Prevalence and characteristics of flavoured tobacco use among students in grades 10 through 12: a national cross-sectional study in Canada, 2012–2013
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School of Public Health, University of Saskatchewan, Saskatoon, Canada
Health Promotion, Lung Association of Saskatchewan, Saskatoon, Canada
Yelena Bird   

School of Public Health, University of Saskatchewan, 104 Clinic Place, E-Wing Health Sciences, Room 3322, Saskatoon, SK S7N 2Z4, Canada
Submission date: 2016-11-06
Acceptance date: 2017-03-20
Publication date: 2017-03-24
Tob. Induc. Dis. 2017;15(March):20
Tobacco use is the leading cause of preventable death in Canada and the world. Despite documented decreases in the prevalence of smoking in Canada, increases in flavoured tobacco use by its youth poses a serious public health concern. This study examined the prevalence and characteristics of flavoured tobacco use among a national sample of Canadian students in grades 10 through 12.

This study used a cross-sectional design on a nationally generalizable, school-based, Youth Smoking Survey (YSS), 2012–2013. It incorporated data from a representative sample of 19,979 students in grades 10–12 from across Canada. Univariate and multivariate logistic regression models were used to examine differences in flavoured tobacco use (menthol cigarettes, flavoured little cigar or cigarillo, flavoured cigar, flavoured tobacco in water pipe [hookah]) by demographic (sex, grade and ethnicity) and social characteristics (friends, siblings, parents/guardians who are smokers and weekly personal spending money).

This study found that 14.8% of the participating students used flavoured tobacco in the past 30-days. Results of the logistic regression analysis show that flavoured tobacco use was significantly higher among male students [(OR = 1.63; 95% CI = 1.36–1.95)], who had at least one friend or sibling who smoke [(OR = 2.20; CI = 1.62 to 2.99) and (OR = 1.51; CI = 1.22 to 1.88), respectively] and who received greater than $20/week in personal spending money [(OR = 1.76; CI = 1.26 to 2.45)].

The results of our study indicate that flavoured tobacco use is a growing public health concern and has a strong appeal among youth in Canada. This is a particularly troubling finding, especially in light of the fact that there is a national ban on certain flavoured tobacco products. To be effective, strategies specifically tailored for youth using flavoured tobacco would require appropriate educational/prevention initiatives, more comprehensive legislation and better regulatory mechanisms.

World Health Organization. Tobacco, Fact Sheet. 2016. mediacentre/factsheets/fs339/en/. Accessed 9 July 2016
Shields M. The Journey to Quitting Smoking. Statistics Canada Health Reports. 2005;16(3). Statistics Canada Catalogue no. 82-003. studies-etudes/82-003/archive/2005/7839-eng.pdf. Accessed 9 July 2016.
Reid JL, Hammond D, Rynard VL, et al. Tobacco Use in Canada: Patterns and Trends, 2014 edition. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo. Accessed 9 July 2016
Statistics Canada. Health fact sheets, smoking. 2014. http://www.statcan.gc. ca/pub/82-625-x/2015001/article/14190-eng.htm#n1. Accessed 9 July 2016.
Minaker LM, Alanna S, Nghia N, Sunday A, Manske SR. Cigarette smoking susceptibility among youth alternate tobacco product users: implications of flavoured tobacco from a national cross-sectional Canadian sample (YSS 2012/2013). BMJ Open. 2015;5:e009549.
Minaker LM, Ahmed R, Hammond D, Manske SR. Flavored tobacco use among Canadian students in grades 9 through 12: prevalence and patterns from the 2010–2011 youth smoking survey. Prev Chronic Dis. 2014;11:E102.
Health Canada. Summary of results of the youth smoking survey 2012–2013. 2014. Accessed 1 Mar 2017.
World Health Organization. The scientific basis for tobacco product regulation: report of a WHO study group. 2007. Available from: tobacco/global_interaction/tobreg/9789241209458.pdf. Accessed 17 Jan 2017.
US Department of Health and Human Services. Preventing tobacco use among youth and young adults: a report of the Surgeon General. Atlanta, GA, CDC; 2012. Accessed 14 Feb 2017.
Richardson A, Ganz O, Vallone D. Tobacco on the web: surveillance and characterisation of online tobacco and e-cigarette advertising. Tob Control. 2014;24(4):341–7.
King BA, Tynan MA, Dube SR, Arrazola R. Flavored-little-cigar and flavored cigarette use among U.S. middle and high school students. J Adolesc Health. 2014;54(1):40–610.
Leatherdale ST, Rios P, Elton-Marshall T, Burkhalter R. Cigar, cigarillo, and little cigar use among Canadian youth: are we underestimating the magnitude of this problem? J Prim Prev. 2011;32(3-4):161–7010.
Delnevo C, Giovenco D, Ambrose B, Corey C, Conway K. Preference for flavoured cigar brands among youth, young adults and adults in the USA. Tob Control. 2014;24(4):389–94.
King B, Dube S, Tynan M. Flavoured cigar smoking among U.S. Adults: findings from the 2009-2010 National Adult Tobacco Survey. Nicotine Tob Res. 2012;15(2):608–14.
Lewis MJ, Wackowski O. Dealing with an innovative industry: a look at flavored cigarettes promoted by mainstream brands. Am J Public Health. 2006;96(21):244–51.
Hoffman AC. The health effects of menthol cigarettes as compared to non-menthol cigarettes. Tob Induc Dis. 2011;9 Suppl 1:S7.
Villanti A, Richardson A, Vallone D, Rath J. Flavored tobacco product use among U.S. young adults. Am J Prev Med. 2013;44(4):388–91.
El-Zaatari Z, Chami H, Zaatari G. Health effects associated with waterpipe smoking. Tob Control. 2015;24 Suppl 1:i31–43.
Health Canada. Canadian Tobacco Use Monitoring Survey 2009–2010. recherche/stat/_ctumsesutc_2011/ann_summary-sommaire-eng.php. Accessed 17 Feb 2017.
Mutti S, Hammond D, Borland R, Cummings MK, O’Connor RJ, Fong GT. Beyond light and mild: cigarette brand descriptors and perceptions of risk in the International Tobacco Control (ITC) four country survey. Addiction. 2011;106(6):1166–7510.
Bill C-32. An Act to Amend the Tobacco Act, 2009. Health Canada 2009. tabac/legislation/federal/2009_factrenseignements-eng.php. Accessed 1 Mar 2017.
Burkhalter R, Cumming T, Rynard V, Manske S. 2012/2013 Youth Smoking Survey microdata user guide. Waterloo (ON): Propel Centre for Population Health Impact, University of Waterloo, 2013:1–47. survey/files/uploads/files/yss12_user_guide_en_v5_20131231.pdf. Accessed 1 Mar 2017.
Leos-Toro C, Hammond D, Manske S. A cross-sectional examination of medicinal substance abuse and use of nonmedicinal substances among Canadian youth: findings from the 2012–2013 youth smoking survey. CMAJ Open. 2015;3(4):E387–94.
Health Canada. Summary of results of the Youth Smoking Survey 2010–2011. 2014. Accessed 1 Mar 2017.
Neff L, Arrazola R, Caraballo R, Corey C, Cox S, King B, et al. Frequency of tobacco use among middle and high school students — United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(38):1061–5.
Freedman KS, Nelson NM, Feldman LL. Smoking initiation among young adults in the United States and Canada, 1998–2010: a systematic review. Prev Chronic Dis. 2012;9(1):E05.
Feirman S, Lock D, Cohen J, Holtgrave D, Li T. Flavoured tobacco products in the United States: a systematic review assessing use and attitudes. Nicotine Tob Res. 2015;18(5):739–49.
Albert D, Steinberg L. Judgment and decision making in adolescence. J Res Adolesc. 2011;21(1):211–24.
Elton-Marshall T, Leatherdale S, Burkhalter R. Tobacco, alcohol and illicit drug use among aboriginal youth living off-reserve: results from the youth smoking survey. Can Med Assoc J. 2011;183(8):E480–6.
Retnakaran R, Hanley A, Connell P, Harris S, Zinman B. Cigarette smoking and cardiovascular risk factors among aboriginal Canadian youths. Can Med Assoc J. 2005;173(8):885–9.
Bird Y, Moraros J, Olsen LK, Forster-Cox S, Staines-Orozco H, Buckingham RW. Smoking practices, risk perception of smoking, and environmental tobacco smoke exposure among 6th-grade students in Ciudad Juárez, Mexico. Nicotine Tob Res. 2007;9(2):195–203.
Bird Y, Staines-Orozco H, Moraros J. Adolescents’ smoking experiences, family structure, parental smoking and socio-economic status in Ciudad Juárez, Mexico. Int J Equity Health. 2016;15(1):29.
Rath J, Villanti A, Williams V, Richardson A, Pearson J, Vallone D. Correlates of current menthol cigarette and flavored other tobacco product use among U.S. young adults. Addict Behav. 2016;62:35–41.
Larson R, Richards M. Daily companionship in late childhood and early adolescence: changing developmental contexts. Child Dev. 1991;62(2):84–300.
Bandura A. Social learning theory. Prentice Hall: Englewood Cliffs (NJ); 1977.
Robinson LA, Dalton 3rd WT, Nicholson LM. Changes in adolescents’ sources of cigarettes. J Adolesc Health. 2006;39(6):861–7.
White MM, Gilpin EA, Emery SL, Pierce JP. Facilitating adolescent smoking: who provides the cigarettes? Am J Health Promot. 2005;19(5):355–60.
Eder D. The cycle of popularity: interpersonal relations among female adolescence. Sociol Educ. 1985;58(3):154–65.
Darling H, Reeder AI, McGee R, Williams S. Brief report: disposable income, and spending on fast food, alcohol, cigarettes, and gambling by New Zealand secondary school students. J Adolesc. 2006;29(5):837–43.
Wong G, Glover M, Nosa V, Freeman B, Paynter J, Scragg R. Young people, money, and access to tobacco. N Z Med J. 2007;120(1267):U2864.
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