E-cigarette use by Ontario public elementary school and secondary school students: Has the use among sociodemographic groups changed from 2017 to 2019?

This project examined e-cigarette use among Elementary School (ES) (grades 7 and 8) and Secondary School (SS) (grades 9-12) students in Ontario, Canada, for 2017 and 2019 and relationships with sociodemographic variables and traditional cigarette use. The data came from the Ontario Student Drug Use and Health Survey OSDUHS (2017, 2019). Socio-demographics included grade, school performance, sex, race, years in Canada, living arrangements and language spoken at home. E-cigarette use and cigarette smoking were any past year use. For 2017, there are a greater percentage of ES males than females who used e-cigarettes, older students, those living in more than one home and those smoking cigarettes. For SS students a greater percentage for those of older age, higher grades, living in Canada all their lives, using only English language at home, self-identified as white, with lower school performance, those with multiple household living arrangements and who reported smoking traditional cigarettes reported using e-cigarettes. Use was lower among females in 2017 (OR = 0.63, 95% CI = 0.46, 0.86, p = 0.002), but by 2019 use was higher among females, which resulted in a non-significant difference between males and females (OR = 0.91, 95% CI = 0.77, 1.09). Greater use of e-cigarettes was found among students who smoked traditional cigarettes compared to those who did not smoke in both years. Monitoring the trends, patterns and trajectories of use and variables related to use needs to be continued which may help inform the development of further legislative and educational measures.

How are lifetime polytobacco users different than current cigarette-only users? Results from a Canadian young adult population.

Current cigarette smoking combined with ever use of other tobacco products (lifetime polytobacco use) is important to examine as users may be at greater risk for illicit drug use, nicotine addiction, and adverse health outcomes. We determined estimates and patterns of lifetime polytobacco use and conducted multivariable analyses to determine demographic, family and friend, psychosocial, and lifestyle factors associated with use among a sample of Canadian young adults. Overall prevalence was 36.3% for current cigarette use; 10.1% for current cigarette use only and 26.2% for lifetime polytobacco use. Among polytobacco users, current cigarette use and ever cigar use was most frequent (67.2%). For males, the final model contained demographic, family and friends, and lifestyle factors. For females, the final model also included psychosocial factors. Illicit drug use was the strongest significant predictor for lifetime polytobacco use among males. We found gender specific differences when comparing lifetime polytobacco users to current cigarette-only users, in particular; male lifetime polytobacco users were more likely to use drugs and alcohol. Interventions focusing on individual substances should consider addressing combinations of use.

Can young adult smoking status be predicted from concern about body weight and self-reported BMI among adolescents? Results from a ten-year cohort study.

We sought to evaluate the relationship between the perception of being overweight and BMI (body mass index) when participants were adolescents and their cigarette smoking as young adults. In 1993, 1598 students in grade 6 from 107 schools in Scarborough (Ontario) completed the base line questionnaire. Of these, 1,543, 1,455 and 1,254 responded at follow-ups in grades 8 and 11, and as young adults (in 2002), respectively. Reported smoking behavior was used to categorize people as current and never smokers. Self-reported height and weight were used to calculate BMI. Girls who thought themselves overweight in grades 8 and 11 were more likely to be smoking as young adults (odds ratios of 1.778 and 1.627, respectively). Boys with higher self-reported BMIs in grades 8 and 11 were more likely to be smokers as young adults (odds ratios of 1.115 and 1.095, respectively). These findings provide evidence of the longitudinal effect of perception of being overweight as an adolescent on smoking as a young adult and suggest possible ways of averting smoking behavior.

Variables related to tobacco use among young adults: are there differences between males and females?

We sought to determine the association of four categories (chunks) of variables: (1) demographic characteristics, (2) family and friends smoking and other drug use, (3) psychosocial factors and attitude, and (4) lifestyle factors to current smoking as compared to never smoking among Canadian young adults. A cohort of 1270 young adults, followed for 10 years, completed a self-administered questionnaire. In multivariable analyses, the best final model for both genders did not include the psychosocial and attitudinal categories, but did contain variables in the demographic, family and friends, and lifestyle categories. Interventions for reducing smoking among young adults may be similar for males and females, a conclusion that differs from conclusions based on findings from younger age groups.

The potential effectiveness of warning labels on cigarette packages: the perceptions of young adult Canadians.

BACKGROUND: Since 1989 when health warning labels appeared on Canadian cigarette packages, the labels have changed from text only covering less than one quarter of the package to text and graphics covering over half the package. This study examines how Canadians in their 20s feel about the current graphic warning labels and their potential to prevent smoking and encourage quitting. METHODS: Participants between 20 and 24 years of age were part of a 10-year cohort study begun when the group was in Grade 6, with the purpose of examining factors that may affect smoking. Five questions about warning labels were added to the 2002 questionnaire requesting information on perceptions of the labels and their potential impact on smoking behaviours of young adults. One item had been included in previous questionnaires. RESULTS: 32.8% (n = 1267) of the respondents were smokers, with males (35.6%) being more likely to smoke than females (30.4%). Current smokers were less likely than experimental/ex-smokers to believe that warning labels with stronger messages would make people their age less likely to smoke. Female current smokers were more likely to think about quitting. CONCLUSION: Despite the efforts taken in developing the labels, some young adults are skeptical about their effects. Warning labels may have to be modified to target issues that are relevant to young adults; gender differences are important in this modification. Warning labels can offer an additional component to a comprehensive tobacco control program, in that they provide health information.

Psychosocial variables in a cohort of students in grades 8 and 11: a comparison of current and never smokers.

BACKGROUND: Specific hypotheses regarding putative mechanisms by which stressful life events might be related to smoking initiation among adolescents have been tested cross-sectionally on a cohort of 1598 grade 6 students in Scarborough, Canada. The purpose of this study was to examine the utility of these cross-sectional models in accounting for current smoking as compared to never smoking when this cohort was in grades 8 and 11. METHODS: Current smoking was defined as reported regular or occasional smoking. Logistic regression and multiple regression models were tested separately for each gender and grade with variables entered in prespecified steps. RESULTS: Current smoking is more strongly related to psychosocial variables and environmental variables among older male adolescents as compared to younger ones. In older female adolescents, current smoking appears to be more strongly related to attitude variables and less strongly related to psychosocial variables than among younger female adolescents. There is some evidence that grade 11 males may use cigarettes as a coping strategy for depression. CONCLUSIONS: Male and female students differ in how stress and a range of psychosocial factors are interrelated with regards to current smoking and these relationships appear to change over time.

Does a relationship exist between body weight, concerns about weight, and smoking among adolescents? An integration of the literature with an emphasis on gender.

It has been speculated that body weight and concern about body weight are important factors in initiation of tobacco use among adolescents, particularly females. An examination of studies that have explored these relationships can provide important information on possible underlying mechanisms that could be used for prevention interventions. This review summarizes recent studies examining weight concerns and youth smoking, with a focus on gender differences. These studies were integrated with the few studies that have examined the relationship between actual body weight and smoking among adolescents. A total of 55 primary research articles met inclusion criteria for the review. Of these, 19 studies assessed the relationship between body weight and smoking, and 50 studies addressed weight concerns and smoking. Some evidence indicated a positive relationship between smoking and body weight among adolescents, although not all studies found a positive association. In terms of the relationship between weight concerns and adolescent smoking, the amount of evidence supporting a positive association differed depending on the dimension of weight concern considered, with the strongest evidence for dieting behaviors. For dieting behaviors, disordered eating symptoms, and some aspects of general weight concerns, the positive relationship with smoking was more consistent among female adolescents than among male adolescents. Possible explanations for these findings are discussed, and priorities for future research are identified.

Latent mixed Markov modelling of smoking transitions using Monte Carlo bootstrapping.

It has been established that measures and reports of smoking behaviours are subject to substantial measurement errors. Thus, the manifest Markov model which does not consider measurement error in observed responses may not be adequate to mathematically model changes in adolescent smoking behaviour over time. For this purpose we fit several Mixed Markov Latent Class (MMLC) models using data sets from two longitudinal panel studies--the third Waterloo Smoking Prevention study and the UWO smoking study, which have varying numbers of measurements on adolescent smoking behaviour. However, the conventional statistics used for testing goodness of fit of these models do not follow the theoretical chi-square distribution when there is data sparsity. The two data sets analysed had varying degrees of sparsity. This problem can be solved by estimating the proper distribution of fit measures using Monte Carlo bootstrap simulation. In this study, we showed that incorporating response uncertainty in smoking behaviour significantly improved the fit of a single Markov chain model. However, the single chain latent Markov model did not adequately fit the two data sets indicating that the smoking process was heterogeneous with regard to latent Markov chains. It was found that a higher percentage of students (except for never smokers) changed their smoking behaviours over time at the manifest level compared to the latent or true level. The smoking process generally accelerated with time. The students had a tendency to underreport their smoking behaviours while response uncertainty was estimated to be considerably less for the Waterloo smoking study which adopted the 'bogus pipeline' method for reducing measurement error while the UWO study did not. For the two-chain latent mixed Markov models, incorporating a 'stayer' chain to an unrestricted Markov chain led to a significant improvement in model fit for the UWO study only. For both data sets, the assumption for the existence of an independence chain did not lead to significant improvement in model fit. The unrestricted two-chain latent mixed Markov model led to a significant improvement of model fit compared to a simple latent Markov model, but this model was overparameterized when the latent transition probabilities and/or response probabilities were assumed nonstationary. For the other models, the manifest/latent transition probabilities and response probabilities (for the four-wave Waterloo study only) were tested to be nonstationary for both data sets.