problems in School, by Province, Canada, Youth Smoking Survey 2002
  • 8-2b
    Ever Received Education about Smoking-related Health Problems in School, by Province, Canada, Youth Smoking Survey 1994
  • 8-3a
    Smoking-related Health Problems Recalled, by Sex and Grade, Canada, Youth Smoking Survey 2002
  • 8-3b
    Smoking-related Health Problems Recalled, by Sex and Grade, Canada, Youth Smoking Survey 1994
  • 8-4a
    Smoking-related Health Problems Recalled, by Category of Smoker and Grade, Canada, Youth Smoking Survey 2002
  • 8-4b
    Smoking-related Health Problems Recalled, by Category of Smoker and Grade, Canada, Youth Smoking Survey 1994
  • 8-5a
    Smoking-related Health Problems Recalled, by Whether or not Received Smoking-related Education, and Grade, Canada, Youth Smoking Survey 2002
  • 8-5b
    Smoking-related Health Problems Recalled, by Whether or not Received Smoking-related Education, and Grade, Canada, Youth Smoking Survey 1994
  • 8-6a
    Number of Smoking-related Health Problems Recalled, by Sex and Grade, Canada, Youth Smoking Survey, 2002
  • 8-6b
    Number of Smoking-related Health Problems Recalled, by Sex and Grade, Canada, Youth Smoking Survey 1994
  • 8-7a
    Number of Smoking-related Health Problems Recalled, by Category of Smoker and Grade, Canada, Youth Smoking Survey 2002
  • 8-7b
    Number of Smoking-related Health Problems Recalled, by Category of Smoker and Grade, Canada, Youth Smoking Survey 1994
  • 8-8a
    Number of Smoking-related Health Problems Recalled, by Whether or Not Received Smoking-related Education and Grade, Canada, Youth Smoking Survey 2002
  • 8-8b
    Number of Smoking-related Health Problems Recalled, by Whether or Not Received Smoking-related Education and Grade, Canada, Youth Smoking Survey 1994
  • 8-9a
    Awareness of Cigarette Package Health Warning Messages, by Category of Smoker, and Grade, Canada, Youth Smoking Survey 2002
  • 8-9b
    Awareness of Cigarette Package Health Warning Messages, by Category of Smoker, and Grade, Canada, Youth Smoking Survey 1994
  • 8-10a
    Cigarette Package Health Warning Messages Recalled, by Sex and Grade, Canada, Youth Smoking Survey 2002
  • 8-10b
    Cigarette Package Health Warning Messages Recalled, by Sex and Grade, Canada, Youth Smoking Survey 1994
  • 8-11a
    Cigarette Package Health Warning Messages Recalled, by Category of Smoker and Grade, Canada, Youth Smoking Survey 2002
  • 8-11b
    Cigarette Package Health Warning Messages Recalled, by Category of Smoker and Grade, Canada, Youth Smoking Survey 1994
  • 8-12a
    Cigarette Package Health Warning Messages Recalled, by Whether or Nor Received Education about Smoking-related Health Problems in School, and Grade, Canada, Youth Smoking Survey 2002
  • 8-12b
    Cigarette Package Health Warning Messages Recalled, by Whether or Nor Received Education about Smoking-related Health Problems in School, and Grade, Canada, Youth Smoking Survey 1994
  • 8-13a
    Number of Cigarette Package Health Warning Messages Recalled, by Sex and Grade, Canada, Youth Smoking Survey 2002
  • 8-13b
    Number of Cigarette Package Health Warning Messages Recalled, by Sex and Grade, Canada, Youth Smoking Survey 1994
  • 8-14a
    Number of Cigarette Package Health Warning Messages Recalled, by Category of Smoker and Grade, Canada, Youth Smoking Survey 2002
  • 8-14b
    Number of Cigarette Package Health Warning Messages Recalled, by Category of Smoker and Grade, Canada, Youth Smoking Survey 1994
  • 8-15a
    Number of Cigarette Package Health Warning Messages Recalled, by Whether or Not Received Smoking-related Education and Grade, Canada, Youth Smoking Survey 2002
  • 8-15b
    Number of Cigarette Package Health Warning Messages Recalled, by Whether or Not Received Smoking-related Education and Grade, Canada, Youth Smoking Survey 1994

Chapter 9

  • 9-A
    Usual Source of Cigarettes, by Grade, Sex and Category of Smoker, Canada, Youth Smoking Survey 2002
  • 9-B
    Usual Place Cigarettes Obtained, by Grade and Category of Smoker, Canada, Youth Smoking Survey 2002
  • 9-1
    Usual Source of Cigarettes, by Grade, Sex and Category of Smoker, Canada, Youth Smoking Survey 2002
  • 9-2a
    Usual Place Cigarettes Obtained Among Students who Smoke, by Grade and by Sex, Canada, Youth Smoking Survey 2002
  • 9-2b
    Usual Place Cigarettes Obtained among Students who Smoke, by Grade, Sex and Category of Smoker, Canada, Youth Smoking Survey 1994
  • 9-3
    Usual Place Cigarettes Obtained, by Grade and Category of Smoker, Canada, Youth Smoking Survey 2002
  • 9-4
    Usual Place Cigarettes Obtained among Students who Smoke, by Province Smokers, Canada, Youth Smoking Survey 2002
  • 9-5a
    Attempts to Purchase Cigarettes Among Students Who Smoke, by Sex and Grade, Canada, Youth Smoking Survey 2002
  • 9-5b
    Attempts to Purchase Cigarettes among Students who Smoke, by Sex and Grade, Canada, Youth Smoking Survey 1994
  • 9-6
    Strategies for Purchasing Cigarettes from Stores by Category of Smoker, by Grade, Sex, and Type of Smoker, Canada, Youth Smoking Survey 2002
  • 9-7
    Strategies for Purchasing Cigarettes from Stores Among Students Who Smoke, by Province, Canada, Youth Smoking Survey 2002
  • 9-8
    Attempts to ask a Stranger to Purchase Cigarettes, All Students by Sex and Grade, Canada, Youth Smoking Survey 2002
  • 9-9
    Attempts to Ask a Stranger to Purchase Cigarettes, by Category of Smoker and Grade, Canada, Youth Smoking Survey 2002
  • 9-10
    Attempts to Ask a Stranger to Purchase Cigarettes, All Students by Province, Canada, Youth Smoking Survey 2002
  • 9-11a
    Brand, Strength, and Tar Levels of Cigarettes Usually Smoked, by Grade, Sex and Category of Smoker, Canada, Youth Smoking Survey 2002
  • 9-11b
    Students* With a Usual Brand, by Sex and Grade, Canada, Youth Smoking Survey 1994
  • 9-12
    Brand, Strength, and Tar Levels of Cigarettes Usually Smoked, by Province, Canada, Youth Smoking Survey 2002
  • 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
  • 9-13b
    Reasons for Smoking Certain Brands Among Smokers With a Usual Brand, by Grade and Sex, Canada, Youth Smoking Survey 1994
  • 9-14a
    Brand Switching Among Smokers With a Usual Brand, by Sex, Grade, and Category of Smoker, Canada, Youth Smoking Survey 2002
  • 9-14b
    Brand Switching Among Smokers with a Usual Brand, by Sex, Grade, and Category of Smoker, Canada, Youth Smoking Survey 1994

Chapter 10

  • 10-A
    Weekend to Weekday Ratio of Daily Cigarette Consumption, Grades 5-9, Canada, Youth Smoking Survey 2002
  • 10-1
    Legal Purchase Age for Cigarettes by Province, Canada, 2002 and 1994
  • 10-2a
    Knowledge of Legal Purchase Age for Cigarettes, by Smoking Category, Grade and Sex, Canada, Youth Smoking Survey 2002
  • 10-2b
    Knowledge of Legal Purchase Age for Cigarettes, by Smoking Category, Grade and Sex, Canada, Youth Smoking Survey 1994
  • 10-3a
    Knowledge of Legal Purchase Age by Smoking Category and Province, Canada, Youth Smoking Survey 2002
  • 10-3b
    Knowledge of Legal Purchase Age by Smoking Category and Province, Canada, Youth Smoking Survey 1994
  • 10-4a
    Reported School Smoking Restrictions by Sex and Grade, Canada, Youth Smoking Survey 2002
  • 10-4b
    Reported School Smoking Restrictions by Sex and Grade, Canada, Youth Smoking Survey 1994
  • 10-5a
    Reported School Smoking Restrictions by Smoking Category, Grades 5-9 Canada, Youth Smoking Survey 2002
  • 10-5b
    Reported School Smoking Restrictions by Smoking Category, Grades 5-9 Canada, Youth Smoking Survey 1994
  • 10-6a
    Reported School Smoking Restrictions by Province, Grades 5-9, Canada, Youth Smoking Survey 2002
  • 10-6b
    Reported School Smoking Restrictions by Province, Grades 5-9, Canada, Youth Smoking Survey 1994
  • 10-7a
    Reported School Rules by Received Education on Health Effects of Smoking Taught in School, Grades 5-9, Canada, Youth Smoking Survey 2002
  • 10-7b
    Reported School Rules by Received Education on Health Effects of Smoking Taught in School, Grades 5-9, Canada, Youth Smoking Survey 1994
  • 10-8a
    Reported Student Compliance with School Rules (%) by Smoking Category, for Students who Reported Any School Smoking Rules, Canada, Youth Smoking Survey 2002
  • 10-8b
    Reported Student Compliance with School Rules by Smoking Category for Students who Reported Any School Smoking Rules, Canada, Youth Smoking Survey 1994
  • 10-9a
    Reported Impact of School Rules by Sex and Grade for Students who Smoked in Last 30 Days and Reported Any School Smoking Restrictions, Canada, Youth Smoking Survey 2002
  • 10-9b
    Reported Impact of School Rules by Sex and Grade for Students who Smoked in Last 30 Days and Reported Any School Smoking Restrictions, Canada, Youth Smoking Survey 1994
  • 10-10a
    Reported Impact of School Rules by Reported School Rules, for Students who Smoked in Last 30 Days and Reported Any School Rules, Canada, Youth Smoking Survey 2002
  • 10-10b
    Reported Impact of School Rules by Reported School Rules, for Students who Smoked in Last 30 Days and Reported Any School Rules, Canada, Youth Smoking Survey 1994
  • 10-11a
    Mean Daily Cigarette Consumption by Reported School Smoking Rules, Sex and Grade, Participants who Smoked in Last 30 Days, Canada, Youth Smoking Survey 2002
  • 10-11b
    Mean Daily Cigarette Consumption by Reported School Smoking Rules, Sex and Grade, Participants who Smoked in Last 30 Days, Grades 5-9, Canada, Youth Smoking Survey 1994
  • 10-12a
    Mean Daily Cigarette Consumption by School Smoking Rules and Day of the Week, Participants who Smoked in Last 30 Days, Grades 5-9, Canada, Youth Smoking Survey 2002
  • 10-12b
    Mean Daily Cigarette Consumption by School Smoking Rules and Day of the Week, Participants who Smoked in Last 30 Days, Grades 5-9, Canada, Youth Smoking Survey 1994

Chapter 11

  • 11-1
    Lifetime Prevalence of Alcohol and Other Drug Use, Grades 7-9, Canada, Youth Smoking Survey 2002
  • 11-2
    Lifetime Prevalence of Alcohol and Other Drug Use by Sex, Grade and Region, Grade 7-9 Students, Canada, Youth Smoking Survey 2002
  • 11-3
    Early Onset, Percentage Using Drug By Age 13, Grades 7-9, Canada, Youth Smoking Survey 2002
  • 11-4
    Lifetime Other Drug Use by Smoking Category, Grades 7-9, Canada, Youth Smoking Survey 2002
  • 11-5
    Lifetime Substance Use By Any Parental Smoking, Grades 7-9 Students, Canada, Youth Smoking Survey 2002
  • 11-6
    Lifetime Prevalence of Alcohol and Other Drug Use, Canadian Versus American Grade 8 Students
  • 11-7
    Percentage Using Cannabis During the Past 12 Months, Derived From Canadian School Surveys, 1990-2003

Chapter 12

  • 12-1
    Tobacco Use, Canada and Unites States, Grades 6-9
  • 12-2
    Smoking Category* by Sex - Canada and United States, Grades 6-9 Percentages
  • 12-3
    Smoking Category, by Grade, Canada and United States, Grades 6-9 Percentages
  • 12-4
    Ever Tried Smoking, by Country and Sex
  • 12-5
    Ever Tried Smoking, by Country and Age (Percentages)
  • 12-6
    Source of Cigarettes, by Grade, Canada and U.S., Grades 6-9 (Percentages)
  • 12-7
    Sales Refusals And Proof Of Age
  • 12-8
    Practices of Health Practitioners, Canada and United States (Percentages)

Acknowledgements

The 2002 Youth Smoking Survey Technical Report resulted from the collaboration of many individuals in a variety of agencies who contributed to its development and production.

The project team, responsible for authoring the report, included all first authors for each chapter. Project management and technical editing were provided by Steve Manske (Principal Investigator) and Margaret Morin from the Centre for Behavioural Research & Program Evaluation at the University of Waterloo, and by Alan Diener from the Tobacco Control Programme at Health Canada. Statistical analysis and verification was carried out by Rashid Ahmed from the University of Waterloo, with assistance from Vanessa Rampersad and Keerat Grewal. Final consistency checks and editing was completed by Eva Makomaski Illing from the Tobacco Control Programme at Health Canada.

Earlier versions of this report underwent multiple peer reviews both by internal and external reviewers who are acknowledged by name in each respective chapter. Thanks are due to Mary Jane Ashley from the University of Toronto who scientifically reviewed the entire report.

Last but not least, readers of this report are indebted to the 19,018 young Canadians who completed the questionnaires and 17,709 parents who completed the interviews and to their teachers and school administrators who demonstrated their interest in youth health by their generous cooperation with project staff.

Disclaimer

This report was written by many researchers across Canada from a variety of agencies and backgrounds, united by an interest in and a concern about youth smoking and youth use of drugs and alcohol. The opinions expressed in the chapters, found primarily in the Discussion sections of each chapter, are those of the authors and are not necessarily endorsed by Health Canada or the employers of the authors.

Notes on the Tables and Figures

Symbols

  • * Moderate sampling variability (CV between 16.5% and 33.3%); interpret with caution.
  • # Data suppressed due to high sampling variability (CV>33.3% or sample size less than 30)
  • - Data not available.

See chapter 2 for a more complete explanation.

Table Numbering
Tables designated by a letter appear in the text on the same page or immediately following the reference to them. Tables designated by a number are more detailed and follow the chapter.

Table Entries
Except for the population estimate, which is in thousands ('000), most table entries are percentages that add up to 100% across the rows. However, since whole numbers are presented, some rounding error may occur, and totals may not equal 100% exactly. All entries are weighted to reflect the estimated distribution among the entire Canadian population of youth in grades 5-9.

Statistical Significance
Differences highlighted in the text are statistically significant at the 5% level. Chapter 2 explains this testing in further detail and provides tables that the reader can use for testing of differences between population subgroups.

Some of the hyperlinks provided are to sites of organizations or other entities that are not subject to the Next link will take you to another Web site Official Languages Act. The material found there is therefore in the language(s) used by the sites in question.

Introduction

Steve R. Manske, EdD
Centre for Behavioural Research & Program Evaluation
University of Waterloo

Sarah J. Robinson, BKin
Department of Health Studies & Gerontology
University of Waterloo

Alan Diener, PhD
Tobacco Control Programme
Health Canada

Acknowledgements: The authors thank Scott Leatherdale (Cancer Care Ontario) and Susan Bondy (Ontario Tobacco Research Unit) who reviewed an earlier draft of this chapter and provided helpful commentary.

Survey Background and Objectives

Context of the 2002 Youth Smoking Survey

Tobacco use is Canada 's number one preventable cause of premature death. In the year 1998, it is estimated that the deaths of 47,581 Canadians were attributable to the use of tobacco industry products1.

The 2002 Youth Smoking Survey (YSS) concerns youth in grades 5-9 (roughly ages 10-14), the population most likely to first try or experiment with smoking. Since the 1994 YSS, we have not had a representative, in-depth picture of smoking among these young Canadians. This report updates the groundbreaking findings of the 1994 report2 and provides insights in additional areas of interest. It focuses exclusively on the youngest cohort reached through school-based surveillance to date. The 1994 YSS also included a phone-based survey of youth aged 15-19. This age group is now captured in the Canadian Tobacco Use Monitoring Survey (CTUMS), which has been conducted annually since 19993. Thus, these youth were not included in the 2002 YSS.

While selected provinces (most notably Ontario) have studied tobacco use among youth in grades 5-9 over a number of years, and others have more recently added periodic surveys (e.g., Atlantic provinces, Alberta, British Columbia), no nationally representative sample of these youth has been surveyed since 1994 (Table1-1). Information about youth in higher grades is somewhat better (Table 1-2), since 15-19 year olds (approximately equivalent to grades 10-13) are sampled in CTUMS. Dramatic shifts in tobacco use have occurred in older adolescent groups3 and adults3. Such shifts may also have occurred among youth in grades 5-9. It is important that planning and evaluation processes are informed by up-to-date data for these youth as well.

Historically, smoking prevalence among grades 5-9 students has remained at low absolute levels in comparison to other ages. Figures 1-A and 1-B display findings for grades 7 and 9 respectively, starting with the 1994 YSS data. In 1994, 7% of the Canadian population in grades 7 and 9 self-reported as current smokers (using a definition of having smoked at least one cigarette in the past 7 days recalculated based on 1994 YSS Technical Report3 data). Note that provincial data reported in Figures 1-A and 1-B use less stringent definitions of smoking.

A comparison of the YSS 1994 rates shown in Figures 1-A and 1-B, reveals the dramatic jump in current smoking rates between students in grades 7 and 9. This jump is also consistently reflected in provincial data reported in Figures 1-A and 1-B. Similar findings hold for males and females. Since 1994, smoking rates in both grade 7 and 9 students declined as illustrated by the provincial rates reported in Figures 1-A and 1-B.

Figure 1-A - Smoking Prevalence* by Province, Grade 7, Canada, 1994-2002

Figure 1-A - Smoking Prevalence* by Province, Grade 7, Canada, 1994-2002

*Note: Current smoking was defined as smoking greater than one cigarette in the past 12 months with two exceptions: (1) Canadian YSS 1994 data where current smoking included daily smokers and smoking in the past week; and, (2) BC data where current smoking was defined as smoking in the past 30 days.

Figure 1-B - Smoking Prevalence* by Province, Grade 9, Canada, 1994-2002

Figure 1-B - Smoking Prevalence* by Province, Grade 9, Canada, 1994-2002

*Note: Current smoking was defined as smoking greater than one cigarette in the past 12 months with two exceptions: (1) Canadian YSS 1994 data where current smoking included daily smokers and smoking in the past week; and, (2) BC data where current smoking was defined as smoking in the past 30 days.

For the next oldest age grouping (approximately grades 10-12), the rapid rise in smoking continues. In 2003, national data indicate 13% of males and17% of females aged 15-17 years were current smokers (defined as answering "yes" to "At the present time do you smoke cigarettes every day or occasionally?")3. These rates increased further to 24% of males and 25% of females aged 18-19 years 3. Similar increases were observed in 2002 data from the United States, where smoking rates rose steadily in high school to peak in twelfth grade students at 26%4. The approximately quadrupling of smoking rates in the 10-year age span is a deep cause for concern. We need ongoing surveillance of smoking rates and related behaviours, attitudes and influences that may contribute to or stem these increases as the cohort ages. This information, in turn, may assist the development of policies and programs to help reduce the impact of smoking on the health of Canadians.

Age of smoking onset is another indicator of the need for surveillance in the youngest age group. The 2003 CTUMS data indicate that more than half (56%) of respondents age 15 and older had their first cigarette by age 152. Age of onset was consistent across genders. The 1994 YSS reported that the greatest relative increase (300%) in beginning smoking was between 10 and 12 years of age (with an increase in the prevalence rate from 2% to 8%)2. Even modest increases in prevalence rates represent large numbers of youth nationally.

To fully understand the impact of youth smoking, we need to translate youth smoking rates into health and economic costs. The majority of these costs are delayed 20+ years from smoking onset, so looking only at the impact on youth is not fully informative. The most recent data suggest that the direct health care costs attributable to smoking among all ages in Canada amounted to $2.4 billion in 19965. Table 1-A partials out these costs for the years 1991 and 1996 and reveals the need for up-to-date and projected costs. While taxes resulting from cigarette sales contributed about $2.1 billion in excise duties and excise taxes to the economy in 19966, total direct (e.g., time in hospital) and indirect (e.g., lost productivity) costs attributable to tobacco smoke far exceeded this figure, amounting to $15.2 billion in that year. Using more stringent assumptions Single and colleagues estimated costs attributable to tobacco smoke were $9.6 billion in 19927. As reported in the YSS Technical Report 1994, these smoking-attributable costs have continued to rise steadily since 1966. Due to the lag period of much smoking-attributable illness and mortality, these figures will remain high for several years and will not drop without significant and sustained efforts to reduce the number of smokers in Canada.

Table 1-A - Smoking Attributable Economic Costs, Canada, 1991 and 1996
Cost Item Cost in 1991
(in $ Billion)7
Cost in 1996
(in $ Billion)8
Direct Costs
Health Care 2.5 2.4
Residential Care 1.5 (not available)
Workers' Absenteeism 2.0 2.2
Fires 0.8 (not available)
Indirect Costs
Lost Future Income Due to Premature Death 10.5 11.3
Adjustments for Future Costs (if Smokers Had Not Died) -1.5 -0.7
Total Costs $15.8 $15.2

The Canadian response to the health crisis posed by the use of tobacco products has grown with time. Built on both Canadian experience and successful interventions elsewhere, this response has incorporated a comprehensive approach. The technical report for the 1994 Youth Smoking Survey2 indicated:

Prevention, cessation, and protection are the three pillars of Canada 's national anti-tobacco strategy. First articulated in the 1987 Directional Paper of the National Program to Reduce Tobacco Use in Canada8 these three objectives were reiterated in the update of the National Strategy to Reduce Tobacco Use in 19939 and the Tobacco Demand Reduction Strategy of 199410. Protection and cessation are the focus of Tobacco Control, A Blueprint to Protect the Health of Canadians, released by Health Canada in late 199511. The strategies and tactics outlined in these documents make it clear that prevention, protection, and cessation are mutually reinforcing. Prevention and cessation both serve to reduce smoking and thus environmental tobacco smoke, while protection measures promote cessation by removing opportunities to smoke. Protective measures also reinforce prevention efforts by reducing the modeling of smoking as a normal and desirable behaviour.

To the above objectives, for the new millennium, the federal strategy12 added harm reduction. Harm reduction refers to efforts to regulate products in such a way as to reduce the risk from tobacco use. Further, the National Tobacco Control Strategy13 endorsed by the federal and provincial/territorial governments and non-governmental organizations, has identified tobacco industry denormalization, as an important objective.

Also complementary to the above strategies, 9 of 10 provinces and 2 of 3 territories have identified provincial / territorial strategies for tobacco control 1. Despite these efforts, Table 1-B indicates that per capita expenditures fall far below those recommended by the Centers for Disease Control (CDC) in the United States to implement evidence-based best practices in state tobacco control. These estimates range from US$7 to $20 per capita [approximately $8.75-$25 Canadian) in states with population under 3 million, to US$5 to $16 per capita (approximately $6.25-$20 Canadian) in states with population over 7 million)14. Canada 's average expenditure (CAN$1.79) lags far behind the US average and even farther behind CDC's recommended per capita expenditures. On the other hand, jurisdictions like California have made substantive inroads into tobacco use reduction with funding that exceeds the Canadian average, but does not reach CDC's recommended level. Canadian jurisdictions should monitor costs and outcomes to assess the value they for resources invested.

Table 1-B - Per Capita Funding for Tobacco-Control (2002-2003) by Territories, Provinces in Canada and Selected US States15
Select Jurisdictions Population 2002-2003 Funding (CDN$) Per Capita Spending (CDN$)
CANADA 30,454,994 54,595,815 1.79
NT 41,186 317,815 7.72
NU 28,300 150,000 5.30
AB 3,086,034 11,700,000 3.79
QC 7,435,504 20,000,000 2.69
NS 943,756 1,600,000 1.70
ON 11,964,104 19,000,000 1.59
BC 4,120,891 4,400,000 1.07
PE 139,330 114,000 0.72
SK 1,014,403 584,000 0.58
MB 1,148,181 668,000 0.52
NL 533,305 250,000 0.47
NB 729,498 Unknown Unknown
YK 28,674 Unknown Unknown
United States (all) 284,796,887 1,190,707,200 4.18
Maine 1,286,670 21,333,504 16.58
Mississippi 2,858,029 31,008,000 10.85
Minnesota 4,972,294 44,806,560 9.01
California 34,501,130 208,590,816 6.05
Maryland 5,375,156 31,085,520 5.78

Objectives of the YSS

To pursue the multiple objectives of tobacco control effectively, comprehensive data are needed on behaviour, attitudes, beliefs, knowledge, and social influences. These data are needed not only for the population as a whole, but also for particular subsets, most notably youth. The YSS is the best source yet of such data at a national level, and this report of the 2002 YSS survey updates findings from the previous 1994 survey.

The 2002 YSS builds upon the objectives of the earlier YSS, and thus are largely consistent with those detailed in the 1994 YSS technical report: Specifically, the 2002 YSS was:

  • to update the 1994 survey and provide a current national picture of youth smoking behaviour for students in grades 5-9;
  • to provide insights into the regulatory, educational, and social influences2 that youth face in deciding whether or not to experiment with or take up smoking, continue with the habit, or stop smoking;
  • to establish a resource for making sound, evidence-based decisions on federal and provincial policies and programs to control tobacco use among Canada's youth; and,
  • ultimately, to contribute to Canada 's tobacco control monitoring systems.

In addition, 2002 YSS objectives were enhanced to gain perspective in the following areas:

  • students' experiences with alcohol and drug use in grades 7-9;
  • the impact of health practitioners (doctors and dentists) on smoking behaviour;
  • other potential correlates of smoking (e.g., physical activity, reading, recreation and self image).

Overview of the YSS Content

Table 1-C summarizes the topics covered in the 2002 YSS compared to those covered in the 1994 survey.

Table 1-C - 2002 & 1994 YSS Questionnaire Content
Questionnaire Content YSS 2002 YSS 1994
Student Questionnaire    
Smoking Prevalence x x
Smoking Behaviour, Other Forms of Tobacco Use, Attempts to Quit x x
Social and Demographic Factors (Influence of Family, Friends, Teachers) x x
Acquisition of Cigarettes x x
Impact Of Policies (In School and at Work) x x (School Only)
Education (At School, Pack Warnings) x x
Attitudes and Beliefs About Smoking x x
Awareness of Health Effects of Smoking x x
Youth Funds Available for Purchasing x x
Tobacco Marketing Influences x x
Experience with Alcohol and Other Drugs* x  
Influence of Health Practitioners x  
Physical Activity, Reading, Recreation, Self Image x  
Parent Interview    
Household Composition x x
Demographics
   Education
   Occupation
   Income
 
x
x
x
 
 
x
Child Access to Health Services (Family Doctor, Dentist) x  
Smoking Restrictions in The Home x  
Smoking Prevalence in The Home x  

* These items were surveyed in grades 7-9 only.
To protect the confidentiality of proprietary business information, brand preference was not included in the file provided by Statistics Canada. It was replaced by derived information on cigarette strength and tar levels.

Uses of the YSS Data

While the data collected for the YSS suit many purposes, they are primarily intended to facilitate the planning and monitoring of tobacco control policies and programs. Given the age group surveyed and national scope of the sample, the YSS is best suited to the prevention focus of the Federal Tobacco Control Strategy 12 and the National Tobacco Control Strategy 13. To a lesser extent, analysis of questions in the survey also contributes to understanding of progress toward cessation, protection, harm reduction (Federal Strategy), and tobacco industry denormalization (National Strategy) objectives.

In general, surveillance needs for older age groups, including older youth, are well served by the Canadian Tobacco Use Monitoring Survey (CTUMS)3, the Canadian Community Health Survey (CCHS)16 and other data collection systems (e.g., School Smoking Profile17. However, Canada lacks current, nationally based trend data for tobacco use in youth in grades 5-93, encompassing the age group marked by the onset of tobacco use2. The 2002 YSS remedies this deficiency. The survey complements behavioural data with items tapping a variety of influences on smoking among students in grades 5-9. Analyses of these data will permit policy-relevant interpretation in the areas of education and health promotion, restrictions on public smoking, and denormalization of the tobacco industry. Finally, the addition of items tapping non-medical substance use in the 2002 YSS will facilitate the linkage of tobacco policy to policy in other areas of health protection and promotion. Chapters 3-12 are organised to improve understanding of this wide range of domains.

In addition to the policy driven uses of YSS data, the 2002 survey may facilitate further research in youth smoking. Unfortunately, this did not happen with the 1994 YSS data. A search of the Medline database from 1996-2004 did not find any reports analysing these data, in spite of their rich potential. The consistency of 2002 YSS items with those in the 1994 survey, and the comparable (large) sample size should make further research using these data more appealing to the research community. Large samples are required especially when behaviours are relatively infrequent, as is the case with many topics relevant to the grades surveyed with the YSS.

Overview of YSS Methods

The 2002 YSS was a two-stage stratified clustered design with schools as the primary sampling units and classes as the secondary units. Within each province, each school containing students in grades 5-9 was placed in one of two strata depending on whether the school was located in a Census Metropolitan Area4 or not, with an additional stratum in Quebec and Ontario for Montreal and Toronto. Within each stratum, for each of grades 5-9, schools were selected with probability proportional to their size. Then from the selected schools, field personnel selected one eligible class at random from those in the school at the designated grade.

The 2002 YSS was administered to students within selected classes and was supplemented by telephone interviews with parents. Although the basic function of the 2002 parent's questionnaire remained the same as it was in 1994 (i.e., the collection of socio-economic information about the child's family), the content was significantly augmented. Both the students' and parents' surveys were conducted under the voluntary provisions of the Statistics Act18.

Sufficient response rates were acquired for the targeted population. The student response rate was 82%, comprising 19,018 usable questionnaires. These questionnaires were used to provide estimates for the 2,027,506 students in the target population (grades 5-9). The number of responses was large enough to perform detailed analysis. This allows reliable provincial estimates to be available for many variables, an important consideration because the provinces have major responsibility for tobacco control in their populations and complete jurisdiction over activities in schools.

Statistics Canada was responsible for the sample design, data collection, and data processing. It collaborated with Health Canada on questionnaire design. The school questionnaire and the parent questionnaire were both developed through feasibility studies, pilot tests, and qualitative testing, including a series of in-depth interviews with children in grades 5-9.

Organization of the Report

Conceptual Framework of the Analysis

Figure 1-C displays a simplified model that guided development of the questionnaire and this report. Consistent with the 1994 survey, the principles used to guide efforts are consistent with a social-cognitive approach to explaining behaviour19 along with the policy context. Potential relationships between content areas are also suggested in Figure 1-C.

Foundational to the YSS is its assessment of past and current smoking behaviour, and expectations about future smoking behaviour, found at the bottom of Figure 1-C. The survey details current smoking behaviour, permitting distinctions at several levels of smoking behaviour appropriate to youth including youth with no smoking experience (Never Smoker who has Never Seriously Thought About Smoking, Never Smoker who has Seriously Thought About Smoking) and those with smoking experience (Puffer, Smoked Beyond Puffing, Not Daily Smoker, Daily Smoker). The survey also permits less-detailed descriptions of past behaviour (e.g., age of initiation for smokers and age of any attempts to stop) and future behaviour (e.g., expectations in one year, experimentation within a month for persons not currently smoking). The boxes surrounding the smoking behaviour box identify potential influences. These include items concerned with acquisition of cigarettes and restrictions on smoking in schools and the home, which could inform potential policy and program initiatives around the availability of cigarettes and the curtailment of where smoking is allowed. Added for 2002 are items that describe other behavioural influences (alcohol and non-medical drug use, recreational activities). The survey also explores selected psychosocial and educational influences that might influence decisions to experiment, start, continue, abstain, or stop smoking. These take the form of intra-personal factors, such as knowledge, beliefs, and attitudes about smoking. Inter-personal or social influences explored include the behaviours of parents and close friends and attitudes of parents. The influence of these social models surrounding youth may be moderated by educational influences. For instance, the survey explores the use of and support from health professionals (doctors and dentists). Respondents describe school lessons on tobacco use and awareness of cigarette pack warnings. Each of these topics may influence decisions to start, continue or stop smoking.

Figure 1-C - Smoking Behaviour and Social-Cognitive-Policy Influences Covered in YSS 2002

Figure 1-C - Smoking Behaviour and Social-Cognitive-Policy Influences Covered in YSS 2002

Format of the Report

The structure of this report is outlined in accordance with the conceptual framework, illustrated in Figure 1-C.

Chapter 2 provides details of survey methods including survey design, sample design, data collection, and analyses. Following this, smoking behaviour is described in Chapters 3 and 4. Chapter 3 provides prevalence data on types of smoking, as well as detail on such behaviours as inhaling, use of smokeless forms of tobacco, age of initiation, and expectations of future behaviour. Chapter 4 is devoted to the topic of stopping smoking, an important issue even among this young population.

Chapters 5 through 10 describe influences on smoking and the acquisition of cigarettes - factors that may either positively or negatively influence the development of smoking or lifelong abstinence.

Social influences originating from peers and parents are the topic of Chapter 5, while Chapter 6 looks at the perceived impact of heath practitioners, specifically doctors and dentists, on smoking behaviour (a topic that is novel to the 2002 YSS). Chapter 7 deals with more cognitive and value-laden influences - beliefs and attitudes about smoking, cigarette package health warning messages, health issues, and the reasons why smokers start. These three chapters are highly relevant to strategies focused on prevention.

Chapter 8 discusses knowledge of health problems and cigarette package health warning messages, the smoker's awareness of the contents of his or her own brand, and whether he or she learned in school about the dangers of smoking. The results of this chapter are important for those who design and deliver prevention-oriented programs, especially health education messages, as well as those whose focus is on protective legislation and regulation.

Chapter 9 examines many aspects of cigarette access that are relevant to tobacco control: usual source of cigarettes, attempts and strategies to purchase cigarettes, and usual brand. Most of these topics are directly relevant to objectives set out in the Federal and National Tobacco Control Strategies.

Regulatory restrictions on smoking are the subject of Chapter 10. This chapter describes the existence of restrictions on smoking in schools and whether these restrictions have had, or would have, the desired impact on youth smoking. Data are also presented on knowledge of the minimum age to purchase cigarettes. All of these topics are relevant to the Federal and National Tobacco Control Strategies and to the objectives of prevention, protection, cessation, harm reduction, and tobacco industry denormalization.

Insight into additional unhealthy behaviours of students is depicted in Chapter 11, including utilization rates of alcohol and drugs for non-medicinal purposes. The content of this chapter is another new component in the 2002 YSS, enabling the relationships among various risk behaviours to be better understood.

Chapter 12 deals with international comparisons of tobacco use and is a new chapter for the 2002 report. Comparison of the progress of Canada and other countries in youth tobacco control may facilitate identification of effective strategies.

Chapter 13 concludes the report with a synthesis of the findings reported in Chapters 3 through 12, and a discussion of the implications of findings, particularly with regard to tobacco control programs and policies.

Format of Chapters 3-12

The ten chapters that present the findings of the 2002 YSS share a common format. Each chapter begins with highlights of its findings, and a description of the methods specific to the chapter. Then, the findings are presented and described using text, tables and figures. Next, the findings are interpreted with reference to any methodological issues and data from other sources. Each chapter concludes with a discussion of policy and program implications of the findings and the identification of unanswered questions that should be addressed in further analysis.

Detailed tables follow each chapter, while summary figures and text tables appear within each chapter. As described in detail in Chapter 2, commonly accepted standards are used for qualifying the data appearing in tables and figures and for testing the significance of differences noted in the text.

Taken together, the chapters in this technical report issue a challenge to tobacco control stakeholders. The enhanced understanding of patterns of tobacco use and related behaviours and correlates offers an opportunity for evidence-based planning of policy and practice in tobacco control. The simple tabulations described suggest opportunities for more complex statistical controls in further research using the data. Difficulties accessing the 1994 data may account for the dearth of reports utilizing that survey. Statistics Canada has now made both the 1994 and 2002 datasets available through Regional Data Centres, thus markedly improving access. The authors of the current report trust that their efforts in this volume will signal the start of considerable activity to utilize the data effectively for further action to reduce the health burden caused by the use of tobacco industry products in Canada. We hope that the next Youth Smoking Survey will reflect further decreases in youth tobacco use as a result of these actions.

Footnotes

1. Provincial Tobacco Control Strategies: British Columbia Tobacco Strategy, Alberta Tobacco Reduction Strategy, Manitoba Provincial Tobacco Control Strategy, Ontario Tobacco Strategy, Plan Québécois de Lutte Contre le Tabagisme, New Brunswick Tobacco Strategy, Prince Edward Island Strategy for Healthy Living, Nova Scotia Comprehensive Tobacco Strategy, Newfoundland ACT Tobacco Reduction Strategy, Yukon Tobacco Reduction Strategy, Northwest Territories Action on Tobacco

2. While the 1994 YSS examined commercial influences [i.e., advertising and sponsorship] as part of social influences, the 2002 YSS did not.

3. This report will refer to the sample by the conventional grade system 5-9. Please note grades 5, 6, 7, 8, and 9 coincide with the Quebec grades Cycle 3-1, Cycle 3-2, Secondaire I, Secondaire II and Secondaire III respectively.

4. A Census Metropolitan Area is an area consisting of one or more adjacent municipalities situated around a major urban core that must have a population of at least 100,000.

References

1. Makomaski Illing, EM, Kaiserman, MJ. Mortality Attributable to Tobacco Use in Canada and its Regions, 1998. Canadian Journal of Public Health 2004; 95 (1): 38-44.

2. Health Canada. Youth Smoking Survey, 1994: Technical Report. Stephens T, Morin M, editors. 1-209. 1996. Ottawa, Minister of Supply and Services Canada.

3. Health Canada. Canadian Tobacco Use Monitoring Survey (CTUMS).

4. Vilsaint M, Green M, Xiao J, Davis K, Vallone D, Allen J. Legacy First Look Report 13. Cigarette Smoking Among Youth: Results from the 2002 National Youth Tobacco Survey. 13. 2004. Washington, DC, The American Legacy Foundation.

5. Health Canada. School-based Smoking Prevention: Economic Costs Versus Benefits. Health Canada. 2004.

6. National Clearinghouse on Tobacco and Health. Do Tobacco Taxes Cover the Health Care Costs Associated with Smoking? Canadian Council for Tobacco Control. 2004.

7. Single E, Robson L, Xie X, Rehm J et al. Next link will take you to another Web site The Costs of Substance Abuse in Canada : A Cost Estimation Study. Highlights (PDF version). O ttawa, ON : Canadian Centre on Substance Abuse, 1996.

8. Consultation PaIC. Directional Paper of the National Strategy to Reduce Tobacco Use in Canada. 1987. Ottawa, Health and Welfare Canada.

9. Health Canada. The Directional Paper of the National Strategy to Reduce Tobacco Use, An Update: 1993. 1993. Ottawa, Health Canada.

10. Health Canada. Tobacco Demand Reduction Strategy: One Year Review and Update. 1995. Ottawa, Health Canada.

11. Health Canada. Tobacco Control, A Blueprint to Protect the Health of Canadians. 1995. Ottawa, Minister of Supply and Services Canada.

12. Health Canada. Federal Tobacco Control Strategy: A framework for action. 12-1-2002.

13. Steering Committee of the National Strategy to Reduce Tobacco Use in Canada. New Directions for Tobacco Control in Canada : A National Strategy. Health Canada. 8-2-2002.

14. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs - August 1999. 1-87. 1999. Atlanta, GA, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

15. Ontario Tobacco Research Unit. Indicators of OTS Progress. 2004. Toronto, ON, Ontario Tobacco Research Unit. Monitoring and Evaluation Series, 2002-2003 (Vol. 9, No. 3).

16. Statistics Canada. Canadian Community Health Survey. Statistics Canada. 18-12-2003.

17. Cameron R, Brown KS, Manske S, Jolin MA, Murnaghan D, Lovato C. Development of Community Level Data Collection Systems to Link Research and Practice: The Example of the School Smoking Profile. Unpublished Paper, University of Waterloo, 8-6-2004.

18. Government of Canada DoJ. Statistics Act (R.S. 1985, c. S-19. Government of Canada. 11-11-2004. 11-11-2004.

19. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall, 1986.

20. Adlaf E, Paglia A. Next link will take you to another Web site Drug Use Among Ontario Students 1997 - 2003 - Detailed OSDUS Findings (PDF version). CAMH Research Document Series No. 13. Toronto : Centre for Addiction and Mental Health. 2003.

21. Alberta Alcohol and Drug Abuse Commission. The Alberta Youth Experience Survey 2002 : Technical report. Alberta Alcohol and Drug Abuse Commission, Edmonton, Canada, 2003.

22. The McCreary Centre Society. Healthy Next link will take you to another Web site Youth Development: Highlights from the 2003 Adolescent Health Survey III. Vancouver, BC : McCreary Centre Society, 2004.

23. Patton D, Brown D, Broszeit B, Dhaliwal J. Next link will take you to another Web site Substance Abuse among Manitoba High School Students (PDF version). Addictions Foundation of Manitoba, 2001.

24. Perron B, Loiselle J. Next link will take you to another Web site Enquête québécoise sur le tabagisme chez les élèves du secondaire, 2002. Rapport d.analyse, Québec: Institut de la statistique du Québec.

25. Liu J, Jones B, Grobe C, Balram C, Poulin C. Next link will take you to another Web site New Brunswick Student Drug Use Survey 2002: Technical Report (PDF version). Fredericton, NB : New Brunswick Health and Wellness.

26. Poulin C. Next link will take you to another Web site Nova Scotia Student Drug Use Survey 2002: Technical Report (PDF version). Halifax, Nova Scotia : Addiction Services, Nova Scotia Department of Health and Dalhousie University, 2002.

27. Van Til L, Poulin C. Next link will take you to another Web site Prince Edward Island Student Drug Survey 2002: Highlights Report (PDF version). Charlottetown, Prince Edward Island : Document Publishing Centre, 2002.

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34. Statistics Canada. Next link will take you to another Web site Survey on Smoking in Canada, 1994. Ottawa : Statistics Canada.



Table 1-1 - Health Behaviour Surveys, Grades 5-9, Canada

SURVEY

YEAR

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

School-Based

Youth Smoking Survey2

T

 

 

 

 

 

 

 

T,A,O, G

 

Ontario Student Drug Use Survey20

 

T,A,O

 

T,A,O

 

T,A,O

 

T,A,O

 

T,A,O

Alberta Youth Experience Survey (TAYES)21

 

 

 

 

 

 

 

 

T,A,O

T,A,O

British Columbia Adolescent Health Survey22

 

 

 

 

T,A,O,G

 

 

 

 

T,A,O,G

Manitoba Addictions Foundation High School Survey23

 

 

 

 

 

 

 

T,A,O

 

 

Quebec Survey of Tobacco Use in High School Students24

 

 

 

 

T

 

T,A,O

 

T,A,O

 

Atlantic Provinces Student Drug Use Survey25-27

 

 

T,A,O,G

 

 

 

 

T,A,O,G

 

 

Yukon A Cappella North 2 (ACN2)28

 

 

 

 

 

 

 

T,A,O

 

 

House-hold Based

National Population Health Survey (age 12+)29,30

T,A,G

 

T,A,G

 

T,A,G

 

T,A,G

 

T,A,G

 

National Longitudinal Survey of Children & Youth31

T,A,O,G

 

T,A,O,G

 

T,A,O,G

 

T,A,O,G

 

T,A,O,G

 

Canadian Community Health Survey (age 12+)16

 

 

 

 

 

 

 

T,A,O,G

 

T,A,O,G

T= Tobacco A= Alcohol O= Other Drugs G= General Health

5 Non school-based surveys did not sample grades, and not all grades were sampled in all surveys.

Table 1-2 - Health Behaviour Surveys, Grades 10-12, Canada

SURVEY

YEAR

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

School-Based

Ontario Student Drug Use Survey20

 

T,A,O

 

T,A,O

 

T,A,O

 

T,A,O

 

T,A,O

Alberta Youth Experience Survey (TAYES)21

 

 

 

 

 

 

 

 

T,A,O

 

British Columbia Adolescent Health Survey22

 

 

 

 

T,A,O,G

 

 

 

 

T,A,O,G

Manitoba Addictions Foundation High School Survey23

 

 

 

 

 

 

 

T,A,O

 

 

Quebec Survey of Tobacco Use in High School Students24

 

 

 

 

T

 

T,A,O

 

T,A,O

 

Atlantic Provinces Student Drug Use Survey25-27

 

 

T,A,O,G

 

 

 

 

T,A,O,G

 

 

1996 NWT Alcohol & Drug Survey32

 

 

T,A,O,G

 

 

 

 

 

 

 

Yukon A Cappella North 2 (ACN2)28

 

 

 

 

 

 

 

T,A,O

 

 

House-hold Based

Youth Smoking Survey2

T

 

 

 

 

 

 

 

 

 

Canada's Alcohol & Other Drugs Survey33

T,A,O

 

 

 

 

 

 

 

 

 

Canadian Tobacco Use Monitoring Survey3

 

 

 

 

 

T

T

T

T

T

Survey on Smoking in Canada34

T

 

 

 

 

 

 

 

 

 

T= Tobacco A= Alcohol O= Other Drugs G= General Health

6Non school-based surveys did not sample grades, and not all grades were sampled in all surveys; Ontario included Grade 13, until 2001, when that grade was eliminated in the province.

Survey Methods

K. Stephen Brown, PhD
Department of Statistics and Actuarial Science &
Health Behaviour Research Group
University of Waterloo

Alan Diener, PhD
Office of Research, Surveillance and Evaluation
Tobacco Control Programme
Health Canada

Rashid Ahmed, MSc
Health Behaviour Research Group
University of Waterloo

David Hammond, MSc
Department of Psychology
University of Waterloo

Acknowledgements: The authors thank Judy Snider (Health Canada) and Sue Bondy (University of Toronto) who reviewed an earlier draft of this chapter and provided helpful commentary.

Introduction

This chapter provides the essential methodological details for the 2002 Youth Smoking Survey (YSS). As described in Chapter 1, the 2002 YSS was designed to provide a comprehensive look at the smoking habits of Canadian youth in grades 5-9, as well as to collect information on the use of alcohol and other drugs by youth in the older grades (7-9). Parents of youth in the survey also provided data. The 2002 YSS was modeled after the school-based portion of the 1994 YSS. Thus, taken with the 1994 YSS, the 2002 YSS provides a means for examining changes in smoking rates among youth in grades 5-9 who were approximately 10-14 years old at the time of each survey. As well, like the 1994 YSS, the 2002 YSS gathered information on a wide array of factors that might be associated with the smoking habits of Canadian youth. The comparisons between these factors and their associations with smoking also offer an opportunity to address changes over the period between surveys, both in these associated variables and in the strength of their association with smoking.

As with any survey, understanding the basic methods used to gather, analyse and present the data is essential in order to put the results in perspective. This chapter describes the basic features of the survey design and the data collection protocol. It also deals with some analysis issues that will be further described or amplified in later chapters. Since a major aim of the analyses presented in later chapters will be to compare findings in 2002 to those from 1994, information on the 1994 survey is also summarized here. Further details on the 1994 survey can be found in the Youth Smoking Survey, 1994: Technical Report 1. In addition, readers wishing more detail on either the 1994 YSS or 2002 YSS should consult the Youth Smoking Survey 1994: Microdata User's Guide 2, and/or the Youth Smoking Survey 2002: Microdata User's Guide3.

Survey Design

The 2002 YSS gathered data from students in grades 5-9 and their parents between November 2002 and January 2003. The survey collected information on the prevalence of smoking, types of smoking behaviour, social and demographic factors associated with the behaviour, where and how youth obtain cigarettes, beliefs and attitudes about smoking, and recollection and opinions on health warnings messages on cigarette packages. In addition to the core set of tobacco questions, students in grades 7-9 were asked questions on their alcohol and non-medical drug use.

The 2002 YSS differed from the 1994 YSS in several respects. First, in 1994, youth aged 10-14 were surveyed in schools, while youth 15-19 were surveyed by telephone at home. Beginning in 1999, data from the 15-19 year age group has been obtained on a regular basis as part of the Canadian Tobacco Use Monitoring Survey (CTUMS). Consequently, youth 15-19 were not surveyed in the 2002 YSS. Second, the 1994 questionnaire focused only on smoking and related variables, whereas the 2002 YSS questionnaire was more comprehensive, including items related to alcohol and other drug use and tobacco control policy (e.g., acquisition of and access to cigarettes). Third, the 2002 YSS included a more extensive survey of the parents of children who participated in the school survey. The parent survey collected information about parental smoking behaviour, smoking restrictions and socio-economic variables. The 1994 YSS parent survey included only items on household membership, occupation and labour force activity. Finally, to be consistent with the way results of provincial school-based surveys are reported, in this report results are presented by g rade, rather than by age as was the case in the 1994 YSS.

Target Population

In any survey, the target population is the population to which the conclusions from the survey may be assumed to apply. In the 2002 YSS, the target population consisted of all young Canadian residents in grades 5-9 inclusive attending public and private schools in the 10 Canadian provinces. Youth residing in the Yukon, Nunavut and the Northwest Territories were not included, nor were youth living in institutions or on First Nations reserves. Further, youth attending special schools (e.g., schools for the blind) or attending schools on military bases were excluded from the target population. In addition, youth enrolled in classes with fewer than 10 children, and young people in remote northern reaches of the provinces were also excluded.

Design

The 2002 YSS was a two-stage stratified clustered design with schools as the primary sampling units and classes as the secondary units. A listing of all public and private schools in Canada that provided enrolment by grade for the 1999-2002 school years was used as the sampling frame. Within each province, each school containing students in grades 5-9 was placed in one of two strata depending on whether the school was located in a Census Metropolitan Area 1 or not, with an additional stratum in Quebec and Ontario for Montreal and Toronto. Within each stratum, for each of grades 5-9, schools were selected with probability proportional to their size, with the selection done independently for each grade so that some schools may have provided classes at more than one grade. Then from the selected schools, field personnel selected one eligible class at random from those in the school at the designated grade. All students in the selected class were to be surveyed. In addition, one parent of each child selected was to complete a 15-item parent survey.

In order to obtain estimates of sample proportions with reasonable precision within province (i.e., a minimum estimable proportion of 0.10 [10%] combined with a maximum coefficient of variation [CV] of 16.5%), it was determined that a total of 20,000 respondents (2,000 per province) would be needed. Within provinces, the sample was allocated proportionately to each stratum based on enrolment figures.

Based on the above considerations, the final sample consisted of 1070 classes in 982 different schools, in 327 distinct school boards.

Data Collection and Response

Sampling and Non-Sampling Errors

Survey methodologists refer to two major types of errors associated with sample surveys such as the 1994 YSS and the 2002 YSS: sampling errors and non-sampling errors. Sampling errors (see below) result because the chosen sample is only one of many that could have been selected using the sampling scheme. Thus, the differences between the results based on a sample and the results from the entire population will differ from sample to sample. These differences are known as sampling errors. The likely size of sampling error can be quantified using statistical methods.

While sampling errors refer to the simple chance aspect of error associated with using a sample rather than the whole population, non-sampling errors are errors that may be introduced due to other factors. A very common cause of non-sampling error is non-response. Non-response is unlikely to be strictly by chance as there may be different kinds of people who refuse the whole, or parts of, the survey. Non-response can be introduced if school boards/districts refuse to participate, if schools in consenting boards do not participate, if students in consenting schools do not get parental permission or refuse to participate, or if students with consent are absent on the day data are collected. Another type of non-response occurs when a student does not answer a question that the student should have answered. This could happen if the student does not understand or misinterprets a question, refuses to answer a question, cannot recall the requested information or misses a question because of skip patterns. In addition, students could answer a question that, based on answers to previous questions, is not intended for them. The results based on those that do provide data may not agree with the true values in the whole population. For example, if schools with very active tobacco control programs are more likely to consent to the survey, and/or if students who are absent are more likely to be smoking, then drawing conclusions for the whole population of youth based on those giving consent for the data collection in consenting schools could under estimate the true smoking rates.

Adjustment for some of the effect for non-response is possible by weighting (see below), but there are no methods for fully quantifying the systematic biases introduced by non-response. Hence, a full discussion of response rates is very important.

School Component Consent Procedures

The consent procedure began in June 2002 with an approach to the school boards/districts that contained selected schools. In addition, the Council of Ministers of Education was given a notice of intention in the fall of 2002. Sampled schools from non-consenting boards/districts were replaced with schools from consenting boards that had a similar profile in terms of enrolment and grades taught. By replacing with similar schools, it was hoped that the impact of non-response would be minimized. In some instances when large boards/districts refused, there were no comparable consenting boards and they were not replaced.

After board/district consent was received, consent was obtained from principals of selected schools. For school refusals, a similar procedure to that for the boards/districts was used to replace the non-consenting schools to reduce the impact of non-response. In instances where selected schools had closed, moved or no longer taught the selected grade, a decision on whether to replace the school with the school to which the students would have relocated was based on whether other students would already be in that grade and/or whether students from the same grade in other schools would have transferred to that school.

Following school approval, trained interviewers visited the school and prepared a package for each student that contained an introductory letter and parental permission consent form. Students were to take the package home. The completed consent forms were picked up at the school by the interviewer one week later. At that second visit, those students who had not returned the parental consent form were identified and their parents were contacted by telephone to provide consent over the telephone. Some principals would not release parents' telephone numbers, and, in these instances, further recruitment of the children who had not returned parental permission forms could not occur.

Parent Component Consent Procedure

If a student had parental consent and if a telephone number was available, an interview was attempted with a parent of the participating child. If there was consent for the child but no telephone number, the parent interview was not attempted. Parents who were contacted by telephone could refuse to participate in the interview.

Sample of Classes and Students

Table 2-A provides participation information at the board/district level and school level. Using the procedures described above, replacements were found for many of the boards/districts and schools that denied consent. However, in some provinces, school boards could not be replaced because the very large size of the boards made them unique, or because there were no other boards of that size available as replacements. This was particularly true in Alberta and Ontario where several large, urban boards refused to provide consent and could not be replaced. In fact, in Alberta, there were no schools selected from major urban boards. Consequently, the proportion of students from major urban boards is less than would be expected, and, if such students are more (or less) likely to smoke, the resulting estimates for these provinces will be biased.

A total of 1070 classes were selected to participate in the survey. After replacement, consent was obtained from boards/districts to approach 1001 schools (94% of the intended number). At the school level, consent was given to conduct the survey in 955 classes, representing 95% of the 1001 classes where approval was obtained from boards/districts and 89% of the intended 1070 classes. By comparison, in 1994, 80 classes per province (800 in total) were chosen for the original sample using the procedure described above. After class replacements, 14270 students from 755 classes provided usable questionnaires for the 1994 YSS.

In the 2002 YSS, the final number of classes where consent was received from boards/districts was less than 90% of the intended sample size for Alberta (73%) and Ontario (88%). Further, in Alberta, the number of classes recruited was less than 90% of the number of classes for which the boards/districts had provided consent. The relatively large coefficients of variation for Alberta and Ontario are due, in part, to this non-response.

Table 2-B gives the data on student response rates by province for the 2002 YSS. At the student level, all provinces except Ontario (77%) and Manitoba (77%) obtained usable questionnaires from at least 80% of the possible students in the classes in the sample. The 2002 overall student-level response rate (82%) is similar to that from the 1994 YSS where 80% of eligible students provided data. In 1994, Quebec (77%), Ontario (71%) and British Columbia (78%) had student response rates lower than 80%.

Total non-response was handled by adjusting the weights attached to the responses of students who did respond to the survey to compensate for those who did not respond (see below).

Table 2 - A - Number of Classes for Which Consent was Given (After Replacement) by Province, Canada, 2002 Youth Smoking Survey
Province Board Level School Level
  Total Consent Rate Total Consent Rate
Canada
(Total)
1,070* 1,001 94% 1,001* 955 95%
NL 78 78 100% 78 77 99%
PE 54 54 100% 54 54 100%
NS 89 89 100% 89 85 96%
NB 83 83 100% 83 79 95%
QC 155 150 97% 150 148 99%
ON 169 148 88% 148 134 91%
MB 96 96 100% 96 91 95%
SK 92 92 100% 92 92 100%
AB 124 91 73% 91 79 87%
BC 130 120 92% 120 116 97%

*Note that the totals have not been adjusted to reflect the addition of replacement boards. Hence the true response rates may be less than shown here.

Table 2 - B - Student Participation Rates by Province, Canada, 2002 Youth Smoking Survey
Province Target Population* Recruited Classes Eligible Students Usable
Ques-
tionnaires
% Usable Questionnaires
Canada
(Total)
2,027,505 955 23,217 19,018 82%
NL 33,944 77 1,862 1,574 85%
PE 10,087 54 1,305 1,091 84%
NS 61,566 85 2,108 1,784 85%
NB 49,049 79 2,020 1,656 82%
QC 487,440 148 3,869 3,229 83%
ON 770,598 134 3,343 2,583 77%
MB 76,157 91 2,000 1,534 77%
SK 67,600 92 2,024 1,707 84%
AB 219,143 79 1,803 1,442 80%
BC 251,921 116 2,883 2,418 84%

*Target population refers to the number of youth in grades 5-9 in the province

Data Collection

Questionnaire content was the responsibility of Health Canada 's Tobacco Control Programme. The 2002 YSS questionnaire (Appendix A) was designed to be comparable with that used in 1994. Minimal modifications were made to the wording of some of the questions and new questions from the National Longitudinal Survey of Children and Youth that asked about activities and self-esteem were added. Questions on alcohol and non-medical drug use were developed in collaboration with the Drug Strategy and Controlled Substances program of Health Canada, and added at the end of the questionnaire for youth in grades 7-9. Both the English and French versions of the 2002 YSS draft questionnaire were pilot tested in the spring of 2002 with boys and girls from various grades, smoking experiences, and levels of academic achievement.

The parent questionnaire (Appendix B) was significantly modified from the 1994 version with additional questions on demographics, child access to health services, smoking restrictions in the home and smoking prevalence in the home.

Trained interviewers were responsible for selecting the classes to be surveyed, arranging for parental consent, administering and gathering the completed questionnaires, and conducting the parent telephone interview. The student questionnaires were completed in the students' classroom with the teacher present. Data collection sessions averaged 30-40 minutes. To preserve confidentiality the teacher was asked not to move amongst the students.

Each child received a questionnaire in an envelope labelled with the student's name. The questionnaire inside contained a unique identifier, but not the student's name or other identifying information. The interviewer read the introduction and instructions, completed the first nine questions with the students to show them how to make different types of entries, and explained how to complete the smoking wheel in question 21. Students were instructed to place their completed questionnaires face down on the desk, not in the original envelope. The interviewer then first collected the empty envelopes and finally the questionnaires were collected. The unique identifier allowed the child's questionnaire to be linked to the parent's questionnaire.

From the original class lists, and the empty envelopes and the envelopes not distributed, it was possible to determine the response rates by class. No attempt was made to collect data from absent students.

Parent Survey

A parent of each participating child was contacted by telephone for the brief 15 question survey using the procedures described above. The survey included questions about the parent's smoking behaviour and attitudes towards smoking, household smoking restrictions, and basic socio-economic information. In total, there were1055 students for whom some or all of the parental information was missing. Most of this was due to non-response to the entire survey rather than non-response to selected items.

Data Processing and Analysis

Data were collected from students and parents between November, 2002 and January, 2003.

Questionnaire data entry and processing were performed at the Statistics Canada head office. The quality of the data entry was checked by random verification of 20% of the questionnaires. It is estimated that the data entry error rate was below 2%.

A total of 17,709 parents were interviewed and agreed to share their results with Health Canada . The data from these parents and their children are contained in a "share file" available only to Health Canada . In total, 19,018 students completed the survey, and, after removing variables that could possibly identify individual students, their responses were stored in the Public Use Master File (PUMF) provided by Statistics Canada. With the exception of certain analyses using data from the parent surveys or variables not available on the PUMF, the analyses that are presented in this report have been based on the Public Use Master File (PUMF). It is important to note that the PUMF does not contain the data obtained from the parent survey except for a family composition variable.

Missing Data

The questionnaire was designed with very few skip patterns to minimize problems with confusion over which questions were to be answered. However, there were certain questions, noted below, where the missing data rate (i.e., the respondent answered "do not know", "refuse" or did not answer at all) exceeded 15%.

  • Question Y_Q8 that asked about the student's preferred weight (15% missing).
  • Question Y_Q46 that asked the students for their opinions on smoking (15-32% missing).
  • Question Y_Q55 that asked about the school rules concerning smoking (16% missing).
  • Question Y_Q56 that asked about whether most smokers obey the school's rules about smoking (42% missing).
  • Question Y_Q59 that asked about the student's spending money (23% missing).
  • Question Y_Q80 that asked for the numbers of deaths due to cigarettes relative to other causes (32-46% missing).

Question 16 ("Have you smoked 100 or more cigarettes in your lifetime?"), Question Y_Q11A ("Have you tried smoking even just a few puffs?"), and Question Y_Q14 (Have you ever smoked a whole cigarette?") are critical questions for defining smoking status (see below) and also for determining valid skip patterns (i.e., which questions should be answered and which could be omitted). If responses to these questions were "Don't know" or were missing altogether, an imputation scheme involving responses to other related questions was used to determine a value for the respondent where possible. Responses to other than these smoking questions were not imputed if missing.

Suppressed Information

Information that could identify individuals who participated in the survey, such as the name of the respondent or the respondent's school, is not reported here. Other information that has been deemed sensitive has been suppressed in this report. For example, to avoid disclosure of cigarette product brand information, responses to Question Y_Q22B ("Which brand do you usually smoke") have been recoded to indicate only the strength of the brand and its tar value. As well, responses to Question Y_Q75 and Question Y_Q78 that mention Ritalin and Gravol have been grouped with other prescription and non-prescription drugs.

Weighting of Responses

The main objective of any sample survey is to provide reasonable estimates of population parameters (e.g., totals, proportions, and means within specified subgroups such as age or sex groups). In the 2002 YSS, responses were obtained from 19,018 students from all 10 provinces. Responses from these 19,018 students are used to provide estimates for the 2,027,506 students in the target population (grades 5-9). Thus, each youth in the 2002 YSS sample represents about 107 Canadian youth. Put another way, the fraction of the target population sampled in the 2002 YSS was 0.0094, or 0.94%. Because of the way the sampling was done, the sampling fractions varied from province to province. For example, in Prince Edward Island, 10.8% of the target population was sampled while in Ontario only 0.34% of the target population was sampled.

Table 2-B (above) gives the sample size and target population size for each of the provinces. In order for the estimates from the sample to be reasonable estimates of the corresponding quantities in the target population, a weight is assigned to each respondent's data representing the number of respondents represented by that individual. These weights reflect the probability of selection of the respondent and adjustments for non-response. For each record, there is an initial sampling weight that is inversely proportional to the probability of selection of that grade-school combination within the stratum. Then there is an adjustment for non-response at the school level. Next there is an adjustment for the class within the school followed by adjustments for class and then student non-response. Finally, there is a post-stratum adjustment to bring the weighted totals in line with the age-sex-province totals in the target population.

In this report, entries in the tables are based on the weighted responses and, hence, give estimates of the total number of students in the target population that satisfy the criteria for inclusion in the tables. Reported proportions and means are based on these weighted estimates. It is important to distinguish between these population estimates and sample sizes that are much smaller but are the relevant figures for quantifying the likely size of sampling errors (see below).

Sampling Error and Reliability

In both the 1994 YSS and the 2002 YSS the estimates of population quantities are based on samples from the target population. The standard error of the estimate is one way to quantify the variation that might exist from (hypothetical) sample to (hypothetical) sample drawn from the target population when using the actual sampling methods. The standard error will depend on the choice of the design, the size of the sample chosen, the actual responses, and the weights assigned to the respondents.

With a complicated two-stage cluster design such as this one, a simple formula relating sample size and precision will not apply. For example, because students in the same class may be more similar than students in another class or school, we would expect that the responses from students in the same class would be correlated (i.e., not independent). As well, two schools in the same board/district may be more similar than two schools in different board/districts, and so the possible dependence between respondents within a board/district must also be considered.

These possible correlations between respondents imply that estimates of variation between samples are larger than those that would be obtained from simple random samples (i.e., independently sampling individual students) from the target population. One statistic that can be calculated to estimate the inflation in the variance due to the more complex survey design is called the design effect . For the 2002 YSS, Statistics Canada estimates the design effect to be 2.70 for the whole design. This means that the design would require 2.70 times more respondents to yield estimates with the same precision as a design that called for a simple random sample of participants from the target population. Of course, a design based on a simple random sample would be much more costly to implement, so the multi-stage design will be more cost-efficient provided the design effect is not too large. In comparison, the design effect for the school component of the 1994 YSS was estimated to be 4.96, leading to greater uncertainty in estimates for the same size sample in YSS 2002 compared to YSS 1994.

One common method for quantifying variation in sample surveys is through the use of the coefficient of variation (CV). The CV for an estimate is defined as the ratio: CV = the standard error of the estimate/the estimate, and it is usually expressed as a percentage. So, if the CV for an estimate is given as 8%, it implies that the size of the standard error of the estimate is 8% of the estimate itself. In general, the lower the CV, the more precise will be statements made about underlying population quantities. The CV takes into account the sample size, design effect, the values of the response and the sample weights.

Statistics Canada has guidelines about releasing estimates based on the CV of the estimate. In general,

  • If an estimate is based on a sample of at least 30 respondents and has a CV between 0% and 16.5%, it is deemed acceptable .
  • If an estimate is based on a sample of at least 30 respondents and has a CV between 16.6% and 33.3%, it is deemed marginal and is reported only with a cautionary note concerning the high levels of error. The message "Moderate Sampling Variability" will accompany such estimates in the tables in later chapters.
  • If an estimate is based on a sample of fewer than 30 individuals or has a CV greater than 33.3%, it is of unacceptable quality and will not be released.

Estimation and Statistical Testing

A 95% confidence interval is a range of values that, with probability 0.95, will contain the true population value for the quantity being estimated. Based on the CV for an estimate, it is possible to provide a confidence interval for the estimated quantity (estimate ± 2 √(estimate*CV/100)). The Microdata Users Guides 2,3 provide detailed tables of CV's for the 1994 YSS and 2002 YSS for estimated totals along with instructions on how to use these tables to obtain standard errors and confidence intervals for proportions, differences between proportions, ratios, and differences between ratios.

It is very common to wish to compare estimates from two or more groups of individuals. For example, it may be of interest to compare male and female smoking rates, or to make comparisons in smoking rates between provinces or to compare smoking rates between those students who report having parents who smoke and those who report having parents who do not smoke, and so forth. With these comparisons, it is important that the observed differences in the estimates be judged against the sampling variation in the estimates. A test of significance can determine whether the observed difference could reasonably be due to chance or whether the difference is so large that it is likely reflective of an underlying true difference between the groups being compared. An element of judgement, sometimes called "clinical" judgment (i.e., understanding the context of the difference), is often required as well, since with large samples, differences that are not meaningful may be judged to be statistically significant.

With complex survey designs such as this one, the calculation of the correct statistical quantities to perform statistical tests is not straightforward. For the purposes of this report, tables to guide the interpretation of tests of significance between percentages for two distinct subgroups of respondents from the total sample are presented in the Appendix. Tables 2-1a, 2-1b, and 2-1c give the smallest estimated population total for the two subgroups being compared that is required for two percentages to be significantly different at the 5% level. Because of the differing design effects, Table 2-1a should be used when comparing subgroups within the 2002 YSS. Table 2-1b should be used when comparing subgroups within the 1994 YSS, and Table 2-1c should be used when comparing one subgroup from 2002 with the same subgroup in 1994. It is important to note that the estimated population totals for significant comparisons within provinces will generally be lower than those for Canada.

  • For example, when using Table 2-1a to compare sub-groups from the 2002 YSS, if one estimated percentage was 45% and a second was 50%, this difference would be judged significant at the 5% level if the smaller of the two estimates of the number of children in a subgroup is at least 229,213. As a second example, if one estimated percentage was 65% and a second was 80%, the smaller subgroup must have an estimated total population of at least 20,362 children for the difference to be significant. This is a conservative test that is only approximate given the complex survey design, but it should serve as a guideline for examining significant differences. Note also that this table applies only when comparing two independent subgroups of children (e.g., percentages of daily smokers in two age groups). It would not apply, for example, when comparing two responses to the same question for a single group of children (e.g., percentages of daily and non-daily smokers in the same age group).

Adjustment for Other Factors

In this report, there has been no adjustment for other factors that might be related to the responses being considered other than those that are controlled by subdividing the data, as reported in the tables. Readers need to be aware that other variables could potentially confound the associations presented here. For example, socio-economic status could confound the association between spending money and cigarette smoking rates. To fully adjust for other variables would require more sophisticated modeling techniques, such as multiple (logistic) regression, that are beyond the scope of this technical report.

Principal Variables

The principal response variable in this report is self-reported cigarette smoking. There are many ways to categorize the smoking habits of youth. For the purposes of this report, the authors have revised the categories that were employed in the 1994 report with ones that are more reflective of the smoking behaviour observed by youth in these grades. In particular, in this population, it may not be appropriate to use the benchmark of having smoked at least 100 cigarettes to be defined as a smoker4 . The YSS population is more at risk of trying, or experimenting with, cigarette use than are children in later grades. Hence, in this report, any child who has smoked even a few puffs of a cigarette is considered to have ever smoked. The definitions employed are as follows:

  • Ever Smoker: Has tried smoking a cigarette, even just a few puffs
    • Ever Smokers can be further classified as Puffers (Has tried a few puffs, but has never smoked a whole cigarette) and Smoked Beyond Puffing (Has smoked a whole cigarette)
    • Smoked Beyond Puffing can be further classified as Smoked Beyond Puffing, Daily Smoker (Has smoked every day in the past 7 days) and Smoked Beyond Puffing, Not Daily Smoker (Has not smoked every day in the past 7 days)
  • Never Smoker:
    • Never Smoker can be further subdivided into Never Smoker who has Never Seriously Thought About Smoking and Never Smoker who has Seriously Thought About Smoking in order to measure those who were more likely to try smoking in the future.

Table 2-C summarizes the categories of smoking behaviour employed in this report. For comparison purposes, the findings from the 1994 YSS have been re-analyzed using the revised definitions of smoking behaviour. Each chapter reports findings according to one of the three types of categorical definitions presented in Table 2-C.

Table 2-C - Definitions of Categories of Smoking Behaviour, Youth Smoking Survey 2002
System Description Definition
2 category Never Smoker Has never tried a cigarette, even just a few puffs (Y_Q11A)
Ever Smoker Has tried a cigarette, even just a few puffs (Y_Q11A)
3 category Never Smoker Has never tried a cigarette, even just a few puffs (Y_Q11A)
Puffer Has tried a cigarette, even just a few puffs (Y_Q11A), but has never smoked a whole cigarette (Y_Q14)
Smoked Beyond Puffing Has smoked a whole cigarette (Y_Q14)
5 category Never Smoker who has Never Seriously Thought About Smoking Has never tried a cigarette, even just a few puffs (Y-Q11A) and has never thought seriously about smoking (Y_Q11B)
Never Smoker who has Seriously Thought About Smoking Has never tried a cigarette, even just a few puffs (Y-Q11A) but has thought seriously about smoking (Y_Q11B)
Puffer Has tried a cigarette, even just a few puffs (Y_Q11A), but has never smoked a whole cigarette (Y_Q14)
Smoked Beyond Puffing, Not Daily Smoker Has smoked a whole cigarette (Y_Q14), but has not smoked each of the past 7 days (Y_Q21)
Daily Smoker Has smoked every day in the past 7 days (Y_Q21)

Note: Some chapters identify other sub groups of smokers. In such instances, the definitions are clearly laid out in the text.

Validity of Self-Report Measures

One common concern with self-reported measures is whether a respondent will respond truthfully for behaviours that could be seen as sensitive or, in some cases, illegal. There is a large literature on measuring smoking behaviours in youth as young as those studied here. In other studies, measures to promote truthful response have included collection of biological samples of breath or saliva to either validate the youth's report or to encourage honest reporting through the threat of being able to validate the response ("bogus pipeline")5 . The collection of such samples is not feasible in a survey as large as the 2002 YSS. Consequently, measures to ensure that students realized that their responses would not be seen by their teachers, other students or parents were the primary means of encouraging truthful responses. These measures included having data collected by trained interviewers and not teachers, having clear instructions on how to complete the questionnaire confidentially, and by having the message that Statistics Canada will keep the answers private and that no one from the student's school or home would see what the student wrote. This information was repeated on each page of the questionnaire.

These measures are the same as those taken for the 1994 YSS. It is not possible to determine if there is systematic under reporting of either smoking behaviour or consumption of cigarettes within the sample; however, the lessons from systematic studies of smoking in youth6 would suggest that the amount of under reporting is likely small.

The self-report of alcohol and other drug use has not been as extensively studied as that of cigarette use in youth in this age range. Other provincial surveys that include alcohol and other drug use7 do use similar methods to ensure confidentiality and, hence, promote truthful response.

Summary

The 2002 YSS is a complex survey that provides important information about the smoking behaviour of Canadian youth in grades 5-9. In the chapters that follow, analyses are presented to examine both the rates of cigarette smoking among Canadian youth and factors associated with the use of cigarettes. In addition, comparisons between the 1994 YSS and the 2002 YSS allow for the study of trends over time in students in these grades. The use of alcohol and other drugs by Canadian youth in grades 7-9 is also examined.

Footnotes

1. A Census Metropolitan Area is an area consisting of one or more adjacent municipalities situated around a major urban core that must have a population of at least 100,000.

References

1. Stephens T, Morin M, editors (Health Canada ), Youth Smoking Survey, 1994: Technical Report. Ottawa : Minister of Supply and Services, Canada, (Catalogue No. H49-98/1-1994E), 1996.

2. Statistics Canada . Youth Smoking Survey, 1994. Microdata User's Guide. Special Surveys Division, 1996.

3. Statistics Canada . Youth Smoking Survey, 2002. Microdata User's Guide. Special Surveys Division, 2004.

4. Mills C, Stephens T, Wilkins K. Summary report on the workshop on data for monitoring tobacco use. Chronic Diseases in Canada 1994; 15: 105-110.

5. Cameron R, Brown KS, Best JAB, Pelkman, C, Madill CL, Manske SR, Payne, ME. The effectiveness of a social influences smoking prevention program as a function of provider type (teacher or nurse), provider training method (workshop or self preparation) and school risk. American Journal of Public Health 1999; 89, 1827-31.

6. Patrick DL, Cheadle A, Thompson DC, Diehr P, Koepsell T, Kinne S. The validity of self-reported smoking: a review and meta-analysis. American Journal of Public Health 1994; 84: 1086-1093.

7. Adlaf EM, Paglia A. Drug Use among Ontario Students 1977-2003: Detailed OSDUS Findings . CAMH Research Document Series No.13. Toronto, ON : Centre for Addiction and Mental Health, 2003.

APPENDIX TABLES

Table 2-1a - Approximate Population Total Required in the Smaller of Two Groups for Significance (p<0.05) when Comparing Two Proportions in Canada for the 2002 Youth Smoking Survey
Proportion

Proportion

0.05(0.95)

0.10(0.90)

0.15(0.85)

0.20(0.80)

0.25(0.75)

0.30(0.70)

0.35(0.65)

0.40(0.60)

0.45(0.55)

0.10(0.90)

63,766

 

 

 

 

 

 

 

 

0.15(0.85)

20,681

100,532

 

 

 

 

 

 

 

0.20(0.80)

11,170

29,298

132,702

 

 

 

 

 

 

0.25(0.75)

7,324

14,745

36,766

160,277

 

 

 

 

 

0.30(0.70)

5,308

9,191

17,809

43,085

183,255

 

 

 

 

0.35(0.65)

4,085

6,411

10,771

20,362

48,255

201,638

 

 

 

0.40(0.60)

3,271

4,787

7,330

12,064

22,404

52,277

215,426

 

 

0.45(0.55)

2,693

3,740

5,362

8,066

13,069

23,936

55,149

224,617

 

0.50(0.50)

2,262

3,016

4,115

5,809

8,617

13,787

24,957

56,872

229,213

0.55(0.45)

1,930

2,489

3,267

4,396

6,128

8,985

14,218

25,468

57,447

0.60(0.40)

1,666

2,091

2,660

3,447

4,584

6,319

9,169

14,362

 

0.65(0.35)

1,452

1,780

2,206

2,773

3,555

4,678

6,383

 

 

0.70(0.30)

1,275

1,532

1,856

2,275

2,830

3,590

 

 

 

0.75(0.25)

1,125

1,329

1,580

1,894

2,298

 

 

 

 

0.80(0.20)

998

1,161

1,356

1,596

 

 

 

 

 

0.85(0.15)

889

1,019

1,172

 

 

 

 

 

 

0.90(0.10)

793

898

 

 

 

 

 

 

 

0.95(0.05)

711

 

 

 

 

 

 

 

 

Note: To use this table, select the two proportions to be compared either both from the values not in parentheses or both from the values in parentheses. The table entry gives the estimated total population for the smaller of the two groups in order that the proportions are significantly different (p<0.05).

Table 2-1b - Approximate Population Total Required in the Smaller of Two Groups for Significance (p<0.05) when Comparing Two Proportions in Canada for the 1994 Youth Smoking Survey
Proportion

Proportion

0.05(0.95)

0.10(0.90)

0.15(0.85)

0.20(0.80)

0.25(0.75)

0.30(0.70)

0.35(0.65)

0.40(0.60)

0.45(0.55)

0.10(0.90)

150,426

 

 

 

 

 

 

 

 

0.15(0.85)

48,787

237,158

 

 

 

 

 

 

 

0.20(0.80)

26,351

69,115

313,049

 

 

 

 

 

 

0.25(0.75)

17,279

34,783

86,732

378,098

 

 

 

 

 

0.30(0.70)

12,522

21,683

42,011

101,639

432,306

 

 

 

 

0.35(0.65)

9,637

15,124

25,410

48,034

113,836

475,672

 

 

 

0.40(0.60)

7,716

11,293

17,292

28,459

52,852

123,322

508,197

 

 

0.45(0.55)

6,352

8,823

12,648

19,027

30,831

56,466

130,098

529,880

 

0.50(0.50)

5,337

7,115

9,708

13,702

20,328

32,525

58,876

134,164

540,721

0.55(0.45)

4,553

5,872

7,708

10,371

14,455

21,195

33,541

60,080

135,519

0.60(0.40)

3,931

4,933

6,274

8,131

10,814

14,907

21,629

33,880

 

0.65(0.35)

3,426

4,200

5,204

6,542

8,385

11,035

15,058

 

 

0.70(0.30)

3,007

3,614

4,379

5,367

6,676

8,470

 

 

 

0.75(0.25)

2,655

3,135

3,727

4,469

5,421

 

 

 

 

0.80(0.20)

2,355

2,738

3,200

3,764

 

 

 

 

 

0.85(0.15)

2,096

2,403

2,766

 

 

 

 

 

 

0.90(0.10)

1,871

2,117

 

 

 

 

 

 

 

0.95(0.05)

1,673

 

 

 

 

 

 

 

 

Note: To use this table, select the two proportions to be compared either both from the values not in parentheses or both from the values in parentheses. The table entry gives the estimated total population for the smaller of the two groups in order that the proportions are significantly different (p<0.05).

Table 2-1c - Approximate Population Total Required in the Smaller of Two Groups for Significance (p<0.05) when Comparing Two Proportions in Canada: One From the 1994 Youth Smoking Survey and One From the 2002 Youth Smoking Survey (continued below)

 

 

Proportion from the 1994 YSS

 

 

0.05(0.95)

0.10(0.90)

0.15(0.85)

0.20(0.80)

0.25(0.75)

0.30(0.70)

0.35(0.65)

0.40(0.60)

0.45(0.55)

0.50(0.50)

Proportion from the 2002 YSS

0.05(0.95)

 

 

 

 

 

 

 

 

 

 

0.10(0.90)

91,598

 

 

 

 

 

 

 

 

 

0.15(0.85)

27,744

151,321

 

 

 

 

 

 

 

 

0.20(0.80)

14,197

42,029

203,713

 

 

 

 

 

 

 

0.25(0.75)

8,874

20,258

54,481

248,775

 

 

 

 

 

 

0.30(0.70)

6,144

12,122

25,506

65,100

286,507

 

 

 

 

 

0.35(0.65)

4,518

8,120

14,912

29,938

73,888

316,909

 

 

 

 

0.40(0.60)

3,451

5,818

9,802

17,244

33,557

80,842

339,981

 

 

 

0.45(0.55)

2,703

4,354

6,915

11,191

19,118

36,360

85,964

355,722

 

 

0.50(0.50)

2,152

3,353

5,107

7,808

12,287

20,533

38,350

89,254

364,134

 

0.55(0.45)

1,730

2,634

3,890

5,710

8,497

13,090

21,491

39,525

90,711

365,215

0.60(0.40)

1,398

2,095

3,025

4,311

6,163

8,982

13,599

21,990

39,885

90,335

0.65(0.35)

1,130

1,678

2,386

3,326

4,618

6,468

9,264

13,816

22,032

39,431

0.70(0.30)

909

1,347

1,897

2,604

3,537

4,810

6,622

9,343

13,739

21,615

0.75(0.25)

724

1,079

1,513

2,056

2,749

3,657

4,888

6,627

9,218

13,368

0.80(0.20)

568

858

1,205

1,629

2,154

2,820

3,687

4,852

6,482

8,889

0.85(0.15)

434

673

954

1,289

1,694

2,192

2,818

3,626

4,701

6,188

0.9(0.10)

317

515

745

1,012

1,328

1,707

2,169

2,743

3,475

4,435

0.95(0.05)

215

381

569

784

1,033

1,325

1,670

2,086

2,595

3,233

Note: To use this table, select the two proportions to be compared either both from the values not in parentheses or both from the values in parentheses. The table entry gives the estimated total population for the smaller of the two groups in order that the proportions are significantly different (p<0.05).

Table 2-1c (continued) Approximate Population Total Required in the Smaller of Two Groups for Significance (p<0.05) when Comparing Two Proportions in Canada : One From the 1994 Youth Smoking Survey and One From the 2002 Youth Smoking Survey

 

 

Proportion from the 1994 YSS

 

 

0.50(0.50)

0.55(0.45)

0.60(0.40)

0.65(0.35)

0.70(0.30)

0.75(0.25)

0.80(0.20)

0.85(0.15)

0.90(0.01)

0.95(0.05)

Proportion from the 2002 YSS

0.55(0.45)

365,215

 

 

 

 

 

 

 

 

 

0.60(0.40)

90,335

358,967

 

 

 

 

 

 

 

 

0.65(0.35)

39,431

88,127

345,388

 

 

 

 

 

 

 

0.70(0.30)

21,615

38,163

84,086

324,478

 

 

 

 

 

 

0.75(0.25)

13,368

20,740

36,080

78,213

296,239

 

 

 

 

 

0.80(0.20)

8,889

12,705

19,407

33,182

70,507

260,670

 

 

 

 

0.85(0.15)

6,188

8,356

11,749

17,615

29,470

60,969

217,770

 

 

 

0.9(0.10)

4,435

5,744

7,620

10,499

15,366

24,944

49,598

167,541

 

 

0.95(0.05)

3,233

4,055

5,150

6,681

8,956

12,658

19,603

36,395

109,981

 

Note: To use this table, select the two proportions to be compared either both from the values not in parentheses or both from the values in parentheses. The table entry gives the estimated total population for the smaller of the two groups in order that the proportions are significantly different (p<0.05).

Smoking Behaviour

Philip Smith, PhD
Department of Psychology
Health Behaviour Research Group
University of Prince Edward Island

Lorraine Begley, BA (Hon)
Department of Psychology
University of Prince Edward Island

Jennifer L. O'Loughlin, PhD
Department of Epidemiology, Biostatistics and Occupational Health
McGill University

Judy Snider, MSc
Tobacco Control Programme
Health Canada

Acknowledgements: The authors thank Michael Chaiton (University of Toronto), Scott Leatherdale (Cancer Care Ontario), and Allison McKinnon (Alberta Alcohol and Drug Abuse Commission), who reviewed an earlier draft of this chapter and provided helpful commentary.

Highlights

  • In 2002, 77% of Canadian youth in grades 5-9 were never smokers, having never tried a cigarette, even a few puffs. The 23% classified as ever smokers represented 457,000 young Canadians. Ten percent (209,000) were puffers, having tried smoking but never having smoked a whole cigarette, 10% (212,000) had smoked beyond puffing but were not daily smokers, and 2% (36,000) were daily smokers, having smoked every day in the previous seven days.
  • The percentage of ever smokers in 2002 (23%) was much smaller than in 1994 (40%). However, daily smokers smoked more cigarettes per day on average in 2002 (8.1) than in 1994 (7.4).
  • The 10% of never smokers who had seriously thought about smoking were, in several respects, more similar to ever smokers than to those never smokers who reported never having seriously thought about trying smoking. This similarity was with respect to the higher proportion who had little money to spend or save each week, the lower proportion who had high self-esteem scores, and, for females, the higher proportion who wanted to weigh less than they did currently.
  • Grade level was strongly related to smoking behaviour. The prevalence of ever smokers increased from 7% in grade 5 to 42% in grade 9. Among students who smoked, those in higher grades smoked more cigarettes per day than did those in lower grades.
  • Overall, there was no difference in the distribution of females and males according to category of smoker. Female daily smokers smoked fewer cigarettes per day on average (7.3) than male daily smokers (8.8).
  • There was substantial variation in smoking behaviour across provinces. Ever smoker percentages ranged from 16% in British Columbia and Ontario to 37% in Quebec . Non-smokers' perception that access to cigarettes would be easy ranged from 12% in Manitoba to 23% in Quebec . Ever smoker proportions declined in every province since 1994.
  • In 2002 a lower percentage of never smokers perceived that if they wanted to try smoking, access to cigarettes was easy (17% compared to 24% in 1994).
  • Use of other tobacco products was associated with smoking cigarettes. In 2002, 59% of ever smokers had tried one or more of cigars, pipes, chewing tobacco, snuff, or bidis, while only 3% of never smokers had done so. The percentage of respondents reporting ever use of cigars or pipes in 2002 (13%) was smaller than in 1994 (20%). The percentage of students reporting ever use of cigars or pipes increased with grade level (from 4% in grade 5 to 26% in grade 9) and was higher in Quebec (24%) than in other provinces.
  • These findings underscore the importance of a comprehensive, ecological approach to smoking prevention and reduction among youth so that the public health gains of recent years can be sustained and further progress can be made. An ambitious research agenda is required to inform and support tobacco control initiatives in legislation, regulation, policy, education, and programming.

Methods

This chapter describes the prevalence of smoking behaviours among youth in grades 5-9, and explores the associations between smoking behaviour and youths' extracurricular activities and perceptions of themselves. The prevalence of smoking behaviours in 2002 is compared to the prevalence in 1994. Methods in this chapter cover definitions and sample issues specific to the chapter. For a detailed description of the survey methods, see Chapter 2.

Definitions

The smoking behaviour taxonomies used in analysis of the 2002 YSS are substantially different from those used 1994 and those commonly used in the literature. Earlier reports used a common, but arbitrary, criterion of smoking 100 or more cigarettes to identify smokers--a criterion carried over from work with adult smokers1, not reflective of the early smoking experience of youth, and for which there is no evidence of a meaningful relationship with expected outcomes of smoking, including dependence and other health impacts. Earlier measures used a non-smoker category that combined youth as diverse as those who never smoked a puff, indeed, who had never even seriously thought about smoking, and youth who had smoked as many as 99 cigarettes. In an effort to better describe the smoking onset process, and to better utilize the data available from this youth sample, a new smoking behaviour taxonomy was developed by a panel of tobacco control researchers with responsibility for analysis of the 2002 YSS (see Chapter 2, especially Table 2-C).

Throughout this chapter, use of the more detailed categorization of smoking behaviour is contingent on sample size and the nature of the relations under investigation. To enable comparison of 2002 YSS results with 1994 results, when the smoking taxonomies or other definitions were substantially different, the 1994 data were reanalyzed according to the 2002 definitions.

Variables used to describe amount of smoking included the number of days in the last 30 when one or more cigarettes was smoked (Y_Q19), the usual number of cigarettes smoked on days in the last 30 when smoking took place (Y_Q20), and the mean number of cigarettes smoked during the seven days preceding the survey (derived from Y_Q21). An indicator of progress into smoking beyond puffing was the reported age at which the first whole cigarette was smoked (Y_Q15). (The YSS did not ask about age of first puff.) Never smokers' perceived ease of access to cigarettes was assessed (Y_Q13).

Respondents' ever use of other tobacco products, namely smoking cigars or pipe tobacco, using chewing tobacco, using snuff, and smoking bidis, was also assessed (Y_Q10).

Several demographic characteristics were examined for associations with smoking behaviour, including respondents' sex (Y_Q2), grade (GRADE), province (PROVINCE), Aboriginal status (Y_Q4), weekly income available to spend or save (Y_Q59), and language most often spoken at home (Y_Q3). With respect to language, we also distinguished between Francophone students living inside and outside Quebec, to explore possible associations between smoking behaviour and minority language status. Parental education was used as a proxy for socioeconomic status, and measured by the highest level of education reported by the responding parent in the companion YSS Parent's Questionnaire (P_Q14a). A second proxy for socioeconomic status, total annual household income, was also assessed in the Parent's Questionnaire (P_Q17).

Other variables investigated for possible links with smoking behaviours included students' perceptions of their academic performance relative to peers (Y_Q54), self-esteem (Y_Q9), satisfaction with body weight (Y_Q8), and involvement in extracurricular activities (Y_Q5a-h), television and video watching (Y_Q6) and reading for fun (Y_Q7).

Sample and Response

Consistent with Statistics Canada (2004)2 guidelines, data are not reported here when the cell size is less than 30 or when the coefficient of variation is greater than 33.3% (see discussion of sampling error and reliability in Chapter 2); these restrictions and the low prevalence of some smoking behaviours among young Canadians limit investigation of some smoking behaviours in several sub-populations.

For most items discussed in this chapter, fewer than 10% of the total responses were missing, with students not answering items they would be expected to answer. Missing items could result from respondents mistakenly skipping the items or choosing not to respond to specific questions. For question 8, regarding students' preferred weight, 15% of responses were missing, and for question 59, regarding the amount of money available each week to spend or to save, 23% of responses were missing.

The results presented in this chapter are descriptive and provide information about youth smoking prevalence and its association with other variables of interest. These analyses do not permit causal interpretations because the data were collected in a cross-sectional survey.

Findings

Tobacco Use Behaviours

Prevalence of Tobacco Use: All Youth

Of all youth surveyed, 77% (representing 1,570,000 Canadians in grades 5-9) were classified as never smokers, reporting that they had never tried a cigarette, even a few puffs. The remaining 23% (457,000) were classified as ever smokers. Ten percent (209,000) were classified as puffers, reporting they had tried smoking but never had smoked a whole cigarette, and a further 10% (212,000) were classified as smoked beyond puffing, not daily smokers, reporting they had smoked a whole cigarette but were not currently daily smokers. Two percent (36,000) of respondents were classified as daily smokers, that is, they had smoked every day in the previous seven days. As seen in Figure 3-A, the smoking prevalence in 2002 among Canadian youth in grades 5-9 was markedly lower than it was in 1994.

Figure 3-A - Comparison of Smoking Categories by Year, Canada, Youth Smoking Survey 2002 and Youth Smoking Survey 1994

Figure 3-A - Comparison of Smoking Categories by Year, Canada, Youth Smoking Survey 2002 and Youth Smoking Survey 1994

(a) Never Smoker who has Never Seriously Thought About Smoking
(b) Never Smoker who has Seriously Thought About Smoking
(c) Smoked Beyond Puffing, Not Daily Smoker
Percentages may not add to 100 due to rounding.

Of youth who had smoked in the last 30 days, 62% smoked five or fewer cigarettes a day on the days they smoked, 28% smoked between 6 and 20 cigarettes, and 11% smoked more than 20 cigarettes on the days they smoked (Table 3-1). These proportions were not significantly different from comparable figures for 1994. Of youth who had smoked in the last 30 days, 44% smoked on one to five days (compared to 40% in 1994) and 25% smoked on all 30 days (compared to 16% in 1994).

Among youth who reported smoking in the seven days preceding the survey, the mean number of cigarettes smoked each day of the preceding week was 4.2 in 2002, compared to 3.9 reported in 1994. The 2002 respondents smoked more cigarettes per day on Fridays and Saturdays (5.0) than on Sundays through Thursdays (4.0). Youth who were classified as daily smokers smoked 8.1 cigarettes per day on average in 2002, an increase over the 7.4 smoked per day on average in 1994.

Other than cigarettes, tobacco products reported as ever used by youth included cigars or pipes (13%), bidis (3%), snuff (2%), and chewing tobacco (2%) (Table 3-2a). The reported use of cigars or pipes and of chewing tobacco in 2002 was less than that reported in 1994 (Table 3-2b). Whereas 23% of students reported ever using cigarettes, 25% reported ever using any tobacco product. More than half of ever smokers (58%) had tried another tobacco product; only 3% of never smokers had done so. 

Never Smokers

A possible indicator of vulnerability to smoking initiation among never smokers is reported contemplation of smoking. Never smokers were asked whether they had ever seriously thought about trying smoking. Ninety percent responded no; these respondents, representing 69% of the population, were categorized as a never smokers, who had never seriously thought about smoking. The other 10% of never smokers (representing 8% of the population) were categorized as never smokers, who had seriously thought about smoking (Figure 3-B).

Figure 3-B - Percentage of Never Smokers Who Had Seriously Thought About Smoking by Grade, Canada, Youth Smoking Survey, 2002, 1994

Figure 3-B - Percentage of Never Smokers Who Had Seriously Thought About Smoking by Grade, Canada, Youth Smoking Survey, 2002, 1994

Never smokers were also asked whether they thought they might try smoking within the next month. Fewer than 1% responded "yes", and 6% responded "I don't know" (Table 3-3a). The vast majority, 94%, responded "no."

Never smokers were asked how difficult or easy it would be for them to get cigarettes if they wanted to try smoking. Seventeen percent (compared to 24% in 1994) of all never smokers responded that it would be easy (Table 3-4).

Smoked Beyond Puffing

Respondents who had ever smoked a whole cigarette were asked how old they were when they first did so. Figure 3-C illustrates that for grade 9 respondents (the only grade level for which there are reportable data for daily smokers) daily smokers were much more likely to have first smoked a whole cigarette below age 11 years than were youth who had smoked beyond puffing but were not daily smokers.

Figure 3-C - Age at Smoking First Whole Cigarette Among Grade 9 Respondents, Canada, Youth Smoking Survey 2002

Figure 3-C - Age at Smoking First Whole Cigarette Among Grade 9 Respondents, Canada, Youth Smoking Survey 2002

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Population Subgroups

Grade

There is a strong relationship between grade level and smoking behaviour, with the prevalence of ever smokers increasing from 7% in fifth grade to 42% in ninth grade (Figure 3-D). Increases through grades 5-9 were observed for each of the three categories of ever smokers (Table 3-5a).

Figure 3-D - Ever Smoker by Grade, Canada, Youth Smoking Survey 2002 and 1994

Figure 3-D - Ever Smoker by Grade, Canada, Youth Smoking Survey 2002 and 1994

Among students who had smoked in the previous seven days, those in the higher grades reported smoking more cigarettes per day than did those in the lower grades (Figure 3-E).

Figure 3-E - Mean Number of Cigarettes Smoked Per Day by Those Who Smoked in Previous Seven Days, by Grade, Canada, Youth Smoking Survey 2002 and 1994

Figure 3-E - Mean Number of Cigarettes Smoked Per Day by Those Who Smoked in Previous Seven Days, by Grade, Canada, Youth Smoking Survey 2002 and 1994

The percentage of youth who had tried cigars or pipes increased with grade, from 4% in grade 5 to 26% in grade 9 (Table 3-2).

Sex

As was the case in 1994, the overall distribution of females and males according to smoking categories did not differ (Tables 3-6a,b). Sex differences in percentages of never smokers were evident in two grades: in grade 5, 95% of females compared to 92% of males were never smokers; in grade 8, 64% of females compared to 71% of males were never smokers.

Males who smoked, smoked more cigarettes per day than did females who smoked. Of youth who smoked in the previous seven days, females and males reported smoking a mean of 3.7 and 4.7 cigarettes per day respectively; the comparable figures for 1994 were 3.4 and 4.4 cigarettes per day for females and males. Among daily smokers - th ose who smoked every day in the previous seven - females reported smoking an average of 7.3 cigarettes per day, and males 8.8 per day (data not shown).

There were no significant differences by sex in measures of thinking about trying smoking in the next month, in perceived ease of access to cigarettes by never smokers, or in age starting to smoke beyond puffing (data not shown).

In 1994, a higher proportion of males than females reported use of tobacco products other than cigarettes (Table 3-2b). In 2002 this difference was not statistically significant, due mostly to decreases in use especially, but not exclusively, by males (Table 3-2a). In 2002 a higher percentage of male never smokers (4%) than female never smokers (2%) reported use of tobacco products other than cigarettes (data not shown).

Province and Region

Provincial variation in smoking behaviour was substantial. Figure 3-F illustrates the proportion of youth classified as ever smokers by province. Ever smoker proportions decreased in every province between 1994 and 2002; they were reduced by more than half in British Columbia, Ontario, Prince Edward Island, Alberta, and Manitoba, the five provinces in which the percentage of ever smokers in 2002 was below the Canadian average of 23%. New Brunswick, Nova Scotia, Saskatchewan, and Newfoundland and Labrador were all within five percentage points of the Canadian average, while Quebec reported the highest ever smoker percentage.

Figure 3-F - Ever Smoker Category by Province, Canada, Youth Smoking Survey 2002 and 1994

Figure 3-F - Ever Smoker Category by Province, Canada, Youth Smoking Survey 2002 and 1994

Of respondents classified as daily smokers, 58% lived in Quebec, a province with 24% of the Canadian population. In contrast, only 9% of those classified as daily smokers lived in Ontario, a province with 38% of the Canadian population (data not shown.)

Provincial variability in amount smoked was evident (Table 3-7). Respondents in Ontario who had smoked in the last seven days reported smoking a mean of 1.5 cigarettes per day over the last week, well below the Canadian mean of 4.2 cigarettes per day. In contrast, respondents in Newfoundland and Labrador, Prince Edward Island, New Brunswick, and Quebec who had smoked in the last seven days reported smoking a mean of 5.0 or more cigarettes per day.

The perception among never smokers that access to cigarettes was easy if they wanted to try smoking ranged from 12% in Manitoba to 23% in Quebec, with a Canadian average of 17% (Table 3-4).

Provincial differences in use of other tobacco products were generally modest; the most notable exception was that the proportion of Quebec respondents who reported ever having tried cigars or pipes was markedly higher than among respondents in any other province (Table 3-8a).

Language

Language most often spoken at home was associated with smoking behaviour (Table 3-9a). A higher percentage of Francophone students reported being ever smokers (39%), followed by those who reported speaking English and French (34%), Anglophone respondents (18%), and students who spoke languages other than French or English (13%). This ordering of proportions of ever smokers by language mirrored the 1994 findings (Table 3-9b). The percentage of Francophone students living outside Quebec who reported ever smoking was 23%, similar to the national average; the percentage of Anglophone students within Quebec who smoked was 17%.

Francophone respondents who reported smoking in the previous seven days smoked a mean of 5.6 cigarettes per day, more than the 3.7 reported by Anglophone students (data not shown).

Proxies for Socioeconomic Status

Parental education was used here as the main proxy for socioeconomic status. Data on the highest education level of the responding parent drawn from the Parent's Questionnaire were matched with YSS responses. Data on youth smoking categories for each of three categories of parental education-less than secondary school, secondary graduate/post secondary education, and university degree-are presented in Table 3-10 and demonstrate that higher parental education was associated with lower levels of youth smoking.

The proportion of ever smokers was lower in 2002 than it was in 1994 among children of parents at each education level, but reductions in ever smoker proportions were greater with higher education (Figure 3-G). The decrease in the percentage of ever smokers among children of university graduates represents a 53% drop, greater than the 43% decrease among children with parents who graduated from secondary school or had some post-secondary education, which in turn was greater than the 27% decrease among children of parents with less than secondary school education.

Figure 3-G - Percentage of Youth Who Ever Smoked by Parental Education, Canada, Youth Smoking Survey 2002 and 1994

Figure 3-G - Percentage of Youth Who Ever Smoked by Parental Education, Canada, Youth Smoking Survey 2002 and 1994

The association between smoking category and parental education was similar for females and males (data not shown.)

The association between youth smoking and parental education is consistent with findings related to total annual household income, as reported in the YSS Parent's Questionnaire, another proxy for socioeconomic status. Percentages of student respondents who were ever smokers ranged from 31% in households with total annual incomes below $30,000 to 16% in households with annual incomes over $80,000 (data not shown).

Aboriginal status

While Aboriginal respondents had an opportunity to identify themselves as North American Indian, Métis, or Inuit, small sample sizes (compounded by exclusion from the survey of territorial youth, youth living in remote northern areas of provinces, and youth living on reserves) made analysis by specific Aboriginal group impossible. Collapsing across Aboriginal groups enabled comparison of smoking behaviours between Aboriginal and non-Aboriginal youth.

Lower percentages of Aboriginal youth were classified as never smokers (61%) compared to non-Aboriginal youth (78%) (Table 3-11). Limited data available from the 1994 YSS make it impossible to contrast 2002 and 1994 findings on Aboriginal smoking behaviours for Canada, although comparison of smoking behaviours for Aboriginal youth in the four Western provinces for both years is possible(Tables 3-12a,b); a higher percentage of Aboriginal youth in these provinces were never smokers in 2002 (64%) than in 1994 (42%), and a lower percentage of Aboriginal youth were categorized as smoked beyond puffing, not daily smokers in 2002 (17%) than in 1994 (33%).

Aboriginal and non-Aboriginal youth did not differ in number of cigarettes smoked by those who smoked, in age smoking first whole cigarette (10.5 years for Aboriginal youth and 11.5 years for non-Aboriginal youth), or in never smokers' perceived ease of access to cigarettes (data not shown).

Student Income

Students were asked to report how much money they usually received each week to spend on themselves or to save, and these reports were related to smoking categories. As seen in Figure 3-H, a higher proportion of never smokers who had never seriously thought about smoking reported having less than $10 a week than was the case in each other category - including never smokers who had seriously thought about smoking. The proportion of daily smokers who reported a weekly income of $20 or more was almost three times that of never smokers who had never seriously thought about smoking.

Figure 3-H - Weekly Income Available by Category of Smoker, Canada, Youth Smoking Survey 2002

Figure 3-H - Weekly Income Available by Category of Smoker, Canada, Youth Smoking Survey 2002

(a) Never Smoker who has Never Seriously Thought About Smoking
(b) Never Smoker who has Seriously Thought About Smoking
(c) Smoked Beyond Puffing, Not Daily Smoker
* Moderate sampling variability; interpret with caution

Among never smokers, a greater percentage of those who reported income of $20 per week or more reported that it would be easy for them to access cigarettes if they wanted to try smoking (29%) than among those who reported income of $10-$19 per week (19%) or of less than $10 per week (13%) (data not shown).

Self-Perception of Academic Performance

The YSS did not gather information about students' actual academic performance, but did ask students to report how they did in school compared to other students in their class. Only 7% of respondents rated their academic performance as below average, 56% rated it as average, and 37% rated it as above average. When we compare students in these three categories we are not comparing students in the bottom, middle, and highest thirds of academic performance, but instead are comparing students with different perceptions of their academic performance.

The percentage of ever smokers differed substantially between those who reported that their academic performance was below average (47%), those who reported it was average (24%), and those who reported it was better than average (15%) (Figure 3-I). A higher percentage of students who rated their performance as below average had ever smoked beyond puffing (29%) compared to those who perceived that their academic performance was average (14%) or better than average (7%).

Figure 3-I - Smoking Category by Self-Perceived Academic Performance, Canada, Youth Smoking Survey 2002

Figure 3-I - Smoking Category by Self-Perceived Academic Performance, Canada, Youth Smoking Survey 2002

Among youth who had smoked in the previous seven days, the mean number of cigarettes smoked per day was higher among those who rated their academic performance as below average (5.9) than it was for those who rated their academic performance as average (3.9) or better than average (3.5).

Among students who rated their academic performance as below average, the percentage who reported having ever tried cigars or pipes (32%) was higher than among students who rated their performance as average (14%) or better than average (9%) (data not shown).

Self Esteem

The YSS included a four-item measure from the General-Self Scale of the Marsh Self Description Questionnaire3 to assess self esteem (see items in Table 3-13). For all individual items in the scale, a greater proportion of never smokers than ever smokers fully endorsed the item reflecting higher self-esteem (i.e., answered "true" rather than "mostly true", "sometimes true/sometimes false", "mostly false", or "false").

Half of YSS respondents (49%) scored above 12 on the16-point scale, where higher scores suggest higher self esteem. Figure 3-J describes the proportion of students who scored above 12 by smoking category and by sex. A higher proportion of students who were never smokers and had never seriously thought about smoking had self esteem scores above 12 than was the case in any other category. Never smokers who had seriously thought about smoking presented self esteem profiles more similar to smokers than to never smokers who had not seriously thought about smoking. A lower percentage of females scored above 12 (47%) than males (52%).

Figure 3-J - Self Esteem by Smoking Category and Sex, Canada, Youth Smoking Survey 2002

Figure 3-J - Self Esteem by Smoking Category and Sex, Canada, Youth Smoking Survey 2002

(a) Never Smoker who has Never Seriously Thought About Smoking
(b) Never Smoker who has Seriously Thought About Smoking
(c) Smoked Beyond Puffing, Not Daily Smoker
* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Preferred Weight

Preferred weight was not associated with smoking categories among male respondents (data not shown). However, a higher proportion of female ever smokers than never smokers reported they wanted to weigh less than they weigh now, and a lower proportion of female ever smokers than never smokers wanted to weigh the same as they weigh now (Figure 3-K). Further, female never smokers who had seriously thought about smoking were similar to ever smokers in their preference to weigh less.

Figure 3-K - Preferred Weight by Smoking Category, Females, Canada, Youth Smoking Survey 2002

Figure 3-K - Preferred Weight by Smoking Category, Females, Canada, Youth Smoking Survey 2002

(a) Never Smoker who has Never Seriously Thought About Smoking
(b) Never Smoker who has Seriously Thought About Smoking

Extracurricular Activities

Never smokers and ever smokers did not differ in reports of sports played and physical activities undertaken without a coach or instructor. They also did not differ in their reports of playing computer or video games (data not shown).

Higher proportions of never smokers than ever smokers reported participating in a wide range of organized activities, hobbies, and reading for fun (Table 3-A). A higher proportion of ever smokers than never smokers reported watching more television or videos and doing more odd jobs.

Table 3-A - Percentage of Ever and Never Smokers Participating In Extracurricular Activities, Canada, Youth Smoking Survey 2002

 

Never Smoker %

Ever Smoker %

Pop. Est. ('000)

1,570

457

Sports with a coach or instructor other than in gym class once a week or more in the past year

61

54

Dance, gymnastics, karate or other groups or lessons, other than in gym class, once a week or more in the past year

38

32

Art, drama, or music groups, clubs, or lessons outside of class, once a week or more in the past year

33

23

Clubs or groups such as Guides or Scouts, 4-H clubs, community, church or other religious groups, once a week or more in the past year

23

15

Hobby or craft once a week or more in the past year

57

47

Read for fun a few times a week or more

64

41

Watch 3 or more hours of television or videos a day

48

56

Odd jobs (e.g. paper route, babysitting) once a week or more in the past year

36

44

No odd jobs in the past year

33

20

Discussion

Prevalence

The remarkable decreases from 1994 to 2002 in the proportion of youth in grades 5-9 who had ever smoked even a few puffs, and who had ever smoked beyond puffing, represent a major public health success in Canada . Decreases in the proportion of ever smokers are robust, evident for both females and males, across grade levels, and in every province.

Rarely do we observe such favourable improvements in health behaviours in so short a time, and it is essential that we attempt to better understand the reasons underlying this success. One possible reason relates to the focus of Canada 's tobacco control interventions. Contrasting with the more individualized approaches to tobacco control in previous decades, Canada has recently shifted its tobacco control efforts to include a greater emphasis on ecological and environmental interventions. Specifically, federal, provincial, and local legislative, regulatory, taxation, policy, and educational initiatives have promoted the social unacceptability of smoking, and restricted access to tobacco in a manner never before seen in Canada.

In spite of this success, major public health concerns continue to exist for the 23% (457,000) of Canadians in this young age group who had tried smoking, including 10% (208,000) who were puffers, 10% ( 212,000) who have smoked beyond puffing, not daily smokers, and 2% (36,000) who were daily smokers. As expected, smoking behaviours increased with higher grade levels, such that by grade 9 half of students had tried smoking (51%), and 26% had smoked beyond puffing. Five percent of grade 9 students were daily smokers.

While the proportion of ever smokers, puffers, and those who had smoked beyond puffing decreased between 1994 and 2002, the amount of cigarettes smoked per day among those who did smoke increased from 7.4 to 8.1. This increased consumption is of considerable concern because of increased daily exposure to nicotine and other dangerous carcinogenic substances in cigarettes. This increased exposure will likely translate into an earlier and more severe public health burden for many young Canadians who are daily smokers. 

Because of their similarity to ever smokers, the 10% of never smokers who seriously thought about smoking might be signalling increased vulnerability to starting to smoke. Similar to ever smokers (and relative to never smokers who had never seriously thought about smoking), a lower proportion received high scores on a self-esteem measure, a lower proportion reported less than $10 each week to spend or to save, and among females, a higher proportion wanted to weigh less than they did currently.

Compared to 1994, a smaller proportion of never smokers in 2002 reported that it was easy for them to get cigarettes if they wanted to try smoking. The proportion varied with income available to spend or save; students who reported more accessible income also reported easier access to cigarettes.

Population Subgroups

Provincial differences in smoking behaviour described in this chapter are striking, and the relatively high prevalence of smoking in Quebec is particularly noteworthy. The identification of provincial differences does not explain what mix of cultural, environmental, educational, legislative, and policy variables created such differences in smoking patterns. It does call for the careful analysis of policies and practices in legislation, regulation, education, and message promotion that are related to differing provincial outcomes, but within the cultural and political context that is unique to each province.

As in 1994, females and males had remarkably similar smoking patterns. An important exception, also apparent in the 1994 data, was that females who smoked, smoked fewer cigarettes per day than males who smoked (e.g., 7.3 per day for female daily smokers and 8.8 per day for male daily smokers). In addition, a lower proportion of females compared to males had high self esteem scores, a variable associated with smoking categories. Also, an association between smoking category and preferences for weighing less than they currently did was apparent for females only. This latter finding supports earlier work documenting links between females' smoking behaviour and concerns about weight, including longitudinal studies suggesting that concern about weight predicts smoking initiation one year later4,5. The current findings emphasise the relevance of this issue even among female never smokers, and in particular, those who have seriously thought about smoking.

Minority language status has been suggested to be protective against tobacco use among youth in the United States6. The findings of the YSS are consistent with this hypothesis. While Francophones were much more likely than Anglophones to report being ever smokers, this applied only to Francophones living in Quebec . These results must be interpreted with caution given the small number of Francophones living outside Quebec in the sample, but they confirm that language ought not to be considered in isolation of other factors in attempts to understand the determinants of youth smoking behaviour.

Because of the small sample size of specific Aboriginal groups, data from North American Indian, Métis, and Inuit were collapsed for this analysis. Such merging of data can mask distinctions in patterns of smoking behaviours in the three groups. As in 1994, higher proportions of Aboriginal than non-Aboriginal youth engaged in smoking behaviour in 2002 and this disparity is of concern. The findings of substantial decreases since 1994 in the proportions of Aboriginal youth who engaged in smoking represent an important and encouraging public health success.

Our main proxy for socioeconomic status--parental education--reveals an exceptionally strong association with smoking behaviour. The percentage of youth who were ever smokers and whose parents reported attaining less than secondary school graduation (36%) was more than twice that of youth whose parents reported attaining a university degree (16%). This disparity merits attention. The significance of socioeconomic status as a determinant of health, and its link with an array of health behaviours, has been well established7; these findings confirm such a link with smoking behaviours even among very young Canadians.

The finding that higher weekly student income was strongly related to increased smoking is intriguing. Does increased income buy greater access to cigarettes? Are students who obtain more money engaged in work or other settings where cigarettes are more available, or where smoking is more normative? Might parents' reduction of cash available to youth make cigarettes less available to them? Unlike the 1994 YSS, the 2002 YSS did not gather information about the number of hours of paid employment among respondents, although we do know that a higher proportion of ever smokers than never smokers reported doing odd jobs in the past year. We do not know the source of weekly income reported by students.

As a group, ever smokers consistently reported lower participation in a range of organized activities, including sports with a coach or instructor; dance, gymnastics or other groups or lessons outside of gym class; art, drama, or music clubs or lessons outside of class, and clubs or groups such as Guides or Scouts, community or religious groups. Reasons for this lower participation are unclear, but might relate to lower socioeconomic status among youth who smoke, with reduced access to fee-bearing activities. Alternatively, this might relate to a lower inclination among ever smokers to participate in organized activities. The possibility that organized activities serve as a protective factor against smoking initiation merits consideration.

Although a lower proportion of ever smokers participated in organized activities, never smokers and ever smokers did not differ in reports of sports or physical activity played without a coach or instructor. Ever smokers watched television or videos more frequently than never smokers, but did not differ in time spent playing computer or video games. Never smokers were more likely to spend time reading. In short, the possibility of linkages between sedentary behaviour and smoking is unresolved.

Implications for Regulatory, Legislative, and Educational Initiatives

There have been many changes since the 1994 YSS in tobacco control activities in Canada, including the introduction of new health warning messages on cigarette packages (1994 and 2000), the enforcement of new federal tobacco legislation through the Tobacco Act (1997) , and the launch of three federal tobacco strategies-- the Tobacco Demand Reduction Strategy (TDRS, 1994-1997), the Tobacco Control Initiative (TCI, 1997-2002), and the Federal Tobacco Control Strategy (FTCS, 2001). These have been accompanied by numerous provincial and territorial strategies, often involving regulatory and legislative initiatives as part of a comprehensive tobacco control program. See Chapter 1 for a listing of provincial / territorial strategies.

The Tobacco Act , passed in 1997, aims to protect the health of Canadians in light of conclusive evidence implicating tobacco use in the incidence of numerous debilitating and fatal diseases; to protect young persons (under 18 years of age) and others from inducements to use tobacco products and the consequent dependence on them; to protect the health of young persons by restricting access to tobacco products; and to enhance public awareness of the health hazards of using tobacco products.

Health Warning Messages (HWMs) were placed on tobacco products according to the Act , to enhance public awareness of the health hazards of using tobacco products. From 1994 to 2000 text HWMs were placed on cigarette packages. After 2000, 16 graphic and larger HWMs were introduced. Since their implementation, the impact of the HWMs has been regularly monitored and evaluated among youth 12 to 18 years old8. Results indicate that the HWMs are an effective vehicle for communicating with youth. Young smokers report that these messages inform them of the health effects of smoking, get them to smoke less around others than they used to, increase the desire to quit, get them to try to quit and also to try to smoke less. Potential smokers (those who have tried smoking, have seriously thought about smoking, or think they might try smoking in the next month) report that they perceive HWMs to be accurate, to provide them with important information about the health effects of smoking, and to make smoking less attractive.

More specifically, the Act prohibits tobacco products from being furnished to a young person in a public place or in a place to which the public reasonably has access. It also requires retailers to post signs that inform the public that the sale or giving of a tobacco product to a young person is prohibited by law. Health Canada tobacco inspectors work with individuals and retailers in order to reduce youth access to tobacco. In accordance with the Act , some of their tasks include ensuring retailer compliance with posting signs stating the legal age for purchasing tobacco, requesting ID from anyone who, appearing to be under the legal age, attempts to buy tobacco, ensuring that retailers do not sell single cigarettes or cigarettes in packages of less than 20 cigarettes, and ensuring that retailers are respecting the restrictions regarding tobacco promotions.

In 1998, an amendment to the Act was passed which set in motion a five-year plan to phase-in a ban of tobacco company sponsorship promotions including those associated with cultural and sporting events. The complete ban came into effect on 1 October, 2003.

Most provinces, territories and more than 300 Canadian municipalities and regional governments now have some form of non-smoking legislation or bylaw9. Smoking restrictions contribute to the social unacceptability of tobacco products and use, limit exposure to second hand smoke, and play a role in preventing youth from taking up smoking and limiting the availability of places where they can go to smoke. The knowledge of school smoking bans and their impact on youth smoking behaviour was measured in this survey and the findings were reported in Chapter 10.

Higher prices are a recognized deterrent to tobacco use. Evidence demonstrates that effective and sustainable tobacco tax policies can significantly contribute to reducing the consumption of tobacco products, particularly among youth. Between administrations of the YSS in 1994--months after dramatic cuts to federal tobacco taxes and to provincial taxes in five province--and in 2002, taxes rose federally and in every province.10,11 A joint federal, provincial and territorial strategy for increasing taxation has been in place since 2001; taxes rose in every province in 2002.

Keys to continuing the trend toward decreasing youth tobacco use include a diverse array of public education (information, mass media, programs and services), research, legislative, policy, and programmatic strategies developed and coordinated at the local, provincial/territorial, national and international levels. Establishing comprehensive and integrated efforts hinges on forging collaboration at all levels.

Implications for Future Monitoring and Further Research

Compared to Canadians aged 15 years and older, reliable data on smoking prevalence among younger Canadians are sparse; this is especially true for adolescents in grades 5-9, who are particularly vulnerable to initiating smoking. The 1994 YSS was the first comprehensive national survey to address smoking behaviours and attitudes among youth aged 10 to 19 years. The 2002 survey of grade 5-9 students has updated this knowledge base. Continued monitoring of tobacco use patterns in youth through the YSS in future years will provide ongoing pertinent, detailed information about smoking behaviour, attitudes, and beliefs of Canadian youth.

Research is required to increase understanding of the dramatic decline in youth smoking prevalence between 1994 and 2002. The lessons to be learned will have implications not only in tobacco control but across all areas of public health. In particular, how have legislative, regulatory, and policy shifts affected smoking in youth? More broadly, in what ways have the comprehensive ecological and environmental interventions contributed to such change? What is required to ensure sustainability of gains to date, as well as continued progress?

How do we best make sense of substantial provincial differences in smoking behavior, and in rates of progress in tobacco control? What mix of legislative, regulatory, policy, and educational initiatives has the greatest impact on smoking, and how does such a mix relate to the specific social, cultural, economic, and political characteristics of a province and its population?

The 2002 YSS findings document progress in reducing cigarette smoking by youth in Quebec as well as in all other provinces. However the substantial differences in tobacco use among Quebec youth and those in other provinces need to be explored. Are school and other policies different in Quebec compared to other provinces? Are cultural differences a factor? What is behind the higher prevalence of smoking for Francophone youth in Quebec ? Are there impediments to the transmission of effective health promotion and smoking prevention messages to Quebec youth?

What lessons can be learned from declines in the proportion of ever smokers among Aboriginal youth between 1994 and 2002? What was the ecological and environmental mix which contributed to reduced smoking, and what can be done to reduce the ongoing disparity in smoking between Aboriginal and non-Aboriginal youth?

One of the most challenging findings in the 2002 survey was the increase since 1994 in the reported mean number of cigarettes smoked per day among daily smokers (from 7.4 to 8.1). Further monitoring will be crucial to confirm whether the 2002 finding is anomalous or whether it represents a trend among young daily smokers. In the meantime, developing a plan for focused research into the influences underlying this observation is warranted so research can inform, in a timely manner, the design, implementation, and evaluation of intervention strategies to reduce smoking among young daily smokers.

We need to better understand never smokers who have seriously thought about smoking. On several measures these youth have more in common with ever smokers than with other never smokers. In what manner, and through what targeted interventions, can their vulnerability to smoking initiation be addressed most effectively?

Males who smoke, smoke more than females who smoke. What are the factors associated with this difference? Are sex-specific interventions required so that young male smokers' increased risk of health problems due to tobacco use can be effectively addressed?

Research is required to better understand how concerns about weight relate to smoking among girls. A comprehensive research agenda is required, one that considers weight within the contexts of girls' personal and social realities, including self esteem and relationships with peers and within families.

Adequate understanding of youth smoking behaviour is impossible without attention to the implications of socioeconomic status. What are the mechanisms by which parental education and household income are so strongly associated with young Canadians' smoking behaviours? What policy and programme initiatives are required if Canada is to reduce the health risks from tobacco use which now disproportionately fall on its low-income young citizens?

The roles of student income, engagement in organized activities, and sedentary lifestyles in youth smoking behaviour all merit research attention. Understanding the mechanisms by which these factors are and are not associated with tobacco use may suggest smoking control interventions available to families, schools, and communities.

In addition to providing benchmark data on national prevalence of smoking, the YSS offers a detailed snapshot of purchasing behaviour (Chapter 9) and knowledge of health risks (Chapter 8). It also provides a unique opportunity to advance our knowledge of the psychosocial correlates of smoking initiation and behaviour including correlates of cessation (Chapter 4). The collection of data from parents at the same time as youth is also unique in a national smoking survey and will help in the investigation of social influences on youth smoking behaviour (Chapter 5). This information is critical to assessing the need for increased legislative controls on tobacco, bolstering public support for these policy options, and gauging the effectiveness of tobacco control efforts.

Given the changes that have been observed over the last eight years, it is important to continue monitoring smoking behaviours in this group of young people. Results from this and future surveys will help develop and guide strategies to prevent or reduce smoking and inform analysts of tobacco policy. They will also serve as an education tool for parents and educators and enable the evaluation of the impact of prevention and control measures. They will also advance our understanding of the psychosocial and environmental influences on smoking in young Canadians.

Limitations

As previously noted in this chapter, and as discussed in Chapter 2, we describe here the association between smoking behaviours and selected variables of interest. However, conclusions regarding causation cannot be drawn from YSS data. Further, when large numbers of possible associations are tested, as was the case in this chapter, there is increased risk that associations may be identified which are the result of chance rather than a reflection of real associations in the population. The large sample size in the YSS also means that even modest associations can be found to be statistically significant; whether such findings are of practical importance is a different matter.

References

1. Mills C, Stephens T, Wilkins K. Summary report on the workshop on data for monitoring tobacco use. Chronic Diseases in Canada 1994; 15: 105-110.

2. Statistics Canada . 2004. Youth Smoking Survey, 2002. Microdata User's Guide . Special Surveys Division.

3. Marsh HW. Self-description Questionnaire, SDQ Manual . San Antonio : The Psychological Corporation 1998.

4. Field AE, Austin SB, Frazier AL . Smoking, getting drunk and engaging in bulimic behaviours: In which order are the behaviours adopted? Journal of the American Academy of Child and Adolescent Psychiatry 2002; 41: 846-853.

5. Stice E, Shaw H. Prospective relations of body image, eating, and affective disturbances to smoking onset in adolescent girls: How Virginia slims. Journal of Consulting and Clinical Psychology 2003; 71 : 129-135.

6. Unger J, Cruz T, Rohrbach L. English language use as a risk factor for smoking initiation among Hispanic and Asian-American adolescents: Evidence for mediation by tobacco-related beliefs and social norms. Health Psychology 2000; 19: 403-410.

7. Canadian Institute for Health Information. Improving the Health of Canadians. 2004. Ottawa : Author.

8. Environics Research Group Limited. Wave 8 Surveys: The Health Effects of Tobacco and Health Warning Messages on Cigarette Packages - Survey of Youth . 2004. Ottawa : Health Canada.

9. Tobacco Control Program. 2003. Tobacco Control By-laws in Canada . Retrieved 28 October, 2004 from Health Canada, Tobacco Control Programme Web site: http://www.hc- sc.gc.ca/hecs-sesc/tobacco/pdf/by_laws2001.pdf

10. Next link will take you to another Web site Average Annual Tax per Pack. Retrieved 2 February, 2005

11. Ontario Tobacco Research Unit. 2003. Tobacco Control Highlights: Ontario and Beyond . [Special Reports: Monitoring and Evaluation Series, 2002-2003, 9(1) ]. Toronto : Author.


Table 3-1 - Amount Smoked in the Last 30 Days on Days When Smoking Occurred, Canada, Youth Smoking Survey 2002 and 1994

 

Cigarettes Smoked On Days When Smoking Occurred

Number Of Days Smoked In Last 30

<5 cigs

6-20 cig

>20 cigs

1-5 days

6-10 days

11-20 days

21-29 days

30 days

2002

61.7

27.6

10.7

43.5

10.5

13.5

8.1

24.5

1994

62.9

25.9

11.2

39.6

15.1

13.8

15.3

16.2

Percentages may not add to 100 due to rounding

Table 3-2a - Prevalence of Ever Use of Tobacco Products Other than Cigarettes, by Sex and by Grade, Canada, Youth Smoking Survey 2002

2002

 

Pop. Est ('000)

Cigars or Pipes (%)

Chewing Tobacco (%)

Snuff (%)

Bidis (%)

Grade

Total

2,028

13.3

2.1

2.2

2.5

Females

988

11.0

#

1.7

2.3

Males

1039

15.4

3.2

2.8

2.7

5

 

397

3.5

#

2.2*

#

6

 

406

6.2

1.1*

1.5*

1.1*

7

 

425

12.3

2.4*

1.9*

2.3*

8

 

404

18.5

2.5*

2.7

3.8

9

 

396

26.2

4.2

2.9

5.1

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Table 3-2b - Prevalence of Ever Use of Tobacco Products Other than Cigarettes, by Sex and by Grade, Canada, Youth Smoking Survey 1994

1994

 

Pop. Est ('000)

Cigars or Pipes (%)

Chewing Tobacco (%)

Snuff (%)

Bidis (%)

Grade

Total

1,949

20.0

7.0

3.5

-

Females

953

16.1

3.2

2.3*

-

Males

997

23.6

10.7

4.6

-

5

 

326

7.1

1.9*

2.3*

-

6

 

422

12.9

4.6*

2.1*

-

7

 

392

19.2

6.5

3.0*

-

8

 

401

27.7

9.5

5.7*

-

9

 

409

30.6

11.6

4.2*

-

* Moderate sampling variability; interpret with caution
- Data not available

Table 3-3a - Percentage of Never Smokers Who Might Try Smoking in Next Month, by Grade and Sex, Canada, Youth Smoking Survey 2002

2002

Grade

Pop. Est. ('000)

Yes might try

Don't know

No

Females %

Males %

Females %

Males %

Females %

Males %

All grades: Females & Males combined

1,560

0.3*

5.7

93.9

All grades

1,560

0.3*

0.4*

6.3

5.2

93.4

94.4

5

366

#

#

2.9

4.2

96.9

95.7

6

358

#

#

4.4

3.1

95.4

96.4

7

334

#

#

6.3

7.2

93.5

92.5

8

273

#

#

10.5

6.9

89.0

92.5

9

229

#

#

10.0

5.1

89.6

94.7

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Table 3-3b - Percentage of Never Smokers Who Might Try Smoking in Next Month, by Grade and Sex, Canada, Youth Smoking Survey 1994

1994

Grade

Pop. Est. ('000)

Yes might try

Don't know

No

Females %

Males %

Females %

Males %

Females %

Males %

All grades: Females & Males combined

1,160

#

8.3

91.2

All grades

1,160

#

0.6*

8.9

7.7

90.5

91.8

5

273

#

#

6.5*

5.8*

93.5

94.1

6

310

#

#

5.7*

7.2*

94.1

92.5

7

234

#

#

11.7

10.1

87.3

89.5

8

179

#

#

12.3

5.5*

86.5

93.4

9

164

#

#

11.6*

11.3*

87.4

88.2

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Table 3-4 - Perceived Easy Access to Cigarettes among Never Smokers by Province, Canada, Youth Smoking Survey 2002 and 1994

 

Pop. Est.
('000)

2002
%

Pop. Est.
('000)

1994
%

Canada

1,557

17.4

1,159

24.0

NL

24

20.8

25

29.5

PE

8

18.4

6

21.5

NS

47

19.1

40

26.0

NB

37

17.2

32

22.6

QC

304

22.8

251

28.3

ON

640

15.7

453

22.1

MB

60

12.2

44

22.3

SK

50

15.5

42

20.4

AB

176

13.8

122

21.9

BC

210

19.4

145

24.8

Table 3-5a - Smoking Category by Province and Grade, Canada, Youth Smoking Survey 2002

2002

Grade

Pop. Est. ('000)

Never Smoker
(a)
%

Never Smoker
(b)
%

Puffer
%

Smoked Beyond Puffing (c)
%

Daily Smoker
%

Canada , 5-9

2,021

69.1

8.3

10.3

10.5

1.8

5

395

86.1

7.1

5.1

1.6*

#

6

404

81.9

7.1

6.4

4.4

#

7

424

70.3

8.5

10.5

9.5

1.3*

8

403

58.2

9.6

13.6

16.0

2.7

9

395

48.9

9.1

16.2

21.0

4.8

NL, 5-9

34

65.3

7.5

11.2

12.3

3.7*

5

6

88.5

#

#

#

#

6

6

82.9

#

#

#

#

7

7

70.3

11.5*

10.4*

#

#

8

7

53.0

#

18.8

17.0*

#

9

7

36.8

#

12.3*

30.9

13.0*

PE, 5-9

10

74.7

7.2

7.5

8.6

#

5

2

89.8

#

#

#

#

6

2

87.5

#

#

#

#

7

2

78.2

#

#

#

#

8

2

62.5

#

#

15.9*

#

9

2

56.5

#

12.8*

19.6*

#

NS, 5-9

61

67.9

7.8

10.0

12.0

2.3*

5

11

91.0

#

#

#

#

6

12

84.3

#

#

#

#

7

13

68.1

9.4*

11.5*

10.6*

#

8

13

51.5

9.0*

13.5

22.7

#

9

12

47.2

#

16.8

19.9

#

NB, 5-9

49

68.4

8.0

10.3

10.5

2.8*

5

9

84.2

#

#

#

#

6

9

81.0

#

#

#

#

7

10

68.8

#

12.0*

10.1*

#

8

10

54.1

13.0*

15.3*

16.2

#

9

11

56.0

#

11.4*

17.9

9.7*

QC, 5-9

486

54.6

8.3

13.9

18.8

4.4

5

96

77.7

9.5

9.2

#

#

6

97

70.2

9.0

9.6

10.8

#

7

111

50.4

9.1

15.9

20.8

#

8

97

41.8

7.0*

16.5

27.0

7.7*

9

85

31.1

6.6*

18.6

33.0

10.6

ON, 5-9

768

74.4

9.4

8.5

7.3

#

5

154

88.7

7.6*

#

#

#

6

156

85.5

7.5*

#

#

#

7

157

79.3

8.4*

8.4*

#

#

8

151

62.8

11.8

12.5

12.3

#

9

151

54.6

11.6*

15.2

17.4

#

MB, 5-9

76

72.1

7.4

10.1

8.7

#

5

14

88.7

#

#

#

#

6

14

87.1

#

#

#

#

7

15

75.8

#

10.3*

#

#

8

16

59.3

#

15.7*

14.3*

#

9

16

52.4

10.4*

13.3*

17.8*

#

SK, 5-9

67

68.4

6.2

13.8

9.7

#

5

13

88.1

#

#

#

#

6

13

77.2

#

12.0*

#

#

7

14

69.4

#

12.0*

#

#

8

14

61.5

#

17.8

12.6*

#

9

14

48.2

#

21.5

18.8

#

AB, 5-9

219

73.9

6.6

10.4

7.7

#

5

42

85.8

#

#

#

#

6

44

87.6

#

#

#

#

7

45

78.4

#

#

#

#

8

45

65.8

#

12.9*

11.5*

#

9

43

52.4

#

16.0

18.8

#

BC, 5-9

251

76.9

7.5

8.0

6.7

#

5

48

92.0

#

#

#

#

6

50

88.0

#

#

#

#

7

50

78.0

8.2*

7.7*

#

#

8

50

71.0

9.0*

9.0*

9.5*

#

9

53

57.5

8.9*

16.1

14.8

#

(a) Never Smoker who has Never Seriously Thought About Smoking
(b) Never Smoker who has Seriously Thought About Smoking
(c) Smoked Beyond Puffing, Not Daily Smoker
* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Table 3-5b - Smoking Category by Province and Grade, Canada, Youth Smoking Survey 1994

1994

Grade

Pop. Est. ('000)

Never Smoker
(a)
%

Never Smoker
(b)
%

Puffer
%

Smoked Beyond Puffing (c)
%

Daily Smoker
%

Canada, 5-9

1,944

50.5

9.0

13.9

22.1

4.5

5

324

75.1

8.9

9.7

6.1*

#

6

420

64.3

9.4

13.5

12.0

#

7

391

49.7

10.0

14.4

22.4

3.4*

8

401

35.7

9.0

15.7

31.7

8.0

9

408

32.1

7.9

15.4

35.5

9.1

NL, 5-9

45

46.4

10.0

13.1

24.3

6.2

5

7

78.4

#

#

#

#

6

8

66.6

11.7*

12.0*

#

#

7

9

44.0

14.4*

15.5*

23.0

#

8

10

35.0

#

15.7*

34.8

#

9

11

24.1

#

13.6*

40.0

16.0*

PE, 5-9

10

52.8

8.6

14.8

20.2

3.6*

5

1

76.9

#

#

#

#

6

2

66.6

10.6*

15.0*

#

#

7

2

53.8

11.2*

17.4*

16.4*

#

8

2

37.7

#

14.5*

32.0

#

9

2

35.1

#

17.7*

37.1

#

NS, 5-9

62

52.8

11.4

11.1

19.6

5.1

5

13

70.8

13.7*

#

#

#

6

12

60.0

11.4*

12.6*

15.5*

#

7

13

49.9

14.4*

10.3*

21.0

#

8

12

43.6

10.4*

14.1*

23.2

#

9

12

38.1

#

#

32.8

#

NB, 5-9

52

54.0

8.8

12.3

21.3

3.7*

5

7

80.6

#

#

#

#

6

11

70.2

8.6*

12.5*

8.7*

#

7

12

51.9

12.5*

14.6*

18.4*

#

8

9

44.8

#

10.8*

28.5

#

9

12

32.1

#

13.3*

40.5

#

QC, 5-9

477

45.9

6.5

12.8

27.5

7.3

5

103

73.4

#

11.1*

#

#

6

88

58.2

#

14.9*

17.9*

#

7

100

43.4

#

14.5*

29.1

#

8

102

28.3

#

12.2*

39.4

15.3*

9

84

23.9

#

11.3*

43.5

12.4*

ON, 5-9

710

53.6

10.0

14.8

19.2

#

5

93

76.6

#

#

#

#

6

174

67.7

9.8*

12.2*

#

#

7

132

54.7

12.1*

12.9*

20.2*

#

8

154

40.2

10.2*

18.7

26.9

#

9

157

36.7

#

18.8*

31.0

#

MB, 5-9

75

50.6

8.0

14.9

22.3

4.1*

5

12

80.7

#

#

#

#

6

14

66.8

#

17.5*

#

#

7

18

43.3

#

20.4

25.1

#

8

15

30.8

10.9*

15.4*

35.6

#

9

16

40.8

#

#

35.4

#

SK, 5-9

76

47.0

8.4

15.6

25.2

*3.9

5

13

69.2

#

#

#

#

6

17

59.4

#

15.8*

15.1*

#

7

16

47.3

10.6*

19.9*

21.4

#

8

15

31.6

#

18.9*

36.2

#

9

16

29.7

#

11.1*

41.4

#

AB, 5-9

201

50.6

9.9

14.0

20.9

4.6*

5

34

73.4

#

#

#

#

6

50

63.2

#

13.2*

13.2*

#

7

42

46.2

11.2*

17.6*

21.2

#

8

35

38.0

10.6*

14.0

29.6

#

9

40

31.0

#

15.0

34.5

11.4*

BC, 5-9

237

50.8

10.2

13.9

20.2

5.0

5

40

77.9

#

#

#

#

6

44

64.7

10.4*

15.0*

9.4*

#

7

48

55.9

10.8*

12.6*

17.0*

#

8

47

34.3

12.0*

15.3*

31.4

#

9

58

30.6

#

16.3*

33.5

10.6*

(a) Never Smoker who has Never Seriously Thought About Smoking
(b) Never Smoker who has Seriously Thought About Smoking
(c) Smoked Beyond Puffing, Not Daily Smoker
* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Table 3-6a - Smoking Category by Sex and Grade, Canada, Youth Smoking Survey 2002

2002

Grade

Pop. Est. ('000)

Never Smoker
(a)
%

Never Smoker
(b)
%

Puffer
%

Smoked Beyond Puffing (c)
%

Daily Smoker
%

Females, 5-9

985

69.3

8.1

9.6

11.1

1.9

5

194

88.2

6.4

4.0*

#

#

6

198

82.5

7.1

5.7

4.6*

#

7

205

72.5

7.6

9.2

9.6

#

8

196

54.7

9.5

13.6

19.3

2.9*

9

192

48.0

10.2

15.6

21.1

5.2*

Males, 5-9

1,036

69.0

8.4

11.0

9.9

1.7

5

201

84.0

7.7

6.1

2.1*

#

6

206

81.4

7.1

7.0

4.2*

#

7

219

68.2

9.3

11.7

9.5

#

8

207

61.5

9.7

13.5

12.9

2.5*

9

202

49.7

8.2

16.7

20.9

4.5*

(a) Never Smoker who has Never Seriously Thought About Smoking
(b) Never Smoker who has Seriously Thought About Smoking
(c) Smoked Beyond Puffing, Not Daily Smoker
* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Table 3-6b - Smoking Category by Sex and Grade, Canada, Youth Smoking Survey 1994

1994

Grade

Pop. Est. ('000)

Never Smoker
(a)
%

Never Smoker
(b)
%

Puffer
%

Smoked Beyond Puffing (c)
%

Daily Smoker
%

Females, 5-9

951

50.3

9.7

13.1

22.1

4.9

5

152

77.5

11.2*

7.4*

#

#

6

204

67.5

8.5*

13.5

9.8*

#

7

189

50.8

11.1*

14.1

20.1

3.9*

8

199

31.5

10.1*

16.0

34.1

8.3*

9

207

30.9

7.9*

13.1

38.1

10.1*

Males, 5-9

993

50.7

8.4

14.7

22.1

4.1

5

172

73.0

6.9*

11.7*

8.3*

#

6

216

61.3

10.1*

13.6

14.0

#

7

203

48.7

9.0*

14.7

24.6

#

8

201

39.8

7.8*

15.5

29.3

7.7*

9

202

33.3

10.0*

17.8

32.7

8.2*

(a) Never Smoker who has Never Seriously Thought About Smoking
(b) Never Smoker who has Seriously Thought About Smoking
(c) Smoked Beyond Puffing, Not Daily Smoker
* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Table 3-7 - Mean Number of Cigarettes Smoked Per Day in Last 7 Days - By Those Who Reported Any Smoking in Last 7 Days - by Province, Canada, Youth Smoking Survey 2002 and 1994

 

2002

1994

Canada

4.2

3.9

NL

5.2

4.0

PE

5.1

3.7

NS

4.4

3.5

NB

5.7

3.6

QC

5.0

5.2

ON

1.5

2.7

MB

4.3

2.8

SK

3.7

3.8

AB

4.0

3.6

BC

3.5

3.6

Table 3-8a - Ever Used Other Tobacco Products, by Province, Canada, Youth Smoking Survey 2002

2002

Pop. Est.
('000)

Cigars or Pipes
(%)

Chewing Tobacco
(%)

Snuff
(%)

Bidis
(%)

Canada

2,028

13.3

2.1

2.2

2.5

NL

34

13.0

#

#

#

PE

10

9.6

3.5*

#

#

NS

62

11.9

2.7*

#

#

NB

49

12.6

2.1*

2.5*

1.9*

QC

487

24.1

2.0*

5.9

7.6

ON

771

8.9

#

#

#

MB

76

11.2

2.2*

#

#

SK

68

14.1

6.1

#

#

AB

219

10.7

3.9*

#

#

BC

252

9.3

2.9*

#

#

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Table 3-8b - Ever Used Other Tobacco Products, by Province, Canada, Youth Smoking Survey 1994

1994

Pop. Est.
('000)

Cigars or Pipes
(%)

Chewing Tobacco
(%)

Snuff
(%)

Bidis
(%)

Canada

1,949

20.0

7.0

3.5

-

NL

45

20.0

4.6

#

-

PE

10

18.5

4.4*

#

-

NS

62

18.6

6.1

#

-

NB

52

19.1

6.0

4.7*

 

QC

478

21.2

4.4*

8.2

-

ON

712

17.6

4.4*

#

-

MB

75

21.9

7.5

2.5*

-

SK

77

25.3

20.1

4.8*

-

AB

202

23.2

16.3

3.7*

-

BC

238

20.1

8.5

#

-

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability
- Data not available

Table 3-9a - Smoking Category by Language Usually Spoken at Home and Grade, Canada, Youth Smoking Survey 2002

2002

Grade

Pop. Est. ('000)

Never Smoker
(a)
%

Never Smoker
(b)
%

Puffer
%

Smoked Beyond Puffing (c)
%

Daily Smoker
%

Canada , 5-9

2,028

69.1

8.4

10.3

10.5

1.8

5

397

86.1

7.1

5.1

1.6*

#

6

406

81.9

7.1

6.4

4.4

#

7

425

70.3

8.5

10.5

9.5

1.3*

8

404

58.2

9.6

13.6

16.0

2.7

9

396

48.9

9.1

16.2

21.0

4.9

English, 5-9

1,373

73.4

8.3

8.9

8.2

1.1

5

258

89.0

5.7

4.0

1.0*

#

6

290

85.2

6.6

5.4

2.7*

#

7

278

76.3

9.1

8.2

6.0

#

8

280

63.5

10.4

11.5

13.7

1.0*

9

267

53.0

9.7

15.7

17.7

3.9

French, 5-9

396

53.1

7.5

14.4

20.0

5.0

5

80

77.5

9.1*

9.6*

#

#

6

71

69.3

7.1*

10.5*

12.4*

#

7

91

48.2

8.8*

15.5

23.3

#

8

79

40.5

6.9*

18.3

25.3

9.0*

9

74

31.1

#

17.8

35.2

11.1*

Both English & French, 5-9

77

58.1

7.6*

16.1

16.4

#

5

12

69.1

#

#

#

#

6

16

81.3

#

#

#

#

7

17

64.6

#

#

#

#

8

15

45.2

#

#

25.8*

#

9

17

33.0

#

#

33.9*

#

Other, 5-9

172

78.3

8.3

8.9

4.4*

#

5

44

92.5

#

#

#

#

6

26

80.6

#

#

#

#

7

37

83.9

#

#

#

#

8

29

70.2

#

#

#

#

9

36

59.6

#

#

13.1*

#

French in Quebec , 5-9

380

52.3

7.6

14.6

20.3

5.2

5

78

77.3

9.3*

9.5

#

#

6

68

68.3

7.2*

10.9*

12.8*

#

7

90

47.6

8.9*

15.5

23.7

#

8

77

39.6

6.6*

18.6

25.8

9.4*

9

67

27.9

5.4*

18.5

36.2

12.1*

French outside Quebec , 5-9

16

72.8

4.4

8.8

13.4

#

5

2

84.8

#

#

#

#

6

3

90.8

#

#

#

#

7

2

84.8

#

#

#

#

8

3

65.9

#

#

#

#

9

7

61.8

#

#

#

#

English in Quebec , 5-9

44

68.7

14.0

#

#

#

5

6

#

#

#

#

#

6

15

#

#

#

#

#

7

8

#

#

#

#

#

8

8

#

#

#

#

#

9

7

#

#

#

#

#

English outside of Quebec , 5-9

1,329

73.6

8.1

9.0

8.2

1.1

5

252

89.0

5.7

4.0

0.1

#

6

275

85.5

6.1

5.6

2.8

#

7

270

76.2

9.0

8.4

6.1

#

8

272

63.9

10.3

11.4

13.3

1.1

9

260

53.4

9.4

15.6

17.9

3.8

(a) Never Smoker who has Never Seriously Thought About Smoking
(b) Never Smoker who has Seriously Thought About Smoking
(c) Smoked Beyond Puffing, Not Daily Smoker
* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Table 3-9b - Smoking Category by Language Usually Spoken at Home and Grade, Canada, Youth Smoking Survey 1994

1994

Grade

Pop. Est. ('000)

Never Smoker
(a)
%

Never Smoker
(b)
%

Puffer
%

Smoked Beyond Puffing (c)
%

Daily Smoker
%

Canada , 5-9

1,942

50.5

9.1

13.9

22.1

4.4

5

322

75.2

9.0

9.5

6.2*

#

6

421

64.3

9.4

13.5

12.0

#

7

391

49.7

10.0

14.4

22.5

3.4*

8

400

35.8

9.0

15.7

31.7

7.9

9

408

32.1

7.9

15.4

35.5

9.1

English, 5-9

1,342

51.1

10.2

14.1

20.9

3.7

5

203

74.2

11.6

9.0*

5.0*

#

6

305

64.9

9.6

13.7

11.0

#

7

269

51.9

11.0

14.6

20.3

#

8

274

38.2

10.8

16.4

29.1

5.5*

9

291

32.0

8.6

15.6

35.0

8.8

French, 5-9

398

45.8

4.8*

12.3

29.5

7.7

5

84

76.4

#

9.9*

9.0*

#

6

72

57.1

#

15.2*

19.6*

#

7

78

45.2

#

12.4*

31.0

#

8

86

25.2

#

11.2*

43.5

17.2

9

78

25.5

#

13.1*

43.9

12.1*

Both English & French, 5-9

69

46.0

10.6*

16.6*

21.2*

#

5

16

61.2

#

#

#

#

6

11

50.9*

#

#

#

#

7

20

42.2*

#

#

#

#

8

9

#

#

#

#

#

9

13

#

#

#

#

#

Other, 5-9

127

61.4

9.2*

15.0*

13.0*

#

5

17

94.1

#

#

#

#

6

31

79.5

#

#

#

#

7

23

45.8*

#

#

#

#

8

29

48.2

#

21.7*

22.2*

#

9

26

46.8*

#

#

#

#

French in Quebec , 5-9

370

45.4

4.7

12.1

29.7

8.1

5

79

76.9

#

#

#

#

6

69

55.8

#

15.5*

20.4*

#

7

75

44.4

#

12.1*

31.9

#

8

82

24.5

#

#

43.7

18.0*

9

65

23.5*

#

13.6*

44.1

#

French outside Quebec , 5-9

28

50.1

#

#

27.6*

#

5

5

67.9*

#

#

#

#

6

3

87.3*

#

#

#

#

7

3

#

#

#

#

#

8

4

#

#

#

#

#

9

13

35.4*

#

#

42.5*

#

English in Quebec , 5-9

56

50.5

15.9*

12.1*

20.0*

#

5

13

#

#

#

#

#

6

7

#

#

#

#

#

7

12

#

#

#

#

#

8

13

#

#

#

#

#

9

11

#

#

#

#

#

English outside of Quebec , 5-9

1,287

51.1

10.0

14.2

20.9

3.8

5

190

74.7

11.2*

9.2*

4.7*

#

6

298

64.9

9.7

13.4

11.3

#

7

257

51.8

11.1

14.5

20.5

#

8

262

37.6

10.7

16.4

29.6

5.8*

9

279

32.5

7.8*

16.2

34.5

9.0

(a) Never Smoker who has Never Seriously Thought About Smoking
(b) Never Smoker who has Seriously Thought About Smoking
(c) Smoked Beyond Puffing, Not Daily Smoker
* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Table 3-10a - Parental Education by Smoking Category, Canada, Youth Smoking Survey 2002

2002

Less Than Secondary

Secondary Graduate and Post

University Degree

Pop. Est. ('000)

186

1,326

496

Never Smoker (a) (%)

57.5

68.1

76.9

Never Smoker (b) (%)

6.9

8.6

7.4

Puffer (%)

13.2

10.7

8.3

Smoked Beyond Puffing (c) (%)

17.2

10.9

6.8

Daily Smoker (%)

5.2*

1.7

#

(a) Never Smoker who has Never Seriously Thought About Smoking
(b) Never Smoker who has Seriously Thought About Smoking
(c) Smoked Beyond Puffing, Not Daily Smoker
* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Table 3-10b - Parental Education by Smoking Category, Canada, Youth Smoking Survey 1994

1994

Less Than Secondary

Secondary Graduate and Post

University Degree

Pop. Est. ('000)

402

1,204

336

Never Smoker (a) (%)

44.0

50.9

56.9

Never Smoker (b) (%)

7.8

9.3

9.5

Puffer (%)

15.8

13.4

13.7

Smoked Beyond Puffing (c) (%)

26.1

22.0

17.6

Daily Smoker (%)

6.2

4.5

2.3*

(a) Never Smoker who has Never Seriously Thought About Smoking
(b) Never Smoker who has Seriously Thought About Smoking
(c) Smoked Beyond Puffing, Not Daily Smoker
* Moderate sampling variability; interpret with caution

Table 3-11 - Smoking Category by Aboriginal Status, Canada, Youth Smoking Survey 2002

 

Pop. Est. ('000)

Never
(a)
%

Never
(b)
%

Puffer
%

Smoked Beyond Puffing (c)
%

Daily Smoker
%

Aboriginal

102

50.9

10.1

15.7

17.6

5.7 *

Non-Aboriginal

1,904

70.2

8.0

10.0

10.1

1.6

(a) Never Smoker who has Never Seriously Thought About Smoking
(b) Never Smoker who has Seriously Thought About Smoking
(c) Smoked Beyond Puffing, Not Daily Smoker
* Moderate sampling variability; interpret with caution
Percentages may not add to 100 due to rounding

Table 3-12a - Smoking Category by Aboriginal Status in the Prairie Provinces and British Columbia, Youth Smoking Survey 2002

2002

Pop. Est. ('000)

Never
(a)
%

Never
(b)
%

Puffer
%

Smoked Beyond Puffing (c)
%

Daily Smoker
%

Aboriginal

55

56.3

7.4*

14.1*

17.3

#

Non-Aboriginal

554

76.2

7.1

9.2

6.7

#

(a) Never Smoker who has Never Seriously Thought About Smoking
(b) Never Smoker who has Seriously Thought About Smoking
(c) Smoked Beyond Puffing, Not Daily Smoker
* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Table 3-12b - Smoking Category by Aboriginal Status in the Prairie Provinces and British Columbia, Youth Smoking Survey 1994

1994

Pop. Est. ('000)

Never Smoker
(a)
%

Never Smoker
(b)
%

Puffer
%

Smoked Beyond Puffing (c)
%

Daily Smoker
%

Aboriginal

37

34.9*

#

#

32.5*

#

Non-Aboriginal

547

51.4

9.7

14.2

20.7

4.1

(a) Never Smoker who has Never Seriously Thought About Smoking
(b) Never Smoker who has Seriously Thought About Smoking
(c) Smoked Beyond Puffing, Not Daily Smoker
* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Table 3-13 - Full Agreement with Self Esteem Items, by Never/Ever Smoker Category, Canada, Youth Smoking Survey 2002

 

Never Smoker
%

Ever Smoker
%

Pop. Est. ('000)

1,570

457

I Like the Way I Am

43.2

31.1

I Have a Lot to be Proud Of

47.0

32.2

A Lot of Things About Me are Good

43.8

30.2

When I do Something, I do it Well

25.3

17.5

Quitting Behaviour

Jennifer L. O'Loughlin, PhD
Department of Epidemiology, Biostatistics and Occupational Health
McGill University
Institut national de santé publique du Québec

Paul W. McDonald, PhD
Department of Health Studies and Gerontology
Health Behaviour Research Group
University of Waterloo

Murray J. Kaiserman, PhD
Tobacco Control Programme
Health Canada

Sarah Viehbeck, MSc
Department of Health Studies and Gerontology
University of Waterloo

Acknowledgements: The authors thank Caroline Murphy (University of British Columbia) and Cathy Backinger (National Cancer Institute) who reviewed an earlier draft of this chapter and provided helpful commentary.

Highlights

  • Of approximately 247,100 students in grades 5-9 across Canada who smoked beyond puffing not daily or daily smokers in 2002, 39% had seriously thought about quitting. One-third of 210,300 students who smoked beyond puffing, not daily smokers had thought about quitting, compared to three-quarters of 36,800 daily smokers.
  • Among 92,100 smoked beyond puffing, not daily smokers and daily smokers who had seriously thought about quitting, 68% had made one or more attempts to quit smoking in their lifetime. The average number of lifetime quit attempts was 3.2 in 2002 compared with 3.4 in 1994.
  • Among 62,100 smoked beyond puffing, not daily smokers and daily smokers who had ever seriously thought about quitting and who had tried to quit, 72% had made at least one recent quit attempt (in the six months preceding the survey).
  • The proportion of smoked beyond puffing, not daily smokers and daily smokers who had ever seriously thought about quitting who had made a recent quit attempt (in the six months preceding the survey) ranged from 65% in Manitoba to 87% in Alberta.
  • Smoked beyond puffing, not daily smokers who had tried to quit were able to remain abstinent longer than daily smokers who had tried to quit - 51% had remained abstinent for longer than one month, compared to only 17% of daily smokers.

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

Smoking Behaviour

This chapter includes only those survey respondents who reported smoking and for whom quitting behaviours are relevant. Specifically, this includes Smoked Beyond Puffing, Not Daily Smokers and Daily Smokers. Those who had tried smoking, even a few puffs, but had never smoked a whole cigarette (the Puffer category) were not included in this chapter - because these individuals had smoked so little, quitting behaviours may not yet be relevant. Smoked beyond puffing, not daily smokers includes respondents who had smoked a whole cigarette but had not smoked every day during the week preceding data collection. The Daily Smoker category includes those who reported smoking cigarettes on each of the seven days preceding data collection. Throughout this chapter, the term "novice smokers" refers collectively to smoked beyond puffing, not daily smokers and daily smokers. The word "novice" reflects that, relative to older adolescents and young adults who have smoked over many months or years, these young persons have less experience smoking and less established smoking patterns.

Quitting Behaviour

Questionnaire items relevant to quitting behaviour included whether or not the respondent had ever seriously thought about quitting (Y_Q32), the number of times the individual had tried to quit smoking in his/her lifetime (lifetime quit attempts) (Y_Q33), the age at which the participant had first tried to quit (Y_Q34), whether or not the participant had tried to quit in the six months prior to the survey (Y_Q35) and finally, the longest time during which the participant had remained abstinent (Y_Q36). Data on lifetime quit attempts were coded only for respondents who had ever seriously thought about quitting. Similarly data on quit attempts for the past six months were coded only for respondents who had ever tried to quit. Thus the data do not permit identification of respondents who had made a successful quit attempt and remained non-smokers.

Additional Variables of Interest

To identify factors other than sex, grade, and type of smoker that might be related to quitting behaviours, we examined the association between whether or not the participant had made a quit attempt in the six months prior to the survey and selected (i) socio-demographic factors (GPP_Q14a; GPP_Q17; Y_Q03 and Y_QDVABORIG); (ii) beliefs about smoking (Y_Q46a, Y_Q46e and Y_Q46j); (iii) facilitators and barriers to smoking in the social and physical environments (Y_Q25; Y_Q29; Y_Q37a; Y_Q39a; Y_Q42; Y_Q44; Y_Q53; Y_Q55 and Y_Q58); (iv) other risk behaviour indicators (Y_Q05a; Y_Q05b; Y_Q05g; Y_Q06; Y_Q08; Y_Q66a; Y_Q dvpdg and Y_Qdvnpg); and finally (v) other potential correlates (Y_Q54 and Y_Q62). We studied recent quit attempts as the outcome of interest in these analyses because they may be less subject to recall bias than lifetime quit attempts. This series of analyses is of interest because they might suggest hypotheses for investigation in future analyses of the YSS database, as well as in future youth tobacco research. 

Sample and Response

A weighted total of 247,100 Canadian youth had smoked in the 30 days preceding data collection, including 210,300 smoked beyond puffing, not daily smokers and 36,800 daily smokers. Of these, 92,100 had seriously thought about quitting, 62,100 had made one or more quit attempts in their lifetime (lifetime quit attempt), and 38,900 had tried to quit in the last six months. Categorization of survey respondents by sex, grade, or type of smoker resulted in small sample sizes with which the power to detect differences between subgroups was low. For example, because there were so few respondents in grades 5-6 who responded positively to the quitting behaviour items, we were not able to investigate grade-related variability in the outcomes of interest by sex. In order to address this limitation, an expanded data set that included all respondents who had smoked (not just those who had smoked in the last 30 days) was used in this chapter, thus making it unique among chapters that report findings. The expanded data set was intended to better capture quitting behaviors among novice smokers". Only comparisons that were statistically significant at the p≤ 0.05 level are reported and discussed. To interpret differences between proportions not discussed in this chapter, the reader is referred to Chapter 2, Tables 2-1a, 2-1b and 2-1c, which provide a guide on differences between proportions that attain a statistical significance level at the 0.05 level.

Missing data on each of the main variables investigated in this chapter accounted for less than 10% of total responses. The data presented are therefore based on respondents for whom complete data were available for the variables under consideration.

Findings

Prevalence of Quitting Behaviours

Quitting Cognitions

Of all respondents in grades 5-9 smoked beyond puffing, not daily smokers, or daily smokers, 39% had seriously thought about quitting (Table 4-A). This proportion did not differ by sex or by grade. How,ever approximately one-third (33%) of smoked beyond puffing, not daily smokers had seriously thought about quitting, compared to about three-quarters (76%) of daily smokers.

Ever Tried to Quit

Among respondents who had seriously thought about quitting, 68% had made one or more attempts to quit smoking in their lifetime (Table 4-B). There were no statistically significant differences in this proportion by sex, grade, or type of smoker. Among respondents who had made at least one quit attempt, the average number of lifetime quit attempts was 3.2 and 3.4 in 2002 and 1994, respectively (Table 4-1, presented at the end of the chapter). The data for both 2002 and 1994 corroborate the findings reported above, that daily smokers had made more quit attempts than smoked beyond puffing, not daily smokers (3.7 compared to 3.0 attempts on average in 2002; and 3.9 compared to 3.1 attempts on average in 1994).

Table 4-2 shows that there was little difference by sex in the longest duration that respondents had successfully stopped smoking. However 51% of smoked beyond puffing, not daily smokers had remained abstinent for longer than one month, compared to only 17% of daily smokers, a difference that was statistically significant.

Table 4-A - Ever Seriously Thought About Quitting by Category of Smoker, Grade, and Sex, Canada, Youth Smoking Survey 2002
 

Pop. Est.
('000)

Ever Seriously Thought About Quitting
(%)

Total

247.1

39.3

Category of Smoker

Smoked Beyond Puffing (c)

210.3

32.9

Daily Smoker

36.8

75.9

Grade

5-6

25.8

38.1

7

44.5

42.0

8

74.1

37.8

9

102.8

39.4

Sex

Males

120.3

37.2

Females

126.9

41.2

(c) Smoked Beyond Puffing, Not Daily Smoker

Table 4-B - Ever Tried To Quit by Category of Smoker, Grade, and Sex, Canada, Youth Smoking Survey 2002

 

Pop. Est.
('000)

Ever Tried to Quit
(%)

Total

92.1

68.2

Category of Smoker

Smoked Beyond Puffing (c)

64.2

64.6

Daily Smoker

27.9

76.6

Grade

5-6

8.9

76.2

7

17.2

68.8

8

26.4

64.2

9

39.6

68.9

Sex

Males

42.4

68.6

Females

49.7

67.9

(c) Smoked Beyond Puffing, Not Daily Smoker

Recent Quit Attempts

Among respondents who had ever tried to quit, 72% had made at least one recent quit attempt in the six months preceding the survey (Table 4-C). This proportion did not differ according to sex or category of smoker, but the proportion of students who had made a recent quit attempt increased significantly from grades 5-6 (48%) to grade 7 (80%).

The proportions of respondents who made a recent quit attempt in both 2002 and 1994 did not differ by number of cigarettes smoked daily (Table 4-D).

Table 4-C - Tried to Quit in the Last Six Months by Category of Smoker, Grade, and Sex (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002

 

Pop. Est.
('000)

Tried to Quit in
Last 6 Months
(%)

Total

62.1

72.1

Category of Smoker

Smoked Beyond Puffing (c)

40.9

71.2

Daily Smoker

21.2

73.7

Grade

5-6

6.6

48.1 *

7

11.8

79.5

8

16.5

69.0

9

27.1

76.5

Sex

Males

28.4

70.4

Females

33.7

73.5

(c) Smoked Beyond Puffing, Not Daily Smoker
* Moderate sampling variability, interpret with caution

Table 4-D - Tried to Quit in the Last Six Months by the Number of Cigarettes Smoked per Day and Sex (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002 and Youth Smoking Survey 1994

 

2002

1994

Number of cigarettes per day

Pop. Est.
('000)

Tried to Quit in Last 6 Months
(%)

Pop. Est.
('000)

Tried to Quit in Last 6 Months
(%)

Total

38.9

75.6

142.4

79.1

0-5

26.0

77.2

74.1

83.4

6-10

6.1

69.9

28.6

73.1

>10

6.7

75.0

39.7

75.4

Recent Quit Attempts by Province

The distributions by province of the proportion of individuals in grades 5-9 who had made at least one quit attempt in the past six months were not statistically significantly different (Table 4-E).

Table 4-E - Tried to Quit in the Last Six Months by Province (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002

Province

Pop. Est.
('000)

Tried to Quit in Last 6 Months
(%)

Total, Canada

62.1

72.1

NL

1.7

75.3

PE

0.2

65.3 *

NS

2.1

72.3

NB

1.8

79.6

QC

33.1

70.2

ON

9.9

71.1

MB

2.3

65.1

SK

1.1

67.3 *

AB

5.6

86.7

BC

4.5

70.2

* Moderate sampling variability, interpret with caution

Relation of Recent Quit Attempts to Other Variables

The data presented in Tables 4-3 to 4-7 (presented at the end of the chapter) explore the associations between recent quit attempts in the last six months and a variety of socio-demographic variables, beliefs about smoking, indicators of the social and physical environment, risk behaviours other than smoking, and other miscellaneous variables. There were no statistically significant differences in the proportion of respondents who reported recent quit attempts across categories for any of the variables investigated. However, recent quit attempts did show at least a 10% difference between two or more categories of the following variables: household income, how youth obtain cigarettes, father smokes, friends smoke, played sports with a coach in the last 12 months, desired weight, use of non-prescription drugs to get high and not for medical purposes, and perceived academic standing. These associations warrant further investigation.

Discussion

The objectives of this chapter are twofold - to describe the prevalence of quitting behaviours among novice smokers and to identify possible correlates of quitting behaviours that will increase our understanding of successful quitting in youth and guide the development of evidence-based interventions.

Thinking about quitting might represent an important first step in the quitting process. Approximately 40% of the novice smokers in the 2002 YSS had seriously thought about quitting, indicating moderate interest in quitting in the early stages of smoking onset. However this proportion was strongly associated with smoking status - only one-third of smoked beyond puffing, not daily smokers had seriously thought about quitting, compared to three-quarters of daily smokers. Possible explanations for this difference are threefold. First, the difference might reflect self-awareness or self-identification as a smoker. Smoked beyond puffing, not daily smokers, especially younger smoked beyond puffing, not daily smokers, might not begin to think about quitting until they have accumulated a certain amount of experience with smoking and actually view themselves as being smokers. Second, the observed difference could reflect a belief among smoked beyond puffing, not daily smokers that they are adequately managing the risks associated with smoking without having to quit. Smoked beyond puffing, not daily smokers may (mistakenly) believe that their smoking pattern allows them to balance the perceived risks and benefits of smoking, while daily smokers may feel more vulnerable to the negative aspects of smoking. Third, the difference could reflect increased exposure over time to anti-smoking education that encourages quitting. One could speculate that youth have been so well educated about the negative aspects of smoking that initiation and experimentation may create cognitive dissonance or negative feelings leading to a desire to quit. Although this explanation is speculative, it will be important to determine if novice smokers who have seriously thought about quitting might benefit from interventions to boost their commitment and self-confidence for quitting.

Approximately 60% of "novice smokers" had never thought about quitting. These individuals may need interventions to increase self-awareness that they are indeed smokers despite low levels of cigarette use, and to increase knowledge about the dangers of even low exposure to cigarettes and the increased difficulty in quitting as smoking becomes established.

The data support the notion that seriously thinking about quitting leads to quit attempts - two-thirds (68%) of "novice smokers" who had seriously thought about quitting, had made at least one attempt to quit smoking, and the majority (72%) had tried recently (i.e., in the six-month period preceding the survey). However, the cross-sectional design used to collect these data renders it difficult to determine the direction of the association. Therefore, it is at least theoretically possible that a recent spontaneous quit attempt may also cause youth to think more seriously about quitting in the future. Recent quit attempts did not differ according to age, sex, or number of cigarettes smoked per day. However the proportion of "novice smokers" who had made a recent quit attempt increased from 48% among "novice smokers" in grades 5-6 to 80% in grade 7. Differences by grade may simply be a function of time since tobacco use initiation whereby those who have smoked for longer periods of time are more likely to try quitting. Controlling for time since tobacco use initiation would help resolve this issue. Alternatively this could reflect increased exposure to tobacco control programming among students in secondary school.

There were marked differences between daily smokers and smoked beyond puffing, not daily smokers in longest time quit; smoked beyond puffing, not daily smokers were able to remain abstinent for longer time periods than daily smokers. This might reflect an increasing need for regular exposure to cigarettes as symptoms of nicotine dependence begin to emerge in daily smokers, with a concomitant desire to avoid the unpleasant symptoms of withdrawal. This difference could also reflect differences in the strength of cues and stimuli to smoke (i.e., daily smokers may receive more frequent positive and negative environmental reinforcement to smoke).

Although the provincial differences were not statistically significant, they are of considerable interest because they could reflect differences among provinces in tobacco control programs and policies that affect quitting behaviours. For example, provinces differ in their levels of tobacco taxation and in the percentage of the population that is covered by comprehensive no smoking legislation. Moreover, tobacco control initiatives in several provinces such as Ontario and Quebec were introduced several years ago and may be subject to "wear out" or habituation, especially if they were introduced before the young smokers studied in this database initiated tobacco use. Whatever the reasons, these "natural experiments", which are initiated when new policies and programs are introduced in some provinces and not in others, warrant investigation to assess their impact on quitting behaviours in youth.

Both cross-sectional and longitudinal studies have identified a variety of determinants of successful cessation in youth. The likelihood of quitting successfully appears to be related to several psychosocial characteristics including anti-tobacco beliefs1 and attitudes2, intentions not to smoke in the future 3,4, self-efficacy2, school performance5, feeling hopeful about life1, having an intact nuclear family3, and not having symptoms of depression6. The evidence is strong that heavy smoking is related to lower success in quitting. Occasional smokers are more likely to quit than regular smokers4,6. In a 4-year longitudinal study6, past quit attempts that lasted longer than two weeks predicted cessation, as did having no past quit attempts. The smoking-related environment also seems to play a role in the cessation process: adolescents are more likely to succeed in quitting if they have fewer friends or family members who smoke1,3,7. The perception of less parental approval of smoking has also been found to be a predictor in some studies1. Finally, policy interventions such as price increases and workplace smoking restrictions have also been found to be an effective means of reducing the likelihood of smoking among youth8. However, whether reductions in youth smoking prevalence are a result of reduced smoking initiation or increased smoking cessation remains unclear9. Regardless, a comprehensive tobacco control program should include attention to the broader context in which youth live through policy initiatives. Beyond analyses of quit behaviours according to grade, sex, smoking status, and province, an attempt was made to delineate hypotheses regarding potential determinants of quitting behaviours in youth. Likely related to small sample sizes, none of these other associations were statistically significant, although several variables ( household income, how youth obtain cigarettes; father smokes, friends smoke, played sports with a coach in the last 12 months, desired weight, use of non-prescription drugs to get high and not for medical purposes, and perceived academic standing) warrant further investigation.

Limitations

A major difficulty in this database is that, because the quit-related questions were asked only of respondents who had smoked in the past 30 days, respondents who had made a successful quit attempt, and had since remained non-smokers could not be identified. Therefore the frequency and determinants of "true" quitting in youth could not be investigated. While we were able to study quit attempts, attempting to quit and successfully quitting may represent very different phenomena with very different frequencies and very different profiles of determinants.

A second limitation relates to the measurement of quit behaviours. Differences in quit behaviours observed in this chapter between smoked beyond puffing, not daily smokers and daily smokers may relate more to differences in the conceptualization of quitting behaviour in these two groups, than to actual differences; smoked beyond puffing, not daily smokers and daily smokers may attribute different meanings to the notion of quit attempts and actual quitting. For example daily smokers may have a different (more developed) conceptualization of what a quit attempt actually is because of more experience with smoking. They may also have been more likely than smoked beyond puffing, not daily smokers to confuse quitting (which infers lifetime abstinence) with stopping smoking (i.e., indefinite abstinence).

A third limitation relates to the relatively small sample size of young smokers, which precluded sub-group analysis and detection of variables possibly associated with quit behaviours in youth.

Implications for Future Monitoring and Further Research

In general, the literature on the quit attempts, successful quitting, and the determinants of youth cessation is impeded by the lack of standardized measures of successful quitting. Therefore an important need exists for the development of valid and reliable questions that enable identification of young smokers who are able to quit successfully. Qualitative research to explore the interpretation and meanings of possible quit-related items in youth will help address this issue, and the development of a standardized set of quit-related items for youth will facilitate surveillance and monitoring efforts, as well as enable relevant comparisons across observational studies in different populations.

There are few reports that document the natural history of tobacco use onset in youth, including attempts to quit and successful quitting. In particular, it will be important to differentiate between periods during which novice smokers stop smoking temporarily as part of the onset trajectory, true quit attempts which reflect a deliberate planned intention to stop smoking completely and forever, and successful quit attempts after which the individual maintains a nonsmoking status on a long term basis. Increased understanding of the natural history of onset and quitting in novice smokers will facilitate the development of survey items on quitting relevant to youth at the various stages of smoking onset process.

Until such time as we better understand the quitting process, future surveys could investigate a wider range of potential determinants of quitting behaviour. These could include variables such as withdrawal symptoms, nicotine dependence symptoms, stress, depression, novelty-seeking, rebelliousness, difficulty with cessation, knowledge of nicotine replacement therapy, knowledge of other resources to help youth quit, and attempts to seek help with cessation. In particular, the role of nicotine dependence in self-initiated cessation, relative to other known predictors of cessation in youth, should be investigated. Dependence likely explains why daily smokers are less likely to maintain a quit status than smoked beyond puffing, not daily smokers. T esting these hypotheses in well-powered longitudinal studies designed specifically to identify determinants, along with improved understanding of the natural history of smoking onset and quitting in youth, will increase our understanding of quit behaviours in youth. It will help identify sub-populations in need of intervention; and it will help direct efforts to develop effective and relevant interventions.

References

1. Sussman S. Effects of sixty six adolescent tobacco use cessation trials and seventeen prospective studies of self-initiated quitting. Tobacco Induced Diseases . 2002; 1(1):25-81.

2. Engels RC et al. Antecedents of smoking cessation among adolescents: who is motivated to change? Prev Med . 1998 May-Jun; 27(3):348-57.

3. Ellickson PL et al. Sex differences in predictors of adolescent smoking cessation. Health Psychol . 2001 May; 20(3):

4. Sargent JD et al. Predictors of smoking cessation in adolescents. Arch Pediatr Adolesc Med . 1998 Apr; 152(4):388-93.

5. Hu TW et al. Teenage smoking, attempts to quit, and school performance. Am J Public Health . 1998 Jun; 88(6):940-3.

6. Zhu SH et al. Predictors of smoking cessation in U.S. adolescents. Am J Prev Med . 1999 Apr; 16(3):202-7.

7. Paavola M et al. Smoking cessation between teenage years and adulthood. Health Educ Res. 2001 Feb; 16(1):49-57.

8. Backinger CL, Fagan P, Matthews E, Grana R. Adolescent and young adult tobacco prevention and cessation: Current status and future directions. Tobacco Control 2003; 12(SIV): 46-53.

9. Taurus JA. Public policy and smoking cessation among young adults in the United States. Health Policy 2004; 68: 321-332.


Table 4-1 - Mean, Median And Range Of Number Of Lifetime Quit Attempts by Type Of Smoker and Sex (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002 and Youth Smoking Survey 1994

 

2002

1994

 

Pop. Est. ('000)

Mean

Median

Range

Pop. Est. ('000)

Mean

Median

Range

Total,

62.5

3.2

2

1-21

141.8

3.4

2

1-24

Smoked Beyond Puffing (c)

41.2

3.0

2

1-21

94.2

3.1

2

1-24

Daily Smoker

21.3

3.7

3

1-20

47.6

3.9

3

1-21

Sex

 

 

 

 

 

 

 

 

Males

28.8

3.5

2

1-21

63.9

3.6

2

1-24

Females

33.7

3.1

2

1-20

77.9

3.2

2

1-22

(c) Smoked Beyond Puffing, Not Daily Smoker
Note: Respondents who responded "I Don't Know" were excluded

Table 4-2 - Longest Length of Time (Days) Successfully Stopped Smoking by Category of Smoker and Sex (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002

 

Pop. Est. ('000)

≤1 Day
%

2-7 Days
%

8-31 Days
%

>1 Month
%

Total

79.1

13.3

27.7

18.4

40.5

Sex

 

 

 

 

 

Males

35.6

12.5

29.4

19.2

38.8

Females

43.4

14.0

26.4

17.7

41.9

Category of Smoker

 

 

 

 

 

Smoked Beyond Puffing (c)

54.7

9.0

20.1

19.9

51.1

Daily Smoker

24.4

23.0

44.8

15.2

17.0

(c) Smoked Beyond Puffing, Not Daily

Table 4-3 - Tried to Quit in the Last Six Months by Socio-Demographic Factors (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002

Socio-Demographic Factors

Pop. Est.
('000)

Tried to Quit in Last Six Months
(%)

Parental Education+

61.6

71.8

Completed Less Than High School

14.2

71.0

Completed High School

24.3

72.6

Post-Secondary/University Degree

23.2

71.6

Household Income

56.4

71.1

Less than $30,000

19.0

79.8

$30,000 to Under $45,000

11.9

68.6

$45,000 or More

25.4

65.8

Language++

59.0

71.6

English

28.4

74.6

French

30.6

68.7

Aboriginal

61.8

72.2

Yes

8.1

70.4

No

53.7

72.4

+Based on responding parents (grade 8 or lower and some secondary=Completed less than high school; grade 11-13 graduated and some post secondary=Completed high school; Post secondary certificate or diploma=Post secondary; and University degree=University degree)
++Excludes respondents who reported "French and English" or "Other"

Table 4-4 - Tried to Quit in the Last Six Months According to Selected Beliefs About Smoking and Sex (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002

Believe.

One Would Have to Smoke Many Years to Affect Health

Quitting Can Reduce Health Damage

Smokers Can Quit Anytime They Want

 

Pop. Est.
('000)

Tried to Quit In Last 6 Months (%)

Pop. Est.
('000)

Tried to Quit In Last 6 Months (%)

Pop. Est.
('000)

Tried to Quit In Last 6 Months (%)

Total

62.1

72.1

62.1

72.1

62.1

72.0

Yes

17.9

70.7

30.1

69.9

17.4

74.9

No

36.2

75.2

21.4

73.6

40.7

70.6

Don't Know

7.9

61.0

10.6

75.3

3.9

74.1

Table 4-5 - Tried to Quit in the Last Six Months by Selected Indicators of the Social And Physical Environment (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002

Indicators of Social and Physical Environment

Pop. Est.
('000)

Tried to Quit in
Last Six Months
(%)

Rules About Smoking at School+

57.6

72.2

No Rules/Allowed in Some Areas

34.7

71.1

Not Allowed

22.9

73.9

Ever Taught About Health Problems Related to Smoking at School*

57.8

73.5

Yes

49.5

74.6

No

8.4

66.8

Usually Obtain Cigarettes by:

50.8

77.3

Buying Them

28.6

78.8

Someone Gives Them to Me

19.3

73.6

Take Them

3.0

86.5

Store Has Refused to Sell You Cigarettes

28.3

72.9

Yes

17.9

74.4

No

10.4

70.3

Mother Smokes++

59.9

72.4

Yes

30.1

74.4

No

29.9

70.3

Father Smokes++

56.2

72.1

Yes

29.1

79.0

No

27.0

65.7

Friends' Smoke

56.8

71.8

None/Less Than Half

21.6

68.4

More Than Half

23.2

71.5

All

11.9

78.4

Ever Smoke Inside Your Home

57.4

74.6

Yes

28.3

77.4

No

29.2

71.9

Believe Health Warning Messages on Cigarette Packages

54.4

71.2

Yes

43.0

71.3

No

5.4

72.2

Don't know

6.0

69.2

+ Excludes respondents who responded "Don't know"
++ Excludes respondents who responded "Don't know" or "Do not live with mother/father"

Table 4-6 - Tried to Quit in the Last Six Months by Other Selected Indicators of Behaviour (Among Students, Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002

Selected Behavioural Indicators

Pop. Est.
('000)

Tried to Quit in Last Six Months
(%)

Played Sports Without a Coach in the Last 12 Months

61.9

72.0

<= 3 Times/Week

37.5

75.3

>= 4 Times/Week

24.5

67.1

Played Sports With a Coach in the Last 12 Months

61.9

72.1

No (Never)

22.9

79.0

Yes (All Other Categories)

39.0

68.0

Played Computer/Video Games In the Last 12 Months

61.9

72.0

<= 3 Times/Week

31.0

73.5

>= 4 Times/Week

30.9

70.5

Hours Per Day Spent Watching TV/Videos

61.6

71.9

0-<1

5.5

69.8

1-2

21.0

70.0

3-4

23.9

73.1

>=5

11.3

73.7

Desired Weight

61.5

71.8

Less

30.6

72.5

Same

18.9

67.9

More

7.0

78.0

Don't Know

5.0

73.7

Ever Had 5 Drinks or More on One Occasion

52.7

75.8

Yes

41.6

73.9

No

11.1

82.7

Use of Prescription Drugs to Get High and Not for Medical Purposes

54.4

75.3

Yes

8.5

72.0

No

45.9

75.9

Use of Non-Prescription Drugs to Get High and Not for Medical Purposes

54.3

75.3

Yes

4.4

66.6 *

No

49.9

76.0

* Moderate sampling variability; interpret with caution 

Table 4-7 - Tried to Quit in the Last Six Months by Other Potential Correlates (Among Students Who Had Ever Seriously Thought About Quitting and Who Had Made at Least One Quit Attempt), Canada, Youth Smoking Survey 2002

Other Potential Correlates

Pop. Est.
('000)

Tried to Quit in Last Six Months
(%)

Perceived Academic Standing

61.3

72.1

Better Than Average

9.7

63.1

Average

38.0

75.1

Below Average

13.6

70.1

Ever Asked A Doctor For Help Quitting

58.9

74.0

Yes

3.0

69.1 *

No

55.9

74.3

* Moderate sampling variability; interpret with caution 

Social Influences

Scott T. Leatherdale, PhD
Division of Preventive Oncology
Cancer Care Ontario,
Department of Health Studies and Gerontology
University of Waterloo, &
Department of Public Health Sciences
University of Toronto

Steve R. Manske, EdD
Centre for Behavioural Research and Program Evaluation
University of Waterloo

Alan Diener, PhD
Tobacco Control Programme
Health Canada

Sarah J. Robinson, BKin(Hons)
Department of Health Studies and Gerontology
University of Waterloo

Acknowledgements: The authors thank Jennifer O'Loughlin (McGill University), and Steve Sussman (University of South California) who reviewed an earlier draft of this chapter and provided helpful commentary.

Highlights

  • Youth smoking behaviour is strongly influenced by people in the social environment. Important people in the social environment include friends, parents, and other people who might live in the youth's home (e.g., siblings).
  • The smoking behaviour of close friends is important. Overall, 28% of youth in grades 5-9 have one or more close friends who smoke. The greater the number of close friends who smoke, the more likely a youth is to smoke. The same relationship exists for males and females. The number of youth with close friends who smoke has declined since 1994.
  • The smoking behaviour of parents is also important. A youth with a father or mother who smokes is more likely to smoke. A female youth is more likely than a male youth to smoke if she has a smoking parent. When both parents smoke, a youth is more likely to smoke than when only one parent smokes. The number of youth who have a father and/or mother who smokes has declined since 1994.
  • Parental attitudes about youth smoking are related to youth smoking behaviour. Permissive attitudes tend to promote smoking. However, the majority of youth smokers reported their parents are not aware of their smoking.
  • Smoking within the home is also related to youth smoking behaviour. Overall, 30% of youth live in a home with one or more people who smoke. The greater the number of smokers inside the home the more likely a youth is to smoke. Youth who have ever smoked inside their home are also more likely to be daily smokers. The number of youth living in a home where no one smokes inside has increased since 1994.
  • Parents' educational attainment continues to be strongly related to smoking among their children.
  • These findings indicate that there is a continuing need for comprehensive tobacco control programming aimed at reducing youth exposure to smoking social models. Although youth reported being exposed to fewer friends and family members who smoke in 2002 compared to 1994, smoking social models continue to have a strong influence on youth smoking behaviour. Additional regulations and education campaigns designed to reduce the prevalence of smoking should target both youth and the important people surrounding youth.

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. In this chapter, data from the 2002 Youth Smoking Survey (YSS) are examined to determine the relationship between cigarette smoking behaviour in youth and the smoking behaviour of friends, parents, and other potentially important people in the social environment surrounding youth (e.g., siblings). These 2002 YSS data are also compared to the 1994 YSS data to determine if the relationships between youth smoking behaviour and friends, parents, and important others has changed over time.

Definitions

The effects of social influences are examined for: Daily Smokers; Smoked Beyond Puffing, Not Daily Smokers; Puffers; Never Smokers who have Seriously Thought about Smoking; and Never Smokers who have Never Seriously Thought about Smoking. The definitions used to categorize these five different types of smokers have been described earlier (see Chapters 2 and 3, especially Table 2-C).

Close friends of youth can exert implicit and explicit social pressure to smoke.1-3 Youths' reports of the number of close friends who smoke (Y_Q44) was examined for an association with the smoking habits of youth.

Parents who smoke can make smoking appear socially acceptable and normative.2,3 Youths' reports of the smoking habits of their father (Y_Q37A) and of their mother (Y_Q39A) was examined for an association with the smoking habits of youth. A variable that combines the smoking habits of the father and the mother was also created to examine the influence of situations in which both parents smoke, the father smokes but the mother does not, the mother smokes but the father does not, and neither parent smokes. Parental attitudes about youth smoking may also be important.3 Youths' reports of their father's attitude about their smoking (Y_Q38) and their mother's attitude about their smoking (Y_Q40) were examined for an association with the smoking habits of the youth.

A variable for parent education was also created to examine the influence of parental education on the smoking behaviour of their child. The parent/guardian who completed the parent survey reported his/her highest grade or level of education (P_Q14A) and the highest grade or level of education for the other parent/guardian in the household (P_Q14B).

The smoking behaviour of people inside the youth's home may make a youth more apt to smoke.2,4 Youths' reports of the number of people (other than the respondents) who smoke inside their home (Y_Q41) was examined for an association with the smoking habits of the youth. Youths' report as to whether they have ever smoked inside their home (Y_Q42) was also examined.

Sample and Response

Missing data for items discussed in this chapter accounted for less than 10% of the total responses. As such, the data presented are based on those for whom complete data were available. According to Statistics Canada guidelines, data are not reportable if the sample size was too small or if there was high sampling variability. Statistically significant group differences were determined using procedures described in Chapter 2.

Findings

Close Friends' Smoking Behaviour

Table 5-1a provides details of the relationship between the smoking behaviour of youth and their close friends, as reported in the 2002 YSS. Among all youth in grades 5-9, 72% reported that none of their close friends smoke, while only 8% reported they have five or more close friends who smoke. There appears to be a strong relationship between the smoking behaviour of close friends and the smoking behaviour of youth. For daily smokers, only 10% reported they have no close friends who smoke, whereas 43% reported they have five or more close friends who smoke. For smoked beyond puffing, not daily smokers, 30% reported they have no close friends who smoke and 23% reported they have five or more close friends who smoke. For puffers, 49% reported they have no friends who smoke and 13% reported they have five or more close friends who smoke. Never smokers have substantially fewer close friends who smoke. For never smokers who have seriously thought about smoking, 63% reported they have no close friends who smoke and 7% reported they have five or more close friends who smoke. For never smokers who have never seriously thought about smoking, 86% reported they have no close friends who smoke and only 3% reported they have five or more close friends who smoke. Very few youth in grades 5-9 (5%) who are never smokers who have not seriously thought about smoking have three or more close friends who smoke.

When considered from a different perspective (Figure 5-A), of all youth in grades 5-9 who reported they have no close friends who smoke, 1% were daily smokers, 3% were smoked beyond puffing, not daily smokers, 7% were puffers, 7% were never smokers who have seriously thought about smoking, and 82% were never smokers who have never seriously thought about smoking. Conversely, of all youth in grades 5-9 who reported they have five or more close friends who smoke, 27% were daily smokers, 23% were smoked beyond puffing, not daily smokers, 19% were puffers, 8% were never smokers who have seriously thought about smoking, and 23% were never smokers who have never seriously thought about smoking.

Figure 5-A - Category of Smoker, by Number of Close Friends Who Smoke, Grades 5-9, Canada, Youth Smoking Survey 2002

Figure 5-A - Category of Smoker, by Number of Close Friends Who Smoke, Grades 5-9, Canada, Youth Smoking Survey 2002

Differences are apparent between grades (Table 5-1a). Never smokers who have never seriously thought about smoking in grades 7-9 were more likely to report having one or more friends who smoke (19%) than never smokers who have never seriously thought about smoking in grades 5-6 (7%). Never smokers who have seriously thought about smoking in grades 7-9 were more likely to report having one or more friends who smoke (43%) than never smokers who have seriously thought about smoking in grades 5-6 (25%). Puffers in grades 7-9 were more likely to report having one or more friends who smoke (55%) than puffers in grades 5-6 (36%). The numbers are too small to reliably report the grade differences for smoked beyond puffing, not daily smokers and daily smokers.

Even though there are differences between grades, the relationship between youth smoking and friends' smoking is also evident within grades (Table 5-A). For example (using population estimates), of the 598,000 youth in grades 5-6 who indicated that they have no close friends who smoke, 88% were never smokers who have never seriously thought about smoking. Conversely, of the 19,000 youth in grades 5-6 who indicated that they have five or more close friends who smoke, only 42% were never smokers who have never seriously thought about smoking. The influence of friends' smoking is also evident for youth in grades 7-9. Of the 689,000 youth in grades 7-9 who indicated they have no close friends who smoke, 76% were never smokers who have never seriously thought about smoking, whereas of the 119,000 youth in grades 7-9 who indicated that they have five or more close friends who smoke, 20% were never smokers who have never seriously thought about smoking.

Table 5-A - Number of Close Friends Who Smoke, by Type Category of Smoker, and Grade, Canada, Youth Smoking Survey 2002

 

Category of Smoker (%)

Number of Close Friends who Smoke

Daily Smoker

Smoked Beyond Puffing, Not Daily Smoker

Puffer

Never
Smoker
(a)

Never
Smoker
(b)

Grades 5-6

#

2.6

6.0

7.1

83.5

0 Friends

#

#

4.4

6.1

88.3

1-2 Friends

#

10.1

17.7

15.0

54.5

3-4 Friends

#

#

#

#

38.9

5 or More Friends

#

#

#

#

41.6

Grades 7-9

7.5

11.2

13.7

9.0

58.6

0 Friends

#

5.1

9.9

8.2

75.6

1-2 Friends

9.3

19.1

20.4

12.9

38.3

3-4 Friends

23.8

24.1

20.2

7.9

24.0

5 or More Friends

29.6

23.8

19.2

7.4

20.0

# Data suppressed due to high sampling variability
(a) Never Smoker who has Seriously Thought About Smoking
(b) Never Smoker who has Never Seriously Thought About Smoking

Table 5-1b provides details of the relationship between the smoking behaviour of youth and their close friends using the 1994 YSS data. Between 1994 and 2002, there was a substantial decrease in the number of youth who have close friends who smoke. When examining the change among all youth in grades 5-9, the percentage of youth with five or more close friends who smoke decreased by 6%, the percentage of youth with three or four close fiends who smoke decreased by 5%, and the percentage of youth with one or two close friends who smoke decreased by 7%. However, the largest change was in the percentage of youth with no close friends who smoke, which increased by 18%. From 1994 to 2002, similar declines in close friend smoking occurred among youth in different grades, and among both males and females.

Father's Smoking Behaviour

In the 2002 YSS there is a strong relationship between the smoking behaviour of youth and their father's smoking behaviour (Table 5-2a). Among all youth in grades 5-9 with a father who smokes, 8% were daily smokers and 11% were smoked beyond puffing, not daily smokers, whereas among youth with a father who does not smoke, only 3% were daily smokers and 6% were smoked beyond puffing, not daily smokers. A significant gender difference was also found, in that 6% of males with a father who smokes were daily smokers and 9% of females with a father who smokes were daily smokers.

Table 5-2b provides details of the relationship between father's smoking and the smoking behaviour of youth, controlling for the father's education level. More youth with a father who smokes reported being a daily smoker, a smoked beyond puffing, not daily smoker, or a puffer if their father has grade 1-10 education than if the father has more than tenth grade education.

Table 5-2c provides details of the relationship found in the 1994 YSS between the smoking behaviour of youth and their father's smoking behaviour. From 1994 to 2002, the overall percentage of youth with a father who smoked decreased by 6%. Among youth with a father who smoked, the percentage of never smokers who have never seriously thought about smoking increased by 17%, and the percentage of smoked beyond puffing, not daily smokers decreased by 16%.

Father's Opinion of Youth Smoking

Table 5-3 provides details of the relationship between the smoking behaviour of youth and their father's opinion of youth smoking that was explored in the 2002 YSS. Among all smoking youth in grades 5-9 who have a father, 43% of daily smokers and 77% of smoked beyond puffing, not daily smokers reported their father doesn't know that they smoke. When fathers are aware that their child smokes, more daily smokers (23%) than smoked beyond puffing, not daily smokers (8%) reported that their father approves or does not care about their smoking. There were no major differences between grades or between males and females in this relationship.

Mother's Smoking Behaviour

There is a strong relationship between the smoking behaviour of youth and their mother's smoking behaviour in the 2002 YSS (Table 5-4a). Among youth with a mother who smokes, 10% were daily smokers and 12% were smoked beyond puffing, not daily smokers, whereas among youth with a mother who does not smoke, only 3% were daily smokers and 6% were smoked beyond puffing, not daily smokers. A significant gender difference was also found, where 8% of males with a mother who smokes were daily smokers and 12% of females with a mother who smokers were daily smokers.

Table 5-4b provides details of the relationship between mother's smoking and the smoking behaviour of youth, controlling for the mother's education level. Similar to the relationship with paternal smoking, more youth with a mother who smokes reported being a daily smoker, a smoked beyond puffing, not daily smoker, or a puffer if their mother has grade 1-10 education than if the mother has more than grade 10 education.

Table 5-4c provides details of the relationship found in the 1994 YSS between the smoking behaviour of youth and their mother's smoking behaviour. From 1994 to 2002, the overall percentage of youth with a mother who smoked decreased by 6%. Similar to the findings with regard to father's smoking, among youth with a mother who smoked, the percentage of never smokers who have never seriously thought about smoking increased by 16%, and the percentage of smoked beyond puffing, not daily smokers decreased by 17%.

Mother's Opinion of Youth Smoking

Table 5-5 provides details of the relationship between the smoking behaviour of youth and their mother's opinion of youth smoking that was explored in the 2002 YSS. (See earlier note about 1994 YSS under father's opinion paragraph.) Among all youth smokers in grades 5-9 who have a mother, over half (51%) reported that their mother doesn't know that they smoke. For youth daily smokers who have a mother, 40% reported their mother does not approve of their smoking and 36% reported their mother does not know they smoke. For smoked beyond puffing, not daily smokers who have a mother, 23% reported their mother does not approve of their smoking and 72% reported their mother does not know they smoke. These results are consistent with the data on father's opinions. (Table 5-3). There were no significant differences between grades or between males and females in this relationship.

Combined Influence of Both Parents Smoking

Table 5-6a provides details of the relationship found in the 2002 YSS between the smoking behaviour of youth and the combined influence of both parents smoking. Among all youth between grades 5-9, 14% reported that both of their parents smoke, 16% reported that only their father smokes, 9% reported that only their mother smokes, and 61% reported that neither parent smokes. There appears to be a strong relationship between the smoking behaviour of youth and the combined influence of both parents smoking. Daily smokers were almost three times more likely than never smokers who have never seriously thought about smoking to have reported that both parents smoke. On the other hand, never smokers who have never seriously thought about smoking were twice as likely as daily smokers to have reported that neither parent smokes. There were no major differences between grades or between males and females in this relationship.

Table 5-6b provides details of the relationship found in the 1994 YSS between the smoking behaviour of youth and the combined influence of both parents smoking. Although the overall percentage of youth with both parents smoking decreased by only 3% from 1994 to 2002, the percentage of youth with neither parent smoking increased by 8% over that same time period. This increase was found among both males and females, and across all grades.

Smoking Inside the Home

There appears to be a strong relationship between the number of smokers inside the home (other than the respondent) and the smoking behaviour of youth in the 2002 YSS (Table 5-7a). Among all youth in grades 5-9, 70% reported that there are no smokers inside their home, 25% reported that there are one or two smokers inside their home, and only 5% reported that there are three or more smokers inside their home. Daily smokers were over six times more likely than never smokers who have never seriously thought about smoking to live in a home where three or more people smoke inside. Not surprisingly, never smokers who have never seriously thought about smoking were more than twice as likely as daily smokers to live in a home where no one smokes inside. Few youth who live in a home where three or more people smoke inside were never smokers who have never seriously thought about smoking (3%). There were no major differences between grades or between males and females in this relationship.

When considered from a different perspective (Figure 5-B), of all youth in grades 5-9 who reported that no one smokes inside their home, 3% were daily smokers, 5% were smoked beyond puffing, not daily smokers, 9% were puffers, 8% were never smokers who have seriously thought about smoking, and 76% were never smokers who have never seriously thought about smoking. Conversely, of all youth in grades 5-9 who reported that three or more people smoke inside their home, 20% were daily smokers, 15% were smoked beyond puffing, not daily smokers, 16% were puffers, 7% were never smokers who have seriously thought about smoking, and 42% were never smokers who have never seriously thought about smoking.

Table 5-7b provides details of the relationship found in the 1994 YSS between the smoking behaviour of youth and the number of people who smoke inside their home. From 1994 to 2002, the percentage of youth living in a home where no one smokes inside increased by 19%. The percentage of youth living in a home where no one smokes inside the home increased among males, females, and all grades of youth from 1994 to 2002.

Figure 5-B - Category of Smoker, by Number of Smokers Inside the Home, Grades 5-9, Canada, Youth Smoking Survey 2002

Figure 5-B - Category of Smoker, by Number of Smokers Inside the Home, Grades 5-9, Canada, Youth Smoking Survey 2002

Youth Smoking Inside the Home

There is a strong relationship between youth ever smoking at home and the smoking behaviour of youth (Table 5-B). Among all youth smokers in the 2002 YSS, 58% of daily smokers reported they have ever smoked inside their home, and 24% of smoked beyond puffing, not daily smokers reported they have ever smoked inside their home. However, youth were not asked whether parents were present at the time. There were no major differences between males and females in this relationship.

Table 5-B - Ever Smoked at Home, by Grade, Sex, and Category of Smoking Behaviour, Canada, Youth Smoking Survey 2002

 

Ever Smoked at Home (%)

 

Daily Smoker

Smoked Beyond Puffing,
Not Daily Smoker

Total, Grades 5-9

57.9

23.7

5-6

#

#

7-9

58.0

23.9

Males, Grades 5-9

57.1

22.9

5-6

#

#

7-9

58.5

22.0

Females, Grades 5-9

58.6

24.6

5-6

#

#

7-9

57.6

25.8

# Data suppressed due to high sampling variability

Discussion

The findings of the 2002 YSS demonstrate that youth exposed to friends and family members who smoke are at increased risk for smoking. These findings are consistent with the results presented in the 1994 YSS1 and support the often observed relationships between youth smoking and the smoking behaviour of important social models in the environment.2-4 Smoking friends and family members can influence a youth in many ways. For instance, youth who are surrounded by smoking friends and family members are more likely to think smoking is normative and acceptable,5 more likely to be provided with social sources of cigarettes that can be used for experimenting with smoking,6 and more likely to believe that social prestige or popularity can be improved by smoking.7 These desirable outcomes being modelled by smokers in the social environment can make a non-smoking youth more apt to try smoking.8

An overall trend emerges when changes between the 1994 YSS and the 2002 YSS are examined; youth in 2002 were exposed to fewer friends and family members who smoke than youth in 1994. Fewer youth reported having close friends who smoke, parents who smoke, or living in a home where people smoke inside. Although youth exposure to smoking social models is declining, additional effort is required to further reduce youth exposure to smoking social models and to make more homes smoke-free. Youth smoking rates in Canada have declined from 1994 to 2002 (refer to Chapter 3 for a thorough discussion of youth smoking behaviour). It is possible that a portion of the decline may be a result of reductions in the number of smoking social models to which youth are exposed.

The relationship identified between having friends who smoke and youth smoking behaviour in the 2002 YSS is consistent with findings from numerous cross-sectional and longitudinal studies of smoking onset2-4 and the 1994 YSS.1 Youth with friends who smoke are more likely to smoke than youth with friends who do not smoke. This relationship is magnified as the number of friends who smoke increases; the more smoking friends a youth has, the more likely the youth is to smoke. Although the percentage of youth with friends who smoke has declined since the 1994 YSS, there is still a strong relationship between friend smoking and youth smoking habits, as evidenced by the findings of the 2002 YSS.

The relationship between friends' smoking and youth smoking status should be interpreted with caution for at least two reasons. First, the relationship between self-reports of others' smoking needs to be interpreted with caution because one's own smoking behaviour may bias one's report of other's smoking behaviour.9 Second, due to the cross-sectional nature of these data, it is not possible to determine if the smoking habits of close friends cause a youth to smoke (peer socialization), or if youth become smokers because of self-selection into a smoking peer-group (peer selection).10 Findings from longitudinal research indicate that certain youth populations are influenced through socialization with smoking friends and others are influenced by self-selection into a smoking peer group.11 As such, prevention programs that only focus on peer resistance skills would not be sufficient for all youth. Additional research is required to examine these underlying mechanisms so that more appropriate prevention interventions can be developed.

The influence of parents or others (e.g., siblings) inside the home is also important. Consistent with the existing literature2-4 and the 1994 YSS,1 youth are more likely to smoke if their father, mother, or someone else inside their home smokes. This finding supports the notion that home smoking restrictions can be an important prevention intervention for youth.4 Not only do home smoking restrictions prevent youth from being exposed to harmful environmental tobacco smoke,12 they also have been shown to reduce smoking uptake in youth.13 If people are not allowed to smoke inside the home, it sends a clear message to youth that smoking is a socially unacceptable and non-normative behaviour.8 Processes by which homes move from smoking to smoke-free status have begun to be reported.14

Most youth smokers reported that their parents are not aware of their smoking. Even when parents are aware that their child smokes, a substantial portion seem to be indifferent about their child's smoking behaviour. This is especially true among male youth and their fathers, and female youth and their mothers. Parents should be encouraged to talk to their children about smoking and provide support in helping smoking children to stop smoking. Even among parents who smoke, talking with their children about the effects of smoking reduces the likelihood of the child starting to smoke.15

Care must be taken not to over interpret the relationships described above. For example, although there is a clear relationship between having close friends who smoke and youth smoking status, the direction of the relationship can not be inferred due to the cross-sectional nature of the data. Specifically, these data are unable to distinguish whether or not the smoking habits of friends influence youth to begin smoking or whether youth who smoke become friends with other youth smokers. These data also do not allow the temporal sequence of the relationships between youth smoking status and parental smoking or smoking inside the home to be determined. The same concerns pertain to the 1994 YSS.

Implications for Regulation and Legislation

While the prevalence of smoking has decreased since 1994, there is still a strong relationship between having close friends who smoke or a parent who smokes and youth smoking behaviour. The relationship between friend smoking and youth smoking suggests the need for regulations in places where youth congregate, such as malls, schools and areas surrounding schools. Such regulations would limit the opportunities that youth have to smoke with their friends, decrease the opportunities for younger youth to see older youth smoking, limit the social exchange of cigarettes among youth experimenting with smoking, and reduce the perception that smoking is a normative acceptable behaviour. The relationship between parental smoking and youth smoking suggests the need for regulations in places where youth are exposed to their parents' smoking. This may include inside the home or inside vehicles. Such regulations would protect youth from being exposed to environmental tobacco smoke and send a clear message to youth that smoking is a non-normative and socially undesirable behaviour. Note that regulations regarding where people can smoke fall under provincial jurisdiction and are not covered under the federal Tobacco Act.

Refer to Chapter 10 for a thorough discussion of restrictions and youth smoking.

Implications for Education and Message Promotion

The youth surveyed in the 1994 YSS were part of the first generation of Canadian youth to be targeted with school-based smoking prevention programming.1 Since 1994, school-based prevention programs have been evolving and expanded in order to address another generation of Canadian youth.16 Although the findings of the 2002 YSS suggest that youth are exposed to fewer smoking social models than were the youth surveyed in 1994, a large number of smoking social models remain within the immediate social environment surrounding youth. As such, it is important to continue providing youth with school-based smoking prevention education and message campaigns designed to teach youth how to resist the influence of the smoking social models in their environment.

School-based campaigns are the most common channel used for education and message promotion with youth.17 There are many different approaches that can be used within a school-based setting, however, research has identified that the most appropriate and effective are social influences programming.17 Social influences programming focuses on teaching youth how to build the skills needed to recognize and resist negative influences for smoking, including recognition of advertising tactics and peer influences, communication and decision-making skills, and assertiveness.17-18 Research has shown that social influences interventions can have a significant effect in reducing the onset and level of tobacco use among youth who attend a school with a high rate of smoking among older students.19 In order to have the most impact, school based campaigns need to begin early (as early as grade 5 to get students before they start smoking) and continually reinforced and maintained until students finish secondary school.

Education and message promotion does not have to be restricted to school-based initiatives. The media or community-based programs can also be used to communicate messages to youth about social influences for smoking.20 Using a comprehensive approach for education and message promotion can improve the reach of programming activities.

The 1994 YSS technical report recommended that education programs and messages needed to be tailored to specific audiences.1 The findings of the 2002 YSS provide additional support for this recommendation. Considering that smoking and non-smoking youth do not have the same exposure to smoking role models, it does not seem efficient or practical to assume that a 'one size fits all' approach to education and message promotion will be suitable. Different programs need to be crafted to be appropriate for various categories of smoking youth and then these programs need to be targeted to the appropriate groups.21 The goal should be to target initiatives to the youth populations who are most likely to respond. For example, never smokers might benefit from a different social influence prevention program than puffers. The benefits of using a targeted approach to intervention delivery has been previously demonstrated with school-based smoking prevention programming.15,22

Implications for Future Monitoring and Further Research

The findings of the 2002 YSS suggest some promising areas for future monitoring. Ongoing monitoring and surveillance is required in order to replicate these findings and determine if and how the identified relationships change as youth age, and also, whether these relationships are maintained in succeeding cohorts of youth. By continually monitoring the smoking behaviour of youth, practitioners and researchers would have the ability to identify how different social models may exert differential influences on youth as they progress though school. For instance, not only would close friends exert different types of influences at different grades (since youth in earlier grades are generally not exposed to as many friends who smoke), the influence of close friends who smoke may have a different influence in maintaining old friendships or developing new friendships for certain youth as they move form grade to grade. A good example would be when youth move through the transition from elementary school to high school. At this time, some youth would be exposed to a potentially new social group of smoking and non-smoking youth.

An area for further research is to collect longitudinal data about the friends and family members of youth who are important social influences. For example, the 2002 YSS data do not enable us to understand if smoking friends influence smoking onset via peer socialization or peer selection, that is, the causal relationships between youth and peer smoking. This knowledge could have a large impact on intervention development as different initiatives would be required to address the causal mechanisms for peer socialization versus the causal mechanisms of peer selection.

A second area for further research would be to examine the characteristics that differentiate sub-populations of youth. For example, a large number of youth who are exposed to smoking friends and family members remain smoke-free ('low-risk' youth), while many youth who are not exposed to smoking friends and family members become smokers ('high-risk' youth). Determining how 'low-risk' youth are able to resist social influences could inform the development of new prevention initiatives designed for youth who are unable to resist social influences. Conversely, it would also be beneficial to identify the characteristics of high-risk youth who smoke but do not appear to be influenced by social models. This information could be used to identify high-risk students who have not yet started smoking, so that they can be targeted with additional support from prevention resources. It is likely that a motivation-skills-decision making program would be relatively effective for such youth.22

Other life factors may interact with social influences, and these should be explored. For example, the present data indicate and replicate a consistent inverse relationship between smoking and socio-economic status.23 However, little work has investigated how changes in socio-economic status might be related to smoking. In fact, stresses related to parental drops in socio-economic status may be related to youth uptake of smoking.23 These changes in status may alter the operation of social influences on youth, perhaps making them more vulnerable. Instruction in stress-coping skills may be helpful to youth who have suffered economic loss.

Finally, future research might also benefit by considering social influences other than friends and family members. For example, an emerging body of literature is demonstrating that role models in the media, via movies, television, and advertising is related to youth smoking behaviour.24-25 Research is also beginning to demonstrate that social modelling characteristics of the school a student attends is related to youth smoking behaviour. 21,26-27 A better understanding of how these broader social influences are related to youth smoking behaviour, will enable the development of more effective social influences prevention programs.

References

1. Stephens T, Morin M. Editors (Health Canada ). Youth Smoking Survey, 1994: Technical Report. Ottawa : Minister of Supply and Service Canada , 1996 (Catalogue No. H49-98/1-1994E).

2. Lloyd-Richardson EE, Papandonatos G, Kazura A, Stanton C, Niaura R. Differentiating stages of smoking intensity among adolescents stage-specific psychological and social influences. Journal of Consulting and Clinical Psychology 2002; 70: 998-1009.

3. Tyas SL, Pederson LL. Psychosocial factors related to adolescent smoking: a critical review of the literature. Tobacco Control 1998; 7:409-420.

4. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health, 1994.

5. Simons-Morton BG. Prospective analysis of peer and parent influences on smoking initiation among early adolescents. Prevention Science 2002; 3:275-283.

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

7. Alexander C, Piazza M, Mekos D, Valente T. Peers, schools, and adolescent cigarette smoking. Journal of Adolescent Health 2001; 29:22-30.

8. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall, 1986.

9. Valente TW, Gallaher P, Mouttapa M. Using social networks to understand and prevent substance use: a transdisciplinary perspective. Substance Use & Misuse 2004; 39:1685-1712.

10. Cleveland HH, Wiebe RP. The moderation of adolescent-to-peer similarity in tobacco and alcohol use by school levels of substance use. Child Development 2003; 74:279-291.

11. Urberg KA, Degirmencioglu SM, Pilgrim C. Close friend and group influence on adolescent cigarette smoking and alcohol use. Developmental Psychology 1997; 33:834-844.

12. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health, 2004.

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. Smith PB, MacQuarrie CR, Herbert RJ, Begley LH. Making homes smoke-free: Household processes toward eliminating children's exposure to environmental tobacco smoke in the home. Unpublished report, University of Prince Edward Island , June 2004.

15. Newman IM, Ward JM. The influence of parental attitude and behaviours on early adolescent cigarette smoking. Journal of School Health 1989; 59:150-152.

16. Manske SR, Brown KS , Cameron AJR. School-based smoking control: a research agenda. Cancer Prevention & Control 1997; 1:196-212.

17. Lantz PM, Jacobson PD, Warner KE, Wasserman J, Pollack HA, Berson J, Ahlstrom A. Investing in youth tobacco control: a review of smoking prevention and control strategies. Tobacco Control 2000; 9:47-63.

18. Manske SR, Dobbins M. Examining youth tobacco use prevention: a discussion paper. Final Report to Health Canada : Ottawa , 2002.

19. Cameron R, Brown KS, Best JA, Pelkman CL, Madill CL, Manske SR, Payne ME. Effectiveness of a social influences smoking prevention program as a function of provider type, training method, and school risk. American Journal of Public Health 1999; 89:1827-1831.

20. Bauer UE, Johnson TM, Hopkins RS, Brooks RG. Changes in youth cigarette use and intentions following implementation of a tobacco control program: findings from the Florida Youth Tobacco Survey, 1998-2000. Journal of the American Medical Association 2000; 284:723-728.

21. Leatherdale S, McDonald P, Cameron R, Brown S. A multi-level analysis examining the relationship between social influences for smoking and smoking onset. American Journal of Health Behaviour . In Press.

22. Sussman S, Earleywine M, Wills T, Cody C, Biglan T, Dent CW, Newcomb MD. The motivation, skills, and decision-making model of "drug abuse" prevention. Substance Use & Misuse 2004; 39:1971-2016.

23. Unger JB, Hamilton JE, Sussman S. A family member's job loss as a risk factors for smoking among adolescents. Health Psychology 2004; 23:308-313.

24. Pierce JP, Choi WS, Gilpin EA, Farkas AJ , Berry CC. Tobacco industry promotion of cigarettes and adolescent smoking. Journal of the American Medical Association 1998; 279:511-515.

25. Schooler C, Feighery E, Flore JA. Seventh graders' self-reported exposure to cigarette marketing and its relationship to their smoking behaviour. American Journal of Public Health 1996; 86:1216-1221.

26. Leatherdale ST , Cameron R, Brown KS , McDonald PW. Senior student smoking at school, student characteristics, and smoking onset among junior students: a multi-level analysis. Preventive Medicine . In Press.

27.Leatherdale ST , Brown KS , Cameron R, McDonald PW. Social modelling in the school environment, student characteristics, and smoking susceptibility: a multi-level analysis. Journal of Adolescent Health . In Press.


Table 5-1a - Number of Close Friends Who Smoke, by Grade, Sex, and Category of Smoker, Canada, Youth Smoking Survey 2002

 

 

Number of Close Friends Who Smoke (%)

 

Pop. Est.
('000)

0

1-2

3-4

≥ 5

Total, Grades 5-9

1,785

72.0

15.1

5.1

7.8

Daily Smoker

87

9.8*

24.5

22.6

43.1

Smoked Beyond Puffing, Not Daily Smoker

142

29.6

32.9

14.9

22.6

Puffer

192

49.1

27.9

9.6

13.4

Never Smoker (a)

148

62.8

24.2

5.6*

7.4

Never Smoker (b)

1,216

86.2

9.2

2.0

2.6

Grades 5-6

683

87.5

7.9

1.8

2.8

Daily Smoker

5

#

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

18

37.0*

30.7*

#

#

Puffer

41

63.9

23.3

#

#

Never Smoker (a)

49

74.7

16.7*

#

#

Never Smoker (b)

570

92.6

5.2

0.8*

1.4*

Grades 7-9

1,102

62.5

19.5

7.2

10.8

Daily Smoker

82

9.9*

24.2

22.9

43.0

Smoked Beyond Puffing, Not Daily Smoker

124

28.5

33.2

15.4

22.9

Puffer

150

45.0

29.2

10.6

15.2

Never Smoker (a)

100

57.0

27.8

6.3*

8.9*

Never Smoker (b)

646

80.6

12.8

2.9

3.7

Males, Grades 5-9

896

72.8

14.4

5.1

7.7

Daily Smoker

36

10.8*

23.2

18.5*

47.5

Smoked Beyond Puffing, Not Daily Smoker

74

32.9

29.7

16.3

21.1

Puffer

104

53.1

23.6

10.0

13.3

Never Smoker (a)

75

67.3

21.3

4.9*

6.5*

Never Smoker (b)

607

85.4

9.5

2.1

3.0

Grades 5-6

341

88.2

7.4

2.0

2.4

Daily Smoker

3

#

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

9

#

#

#

#

Puffer

24

71.7

#

#

#

Never Smoker (a)

25

78.2

#

#

#

Never Smoker (b)

280

92.8

4.9

#

#

Grades 7-9

556

63.4

18.6

7.0

11

Daily Smoker

34

#

21.4*

19.2*

48.8

Smoked Beyond Puffing, Not Daily Smoker

64

31.8

29.7

16.7

21.8

Puffer

81

47.6

26.0

10.7*

15.7

Never Smoker (a)

50

61.9

24.2

5.9*

#

Never Smoker (b)

327

79.1

13.5

3.1*

4.3

Females, Grades 5-9

889

71.3

15.8

5.1

7.7

Daily Smoker

51

9.1*

25.4

25.6

39.9

Smoked Beyond Puffing, Not Daily Smoker

68

26.0

36.3

13.5

24.2

Puffer

88

44.4

33.1

9.0*

13.5

Never Smoker (a)

73

58.1

27.2

6.3*

8.4*

Never Smoker (b)

609

87.0

8.9

1.8

2.3

Grades 5-6

342

86.8

8.5

1.5

3.2

Daily Smoker

3

#

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

9

#

#

#

#

Puffer

17

53.5

33.8*

#

#

Never Smoker (a)

23

70.9

18.0*

#

#

Never Smoker (b)

290

92.4

5.5

#

#

Grades 7-9

547

61.5

20.4

7.4

10.7

Daily Smoker

49

9.5*

26.1

25.5

38.9

Smoked Beyond Puffing, Not Daily Smoker

60

25.0

37.0

14.1*

23.9

Puffer

70

42.1

32.9

10.5*

14.5

Never Smoker (a)

49

52.1

31.5

#

9.7*

Never Smoker (b)

319

82.1

12.0

2.8*

3.1*

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability
(a) Never Smoker who has Seriously Thought About Smoking
(b) Never Smoker who has Never Seriously Thought About Smoking

Table 5-1b - Number of Close Friends Who Smoke, by Grade, Sex, and Category of Smoker, Canada, Youth Smoking Survey 1994

 

 

Number of Close Friends Who Smoke (%)

 

Pop. Est.
('000)

0

1-2

3-4

≥ 5

Total, Grades 5-9

1,775

54.1

22.2

10.2

13.5

Daily Smoker

83

#

20.4*

21.6*

56.0

Smoked Beyond Puffing, Not Daily Smoker

406

17.9

33.6

22.0

26.6

Puffer

254

44.6

31.7

12.3

11.4

Never Smoker (a)

159

56.6

24.3

7.9*

11.2*

Never Smoker (b)

873

78.2

14.0

3.4

4.4

Grades 5-6

667

73.0

4.5

5.5

Daily Smoker

4

#

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

66

25.6*

39.3

15.0*

19.1*

Puffer

83

50.9

29.6

9.8*

9.7*

Never Smoker (a)

62

72.5

17.2*

#

9.3*

Never Smoker (b)

452

84.4

11.3

1.6*

2.7*

Grades 7-9

1,108

42.7

25.4

13.6

18.3

Daily Smoker

79

#

19.6*

22.0*

57.0

Smoked Beyond Puffing, Not Daily Smoker

340

16.2

32.5

23.3

28.0

Puffer

171

41.5

32.7

13.5

12.3*

Never Smoker (a)

98

46.6

28.7

8.5*

16.2*

Never Smoker (b)

420

71.4

16.9

5.5*

6.2

Males, Grades 5-9

887

55.3

21.3

8.8

14.6

Daily Smoker

39

#

16.5*

22.5*

57.5

Smoked Beyond Puffing, Not Daily Smoker

204

21.2

32.0

19.1

27.7

Puffer

137

46.1

31.2

10.2

12.5*

Never Smoker (a)

76

59.4

18.5*

8.1*

14.0*

Never Smoker (b)

431

78.2

14.0

2.4*

5.4*

Grades 5-6

336

71.4

17.8

4.2

6.6

Daily Smoker

2

#

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

42

31.3*

34.9*

13.3*

20.5*

Puffer

46

51.5

28.2*

#

11.3*

Never Smoker (a)

30

76.2

#

#

#

Never Smoker (b)

216

83.3

12.8

#

3.0*

Grades 7-9

550

45.4

23.4

11.6

19.6

Daily Smoker

36

#

14.1*

23.8*

59.5

Smoked Beyond Puffing, Not Daily Smoker

162

18.7

31.2

20.5

29.6

Puffer

91

43.3

32.7

10.9*

13.1*

Never Smoker (a)

47

48.4

22.9*

#

20.4*

Never Smoker (b)

214

73.1

15.1

3.9*

7.9*

Females, Grades 5-9

888

52.9

23.2

11.6

12.3

Daily Smoker

44

#

23.9*

20.9*

54.7

Smoked Beyond Puffing, Not Daily Smoker

203

14.5

35.2

24.9

25.4

Puffer

117

42.9

32.2

14.7

10.2*

Never Smoker (a)

83

54.1

29.6

7.7*

8.6

Never Smoker (b)

441

78.2

14.0

4.5*

3.3*

Grades 5-6

330

74.6

16.2

4.9

4.3

Daily Smoker

1

#

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

25

#

46.7*

#

#

Puffer

37

50.3

31.3*

#

#

Never Smoker (a)

32

69.0

22.5*

#

#

Never Smoker (b)

236

85.6

9.8

#

#

Grades 7-9

558

40.0

27.3

15.6

17.1

Daily Smoker

43

#

24.3*

20.4*

54.9

Smoked Beyond Puffing, Not Daily Smoker

178

13.9

33.6

25.8

26.7

Puffer

80

39.5

32.7

16.5*

11.3*

Never Smoker (a)

51

44.9

34.1

#

12.4*

Never Smoker (b)

206

69.8

18.7

7.1*

4.4*

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability
(a) Never Smoker who has Seriously Thought About Smoking
(b) Never Smoker who has Never Seriously Thought About Smoking

Table 5-2a - Father Smokes, by Category of Smoker, Grade, and Sex, Canada, Youth Smoking Survey 2002

 

Category of Smoker (%)

Grade

Pop. Est. ("000)

Daily Smoker

Smoked Beyond Puffing, Not Daily Smoker

Puffer

Never Smoker
(a)

Never
Smoker
(b)

Father Smokes

Total, 5-9

553

7.7

11.2

12.9

8.8

59.4

5-6

209

#

4.6*

8.8

9.1

76.3

7-9

344

11.6

15.2

15.4

8.6

49.2

Males, 5-9

274

6.2

10.9

13.1

9.6

60.2

5-6

107

#

4.8*

9.0

9.5

75.6

7-9

167

9.4

14.8

15.8

9.7

50.3

Females, 5-9

279

9.1

11.5

12.7

8.0

58.7

5-6

103

#

4.4*

8.6*

8.7*

77.0

7-9

176

13.6

15.7

15.1

7.6

48.0

Father Does Not Smoke

Total, 5-9

1,336

3.3

5.7

9.0

8.1

73.9

5-6

534

#

1.3*

4.0

6.4

87.9

7-9

802

5.2

8.8

12.3

9.2

64.5

Males, 5-9

696

2.7

6.2

9.7

8.0

73.4

5-6

274

#

#

4.8

6.9

86.3

7-9

422

4.1

9.2

12.9

8.7

65.1

Females, 5-9

640

3.9

5.3

8.2

8.3

74.3

5-6

260

#

#

3.1*

5.9

89.6

7-9

380

6.4

8.2

11.6

9.9

63.9

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability
(a) Never Smoker who has Seriously Thought About Smoking
(b) Never Smoker who has Never Seriously Thought About Smoking

Table 5-2b - Father Smokes, by Category of Smoker, and Father's Education Level, Canada, Youth Smoking Survey 2002

 

Father's Education Level Among Youth Who Have a Father Who Smokes (%)

Category of Smoker

Grade 1-10

Grade 11-13,
Some Post-Secondary,
Or College Diploma

University Undergraduate or Graduate Degree

All Youth

39.0

29.5

13.2

Daily Smoker

51.3

44.2

#

Smoked Beyond Puffing, Not Daily Smoker

48.0

46.8

27.1

Puffer

43.0

35.9

16.3

Never Smoker (a)

#

31.6

15.3

Never Smoker (b)

36.2

25.7

11.6

# Data suppressed due to high sampling variability
(a) Never Smoker who has Seriously Thought About Smoking
(b) Never Smoker who has Never Seriously Thought About Smoking

Table 5-2c - Father Smokes, by Category of Smoker, Grade, and Sex, Canada, Youth Smoking Survey 1994

 

Category of Smoker (%)

Grade

Pop. Est.
("000)

Daily Smoker

Smoked Beyond Puffing, Not Daily Smoker

Puffer

Never Smoker
(a)

Never
Smoker
(b)

Father Smokes

Total, 5-9

673

6.8

27.3

15.8

7.7

42.4

5-6

257

#

15.0

14.6

8.3*

61.4

7-9

416

10.5

35.0

16.6

7.3

30.6

Males, 5-9

334

5.2

27.9

16.9

7.6

42.4

5-6

134

#

17.8

17.2

8.9*

55.5

7-9

200

8.3

34.7

16.7

6.8

33.5

Females, 5-9

339

8.3

26.8

14.8

7.8

42.3

5-6

123

#

12.0*

11.7*

7.5*

67.8

7-9

216

12.5

35.3

16.5

7.9*

27.8

Father Does Not Smoke

Total, 5-9

1,257

3.1

19.3

12.9

9.8

54.9

5-6

481

#

6.4

10.4

9.7

73.1

7-9

776

4.8

27.4

14.4

9.9

43.5

Males, 5-9

653

3.4*

19.2

13.6

8.9

54.9

5-6

249

#

8.0*

10.5

8.6*

72.4

7-9

404

5.1*

26.1

15.6

9.1

44.1

Females, 5-9

604

2.8

19.5

12.1

10.8

54.8

5-6

232

#

4.6*

10.4

10.9

74.0

7-9

372

4.4*

28.8

13.1

10.8

42.9

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability
(a) Never Smoker who has Seriously Thought About Smoking
(b) Never Smoker who has Never Seriously Thought About Smoking

Table 5-3 - Father's Opinion of His Child's Smoking, by Grade, Sex, and Category of Smoking Behaviour, Canada, Youth Smoking Survey 2002

 

 

Father's Opinion (%)

 

Pop. Est.
('000)

Approves or Does Not Care

Does Not Approve

Does Not Know

All Smokers, Grades 5-9

101

17.0

26.6

56.4

Daily Smoker

60

23.0

34.1

42.9

Smoked Beyond Puffing, Not Daily Smoker

40

7.8*

15.3*

76.9

Grades 5-6

6

#

#

72.6

Daily Smoker

2

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

4

#

#

79.2

Grades 7-9

94

17.3

27.5

55.2

Daily Smoker

58

22.9

35.1

42.0

Smoked Beyond Puffing, Not Daily Smoker

36

#

15.2*

76.6

Male Smokers, Grade 5-9

45

19.2

26.1

54.7

Daily Smoker

25

27.5*

35.5

37.0

Smoked Beyond Puffing, Not Daily Smoker

20

8.9

#

77.0

Grades 5-6

3

#

#

#

Daily Smoker

1

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

2

#

#

#

Grades 7-9

42

19.5*

26.5

54.0

Daily Smoker

24

27.3*

36.2

36.5

Smoked Beyond Puffing, Not Daily Smoker

18

#

#

77.6

Female Smokers, Grades 5-9

55

15.1*

27.1

57.8

Daily Smoker

35

19.8*

33.1

47.1

Smoked Beyond Puffing, Not Daily Smoker

20

#

#

76.7

Grades 5-6

3

#

#

#

Daily Smoker

1

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

2

#

#

#

Grades 7-9

52

15.4*

28.3

56.3

Daily Smoker

34

19.7*

34.3

46.0

Smoked Beyond Puffing, Not Daily Smoker

18

#

#

75.6

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Table 5-4a - Mother Smokes, by Category of Smoker, Grade, and Sex, Canada, Youth Smoking Survey 2002

 

Category of Smoker (%)

Grade

Pop. Est. ("000)

Daily Smoker

Smoked Beyond Puffing, Not Daily Smoker

Puffer

Never Smoker
(a)

Never Smoker
(b)

Mother Smokes

Total, 5-9

459

9.6

12.4

14.7

8.8

54.5

5-6

172

#

5.1*

9.6

10.5

73.3

7-9

287

14.6

16.7

17.7

7.8

43.2

Males, 5-9

223

7.5

11.0

15.3

9.5

56.7

5-6

84

#

#

9.1*

10.6*

74.2

7-9

139

11.4

14.6

19.0

8.9

46.1

Females, 5-9

236

11.7

13.7

14.1

8.1

52.4

5-6

88

#

5.3*

10.0*

10.4*

72.5

7-9

148

17.6

18.7

16.5

6.8

40.4

Mother Does Not Smoke

Total, 5-9

1,499

3.1

6.0

8.9

8.1

73.9

5-6

599

#

1.5*

4.5

6.2

87.3

7-9

900

4.8

9.0

11.8

9.4

65.0

Males, 5-9

775

2.6

6.7

9.6

8.0

73.1

5-6

309

#

1.8*

5.9

6.5

85.3

7-9

466

3.9

10.0

12.1

9.0

65.0

Females, 5-9

724

3.6

5.3

8.1

8.3

74.7

5-6

290

#

#

3.1*

5.8

89.5

7-9

434

5.8

8.0

11.4

9.9

64.9

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability
(a) Never Smoker who has Seriously Thought About Smoking
(b) Never Smoker who has Never Seriously Thought Smoking

Table 5-4b - Mother Smokes, by Category of Smoker, and Mother's Education Level, Canada, Youth Smoking Survey 2002

 

Mother's Education Level Among Youth Who Have a Mother Who Smokes (%)

Category of Smoker

Grade 1-10

Grade 11-13, Some Post-Secondary, or College Diploma

University Undergraduate or Graduate Degree

All Youth

30.3

23.4

8.1

Daily Smoker

55.2

40.2

#

Smoked Beyond Puffing, Not Daily Smoker

50.0

36.4

21.2

Puffer

39.1

32.9

12.3

Never Smoker (a)

#

24.2

8.2

Never Smoker (b)

21.2

19.7

6.5

# Data suppressed due to high sampling variability
(a) Never Smoker who has Seriously Thought About Smoking
(b) Never Smoker who has Never Seriously Thought Smoking

Table 5-4c - Mother Smokes, by Category of Smoker, Grade, and Sex, Canada, Youth Smoking Survey 1994

 

Category of Smoker (%)

Grade

Pop. Est.
("000)

Daily Smoker

Smoked Beyond Puffing, Not Daily Smoker

Puffer

Never Smoker
(a)

Never Smoker
(b)

Mother Smokes

Total, 5-9

571

8.1

29.1

16.7

7.8

38.3

5-6

226

#

16.0

15.8

10.1

57.1

7-9

345

12.7

37.7

17.3

6.3*

26.0

Males, 5-9

281

7.3*

29.9

16.7*

7.0*

39.1

5-6

117

#

19.7

16.9

9.0*

53.1

7-9

164

11.6*

37.1

16.5

5.6*

29.2

Females, 5-9

290

8.8

28.4

16.8

8.6

37.4

5-6

109

#

11.9*

14.6*

11.2*

61.5

7-9

181

13.6

38.3

18.1

7.0

23.0

Mother Does Not Smoke

Total, 5-9

1,361

2.8

19.2

12.7

9.6

55.7

5-6

514

#

6.4

10.2

8.8

74.3

7-9

847

4.4

26.8

14.3

10.1

44.4

Males, 5-9

706

2.7*

19.0

14.0

9.0

55.3

5-6

267

#

7.7*

11.1

8.5*

72.4

7-9

439

4.2*

25.8

15.8

9.3

44.9

Females, 5-9

655

3.0

19.4

11.4

10.2

56.0

5-6

247

#

5.1*

9.2

9.0*

76.4

7-9

408

4.7*

28.0

12.7

10.9

43.7

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability
(a) Never Smoker who has Seriously Thought About Smoking
(b) Never Smoker who has Never Seriously Thought Smoking

Table 5-5 - Mother's Opinion of Her Child's Smoking, by Grade, Sex, and Category of Smoking Behaviour, Canada, Youth Smoking Survey 2002

 

 

Mother's Opinion (%)

 

Pop. Est.
('000)

Approves or Does Not Care

Does Not Approve

Does Not Know

All Smokers, Grades 5-9

107

16.4

33.1

50.5

Daily Smoker

65

23.8

40.0

36.2

Smoked Beyond Puffing, Not Daily Smoker

42

#

22.7

72.1

Grades 5-6

7

#

#

65.3

Daily Smoker

3

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

4

#

#

#

Grades 7-9

100

16.4

34.2

49.4

Daily Smoker

62

23.6

40.7

35.7

Smoked Beyond Puffing, Not Daily Smoker

38

#

23.8

71.5

Male Smokers, Grades 5-9

47

14.9*

34.5

50.6

Daily Smoker

27

23.0*

43.5

33.5

Smoked Beyond Puffing, Not Daily Smoker

20

#

22.4*

73.3

Grades 5-6

3

#

#

#

Daily Smoker

1

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

2

#

#

#

Grades 7-9

44

14.8*

35.2

50.0

Daily Smoker

26

22.8*

44.4

32.8

Smoked Beyond Puffing, Not Daily Smoker

18

#

#

73.8

Female Smokers, Grades 5-9

61

17.5

32.1

50.4

Daily Smoker

38

24.3

37.5

38.2

Smoked Beyond Puffing, Not Daily Smoker

23

#

23.0*

71.0

Grades 5-6

4

#

#

#

Daily Smoker

2

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

2

#

#

#

Grades 7-9

56

17.5

33.5

49.0

Daily Smoker

36

24.1

38.2

37.7

Smoked Beyond Puffing, Not Daily Smoker

20

#

25.0*

69.4

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability

Table 5-6a - Combined Influence of Both Parents Smoking, by Grade, Sex, and Category of Smoker, Canada, Youth Smoking Survey 2002

 

 

Parental Smoking (%)

 

Pop. Est.
('000)

Both Smoke

Father Smokes Only

Mother Smokes Only

Neither Smokes

Total, Grades 5-9

1,866

13.5

15.5

9.4

61.4

Daily Smoker

85

31.6

17.6

16.8

34.0

Smoked Beyond Puffing, Not Daily Smoker

136

24.2

20.4

13.4

42.0

Puffer

189

17.0

20.0

16.3

46.7

Never Smoker (a)

155

14.3

16.7

10.0

59.0

Never Smoker (b)

1,301

10.7

14.1

7.5

67.7

Grades 5-6

732

13.0

14.8

8.7

63.5

Daily Smoker

5

#

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

16

36.4*

#

#

28.8*

Puffer

39

20.3*

24.8

14.1*

40.8

Never Smoker (a)

52

20.2

15.9*

12.2*

51.7

Never Smoker (b)

620

11.1

13.9

8.0

67.0

Grades 7-9

1,134

13.9

15.9

9.8

60.4

Daily Smoker

80

31.2

17.8

17.5

33.5

Smoked Beyond Puffing, Not Daily Smoker

120

22.5

20.2

13.3

44.0

Puffer

150

15.9

18.7

16.9

48.5

Never Smoker (a)

103

11.2

17.1

8.8*

62.9

Never Smoker (b)

681

10.3

14.2

6.9

68.6

Males, Grades 5-9

957

12.5

15.5

9.2

62.8

Daily Smoker

35

26.6

20.9*

17.7*

34.8

Smoked Beyond Puffing, Not Daily Smoker

71

19.0

21.9

11.5*

47.6

Puffer

102

15.2

19.1

15.5

50.2

Never Smoker (a)

80

14.7

17.6

10.0*

57.7

Never Smoker (b)

669

10.4

13.8

7.4

68.4

Grades 5-6

375

12.2

15.5

8.5

63.8

Daily Smoker

3

#

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

9

#

#

#

#

Puffer

22

#

27.1*

#

47.9

Never Smoker (a)

28

17.8*

17.9*

#

51.7

Never Smoker (b)

313

10.8

14.3

7.9

67.0

Grades 7-9

582

12.7

15.5

9.6

62.2

Daily Smoker

32

26.4

21.2*

18.6*

33.8

Smoked Beyond Puffing, Not Daily Smoker

62

17.2

21.8

11.3*

49.7

Puffer

80

15.6

16.8

16.9

50.7

Never Smoker (a)

52

12.9*

17.4

8.8*

60.9

Never Smoker (b)

356

10.0

13.4

7.0

69.6

Females, Grades 5-9

909

14.6

15.5

9.6

60.3

Daily Smoker

50

35.0

15.3*

16.2*

33.5

Smoked Beyond Puffing, Not Daily Smoker

65

29.5

18.6

15.2

36.7

Puffer

87

18.8

21.0

17.2

43.0

Never Smoker (a)

75

13.8

15.8

9.7*

60.7

Never Smoker (b)

632

11.0

14.4

7.5

67.1

Grades 5-6

357

13.8

14.0

8.9

63.3

Daily Smoker

2

#

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

7

#

#

#

#

Puffer

17

28.9*

#

#

29.8*

Never Smoker (a)

24

23.1*

#

#

51.0

Never Smoker (b)

307

11.4

13.6

8.1

66.9

Grades 7-9

552

15.1

16.4

10.0

58.5

Daily Smoker

48

34.5

15.5*

16.7*

33.3

Smoked Beyond Puffing, Not Daily Smoker

58

28.1

18.5

15.4*

38.0

Puffer

70

16.4

20.8

16.9

45.9

Never Smoker (a)

51

9.5*

16.9*

8.7*

64.9

Never Smoker (b)

325

10.6

15.1

6.9

67.4

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability
(a) Never Smoker who has Seriously Thought About Smoking
(b) Never Smoker who has Never Seriously Thought About Smoking

Table 5-6b - Combined Influence of Both Parents Smoking, by Grade, Sex, and Category of Smoker, Canada, Youth Smoking Survey 1994

 

 

Parental Smoking (%)

 

Pop. Est.
('000)

Both Smoke

Father Smokes Only

Mother Smokes Only

Neither Smokes

Total, Grades 5-9

1,930

17.2

17.8

12.4

52.6

Daily Smoker

85

36.5

17.3*

17.9*

28.3

Smoked Beyond Puffing, Not Daily Smoker

427

22.7

20.5

16.3

40.5

Puffer

269

20.3

19.4

15.1

45.2

Never Smoker (a)

175

14.3

15.3

11.2*

59.2

Never Smoker (b)

974

12.7

16.6

9.7

61.0

Grades 5-6

738

17.8

17.2

12.7

52.3

Daily Smoker

4

#

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

69

33.8

22.3*

18.3*

25.6*

Puffer

87

22.2*

20.5*

18.3*

39.0

Never Smoker (a)

68

17.0*

14.3*

16.5*

52.2

Never Smoker (b)

510

14.7

16.3

10.5

58.5

Grades 7-9

1,192

16.8

18.1

12.2

52.9

Daily Smoker

81

36.3

17.7*

17.8*

28.2

Smoked Beyond Puffing, Not Daily Smoker

358

20.5

20.2

15.9

43.4

Puffer

181

19.4

18.8

13.6

48.2

Never Smoker (a)

107

12.6*

15.9*

7.9*

63.6

Never Smoker (b)

465

10.5

16.9

8.8

63.8

Males, Grades 5-9

986

16.3

17.6

12.2

53.9

Daily Smoker

40

30.0*

13.9*

22.0*

34.1*

Smoked Beyond Puffing, Not Daily Smoker

218

21.9

20.9

16.7

40.5

Puffer

145

18.5

20.3

13.6*

47.6

Never Smoker (a)

83

15.0*

15.6*

8.8*

60.6

Never Smoker (b)

500

12.4

16.0

9.6

62.0

Grades 5-6

383

17.9

17.2

12.6

52.3

Daily Smoker

2

#

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

44

30.6*

24.3*

22.4*

22.7*

Puffer

49

24.3*

22.7*

15.7*

37.3

Never Smoker (a)

33

19.5*

16.5*

#

51.9

Never Smoker (b)

255

14.1

15.2

10.2

60.5

Grades 7-9

603

15.4

17.8

11.9

54.9

Daily Smoker

38

29.8*

14.7*

21.4*

34.1*

Smoked Beyond Puffing, Not Daily Smoker

174

19.7

20.1

15.2

45.0

Puffer

96

15.6

19.1

12.5

52.8

Never Smoker (a)

50

12.0*

15.0*

#

66.4

Never Smoker (b)

245

10.6

16.8

8.9

63.7

Females, Grades 5-9

943

18.0

17.9

12.6

51.5

Daily Smoker

45

42.2

20.4*

14.2*

23.2*

Smoked Beyond Puffing, Not Daily Smoker

209

23.5

20.1

15.9

40.5

Puffer

123

22.4

18.3

17.0

42.3

Never Smoker (a)

91

13.7*

15.0*

13.4*

57.9

Never Smoker (b)

475

13.0

17.2

9.7

60.1

Grades 5-6

355

17.6

17.1

12.9

52.4

Daily Smoker

2

#

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

25

39.4*

#

#

30.4*

Puffer

38

19.5*

17.8*

21.5*

41.2

Never Smoker (a)

35

#

#

20.8*

52.3

Never Smoker (b)

255

15.3

17.5

10.7

56.5

Grades 7-9

589

18.3

18.4

12.5

50.8

Daily Smoker

44

41.8

20.3

14.6*

23.3

Smoked Beyond Puffing, Not Daily Smoker

184

21.3

20.2

16.5

42.0

Puffer

84

23.8

18.5*

14.9*

42.8

Never Smoker (a)

57

13.1*

16.7*

#

61.2

Never Smoker (b)

220

10.4

17.0

8.6*

64.0

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability
(a) Never Smoker who has Seriously Thought About Smoking
(b) Never Smoker who has Never Seriously Thought About Smoking

Table 5-7a - Number of Smokers Inside the Home, by Grade, Sex, and Category of Smoker, Canada, Youth Smoking Survey 2002

 

 

Number of Smokers in the Home (%)

 

Pop. Est.
('000)

None

1-2

3 or more

Total, Grades 5-9

2,012

70.0

24.7

5.3

Daily Smoker

94

36.7

40.3

23.0

Smoked Beyond Puffing, Not Daily Smoker

154

48.1

4.1*

10.8

Puffer

206

56.3

35.6

8.1

Never Smoker (a)

167

67.7

27.4

4.9*

Never Smoker (b)

1,391

76.9

19.9

3.2

Grades 5-6

792

71.8

23.4

4.8

Daily Smoker

6

#

46.7*

#

Smoked Beyond Puffing, Not Daily Smoker

19

34.8*

53.2

#

Puffer

44

52.5

36.5

11.0*

Never Smoker (a)

56

59.7

31.0

9.3*

Never Smoker (b)

667

75.4

20.8

3.8

Grades 7-9

1,220

68.8

25.5

5.7

Daily Smoker

88

36.6

39.9

23.5

Smoked Beyond Puffing, Not Daily Smoker

135

50.0

39.4

10.6

Puffer

162

57.3

35.4

7.3

Never Smoker (a)

111

71.7

25.6

#

Never Smoker (b)

724

78.4

19.0

2.6

Males, Grades 5-9

1,030

70.3

24.6

5.1

Daily Smoker

39

36.3

39.6

24.1

Smoked Beyond Puffing, Not Daily Smoker

81

52.0

39.8

8.2*

Puffer

112

58.8

32.6

8.6*

Never Smoker (a)

87

65.8

28.8

5.4*

Never Smoker (b)

711

76.6

20.3

3.1

Grades 5-6

403

71.4

23.6

5.0

Daily Smoker

3

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

10

43.6*

46.0*

#

Puffer

25

61.8

25.8*

#

Never Smoker (a)

30

60.3

29.7

#

Never Smoker (b)

335

74.1

22.1

3.8

Grades 7-9

627

69.6

25.2

5.2

Daily Smoker

36

35.0

39.8

25.2

Smoked Beyond Puffing, Not Daily Smoker

71

53.2

38.9

7.9*

Puffer

87

58.0

34.6

7.4*

Never Smoker (a)

57

68.7

28.4

#

Never Smoker (b)

376

78.9

18.6

2.5*

Females, Grade 5-9

982

69.6

24.8

5.6

Daily Smoker

55

37.0

40.8

22.2

Smoked Beyond Puffing, Not Daily Smoker

73

43.8

42.6

13.6

Puffer

94

53.4

39.1

7.5*

Never Smoker (a)

80

69.7

25.9

#

Never Smoker (b)

680

77.3

19.5

3.2

Grades 5-6

389

72.2

23.1

4.7

Daily Smoker

3

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

9

#

61.7

#

Puffer

19

40.2

50.7

#

Never Smoker (a)

26

59.1

32.5

#

Never Smoker (b)

332

76.7

19.5

3.8

Grades 7-9

593

68.0

25.9

6.1

Daily Smoker

52

37.6

39.9

22.5

Smoked Beyond Puffing, Not Daily Smoker

64

46.4

40.1

13.5*

Puffer

75

56.6

36.3

7.1*

Never Smoker (a)

54

75.0

22.7

#

Never Smoker (b)

348

77.8

19.4

2.8*

* Moderate sampling variability; interpret with caution
# Data suppressed due to high sampling variability
(a) Never Smoker who has Seriously Thought About Smoking
(b) Never Smoker who has Never Seriously Thought About Smoking

Table 5-7b - Number of Smokers Inside the Home, by Grade, Sex, and Category of Smoker, Canada, Youth Smoking Survey 1994

 

 

Number of Smokers in the Home (%)

 

Pop. Est.
('000)

None

1-2

3 or more

Total, Grades 5-9

1,906

51.2

41.7

7.1

Daily Smoker

84

19.6*

46.2

34.2

Smoked Beyond Puffing, Not Daily Smoker

420

35.1

53.0

11.9

Puffer

267

44.9

48.9

6.2*

Never Smoker (a)

172

59.4

34.3

6.3*

Never Smoker (b)

963

61.3

35.7

3.0

Grades 5-6

725

52.3

40.8

6.9

Daily Smoker

4

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

63

19.6*

59.6

20.8*

Puffer

87

38.7

49.8

11.5*

Never Smoker (a)

66

51.0

38.9

10.1*

Never Smoker (b)

505

59.2

37.2

3.6*

Grades 7-9

1,181

50.5

42.2

7.3

Daily Smoker

81

19.8*

46.8

33.3

Smoked Beyond Puffing, Not Daily Smoker

357

37.9

51.8

10.3

Puffer

180

47.8

48.4

3.8*

Never Smoker (a)

106

64.6

31.5

#

Never Smoker (b)

457

63.6

34.0

2.4*

Males, Grades 5-9

967

52.5

40.1

7.4

Daily Smoker

39

21.4*

41.2

37.4*

Smoked Beyond Puffing, Not Daily Smoker

212

36.0

51.4

12.6

Puffer

144

47.7

46.3

6.0*

Never Smoker (a)

82

60.9

33.3

#

Never Smoker (b)

490

62.2

34.5

3.3*

Grades 5-6

374

52.6

41.0

6.4

Daily Smoker

2

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

39

17.4*

61.6

21.0*

Puffer

49

36.2

53.4

#

Never Smoker (a)

32

52.5

42.4*

#

Never Smoker (b)

252

61.6

35.1

3.3*

Grades 7-9

593

52.5

39.6

7.9

Daily Smoker

37

21.4*

40.7

37.9*

Smoked Beyond Puffing, Not Daily Smoker

173

40.2

49.0

10.8*

Puffer

95

53.5

42.7

#

Never Smoker (a)

50

66.4

27.4*

#

Never Smoker (b)

238

62.9

33.8

3.3*

Females, Grade 5-9

939

49.8

43.3

6.9

Daily Smoker

45

18.0*

50.6

31.4*

Smoked Beyond Puffing, Not Daily Smoker

208

34.2

54.6

11.2

Puffer

123

41.6

51.8

6.6*

Never Smoker (a)

90

58.1

35.3

6.6*

Never Smoker (b)

473

60.3

36.9

2.8*

Grades 5-6

351

51.9

40.6

7.5

Daily Smoker

2

#

#

#

Smoked Beyond Puffing, Not Daily Smoker

24

23.0*

56.5

20.5*

Puffer

38

41.9

45.2

#

Never Smoker (a)

33

49.5

35.5*

#

Never Smoker (b)

254

56.8

39.3

3.9*

Grades 7-9

588

48.5

44.9

6.6

Daily Smoker

44

18.5*

52.1

29.4

Smoked Beyond Puffing, Not Daily Smoker

183

35.7

54.4

9.9*

Puffer

85

41.4

54.8

#

Never Smoker (a)

57

63.1

35.1

#

Never Smoker (b)

219

64.3

34.2

#

# Data suppressed due to high sampling variability
(a) Never Smoker who has Seriously Thought About Smoking
(b) Never Smoker who has Never Seriously Thought About Smoking

Influence of Health Practitioners

Judy Snider, MSc
Tobacco Control Programme
Health Canada

Joan M. Brewster, PhD
Ontario Tobacco Research Unit
Department of Public Health Sciences, University of Toronto

Acknowledgements: The authors thank Joanna Cohen (University of Toronto) and Deborah Ossip-Klein (University of Rochester) who reviewed an earlier draft of this chapter and provided helpful commentary.

Highlights

  • Overall, less than one in five young people reported being asked by a health professional (doctor or dentist) about their use of tobacco products, and less than one in four students reported being advised by these professionals about the health risks of smoking. Young people reported that doctors were much more likely than dentists to both ask them about their use of tobacco products (17% vs. 5%) and talk to them about the health risks (21% vs. 10%).
  • Whether or not the youth had a regular family practitioner (doctor or dentist) was not related to the reports of doctors' or dentists' practices of asking about tobacco product use and advising about health risks.
  • As youth matured through grades 5-9, the reported prevalence of health professionals asking about tobacco product use increased, but the reported prevalence of them talking to students about health effects decreased.
  • The reported prevalence of doctors asking young people about tobacco product use and talking to them about health effects of tobacco was related to respondents' level of smoking: those who had smoked in the last 30 days were most likely to report physician advice, followed by those who smoked beyond puffing.
  • Ninety-six percent of students who had smoked within the last thirty days reported that they did not ask a doctor for help to quit smoking.
  • Both doctors and dentists need to be encouraged to speak to youth in grades 5-9 about possible tobacco product use, and where necessary, youth-centered tools may need to be developed and disseminated to further assist them in these areas.

Methods

Data from the 2002 Youth Smoking Survey (YSS) were analyzed to examine the role health professionals (doctors and dentists) may play with respect to adolescent smoking behaviours. Variables examined include family situation, demographics and thinking about quitting. Descriptive analyses were undertaken to provide information about students' reported experience with health practitioners' asking about the use of tobacco products and advising about the health effects from using tobacco products and the association of these practices with variables of interest.

Definitions

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. Specifically, the definitions used to categorize the different smokers have been described earlier (Chapter 2, especially Table 2-C and Chapter 3). The smoking behaviour analyses in this chapter were carried out using the three point derived variable (Never Smoker, Puffer and Smoked Beyond Puffing).

Access to health professionals (doctors and dentists) may play a role in whether youth take up or quit smoking. Health professionals have an opportunity to ask youth about their tobacco use behaviours (Y_Q60 and Y_Q63) and to inform them of the health risks associated with tobacco product use (Y_Q61 and Y_Q64). Having a regular family doctor (P_Q09A) or dentist (P_Q9B) was also assessed, as an established relationship between health practitioners and youth could facilitate frank discussions. Youth who smoke may ask doctors for help to quit smoking (Y_Q62). Students thinking about quitting (Y_Q32) may also trigger discussions about tobacco use with doctors.

Family situations may also play a part in health practitioners' practice with respect to smoking and youth. Analyses of these associations included examining derived variables from the Parent's Questionnaire including ‘any parent smoked' which was based on the smoking habits of the father (P_Q13a) and the mother (P_Q13b). The derived variable ‘grouped household income' (GPP_17) was used as a proxy for socio-demographic factors, which could also influence health professionals' behaviours.

The students' demographic variables used in these analyses included sex (Y_Q02), grade in school (GRADE), and aboriginal status (DVABORIG).

Sample & Response

Students were instructed to answer all the questions. In the processing of the data file, Statistics Canada applied business rules which in turn limited the coverage for some variables. Coverage for the variables asking doctors for help to quit smoking (Y_Q62) and thinking about quitting (Y_Q32) was limited to respondents who reported having smoked in the last 30 days. The questions on family situation were asked of all parents.

In general, missing data for items discussed accounted for less than 10% of the total responses. Notable exceptions include the derived variables for household income (11%) and any parent smoked (14%). The data presented are based on those for whom complete information was available.

The questions on health professionals in the 2002 YSS are new items. Thus, comparisons with the 1994 YSS are not possible.

Statistical testing for differences and the data quality level testing according to the guidelines set by Statistics Canada were undertaken for the findings presented are described in Chapter 2. In the text and tables, findings that have moderate variability where numbers should be interpreted with caution are marked with a star (*).

Findings

Overall, parents reported that the vast majority of students had a regular family doctor (89%) and a regular family dentist (93%).

Doctor Asked About Smoking Cigarettes or the Use of Smokeless Tobacco

When asked whether a doctor had ever asked whether they smoke or use smokeless tobacco products, 17% of students responded positively (Table 6-1). Of these, 66% were never smokers, 20% puffers and 21% smoked beyond puffing. No difference in reports was found between males (17%) and females (17%). The data were analyzed by smoking category and a greater percentage of female students who smoked beyond puffing reported that their doctor asked about tobacco product use than males who smoked beyond puffing (35% vs. 25%) (Figure 6-A).

Figure 6-A - Doctor Ever Asked About Tobacco Product Use by Sex and Smoking Category, Grades 5-9, Canada, Youth Smoking Survey 2002

Figure 6-A - Doctor Ever Asked About Tobacco Product Use by Sex and Smoking Category, Grades 5-9, Canada, Youth Smoking Survey 2002

Only one-third (35%) of students who had smoked in the last 30 days reported that a doctor had ever asked them about the use of tobacco products. Among this group of students, those who had ever thought about quitting were equally likely to report being asked by a doctor (39%) than were those who had not ever thought of quitting (28%*).

As students matured through the grades, the reported prevalence of doctors ever asking about tobacco product use grew from 12% in grade 5 to 26% in grade 9. This was further examined by sex where differences were noted (Table 6-1). Males in grades 5 and 7 were more likely to be asked than females (15% vs. 8% and 17% vs. 12%). By grade 9 the situation was reversed, with 30% of females and 22% of males reporting having been asked about tobacco product use.

Being asked by a doctor about tobacco use also varied by province with students in British Columbia reporting the lowest rate (14%) while students in Quebec reported the highest rate (21%) (Table 6-2). These two provinces held the same ranking for the prevalence of students reporting that they had ‘ever tried smoking a cigarette' ( British Columbia 16% vs. Quebec 37%) (Chapter 3, Figure 3-F). An examination of physician intervention by smoking category among youth in the provinces revealed a different pattern. Of those students who reported smoking beyond puffing, 40% in New Brunswick stated that a doctor asked them about tobacco product use followed by students in Quebec (35%) and Saskatchewan (33%).

Having a regular doctor was not related to doctors' asking students about their use of tobacco products (17% for youth both with and without a regular doctor). An inverse relationship was noted with regard to household income: the frequency of doctors' asking youth about tobacco product use decreased as income increased, from 19% among households with less than $30,000 to 15% among households reporting $80,000 or more per year.

Students of aboriginal origin were no more likely than others to report being asked by a doctor about the use of tobacco products (20% vs. 17% for non-aboriginal origin). Students with at least one parent who smokes were slightly more likely to report being asked (19% vs. 16% for those with no parent who smokes).

Doctor Talked About Health Risks from Smoking Cigarettes or Using Smokeless Tobacco

Twenty-one percent of students reported that a doctor had ever talked to them about the health risks from using tobacco products (Table 6-1). Of these, 75% were never smokers, 10% puffers and 15% smoked beyond puffing. No difference in reports of ever talking was found between females (18%) and males (23%).

An opposite pattern was found when comparing the prevalence of doctors asking about tobacco use to the prevalence of doctors talking about health risks. While the former increased with grade, the percentage of youth who reported that their doctor had talked to them decreased across the school grades with 26% in grade 5 and 17% in grade 9 (Table 6-1). This pattern was noted in both sexes. Also, by grade 9 no difference was seen between the sexes (males 18%, females 17%), however, for the most part more males than females reported being talked to in the younger grades (Figure 6-B).

Figure 6-B - Doctor Ever Talked About Health Risks from Tobacco Product Use by Sex and Grade, Canada, Youth Smoking Survey 2002

Figure 6-B - Doctor Ever Talked About Health Risks from Tobacco Product Use by Sex and Grade, Canada, Youth Smoking Survey 2002

When analyzed by sex and grade, regardless of the category of smoking behaviour, slightly more males than females reported that their doctor talked to them about the health risks (Table 6-3).

Less than one third (29%) of students who smoked in the last 30 days reported that a doctor had ever talked to them about the health risks of tobacco product use. This rate was no different than that reported by those who smoked beyond puffing. Among this group of students, there was no difference between those who had ever thought about quitting (33%) and those who had not ever thought of quitting (26%*) in whether a doctor had talked to them about health risks.

There was a cluster of provinces ( British Columbia , Quebec and Prince Edward Island ) where 22% of students reported being talked to about the health risks from tobacco product use (Table 6-2). This type of cluster was not seen among the provinces with regard to reports about being asked about tobacco use. When this was further examined by smoking category, no differences were seen among the provinces (Table 6-4).

Youth with and without a regular doctor were similar in their reports of being talked to about the health risks from using tobacco products (21% and 18%, respectively). When examined by quintiles of household income, no differences in reports of being talked to were found; reports ranged from 20% to 22%.

Students of aboriginal origin were no more likely than others to report that a doctor had talked to them about the health risks from tobacco product use (25% vs. 21% for students of non-aboriginal origin). Students with at least one parent who smokes were slightly more likely to report being talked to about health risks (23% vs. 20% for those with no parent who smokes).

Students Ever Asked a Doctor for Help to Quit Smoking

Asking a doctor for help to quit smoking was rare among the students who had smoked within the last 30 days. The vast majority (96%) of students who responded to this question reported they had never asked a doctor for help to quit smoking. There was no difference between the grades, sexes, provinces or parental smoking.

Dentist Asked About Smoking Cigarettes or the Use of Smokeless Tobacco

Even though more parents reported that their children had a regular family dentist (93%) than a regular family doctor (89%), fewer youth reported having a dentist ask about their use of tobacco products or talk to them about the health risks from tobacco product use. When examined by grade, dentists appeared to be more likely to have talked to students in grades 5-8 about the health risks of tobacco use than to have asked about tobacco product use (Figure 6-C).

Figure 6-C - Dentist Ever "Asked About Tobacco Product Use" or "Talked About Health Risks from" Tobacco Product Use by Grade, Grades 5-9, Canada, Youth Smoking Survey 2002

Figure 6-C - Dentist Ever "Asked About Tobacco Product Use" or "Talked About Health Risks from" Tobacco Product Use by Grade, Grades 5-9, Canada, Youth Smoking Survey 2002

Overall, 5% of respondents were asked by a dentist about tobacco product use. Smoking behaviour was related to being asked about tobacco product use. Only 4% of never smokers were asked, while 6% of puffers and 12% of those who smoked beyond puffing were asked. No differences were seen between the sexes.

Reports of being asked about tobacco use by dentists ranged from 4% in British Columbia , Alberta *, Ontario and Nova Scotia to 8% in Quebec (Table 6-5).

Having a regular family dentist was not related to the percent of youth who reported being asked by a dentist about tobacco use (5%), regardless of their smoking category. When examined by household income, reports of a dentist asking about tobacco use decreased from 7% among families with less than $30,000 to 4% among families reporting $80,000 or more. Students of aboriginal origin were more likely than others to report being asked by a dentist about their use of tobacco products (9%* vs. 5% for students of non-aboriginal origin). There was no difference in being asked by a dentist about tobacco use between students with at least one parent who smokes and those with no parent who smokes.

Dentist Talked About Health Risks from Smoking Cigarettes or Using Smokeless Tobacco

Overall, 10% of youth reported that a dentist ever talked to them about the health risks from tobacco product use. No difference was detected by smoking category: 10% of never smokers were talked to; 9% of puffers and 11% of those who smoked beyond puffing.

No difference was detected between the sexes (11% males vs. 9% females). The percentage of youth who reported that a dentist talked to them about the health risks from tobacco product use decreased across grades: 14% in students in Grade 5 reported being talked to compared to 9% of students in Grade 9 (Figure 6-C). This pattern was, for the most part, seen in both sexes (Figure 6-D).

Figure 6-D - Dentist Ever Talked About Health Risks from Tobacco Product Use by Sex and Grade, Grades 5-9, Canada, Youth Smoking Survey 2002

Figure 6-D - Dentist Ever Talked About Health Risks from Tobacco Product Use by Sex and Grade, Grades 5-9, Canada, Youth Smoking Survey 2002

Youth living in New Brunswick , Newfoundland and Labrador , Prince Edward Island and Ontario reported the highest rate (11%) of having been talked to by dentists about the health risks from tobacco product use. The lowest rates were reported in Manitoba and Alberta (8%) (Table 6-5).

Youth with and without a regular family dentist were similar in their reports of being talked to by a dentist about the health risks from using tobacco products (10% and. 8%*, respectively). Household income showed some fluctuations (9% to 12%), with respondents from the lowest two quintiles (less than $45,000) reporting the highest proportion of being talked to by dentists about health risks (12%).

Students of aboriginal origin were no more likely than others to report that a dentist had talked to them about the health risks from tobacco product use (12% vs. 10% for youth of non-aboriginal origin). Students with at least one parent who smokes were slightly more likely to report that a dentist had talked to them (11%) than those (9%) with no parent who smokes.

Discussion

In the 2002 YSS, only a minority of students reported having had a health practitioner either ask them about tobacco product use (less than one in five) or talk to them about the health risks from tobacco product use (less than one in four). The paucity of these reports may reflect a tendency among students to under-report these contacts, but this would not fully account for the very low prevalence. Activities need to be undertaken to encourage doctors and dentists to approach students regarding their smoking behaviours and advise them about the health risks associated with tobacco product use.

The vast majority of students in Canada have a regular family doctor and a regular family dentist, suggesting that there is opportunity for widespread interaction with youth. Those who have a regular family doctor or dentist were no more likely to report being asked about smoking, or advised about health risks, than were those who do not have a family practitioner. The proportion of students reporting that physicians had asked them about use of tobacco products or talked with them about health risks is consistent with reports in the literature,1-3 although some published studies of “adolescents” have included older samples. Published reports suggest that physician discussion of tobacco with youth increases with age,3 consistent with the 2002 YSS findings.

Doctors were much more likely than dentists to both ask young people about their use of tobacco products (17% vs. 5%) and talk to them about the health risks (21% vs. 10%). This difference is consistent with previous findings regarding physician and dentist advice to young patients who smoke.4,5. Physicians are more likely to discuss smoking with patients, and to help them quit, than are dentists. According to the 2002 YSS findings, dentists were twice as likely to talk about the health risks from tobacco product use (10%) than to ask young people about its use (5%). The disparities in asking and talking were less extreme among doctors (21% and 17% respectively), but the difference was in the same direction. Dentists may be less comfortable in approaching patients directly about their own smoking than in discussing health risks in general. Barriers to tobacco-related counselling among physicians and dentists include perceived lack of interest in quitting by patients, the need for further training, lack of time, and low priority of tobacco-related issues.6,7 There are few studies specific to adolescents, but physicians report that they are reluctant to discuss smoking when parents are present as young patients may not respond truthfully.8

Doctors living in provinces with higher smoking rates were more likely to ask youth about their use of tobacco products. This suggests that doctors may be more aware of the issue in these provinces. More specifically, British Columbia , the province with the lowest rate for youth ever trying cigarettes (16%), also has the lowest rate of doctors asking youth about their tobacco product use while Quebec , the province with the highest rate for youth ever trying cigarettes (37%), has the highest rate of doctors asking youth about their tobacco product use. Doctors may be more aware of the issue in provinces with higher smoking rates. However, these provincial smoking rates did not appear to influence the rate of doctors talking about the health risks from tobacco use. In dentists, there did not appear to be any relationship between provincial smoking rates and either asking about use of tobacco products or advising about health risks from tobacco product use. Students' reports of being asked by a doctor about their use of tobacco products and being talked to by a doctor about the health risks of tobacco product use were related to smoking category, with those who smoked beyond puffing being most likely to have been asked or talked to. Among those who smoked within the last 30 days, those who had ever thought about quitting were most likely to have been advised by a physician. Taken together, these results suggest that doctors are more likely to advise young smokers than never smokers about the use of tobacco products. In addition, knowledge of parents' smoking status may increase health practitioners' intervention by increasing awareness of family smoking. However, previous studies have found that pediatricians are less likely to advise parents about smoking than to advise young patients about smoking.9. There is currently little evidence regarding the effectiveness of brief advice from doctors in helping young people to quit smoking, but brief interventions by doctors and dentists are effective in helping adult smokers to quit.10

Doctors and dentists were also more likely to ask youth from lower socioeconomic groups about their smoking than to ask those from higher income groups. This may be due to the health practitioners' perception that there are more smokers from lower socio-economic groups (e.g., lower education and income) than among people from higher lower socio-economic groups, or, in view of the finding that health practitioners are more likely to advise those who smoke beyond puffing, it could be related to a higher prevalence of smoking among students from lower socioeconomic groups (Chapter 3). Further investigation of these patterns requires multivariate analyses of the data.

Limitations

It is important to note that the YSS is a cross-sectional survey and the survey methodology precluded determination of the frequency, timing, and nature of the health professionals' intervention (asking/talking) with the students with respect to their smoking behaviour. Reliability of the self-reported discussions with health practitioners may be influenced by recall or reporting bias. The analyses regarding youth asking a doctor for help to quit is quite restricted due to the low prevalence of this behaviour and the limitation that the data for this variable included only students who reported smoking within the last 30 days. Finally, the absence of these health practitioner variables in the 1994 YSS precludes discussion of changes over time.

Implications for Education and Message Promotion

Youth report receiving information on the health effects of tobacco product use as part of the school curriculum, but this may not happen until they are in their teens (Chapter 8), by which time they may have started experimenting with tobacco products. Health practitioners have the opportunity to start the dialogue on smoking on a ‘one on one' basis at an early age, but they do not appear to be taking advantage of this opportunity. This kind of patient contact could further support existing school-based initiatives to prevent the uptake of smoking and support cessation programs available to students.

Brief interventions by doctors and dentists are effective in helping adult smokers to quit, but the effectiveness of interventions with youth has yet to be identified, mainly due to lack of youth-specific research.10,11 The medical and dental professions in Canada12 and the Canadian Pediatric Society13 have endorsed tobacco-related advice and smoking cessation intervention as important roles for practitioners. Both doctors and dentists should be encouraged to ask all youth, including those in the earlier grades, about tobacco product use and advise them about the health effects from such use. Continuing research is needed to develop and disseminate youth-centered tools to further assist health professionals in carrying out these practices. Through increased training and resources, the communication skills and confidence of health professionals may be improved to increase their comfort in helping youth to avoid tobacco product use.

As well, youth smokers should be encouraged to seek the assistance of health practitioners to help them to quit. Messaging that informs and educational programs that open the doors of communication with health professionals need to be developed for inclusion in youth smoking cessation programs. Given the opportunities that health professionals have when treating families, and the relationship between parental smoking and the uptake of smoking by their children, multi-pronged approaches and messages that target both young people and their parents should be developed to support quit attempts in both adults and youth who smoke, and to prevent initiation by youth who do not smoke.

Implications for Future Monitoring and Further Research

Surveillance cannot provide adequate information on the sequence, timing, nature and success of health practitioner interventions with youth, or the relationships between these interventions and young people's experimentation with and uptake of tobacco product use or their attempts to quit smoking. A longitudinal research protocol that measures these activities over time would be invaluable in assessing the potential impact of health professional interventions on youth smoking behaviour.

Given the unknown impact of youth-specific smoking cessation tools for doctors and dentists, an evaluation program should be in place prior to dissemination of these packages. Without information on the effectiveness of these interventions, it will be difficult to secure funds to support the development of new strategies and technologies to assist health practitioners in their practices. An evaluation strategy should also be considered to measure the success of a multi-pronged approach for health professionals to assist parents who smoke with quitting while preventing youth from taking up smoking.

In addition to education and skill-building, practitioner behaviour is related to the practice environment and patient characteristics.9,10 The 2002 YSS findings indicate that there is a relationship between practitioner interventions and youth and parent smoking behaviour and family socioeconomic status. Further research is needed to explore patient factors that cue health practitioners for preventive and early interventions with youth and professional and environmental factors that encourage and support such interventions.

References

1. Alfano CM, Zbikowski SM, Robinson LA, Klesges RC, Scarinci IC. Adolescent reports of physician counseling for smoking. Pediatrics 2002; 109: e47.

2. Klein JD, Levine LJ, Allan MJ. Delivery of smoking prevention and cessation services to adolescents. Archives of Pediatrics and Adolescent Medicine 2001; 155: 597-602.

3. Sims TH, Meurer JR, Sims M, Layde PM. Factors associated with physician interventions to address adolescent smoking. Health Services Research 2004; 39: 571-585.

4. Gregorio DI. Counseling adolescents for smoking prevention: A survey of primary care physicians and dentists. American Journal of Public Health 1994; 84: 1151-1153.

5. Secker-Walker RH, Solomon LJ, Flynn BS, Dana GS. Comparisons of the smoking cessation counseling activities of six types of health professionals. Preventive Medicine 1994; 23: 800-808.

6. Campbell HS, Macdonald JM. Tobacco counselling among Alberta dentists. Journal of the Canadian Dental Association 1994; 60: 218-226.

7. Goldberg R, Ockene I, Ockene J. Physicians' attitudes and reported practices toward smoking intervention. Journal of Cancer Education 1993; 8: 133-139.

8. Kaplan CP, Pérez-Stable EJ, Fuentes-Afflick E, Gildengorin V, Millstein S, Juarez-Reyes M. Smoking counseling with young patients: The practices of family physicians and pediatricians. Archives of Pediatrics and Adolescent Medicine 2004; 158: 83-90.

9. Zapka JG, Fletcher K, Pbert L, Druker SK, Ockene JK, Chen L. The perceptions and practices of pediatricians: Tobacco Intervention. Pediatrics 1999; 105: e65.

10. Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence: Clinical Practice Guideline. Rockville , MD : U.S. Department of Health and Human Services, Public Health Service, June 2000.

11. Backinger CL, McDonald P, Ossip-Klein DJ, Colby SM, Maule CO, Fagan P, Husten C, Colwell B. Improving the future of youth smoking cessation. American Journal of Health Behavior 2003; 27(Suppl 2): S170-S184.

12. Canadian Medical Association, Canadian Dental Association, and 7 other national health professional associations. Tobacco: The role of health professionals in smoking cessation: Joint Statement. January 2001 Available: http://www.cma.ca//multimedia/staticContent/HTML/N0/l2/where_we_stand/tobacco.pdf

13. Canadian Paediatric Society. Role of the physician in smoking prevention. Paediatrics and Child Health 2001; 6: 89-95.


Table 6-1 - "Doctor Ever Asked About" or "Doctor Ever Talked About Health Risks from Tobacco Product Use" by Sex and Grade, Canada, Youth Smoking Survey 2002
    % Ever asked % Ever Talked
Grade Pop. Est
(000)
Yes No Yes No

Total, 5-9

1,995 17 83 21 79

5

386 12 88 26 74

6

396 12 88 23 77

7

418 15 85 19 81

8

403 22 78 20 80

9

393 26 74 17 83

Males, 5-9

1,022 17 83 23 77

5

195 15 85 28 72

6

203 13 87 26 74

7

216 17 83 23 77

8

206 21 79 22 78

9

201 22 78 18 82

Females, 5-9

973 17 83 18 82

5

190 8 92 24 76

6

193 12 88 19 81

7

202 12 88 15 85

8

196 22 78 18 82

9

192 30 70 17 83
Table 6-2 - "Doctor Ever Asked About" or "Doctor Ever Talked About Health Risks from Tobacco Product Use" by Province, Canada, Youth Smoking Survey 2002
    % Ever asked % Ever talked
  Pop. Est
(000)
Yes No Yes No
Canada 1,995 17 83 21 79
NL 33 16 84 21 79
PE 10 15 85 22 78
NS 61 16 84 19 81
NB 48 19 81 21 79
QC 475 21 79 22 78
ON 761 17 83 21 79
MB 75 16 84 18 82
SK 67 16 84 19 81
AB 218 15 85 19 81
BC 246 14 86 22 78
Table 6-3 - "Doctor Ever Talked About Health Risks from Tobacco Product Use" by Sex, Smoking Category and Grade, Grades 5-9, Canada, Youth Smoking Survey 2002
    %Doctor Talked About Health Risks
  Pop. Est
(000)
Yes No
Grades 5-9 1,995 21 79
Never Smoker 1,544 20 80
Puffer 206 20 80
Smoked Beyond Puffing 244 25 75
Males      
Grade 5 195 28 72
Never Smoker 179 28 72
Puffer 12 28* 72
Smoked Beyond Puffing 4 # 66
Grade 6 203 26 74
Never Smoker 180 26 74
Puffer 14 29* 71
Smoked Beyond Puffing 9 34* 66
Grade 7 216 23 77
Never Smoker 169 23 77
Puffer 25 19* 81
Smoked Beyond Puffing 22 24* 76
Grade 8 206 22 78
Never Smoker 147 22 78
Puffer 28 18* 82
Smoked Beyond Puffing 32 28 72
Grade 9 201 18 82
Never Smoker 116 14 86
Puffer 34 22* 78
Smoked Beyond Puffing 51 23 77
Females   #  
Grade 5 190 24 76
Never Smoker 180 24 76
Puffer 7 # 83
Smoked Beyond Puffing 2 #
Grade 6 193 19 81
Never Smoker 173 19 81
Puffer 10 # 75
Smoked Beyond Puffing 9 # 73
Grade 7 202 15 85
Never Smoker 162 14 86
Puffer 19 # 84
Smoked Beyond Puffing 22 20* 80
Grade 8 196 18 82
Never Smoker 126 16 84
Puffer 27 15* 85
Smoked Beyond Puffing 44 25 75
Grade 9 192 17 83
Never Smoker 112 12 88
Puffer 30 20* 80
Smoked Beyond Puffing 50 25 75

* Moderate variability; interpret with caution
# suppressed due to high sampling variability

Table 6-4 - "Doctor Ever Talked About Health Risks from Tobacco Product Use" by Province and Smoking Category, Canada, Youth Smoking Survey 2002
    %Doctor Talked About Health Risks
  Pop. Est
(000)
Yes No
Canada 1,995    
Never Smoker 1,544 20 80
Puffer 206 20 80
Smoked Beyond Puffing 244 25 75
NL      
Never Smoker 24 19 81
Puffer 4 27 73
Smoked Beyond Puffing 5 22 78
PE      
Never Smoker 8 22 78
Puffer 0.7 # 76
Smoked Beyond Puffing 1 # 78
NS      
Never Smoker 46 19 81
Puffer 6 20* 80
Smoked Beyond Puffing 9 19* 81
NB      
Never Smoker 37 18 82
Puffer 5 23* 77
Smoked Beyond Puffing 6 34 66
QC      
Never Smoker 300 21 79
Puffer 66 21 79
Smoked Beyond Puffing 110 26 74
ON      
Never Smoker 636 21 79
Puffer 65 21* 79
Smoked Beyond Puffing 59 23* 77
MB      
Never Smoker 60 17 83
Puffer 8 # 82
Smoked Beyond Puffing 8 28* 72
SK      
Never Smoker 50 19 81
Puffer 9 17* 83
Smoked Beyond Puffing 8 20* 80
AB      
Never Smoker 176 19 81
Puffer 23 # 89
Smoked Beyond Puffing 20 27* 73
BC      
Never Smoker 207 21 79
Puffer 19 25* 75
Smoked Beyond Puffing 19 30 70

* Moderate variability; interpret with caution
# suppressed due to high sampling variability

Table 6-5 - "Dentist Ever Asked About" or "Dentist Ever Talked About Health Risks from Tobacco Product Use" by Province, Canada, Youth Smoking Survey 2002
    % Ever asked % Ever Talked
  Pop. Est
(000)
Yes No Yes No
Canada 1,995 5 95 10 90
NL 33 6 94 11 89
PE 10 5* 95 11 89
NS 61 4 96 9 91
NB 48 6 94 11 89
QC 476 8 92 10 90
ON 760 4 96 11 89
MB 75 5* 95 8 92
SK 67 5 95 9 91
AB 218 4* 96 8 92
BC 246 4 96 9 91

* Moderate variability; interpret with caution

Beliefs and Attitudes

Michael Chaiton, MSc
Department of Public Health Sciences
University of Toronto

Joanna Cohen, PhD
Ontario Tobacco Research Unit, &
Department of Public Health Sciences
University of Toronto

Murray J. Kaiserman, PhD
Tobacco Control Programme
Health Canada

Scott T. Leatherdale, PhD
Division of Preventive Oncology
Cancer Care Ontario,
Department of Health Studies and Gerontology
University of Waterloo, &
Department of Public Health Sciences
University of Toronto 

Acknowledgements: The authors thank Bill Morrison (University of New Brunswick), Dave Hammond (University of Waterloo), Alan Diener (Health Canada), Cynthia Doucet (University of New Brunswick) and Geoff Fong (University of Waterloo) who reviewed an earlier draft of this chapter and provided helpful commentary.

Highlights

  • Most students in grades 5-9 believed smoking is addictive (88%), and that secondhand smoke is harmful to non-smokers (86%), and these beliefs increased with grade. Only a minority of students in grades 5-9 (37%) believed that quitting smoking will reduce damage even after years of smoking. Students in grades 5-9 in Quebec (57%) were much less likely than students in other provinces (69%) to believe that occasional smoking causes harm.
  • Students in higher grades 7-9, especially those who have smoked beyond puffing, were more likely to perceive benefits from smoking. The majority of students in grades 5-9 (74%) believed that it is nicer to date non-smokers, even among students who have tried smoking (59%). Very few students in grades 5-9 (3%) believed that smoking is cool; however, more than one quarter of students who have smoked beyond puffing in grades 5- 6 (32%) believed that smoking is cool. Students with friends who smoke were more likely to believe smoking is cool.
  • Students in grades 5-9 reported that friends' smoking or peer pressure was the main reason for youth smoking (64%). Among students in grades 5-6, "popular kids smoke" was the second most endorsed reason (45%) while among students in grades 7-9, curiosity was the second most endorsed reason (56%). Never smokers were more likely to give reasons of status (it's cool, popular kids smoke) as reasons why youth smoke than students who smoked beyond puffing.
  • The majority of students believed the health warning messages on cigarette packages and agreed that health warning messages should be on cigarette packages. However, the majority of students in grades 5-9 who smoked beyond puffing were somewhat less likely to endorse or believe the health warning messages compared to never smokers. Students in grades 5-9 who reported seeing the health warning messages often were more likely to agree with them.
  • Students in grades 5-9 in the 2002 YSS were more likely to report that occasional smoking endangers health than were similar students in 1994 YSS, but students in the 2002 YSS were more likely to believe that smokers can quit anytime and smoking helps people relax. However, students in the 2002 YSS in grades 5-9 who smoked beyond puffing were more likely to believe that it is nicer to date non-smokers and less likely to report that it was cool to smoke than were students in the 1994 YSS.

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

The 2002 Youth Smoking Survey (YSS) included numerous questions looking at the attitudes and beliefs of students in grades 5-9. This chapter presents data related to the health effects of smoking (Y_Q46A-H, J), attitudes toward smoking (Y_Q46I, Y_Q46K), reasons why students start smoking (Y_Q47), beliefs about health warning labels on cigarette packages (Y_Q52, Y_Q53), and questions quantifying the deadliness of tobacco (Y_Q80, Y_Q81). Questions on tobacco sponsorship, which were in the 1994 YSS, were not asked in the 2002 YSS.

Closed-ended questions in which the student endorsed whether or not they believed the item to be true were used for many of the response categories. Unlike the 1994 YSS, where older students were administered the survey differently, there was no component in which answers were given unaided or unprompted. All responses were selected from a list provided. For question Y_Q52, in which students were asked how much they agreed with cigarette packages having health warning labels (agree a lot, agree a little, neither, disagree a little or disagree a lot) only "agree a lot" is reported in this chapter.

Beliefs and attitudes were examined according to type of smoker, grade (GRADE), sex (Y_Q2), and province (PROVINCE). The three-category definition of type of smoker was used in this chapter (Never Smoker, Puffer, Smoked Beyond Puffing). Refer to Chapter 2, especially Table 2-C, and Chapter 3 for definitions and a thorough discussion of these categories. Other correlates used in this chapter include the proportion of friends who smoke, the proportion of smokers in the household, self-rated academic performance relative to peers (Y_Q54), and language group (Y_Q3).

Sample and Response

Missing data for items discussed accounted for less than 10% of the total responses. As such, the data presented are based on those for whom complete data were available. According to Statistics Canada guidelines, data are not reportable if the sample size was too small or if there was high sampling variability. Statistically significant group differences were determined using procedures described in Chapter 2.

Findings

Beliefs about Smoking and Health

The beliefs of students in the 2002 YSS about the harms of tobacco and about quitting are shown in Table 7-1a. Overall, the majority of all students in grades 5-9 believed that tobacco is addictive (88%), that environmental tobacco smoke (ETS) is harmful to non-smokers (86%), and that occasional smoking is harmful to health (67%). Just over one third of students believed that quitting smoking reduces damage even after years of smoking (37%). Twenty-nine percent believed smokers can quit any time. Less than one fifth (17%) believed that one must smoke for many years before health is harmed.

Students in grades 5-6 were more likely than students in grades 7-9 to believe that smokers can quit anytime (36% and 24%, respectively). Conversely, students in grades 7-9 were more likely than students in grades 5-6 to believe quitting smoking even after years reduces damage (40% and 31%, respectively), tobacco is addictive (91% and 83%, respectively), and ETS is harmful to non-smokers (91% and 78%, respectively).

Figure 7-A - Health Beliefs by Category of Smoker, Canada, Youth Smoking Survey 2002

Figure 7-A - Health Beliefs by Category of Smoker, Canada, Youth Smoking Survey 2002

In the 2002 YSS there was a strong association between smoking behaviour and beliefs about the harms of tobacco and the benefits of quitting (Figure 7-A). Students who have smoked beyond puffing were more likely than never smokers to believe tobacco is addictive (93% and 87%, respectively), ETS is harmful to non-smokers (91% and 85%, respectively), quitting smoking reduces damage even after years of smoking (43% and 35%, respectively), and you must smoke for many years before you hurt your health (24% and 16%, respectively). Conversely, students who have never smoked were more likely than students who have smoked beyond puffing to believe occasional smoking endangers health (70% and 56%, respectively).

Differences were found between males and females. Among students in grades 7-9, males who smoked beyond puffing were more likely than comparable females to believe that you must smoke for many years before you hurt your health (29% and 19%, respectively), or that quitting smoking reduces damage even after years (49% and 39%, respectively).

Overall, the awareness of the harms of tobacco was greater in the 2002 YSS than the 1994 YSS. The belief that occasional smoking endangers health increased from 62% in 1994 to 67% in 2002. (Tables 7-1a and 7-1b) In grades 7-9 only 59% of the 1994 cohort believed in dangers of occasional smoking, but 68% of the 2002 cohort in grades 7-9 endorsed this belief. However, substantially more students in 2002 thought that smokers can quit anytime (29% in 2002 vs. 17% in 1994). Furthermore, in 2002 fewer students believed that quitting smoking reduces damage even after years (37% vs. 47% in 1994).

The majority of students in the 2002 YSS did not perceive benefits from smoking (Table 7-2). The most commonly perceived benefit was that smoking helped people relax (36%). Some students also felt that smoking helped with weight control (18%), and helped people when they were bored (13%). Perceptions of cigarettes as a tool to help people relax, help people stay slim, and prevent boredom increased with grade. The belief that cigarettes help people relax more than doubled from grades 5-6 (24%) to grades 7-9 (49%). In the higher grades, more students believed that smoking helps people stay slim (12% in grade 5-6 compared to 21% in grades 7-9).

There were no significant sex differences in beliefs about the perceived benefits of smoking.

In the 2002 YSS a majority of those who have smoked beyond puffing (62%) believed smoking helps people relax compared to puffers (45%) and never smokers (30%). Students who have smoked beyond puffing were also more likely than never smokers to believe smoking helps people stay slim (29% and 15%, respectively), and smoking helps people when they are bored (27% and 10%, respectively) (Table 7-2a).

From the 1994 to the 2002 YSS, there were changes in belief that smoking helps people relax, but no significant difference in beliefs that smoking makes you slim or helps when bored. Youth in all smoking categories surveyed in 2002 were more likely than students in 1994 to endorse the belief that smoking helps people relax: never smokers (2002: 30%; 1994: 21%), puffers (2002: 45%; 1994: 35%) and students who had smoked beyond puffing (2002: 62%; 1994: 53%) (Table 7-2a and Table 7-2b).

While many students were aware of the relative deadliness of smoking, they were not aware that the death toll from cigarettes is more than that for each of alcohol, suicides, accidents, murders, drugs, and AIDS (Table 7-3). A majority of students believed that the death toll due to smoking is higher than alcohol (60%) and suicide (53%). However, 63% of students thought AIDS is responsible for more deaths than tobacco. Younger students (in grades 5-6) were more likely than older students (in grades 7-9) to underestimate the relative harm of tobacco for each cause of death except alcohol and accidents, for which reports of harm were similar in the two groups (Figure 7-B). Females were more likely than males to underestimate the relative number of deaths from tobacco compared to each of the other causes of deaths. For instance, 65% of males compared to 54% of females believed that cigarettes cause more deaths than alcohol. Students who have smoked beyond puffing were more likely than never smokers to believe smoking causes more deaths than each of suicides, murders, drugs and AIDS. Whereas 50% of students who have smoked beyond puffing believed there are more deaths due to smoking than due to drugs, only 38% of never smokers held this belief. It should be noted that even these findings underestimate students' failure to appreciate the relative deadliness of smoking. The survey questions asked students to compare the deadliness of smoking to each cause of death. But, in fact, smoking causes more deaths than all of these other causes combined.

Figure 7-B - Percentage of Students Who Believe that Smoking is Responsible for More Deaths than AIDS, Drugs, Murders, Accidents, Suicides, and Alcohol, Canada, Youth Smoking Survey 2002

Figure 7-B - Percentage of Students Who Believe that Smoking is Responsible for More Deaths than AIDS, Drugs, Murders, Accidents, Suicides, and Alcohol, Canada, Youth Smoking Survey 2002

Figure 7-C - Estimates of Numbers of Deaths Due to Smoking by Grade, Canada, Youth Smoking Survey 2002

Figure 7-C - Estimates of Numbers of Deaths Due to Smoking by Grade, Canada, Youth Smoking Survey 2002

Fifteen percent of students were able to correctly estimate that 45,000 people die from smoking each year in Canada , while 46% underestimated and 40% overestimated the death toll (Figure 7-C). The most common response reported by students (20%) was that more than 100,000 die from smoking each year. Half of students in grades 5-6 (50%) underestimated the death numbers, compared to 43% in grades 7-9. Females were more likely to underestimate the numbers than males (50% and 41%, respectively). There was no significant difference by category of smoker in the estimates of the number of deaths due to smoking.

There was little provincial variation in perceptions of the benefits of smoking. However, compared to all students, students in Quebec were less likely to report that smoking is addictive, there is danger from an occasional cigarette, smokers can quit anytime, and smoking helps people relax and more likely to report that one must smoke for years to hurt health, and that smoking helps people stay slim (Table 7-4).

Anglophone students were more likely than Francophone students to believe tobacco is addictive (91% and 78%, respectively), there is danger from an occasional cigarette (70% and 57%, respectively), and smoking helps people relax (39% and 25%, respectively) (Table 7-5).  

Students with self-perceived above average class standing were more likely to believe that occasional smoking endangers health, but otherwise class standing was not generally associated with belief in the harms of smoking (Table 7-5).

Students who reported all their close friends smoke were more likely to believe that smoking helps people relax than were students with no close friends who smoke (57% and 31%, respectively) (Table 7-5). Belief that smoking helps people relax was lowest (33%) among students who report that no one smokes in the household and highest among students who report that all people in the home smoke (50%). Similarly, students who reported that all their close friends smoke were more likely to report that smoking helps when bored compared to students with no close friends who smoke (28% and 11%, respectively). Also, students from households where all in the household smoke were more likely to believe that smoking helps when bored than were students from households where no one smokes (25% and 12%, respectively).

Attitudes toward Smoking

Three-quarters (74%) of respondents believed that it is nicer to date non-smokers than smokers (Table 7-6a). Even among those who have smoked beyond puffing, a majority (59%) believed it is nicer to date non-smokers. There were only minor variations by grade and sex, except that both male and female reports that it is nicer to date non-smokers were higher among students in later grades.

Table 7-A - Attitudes Toward Smoking, By Category of Smoker, Canada, Youth Smoking Survey 2002, 1994

 

It's Nicer to Date Non-smokers
(% Yes)

Smoking is Cool
(% Yes)

2002

Total

74

3

Never Smoker

76

1

Puffer

71

5

Smoked Beyond Puffing

59

11

1994

Total

69

6

Never Smoker

77

2

Puffer

70

5

Smoked Beyond Puffing

48

16

A very small percentage of students (3%) believed smoking is cool (Table 7-6a). However, students who have tried cigarettes were more likely to report that smoking is cool (11% of those who have smoked beyond puffing compared to 5% of puffers and 1% of never smokers) (Table 7-A, 7-6a).

Students who responded to the 2002 YSS had more negative attitudes toward smoking than students in the 1994 YSS (Tables 7-6a and 7-6b). More students who smoked beyond puffing in 2002 believed it is nicer to date non-smokers compared to students who smoked beyond puffing in 1994 (59% and 48%, respectively). In 1994, 6% felt that it was cool to smoke compared to 3% in 2002. The reduction in the percentage who felt that smoking is cool reflects both the decreasing perception of coolness in those who have smoked beyond puffing and changes in the prevalence of smoking, as never smokers tend to believe that smoking is not cool.

Among students in the 2002 YSS the attitude that it is nicer to date non-smokers decreased as the proportion of friends who smoke increased, from 77% in students with no close friends who smoke to 41% in students who reported that all their close friends smoke (Table 7-B, 7-8). Support of the statement that smoking is cool increased directly with the percentage of close friends who smoke from 1% of students with no friends who smoke up to 14% of those with all friends who smoke. Similar trends in these attitudes were seen as the proportion of people who smoked in the student's household increased. Anglophone students were more likely than Francophone students to prefer dating non-smokers (76% and 62%, respectively) (Table 7-5).

Table 7-B - Attitudes Toward Smoking by Proportion of Friends Who Smoke and Proportion of Smokers in the Household, Canada, Youth Smoking Survey 2002

 

It's Nicer to Date Non-smokers (% Yes)

Smoking is Cool
(% Yes)

Proportion of Friends who Smoke

74

3

None

77

1

Less than Average

75

4

Average or Greater

60

8

All

41

14

Proportion of Smokers in the Household

74

3

None

77

2

Less than Average

69

4

Average or Greater

65

4

All

55

6

Perceived Reasons Youth Start Smoking

Most students (64%) thought that students start smoking because their friends smoke (Table 7-9a). Many students also endorsed "curiosity" (49%), "popular kids smoke" (46%) and "it's cool" (45%), as reasons for starting. Very few students believed youth start smoking because "it's relaxing" (12%).

The perception that youth start smoking because their friends smoke increased with grade: 58% of grade 5-6 students thought that youth start smoking because their friends smoke compared to 69% of grade 7-9 students. Similarly, the perception that smokers start out of curiosity was more prevalent among students in grades 7-9 than among those in grades 5-6 (56% and 39%, respectively. Fewer grade 5-6 students compared to older students in grades 7- 9 thought that youth start smoking because siblings smoke (23% and 27%, respectively), it's something to do (12 and 16%, respectively), it's not allowed (9% and 17%, respectively), for weight control (11% and 14%, respectively), and it's relaxing (8% and 14%, respectively). There were no statistically significant differences by grade in perceptions that youth start because popular kids smoke, because it is cool, and because parents smoke.

Never smokers were more likely than students who smoked beyond puffing to agree that people their age start smoking because it is cool (46% and 35%, respectively) and because popular kids smoke (49% and 31%, respectively). However, 20% of those who have smoked beyond puffing thought people their age start smoking because it is relaxing compared to 10% of those who never smoked.

There were gender differences in perceptions about reasons why youth start to smoke. More than half (54%) of the female students thought people their age start smoking because popular kids smoke compared to about two-fifths (39% ) of the male students. Females were more likely than males to think people their age started smoking out of curiosity (54% and 44%, respectively) and that youth start smoking because it is cool (49% and 41%, respectively). Seventeen percent of females thought that people their age start smoking to lose weight or stay slim while only 9% of males thought this was a reason for smoking.

Generally, the patterns of reasons why students start smoking were similar in the 2002 and 1994 YSS. Two patterns did exhibit significant differences. Students responding to the 1994 YSS, as compared to students in the 2002 YSS, were more likely to endorse "friend smoking" (74% vs. 64%) and "curiosity" (56% vs. 49%) as reasons for smoking (Table 7-9a and 7-9b).

Significantly more Anglophone than Francophone students thought that youth started smoking because popular kids do (49% and 38%, respectively (Table 7-10). However, fewer Anglophones (63%) than Francophones (71%) perceived that youth start smoking because friends smoke.

Fifty-one percent of students with self-perceived better than average school standing thought that people their age start smoking because popular kids smoke, compared to 45% of average standing and 35% of below average standing (Table 7-10). Students who perceived themselves to have above average standing were also more likely than students who perceived themselves below average standing to think that people their age start out of curiosity (55% vs. 44%) and because it is cool (49% vs. 38%).

The reasons why students thought youth their age start smoking also differed by the percentage of friends they have who smoke and smoking in the household. Only 30% of respondents who report all their close friends smoke thought "popular kids smoke" is a reason for smoking, compared to nearly half (49%) of those with no close friends who smoke. The reverse is true for perceiving relaxation is a reason for smoking. In this case, one in five (21%) students who report all their close friends smoke thought this is a reason for smoking compared to 9% of those with no close friends who smoke. Similar patterns for these two perceived reasons for smoking were found with regard to smoking by people in the household.

Beliefs about Cigarette Package Health Warning Messages

Nearly all students believed the health warning messages on cigarette packages and there was little variation by grade and sex. There was a significant difference by smoking status: 94% of never smokers believed the health warning messages compared to 84% of those who have smoked beyond puffing (Table 7-C). Having more close friends who smoke was also related to a lower percentage of those who believed the health warning messages. While 94% of those who have no close friends who smoke believed the health warning messages, just 84% of those who reported all their close friends smoke believed them. Similarly, as the percentage of people in the household who smoke increased, the percentage believing the health warning message decreased. There also appeared to be a difference by perceived academic performance relative to peers; 86% of those reporting a below average standing believed the health warning messages compared to 94% of students reporting above average standing.

Table 7-C - Beliefs About Cigarette Package Health Warning Messages by Type of Smoker, Canada, Youth Smoking Survey 2002, 1994

 

Believe the Health Warning Message
(%yes)

Agree A Lot with Having Health Warning Message on Cigarette Packages (%yes)

2002

Never Smokers

94

87

Puffers

92

77

Smoked Beyond Puffing

84

61

1994

Never Smokers

91

85

Puffers

94

80

Smoked Beyond Puffing

87

55

Since 1994 there have been no significant changes in the belief or agreement with the health warning messages (Table 7-C, Table 7-11).

It is encouraging to note that the percentage of students who believed the health warning messages on cigarette packages increased with the reported frequency of looking at the health warning messages (Table 7-12). This effect was most noticeable in those who have smoked beyond puffing where 79% of those who "never" look at the health warning message believed the message, but 93% of those who look at the health warning message at least once a day believed the message, a percentage which is comparable to that found among never smokers.

A majority of the students "agreed a lot" that cigarette packages should have health warning messages (Table 7-C). There were no major differences by grade or sex. However, strong agreement with having the health warning messages varied substantially with the category of smoker: 87% of never smokers agreed a lot with the health warning messages compared to 77% of puffers and 61% of those who have smoked beyond puffing (Table 7-C). Knowing other people who smoked was related to reduced support for having warning messages. While 84% of those who have no close friends who smoke agreed with having health warning messages, only 56% of those reporting that all close friends smoke strongly agreed with having them. Similarly, only 66% of students who live in households where all the members smoked agreed a lot with having health warning messages. Class standing was also associated with agreement with 83% of students describing themselves as above average standing supporting health warning messages compared to 67% of those with below average standing. A smaller number of students in Quebec (71%) agreed with having the health warning messages compared with students overall. This was in line with the percentages of Anglophone and Francophone students who agreed with having the health warning messages (83% and 70%, respectively).

Discussion

Beliefs about Smoking and Health

The continued health campaigns against tobacco use appear to be effective in changing the beliefs of Canadian youth. A majority of Canadian students in grade 5-9 believed that tobacco is addictive, and, that while quitting smoking can be difficult, it will reduce damage to health. Students generally understood that occasional smoking can be dangerous, and that the harms from tobacco can come without smoking for many years. Beliefs about the harms of occasional smoking have increased significantly since the 1994 YSS.1

Although the dangers of smoking are generally understood, students underestimated the number of deaths caused by smoking compared to other causes. Nevertheless, unfortunately, many students do not have an accurate perception of the relative harm of smoking compared to alcohol, drugs, accidents, AIDS, suicides, and murder and fail to recognize that smoking is responsible for many more deaths than these causes. Many students may be exposing themselves to this hazard because of failure to recognize the magnitude of the risk.

The findings of the YSS 2002 indicated that students in the higher grades have more accurate perceptions of risk, as perhaps these students have been more exposed to information about the relative risks present in society. Also, they may have received more education in school on the topic of smoking. Findings from the 2002 Ontario Student Drug Use Survey also indicate that perception of the risk of tobacco use is more accurate among students in the higher grades. Among students in that survey, 25% of grade seven students believed that people, if they smoke one or more cigarettes a day, put themselves at great risk of harm, compared to 37% of grade 12 students.2

Although past research has shown that there is a tendency for student smokers to dismiss the negative effects of smoking,3 this was not consistently found in the 2002 YSS. Students who had smoked beyond puffing were, in fact, more likely than never smokers to believe in the harms from cigarettes, such as the addictiveness of tobacco and the harmfulness of secondhand smoke. With respect to risk, these findings should be interpreted with caution. Studies on how individuals construct numerical estimates have found that such estimates are subject to considerable bias and error.4

On the other hand, students who smoked beyond puffing were less likely to believe in the dangers of occasional smoking. They were also more likely than never smokers to believe that smoking has positive effects (i.e., it's relaxing, helps when bored, and controls weight). Personal experience with or observation of people at home or school who smoke may have an effect on these beliefs. Beliefs in the positive effects of smoking appeared to increase with items associated with experience of smoking such as grade, number of friends who smoke, and number of smokers in the household.

It has been hypothesized that the perception of smoking as relaxing is a function of nicotine dependence and a symptom of withdrawal.5 That is, smoking is perceived as relaxing because it alleviates the effects of withdrawal (irritability, restlessness, and weight gain) from nicotine itself. Findings from the 1994 YSS suggests that awareness of the ability of nicotine to affect these symptoms is reflective of physical dependence.1 The strong endorsement of these beliefs in smokers who have had only a single puff on a cigarette or who are not yet daily smokers may suggest that physical dependence on cigarettes may require much less smoking experience than has been previously thought, consistent with recent research on teens in Quebec.6 Because the YSS was a cross-sectional survey, however, it cannot show whether beliefs about the perceived benefits of smoking come prior to smoking or whether the perceived benefits are used to justify smoking behaviour.

Attitudes towards Smoking

A majority of students believed that it is nicer to date non-smokers. This position identified a common perception that smoking is not desirable; however, it is not known whether the youth are reacting to physical symptoms of smoking such as "smell" or the social aspects of smoking, that is, having a partner who is a smoker is less desirable from the point of view of social acceptability. From an intervention perspective, either attitude could potentially be an effective deterrent, but the meaning of these reports needs to be better understood before messages can be constructed.

Certainly, smoking was not regarded as "cool" by most students. Nearly all students deny the coolness of smoking, even 91% of those who have smoked beyond puffing. The exception was among grades 5-6 students who have smoked beyond puffing, where over a quarter reported believing that smoking is cool. The 1994 YSS findings suggested that the dissolution of the belief that smoking is cool is an effect of adaptation to smoking by older smokers who have passed the initiation and experimentation stage and smoke out of addiction.1 However, in the 2002 YSS findings, the shift in attitudes toward smoking was noticeable by seventh grade, where few have smoked for substantial periods of time. This suggests that either adaptation is far quicker than previously hypothesized or that this finding is a function of another process.

Social environment clearly played a part in attitudes, particularly, in the percentage of friends who smoke. A greater percentage of youth whose close friends all smoked reported that smoking was cool, and more people felt it was nicer to date smokers than non-smokers compared to youth with no close friends who smoked. It was unclear from the 2002 YSS the direction of effect as to whether the influence of peers determined the attitude of smoking, or whether the groups were self-defining where like-minded youth associated with each other. The effect of smokers in the household also had an effect on the attitudes toward smoking, but this appeared to be less influential than that of friends.

Reasons Youth Start Smoking

Consistent with the 1994 YSS, students still reported that having friends who smoke, curiosity, and the coolness of smoking are the major reasons for starting smoking. Peer pressure of friends is the most commonly endorsed reason for starting. Students were more likely to report curiosity as a reason for starting smoking as grade and smoking increased.

Students who have smoked beyond puffing were less likely than never smokers to endorse "it's cool" and "popular kids smoke" as reasons that youth start smoking. They may be reluctant to attribute their smoking to the desire to be "cool." The 1994 YSS technical report suggests that this reluctance was also evident in the fact that fewer younger students who smoked beyond puffing endorsed "friends smoke" as a reason youth start; however, this effect was not clear in the 2002 data. The basis for why endorsement of both "friends smoking" and "curiosity" as reasons to start was higher in older students is unclear, but perhaps it has to do with increased experience in seeing other students start smoking in the peer group environment.

Students who smoked beyond puffing reported divergent reasons for starting smoking and beliefs about the experience of smoking. For instance, while a majority of students who have smoked beyond puffing believe that smoking helps people relax, only 20% gave this as a reason for starting. This divergence may arise as reasons for continuing smoking, particularly the onset of addiction, are different from the reason for their first experimentations, which may be largely driven by social reasons. It must be noted that while self-reports of reasons for starting smoking are valuable, these data have limitations. In particular, smokers may not be able to fully document or be conscious of their own reasons for starting.

Beliefs about Cigarette Package Health Warning Messages

New and innovative health warning messages for cigarette packages appeared in Canada in 2000, and evaluation of the impact of the health warning messages suggests it was still being felt in 2002. Support for and belief in the health warning messages was high among almost all Canadian students; although, fewer people who smoked beyond puffing believed the health warning messages compared to never smokers. Interestingly, the more the health warning messages were seen the more likely they were to be believed. This suggests that the health warning messages are having an effect on the attitudes of smokers, and may contribute to the higher beliefs in the harms of tobacco in some areas for puffers and those who have smoked beyond puffing compared to never smokers. This is consistent with previous research. For instance, in Wave 5 of the Health Canada evaluation of the health warning messages conducted in July 2002, 36% of young smokers (12 to 18 years old) were able to identify the smoking attributable mortality in Canada as 45,000 deaths a year, a figure which appears as one of the health warning messages, compared to the 27% of potential smokers.7 The high level of belief or agreement with the health warning messages has been maintained since the dramatic changes in the health warning messages in December 2000, when graphic images and stronger text, both outside and inside the cigarette package, were added.

Implications for Regulation and Legislation

Since the 1994 YSS, tobacco company sponsorship has been eliminated and improved health warning messages have appeared on cigarette packages. Current tobacco control activities have integrated five major themes: prevention, cessation, protection, harm reduction, and tobacco industry denormalization (Chapter 1). In preventing youth from taking up smoking, Canada has integrated legislation, regulation, public education, program supports, and mass media activities. These include restricted access of youth to tobacco products; health warning messages on cigarette packages targeted specifically to youth; school-based initiatives; a Youth Action Committee and mass media campaigns. The cessation and protection (from second-hand smoke) themes are also made explicit through the integration of regulation, health warning messages and smoking bans; school-based initiatives; enforcement and mass media campaigns. Population-level interventions have been shown to be successful in changing beliefs concerning tobacco and smoking.8-11

Youth continued to trust messages from the government, as seen in their strong agreement with and belief in the cigarette package health warning messages, which are credited to Health Canada. It appears that the cigarette package is an effective site for transmitting messages to youth at risk of smoking or who are already smoking, as these youth have more exposure to the cigarette packages. Introducing new messages could help maintain the impact of these health warning messages. It is particularly important to address the increases in the beliefs about the positive effects of smoking such as the belief that cigarettes help people relax.

Curiosity and the influence of their peer group continued to be the most endorsed reasons why students believe youth start smoking. Efforts at reducing the availability and omnipresence of cigarettes might do much to reduce the interest in attempting to use cigarettes. Placing cigarettes out of sight in convenience stores, or restricting sale of tobacco industry products to a limited number of venues could decrease the pervasiveness of tobacco industry products.

Implications for Education and Message Promotion

When the first YSS was conducted in 1994, it encompassed the first generation of Canadian youth to be targeted with school-based health education and message promotion about the harmful effects of tobacco smoke. Since 1994, these health education messages have been evolving and have become more comprehensive in order to address another generation of Canadian youth. The 2002 YSS findings identify areas where education and message promotion appears to be working. Particularly, success appears to have been achieved in communicating the harms of tobacco use and reducing the number of students who think smoking is cool. Although potentially due to shifts in the cultural milieu, it appears that the message that smoking is not a socially normative or acceptable behaviour is permeating into youth culture. The 2002 YSS findings also identify areas where education and message promotion about smoking is not as effective. Substantial numbers hold positive beliefs about smoking (e.g., that smoking helps people to relax and stay slim) and that smokers can quit anytime they want. New education messages and promotional campaigns may help to address the beliefs and attitudes of youth that are still vulnerable to starting to smoking.

The 1994 YSS Technical Report recommended that education programs and messages needed to be tailored to specific audiences.1 The results of the 2002 YSS provide additional support for this recommendation. Considering that smoking and non-smoking youth have different beliefs and attitudes about smoking, it does not seem efficient or practical to assume that a 'one size fits all' approach to education and message promotion will be suitable. Education and message promotion campaigns might benefit from targeting initiatives to the youth populations who are most likely to respond. The benefits of using a targeted approach to intervention delivery has been previously demonstrated with school-based smoking prevention programming.14

More effort in prevention programs is required to emphasize the dangers of occasional smoking and the role that social influences have on smoking onset. This could include teaching youth about the immediate health consequences associated with occasional smoking (e.g., addiction or decreased aerobic sports performance15), the immediate social consequences associated with smoking (e.g., most young Canadians would prefer to date a non-smoker), the influence that people in the social environment have on smoking onset (e.g., the benefit of being taught the skills required to refuse cigarette offers from friends), and the benefits of remaining smoke-free (e.g., financial benefits, health and lifestyle benefits). Prevention programs might also benefit from teaching never smoking youth about the role of tobacco industry advertising and promotion on youths' smoking onset.

Future education and message promotion initiatives need to continue to educate youth who smoke about the health benefits of cessation, methods for quitting, and what to expect when quitting. Because of the strong influence of friends in perceived reasons for starting smoking, youth need to be informed about the role that people in the social environment have on smoking maintenance and cessation. For example, being surrounded by smokers can make quitting harder as smoking friends generally do not support quit attempts and often provide cigarettes at time of relapse.15 Youth cessation programs need to talk to youth in terms they understand, and highlight the immediate positive consequences associated with quitting smoking (e.g., most youth would rather date a non-smoker, improvements in aerobic athletic ability, or financial savings of not smoking) rather than focusing on the long-term benefits. Health warning messages act as an effective means for providing youth with smoking related education and information since the youth could be exposed to such information every time they reach for a cigarette.

Effective education and message promotion is one part of this comprehensive approach. This promotion could target youth of different ages using a variety of different promotional and educational mediums. School-based smoking prevention campaigns could use a best-practices approach, beginning early in elementary school. Based on the 2002 YSS findings, it appears important to target youth as early as grade 5 and 6, as major changes in the beliefs and attitudes about smoking occurred before grade 7. This might be a critical period where interventions could have dramatic results. The messages and information provided in school-based programs could also evolve with the changing needs of students as they age and as cultural changes occur.

It was stated in the 1994 YSS report that there might be some value in educating youth about the aggressive marketing campaigns of tobacco companies with regard to youth.1 Since 1994, this concept of tobacco industry denormalization has proven beneficial, as demonstrated in the youth-focused Florida Pilot Program on Tobacco Control (FPPTC).10 The FPPTC used youth-led innovative media approaches (i.e., TRUTH campaign), community activities, and school-based education programs to reduce cigarette use and intentions to smoke among Florida youth. Youth-led programs can address the unique needs of youth, by providing information in a manner that is both appealing and effective for youth. Similar types of youth-led initiatives could run parallel with existing school-based prevention programs.

Implications for Future Monitoring and Further Research

There are several additional aspects of youth beliefs and attitudes that could be monitored in the future, with the goal of gaining a more comprehensive picture of where youth stand in this regard. In addition to views about health beliefs and general attitudes toward smoking, it would be useful to know the levels of youth support for various policy measures (e.g., increased cigarette prices, bans on the display of cigarettes, restrictions on smoking). Preliminary data from the 2003 OSDUS on the attitudes of youth in Ontario indicate that youth were more likely to be supportive of restricting cigarette sales, raising prices and agree that government should make smoking against the law.16 In the same survey, however, youth were less likely than adults to distrust the tobacco companies; beliefs about and attitudes toward the tobacco industry itself is a key area to monitor as an important mediator of smoking behaviour.

Provincial differences in beliefs and attitudes should continue to be monitored. Although students in Quebec had more positive beliefs about benefits of smoking than students in other provinces, it is hypothesized that this province will move closer to the national average over time, particularly given the decline in adult smoking prevalence in Quebec.3 However, if, at the time of the next Youth Smoking Survey, youth beliefs and attitudes in Quebec are found not to be approaching the national pattern, strategies targeted specifically toward this group could be considered.

The findings reported in this chapter raise a number of issues that require further research. It has been found that beliefs and attitudes are associated with smoking status, but this cross-sectional survey does not provide insight into questions about causality. Do beliefs and attitudes precede changes in smoking status, or do changes in smoking status result in changes in beliefs and attitudes? Or, are both pathways at work? The evidence is generally in favour of a dual pathway model, but the mechanisms are not fully understood.12 A longitudinal study design is required to separate these different effects. In addition to determining whether changes in beliefs lead to changes in smoking status, it is essential to establish the relative importance of these determinants in relation to other predictors. Further research could also examine the role of one's environment (including the home, peer, school and community policy environments) in shaping youth beliefs and attitudes.

Future studies could investigate how best to influence youth beliefs and attitudes. Do youth respond well to television media campaigns? What about school programs? Are changes to the policy environment (e.g., restrictions on smoking, increased cigarette prices, reduced availability and accessibility of tobacco products) effective in promoting youth beliefs and attitudes that oppose smoking and support tobacco control? Answers to these questions could lead to more effective program planning.

References

1. Stephens T, Morin M. Eds (Health Canada ). Youth Smoking Survey, 1994: Technical Report. 1996 Ottawa : Minister of Supply and Services Canada. (Catalogue No. H49-98/1-1994E).

2. Ontario Student Drug Use Survey 2002. Public Use Microdata Files.

3. Statistics Canada. Canadian Tobacco Use Monitoring Survey. Wave 1, 2002. Public Use Microdata Files.

4. Slovic P. Cigarette smokers: Rational actors or rational fools? In P. Slovic (Ed.), Smoking: Risk , Perception, and Policy Thousand Oaks , CA : Sage. 2001: 397-420.

5. Parrott A. Does cigarette smoking cause stress? American Psychologist 1999; 54(10): 817-20.

6. O'Loughlin J, DiFranza J, Tyndale RF, Meshefedjian G, McMillan-Davey E, Clarke PB, Hanley J, Paradis G. Nicotine-dependence symptoms are associated with smoking frequency in adolescents. American Journal of Preventive Medicine 2003; 25(3): 219-25.

7. Kaiserman M, Makomaski Illing, E, Dasko D. The Evaluation of Canada's Health Warning Messages: 18 Month Follow-Up. Presentation to 12 th World Conference on Tobacco or Health. Helsinki , Finland , August 2003.

8. Siegel M. The effectiveness of state-level tobacco control interventions: A review of program implementation and behavioral outcomes. Annual Review of Public Health 2002; 23: 45-71.

9. Thrasher JF, Niederdeppe J, Farrelly MC, Davis KC, Ribisl KM, Haviland ML. The impact of anti-tobacco industry prevention messages in tobacco producing regions: evidence from the US truth(R) campaign. Tobacco Control 2004; 13(3): 283-8.

10. Bauer UE, Johnson TM, Hopkins RS, Brooks RG. Changes in youth cigarette use and intentions following implementation of a tobacco control program. Journal of the American Medical Association 2000; 284: 723-8.

11. Niederdeppe J, Farrelly MC, Haviland ML. Confirming "truth": more evidence of a successful tobacco countermarketing campaign in Florida. American Journal of Public Health 2004; 94(2): 255-7.

12. Biener L. Anti-tobacco advertisements by Massachusetts and Philip Morris: what teenagers think. Tobacco Control 2002;11(Suppl 2): ii43-6.

13. Rigotti NA, Regan S, Majchrzak NE , Knight JR, Wechsler H. Tobacco use by Massachusetts public college students: long term effect of the Massachusetts Tobacco Control Program. Tobacco Control 2002; 11(Suppl 2): ii20-4.

14. Cameron R, Brown KS, Best JA, Pelkman CL, Madill CL, Manske SR, Payne ME. Effectiveness of a social influences smoking prevention program as a function of provider type, training method, and school risk. American Journal of Public Health 1999; 89(12): 1827-31.

15. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General . Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health, 1994.

16. Waller BJ, Cohen JE, Ashley MJ. Youth attitudes towards tobacco control: A preliminary assessment. Chronic Diseases in Canada 2004; 25(3/4):97-100.


Table 7-1a - Beliefs About Harms of Tobacco and Quitting (% Yes) by Sex, Category of Smoker and Grade, Canada, Youth Smoking Survey 2002
  Pop. Est.
(000's)
Tobacco is Addictive (% Yes) ETS Is Harmful to Non-smokers
(% Yes)
Occasional Smoking Endangers Health
(% Yes)
Quitting Smoking Reduces Damage Even After Years
(% Yes)
Smokers Can Quit Anytime (% Yes) Must Smoke for Many Years Before Hurt Health
(% Yes)
Total 2014 88 86 67 37 29 17
Grades 5-6 793 83 78 66 31 36 20
Grades 7-9 1222 91 91 68 40 24 16
Never Smoker 1562 87 85 70 35 30 16
Puffer 206 88 89 63 39 25 21
Smoked Beyond Puffing 246 93 91 56 43 26 24
Males 1032 87 86 67 40 26 20
Grades 5-6 395 82 78 67 35 32 21
Grades 7-9 618 90 90 68 43 22 19
Never Smoker 800 86 84 70 38 27 18
Grades 5-6 365 82 78 67 42 32 20
Grades 7-9 435 89 90 72 34 22 16
Puffer 112 88 89 63 38 25 23
Grades 5-6 27 81 78 63 35 30 26
Grades 7-9 87 90 92 63 39 23 23
Smoked Beyond Puffing 120 92 90 56 48 23 28
Grades 5-6 13 85 75 59 44 32* 24*
Grades 7-9 106 92 92 56 49 22 29
Females 982 90 86 67 33 32 15
Grades 5-6 380 85 78 65 27 39 18
Grades 7-9 586 93 91 69 37 27 13
Never Smoker 762 89 85 70 32 33 14
Grades 5-6 359 85 78 66 27 40 18
Grades 7-9 403 93 91 72 36 27 11
Puffer (b) 94 87 89 63 39 25 19
Grades 5-6 19 89 79 58 25* 31 30*
Grades 7-9 75 81 92 64 43 24 16
Smoked Beyond Puffing 126 93 92 56* 38 28 19
Grades 5-6 11 79 78 48 35* 28* #
Grades 7-9 115 95 93 57 39 28 19

* Moderate sampling variability interpret with caution
# Data suppressed due to high sampling variability

Table 7-1b - Beliefs About Harms of Tobacco and Quitting (% Yes) by Sex, Category of Smoker and Grade, Canada, Youth Smoking Survey 1994
  Pop. Est.
(000's)
Tobacco is Addictive (% Yes) ETS Is Harmful to Non-smokers
(% Yes)
Occasional Smoking Endangers Health
(% Yes)
Quitting Smoking Reduces Damage Even After Years
(% Yes)
Smokers Can Quit Anytime (% Yes) Must Smoke for Many Years Before Hurt Health
(% Yes)
Total 1949 85 84 62 47 17 21
Grades 5-6 747 79 79 67 41 21 21
Grades 7-9 1202 88 87 59 51 14 21
Never Smoker 1163 83 83 70 44 18 18
Puffer 271 86 87 55 49 16 22
Smoked Beyond Puffing 516 87 85 46 53 14 27
Males 997 82 84 63 49 17 23
Females 953 88 84 61 44 17 19
Table 7-2a - Beliefs About Perceived Benefits of Smoking by Sex, Category of Smoker and Grade, Canada, Youth Smoking Survey 2002
  Pop. Est.
(000's)
Smoking Helps People Relax
(% Yes)
Smoking Helps People Stay Slim
(% Yes)
Smoking Helps People when they are Bored
(% Yes)
Total 2014 36 18 13
Grades 5-6 793 24 12 10
Grades 7-9 1222 49 21 16
Never Smoker 1562 30 15 10
Puffer 206 45 23 16
Smoked Beyond Puffing 246 62 29 27
Males 1032 35 17 14
Grades 5-6 395 24 12 10
Grades 7-9 618 42 20 17
Never Smoker 800 30 14 11
Grades 5-6 365 23 12 9
Grades 7-9 435 36 16 13
Puffer 112 43 20 16
Grades 5-6 27 30 14* 14*
Grades 7-9 87 47 22* 17
Smoked Beyond Puffing 120 61 30 29
Grades 5-6 13 47 17 26*
Grades 7-9 106 62 31 30
Females 982 36 18 12
Grades 5-6 380 24 13 10
Grades 7-9 586 44 22 14
Never Smoker 762 30 16 10
Grades 5-6 359 23 12 9
Grades 7-9 403 37 19 11
Puffer 94 47 27 16
Grades 5-6 19 32* 19* 23*
Grades 7-9 75 41 29 14
Smoked Beyond Puffing 126 63 29 24
Grades 5-6 11 43* 25* #
Grades 7-9 115 64 30 25

* Moderate sampling variability interpret with caution
# Data suppressed due to high sampling variability

Table 7-2b - Beliefs About Perceived Benefits of Smoking by Sex, Category of Smoker and Grade, Canada, Youth Smoking Survey 1994s
  Pop. Est.
(000's)
Smoking Helps People Relax
(% Yes)
Smoking Helps People Stay Slim
(% Yes)
Smoking Helps People when they are Bored
(% Yes)
Total 1949 32 18 12
Grades 5-6 747 21 15 8
Grades 7-9 1202 38 20 15
Never Smoker 1163 21 15 7
Puffer 271 35 18 12
Smoked Beyond Puffing 516 53 25 24
Males 997 32 17 13
Females 953 31 19 11
Table 7-3 - Perceptions that Smoking Causes More Death than Other Causes by Sex, Category of Smoker and Grade, Canada, Youth Smoking Survey 2002
  Pop. Est.
(000's)
More Deaths Than Alcohol
(% Yes)
More Deaths Than Suicides
(% Yes)
More Deaths Than Accidents
(% Yes)
More Deaths Than Murders
(% Yes)
More Deaths Than Drugs
(% Yes)
More Deaths Than AIDS
(% Yes)
Total 2014 60 53 47 43 40 37
Grades 5-6 793 59 44 46 37 33 30
Grades 7-9 1222 60 59 48 47 45 42
Never Smoker 1562 60 52 48 42 38 36
Puffer 206 59 56 43 44 41 41
Smoked Beyond Puffing 246 59 56 48 48 50 44
Males 1032 65 58 52 47 44 42
Grades 5-6 395 63 49 49 39 35 35
Grades 7-9 618 66 64 53 52 49 48
Never Smoker 800 65 57 52 45 42 40
Grades 5-6 365 64 49 50 39 35 33
Grades 7-9 435 70 63 54 51 66 46
Puffer 112 65 61 46 48 46 48
Grades 5-6 27 64 49 43 38 36 42
Grades 7-9 87 65 64 47 51 49 50
Smoked Beyond Puffing 120 64 65 55 53 57 51
Grades 5-6 13 54 49 52 44 38* 44*
Grades 7-9 106 65 67 55 54 60 52
Females 982 54 47 43 40 36 32
Grades 5-6 380 54 39 42 35 30 25
Grades 7-9 586 55 53 43 43 40 37
Never Smoker 762 54 47 43 39 35 31
Grades 5-6 359 54 39 42 35 30 25
Grades 7-9 403 54 54 45 43 39 37
Puffer 94 51 50 39 39 36 33
Grades 5-6 19 47 39 34 28 23* 22*
Grades 7-9 75 53 53 40 43 39 36
Smoked Beyond Puffing 126 54 48 40 43 42 38
Grades 5-6 11 43* 45 30* 38* 26* 38*
Grades 7-9 115 55 48 41 43 44 38

* Moderate sampling variability interpret with caution

Table 7-4 - Health Beliefs by Province, Canada, Youth Smoking Survey 2002
  Beliefs about Harms of Tobacco and Quitting Perceived Benefits
  Pop Est (000's) Tobacco is Addictive
(% Yes)
ETS is Harmful to Non-smokers
(% Yes)
Occasional Smoking Endangers Health
(% Yes)
Quitting Smoking Reduces Damage Even After Years
(% Yes)
Smokers Can Quit Anytime
(% Yes)
Must Smoke for Many Years Before Hurt Health
(% Yes)
Nicer to Date Non-smokers
(% Yes)
Smoking Helps People Relax
(% Yes)
Smoking Helps People Stay Slim
(% Yes)
Smoking Helps People when They Are Bored
(% Yes)
Smoking is Cool
(% Yes)
Canada 2014 88 86 69 36 29 18 74 36 18 13 3
NL 34 93 91 69 34 26 14 72 32 16 11 2
PE 10 91 88 75 38 34 13 76 32 19 10 2
NS 61 91 88 68 37 27 15 71 37 17 14 3
NB 48 83 85 67 35 28 16 67 28 17 13 3
QC 484 79 86 57 36 23 20 64 26 21 14 6
ON 767 91 87 70 36 31 18 77 38 17 12 2
MB 76 86 82 67 37 31 18 75 36 17 15 3
SK 67 92 84 70 36 34 16 74 37 16 12 2
AB 217 94 86 72 37 34 14 78 36 15 13 1
BC 249 90 84 73 39 28 17 80 45 17 14 2
Table 7-5 - Health Beliefs by Language Spoken at Home, Perceived Class Standing Relative to Peers, and Percentage of Friends who Smoke, Percentage in the Household who Smoke, Canada, Youth Smoking Survey 2002
  Beliefs about Harms of Tobacco and Quitting Perceived Benefits
  Pop Est (000's) Tobacco is Addictive
(% Yes)
ETS is Harmful to Non-smokers
(% Yes)
Occasional Smoking Endangers Health
(% Yes)
Quitting Smoking Reduces Damage Even After Years
(% Yes)
Smokers Can Quit Anytime
(% Yes)
Must Smoke for Many Years Before Hurt Health
(% Yes)
Nicer to Date Non-smokers
(% Yes)
Smoking Helps People Relax
(% Yes)
Smoking Helps People Stay Slim
(% Yes)
Smoking Helps People when They Are Bored
(% Yes)
Smoking is Cool
(% Yes)
Canada 2014 88 86 69 36 29 18 74 36 18 13 3
English 1569 91 86 70 36 31 17 77 39 17 13 2
French 458 78 87 57 36 22 21 62 25 22 15 6
Better than Average Class Standing 750 90 88 69 40 27 16 79 35 18 13 2
Average Class Standing 1082 88 85 66 34 30 18 72 35 17 13 3
Below Average Class Standing 168 86 82 62 38 26 24 63 32 21 16 6
No Friends Smoke 1468 88 85 69 35 30 16 77 31 15 11 1
All Friends Smoke 45 86 82 60 43 26 26 41