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.

The relationship between motor vehicle collisions and cigarette smoking in Ontario: Analysis of CAMH survey data from 2002 to 2016.

Research has shown that tobacco users have an increased risk of collisions compared to nonsmokers. Studies from 1967 through 2013 documented a crude relative risk of collision involvement of about 1.5 among smokers compared to nonsmokers. In January 2009, in response to concerns about the health risks associated with potentially high concentrations of secondhand smoke resulting from smoking in vehicles, the provincial government in Ontario, Canada, introduced legislation restricting smoking in vehicles where children and adolescents are present. We examined the association between reported smoking and involvement in a motor vehicle collision in a large representative sample of adult drivers in Ontario, Canada, from 2002 and 2016, with particular focus on 2002-2008 and 2010-2016, periods before and after the legislation. Data are based on the Centre for Addiction and Mental Health (CAMH) Monitor. Among licensed drivers, prevalence of self-reported collision involvement within the past year for 2002-2008 was 9.39% among those who currently smoked compared to 7.08% of nonsmokers. Following implementation of the legislation, for 2010-2016, the prevalence of collisions for smokers was 7.01% and for nonsmokers was 6.02%. The overall difference for both smokers and nonsmokers between the two time periods was statistically significant; however, the difference between the two groups for the pre-legislation period was significant even after adjusting for potential confounders, while post legislation the difference was not significant. Prior to the legislation, the prevalence of collision was higher among smokers than nonsmokers; following the introduction of the legislation the prevalence was similar for the two groups.

Is there a link between motor vehicle collisions and being a cigarette smoker in Canada? Analysis of survey data from Ontario from 2002 to 2014.

OBJECTIVE: Although most research on drugs and driving has focused on the use of alcohol and cannabis, research that has been conducted on cigarette smoking and collisions has found that smokers have an increased collision involvement. Studies dating from 1967 through 2013 have shown a crude relative risk of about 1.5 among smokers compared to nonsmokers. In Canada, the association between smoking and collisions has not been recently investigated. Studies that have examined the association between smoking and collisions often did not control for all confounding factors, such as alcohol use and driving exposure, which have been associated with increased collision rates. Additionally, a number of these studies were examined in countries and at times when prevalence of smoking was much higher than is currently the case in Canada. The purpose of this research is to examine the association between self-reported current smoking and past-year collision involvement, controlling for confounding factors, in a large representative sample of adult drivers in Ontario, Canada, from 2002 and 2014. METHOD: Data are based on the Centre for Addiction and Mental Health (CAMH) Monitor, an ongoing, rolling telephone survey of Ontario adults that provides epidemiological surveillance of indicators related to alcohol, tobacco, and other drug use, as well as physical and mental health. The survey uses random-digit-dialing methods via Computer-Assisted Telephone Interview, with response rates over 50%. RESULTS: Prevalence of self-reported collision involvement within the past year for 2002-2014 was 8.6% among those who currently smoke compared to 6.5% of nonsmokers. Logistic regression analysis, controlling for the potential confounding effects of sociodemographics, driving exposure measures, drinking frequency, and hazardous alcohol use, found that the overall odds for collision involvement in the preceding year among current smokers for 2002-2014 was 1.27 (95% confidence interval [CI], 1.06-1.53) times that of nonsmokers. CONCLUSIONS: These findings indicate that despite a substantial reduction in overall prevalence of smoking in Canada, smokers still have a significantly increased odds of collision involvement, even when controlling for alcohol and exposure. Additionally, the results are consistent with the increased odds/risks of motor vehicle collisions found in other countries.

Past Year Quit Attempts and Use of Cessation Resources Among Cigarette-Only Smokers and Cigarette Smokers Who Use Other Tobacco Products.

INTRODUCTION: It is unclear how use of other tobacco products impacts cigarette-smoking cessation. We assessed differences in past year cigarette smoking quit attempts and use of counseling and medication among current cigarette-only users, cigarette and cigar users, and cigarette and smokeless tobacco (SLT) users. METHODS: Data came from 24 448 current cigarette-only, 1064 cigarette and cigar only, and 508 cigarette and SLT only users who responded to the 2010-2011 Tobacco Use Supplement to the Current Population Survey. Demographic, smoking, and cessation characteristics were computed by group. Bivariate and multivariable logistic regression models assessed the relationship of tobacco use group to making a past year quit attempt, and use of counseling or medication during the last quit attempt. RESULTS: Dual users of cigarettes and cigars or SLT had similar interest in quitting and prevalence of reported past year quit attempts compared to cigarette-only users. In unadjusted analyses, cigarette and SLT users had higher odds of trying to quit in the past year compared to cigarette-only users (odds ratio [OR] = 1.31, 95% confidence interval [CI] = 1.05, 1.64); no differences were found for cigarette and cigar users. However, adjusting for demographic and cigarette smoking variables, both groups of dual users had similar odds as cigarette-only users for having made a past year cigarette smoking quit attempt, and to have used counseling or medication during the last quit attempt. CONCLUSION: Dual tobacco use was not associated with decreased attempts to quit smoking cigarettes; however, use of evidence-based treatment was sub-optimal among cigarette-only and dual users, and should be increased.

Trends in US newspaper and television coverage of tobacco.

PURPOSE: The news media plays an important role in agenda setting and framing of stories about tobacco control. The purpose of this study was to examine newspaper, newswire and television coverage of tobacco issues in the USA over a 7-year period. METHODS: Analyses of 2004-2010 news media surveillance system data from the US Centers for Disease Control and Prevention's Office on Smoking and Health, based on content analysis and quantitative methods. Information on extent of news coverage, and types of tobacco-related themes, were examined from articles in 10 newspapers and 2 major newswires, as well as transcripts from 6 national television networks. RESULTS: The overall extent of newspaper, newswire and television stories about tobacco, and level of coverage by specific media outlets, varied over time, especially for newspapers. Nevertheless, there was an average of 3 newspaper stories, 4 newswire stories, and 1 television tobacco-related story each day. Television stories were more likely to contain cessation/addiction or health effects/statistics themes and less likely to contain secondhand smoke or policy/regulation themes than newspaper/newswire stories. There was more variation in the choice of tobacco theme among individual newspapers/newswires than television media outlets. CONCLUSIONS: News coverage of tobacco in the USA was relatively constant from 2004 to 2010. Audiences were more likely to be exposed to different tobacco themes in newspapers/newswires than on television. Tracking information about tobacco news stories can be used by advocates, programs and others for planning and evaluation, and by researchers for hypothesis generation.

Relapse among cigarette smokers: the CARDIA longitudinal study - 1985-2011.

RATIONALE: There is little information about long-term relapse patterns for cigarette smokers. OBJECTIVE: To describe long-term prevalence of relapse and related smoking patterns by sex, race, age, and education level among a community-based cohort of young adults followed for 25 years. METHODS: We examined 25 years of data from Coronary Artery Risk Development in Young Adults (CARDIA), an ongoing study of a community-based cohort of 5115 men and women aged 18 to 30 years at baseline with periodic re-examinations. At each examination smoking, quitting, and relapse were queried. We examined prevalence of smoking relapse among 3603 participants who attended at least 6 of the 8 examinations. RESULTS: About 53% of 3603 participants never reported smoking on a regular basis. Among the remaining 1682 ever smokers, 52.8% of those who reported current smoking at baseline were still smoking by the end of the study, compared to 10.7% of those who initiated smoking by year 5. Among those classified as former smokers at baseline, 39% relapsed at least once; of these, 69.5% had quit again by the end of the study. Maximum education level attained, age at study baseline, and race were associated with failure to quit smoking by the end of the study and relapse among those who did quit. Maximum education level attained and age at study baseline were also associated with ability to successfully quit after a relapse. CONCLUSIONS: Smoking relapse after quitting is common, especially in those with lower education level. Education was the strongest predictor of all three outcomes. Improvements in access to treatment and treatment options, especially for underserved populations, are needed to prevent relapse when smokers quit.

Reactions of adult smokers and former smokers to current US warning labels.

OBJECTIVE: To assess current and former smokers' reactions to US warning labels as a baseline for comparison to new labels. METHODS: The mail-in Consumer-Styles survey was sent to a representative sample of US adult consumers in 2010 (N = 10,328). RESULTS: Among current smokers, 51.5% (95% CI: 47.5-55.5) reported that they had 'never/rarely' seen or looked closely at the labels in the past 30 days. Current smokers (91.1%) reported that warning labels never stopped them from having a cigarette (95% CI: 89.1-93.1) and that the labels had no effect on their likelihood of quitting (75.5%; 95% CI: 71.6-79.4). CONCLUSIONS: Current warning labels do not make smokers think about the risks of smoking or have an effect on their likelihood of forgoing cigarettes or quitting.

Tobacco use, cessation, and home smoking rules in a Hispanic community.

OBJECTIVE: To determine prevalence of smoking, quit ratios, and home smoking rules among Hispanics residing in colonias in El Paso, Texas. METHODS: Face-to-face interviews with 1485 Hispanic adults. GeoFrame™ field enumeration methods were used to develop a sampling frame from households in randomly selected colonias. RESULTS: The overall percent of current cigarette smoking was 14.6% (95% CI 12.4 to 16.8); Over 55% of smokers reported a serious quit attempt. Participants overwhelmingly reported that smoking was not allowed in their homes. CONCLUSIONS: Prevalence estimates for current smoking and restriction in the home were similar to those reported for recent national surveys.

News media outreach and newspaper coverage of tobacco control.

INTRODUCTION: Little is known about the impact of media outreach on news media coverage of tobacco control. METHODS: Media outreach data were obtained from the Centers for Disease Control and Prevention's Office on Smoking and Health (CDC/OSH) from 2003 to 2006; one to six types of outreach activities for 50 scientific publications were performed during 35 discrete time periods. The authors analyzed quantitatively and qualitatively 205 newspaper articles generated based on the CDC/OSH scientific publications. RESULTS: Media coverage of specific CDC/OSH-related tobacco themes was highest for disparities (100%) and tobacco statistics (98%). More outreach activities increased the likelihood of moderate pickup of the number of themes in newspaper articles (odds ratio = 2.0, 95% confidence interval = 1.5-2.8), but there appeared to be a ceiling effect. Certain types of outreach were more strongly associated with front page and headline coverage. CONCLUSIONS: The extent and type of outreach were associated with increased newspaper coverage but the relationship is not necessarily straightforward. Additional research is needed to better understand relationships between scientific findings, outreach, and news media coverage of tobacco.

The changing marketing of smokeless tobacco in magazine advertisements.

INTRODUCTION: Concerns about secondhand smoke, increasing indoor smoking bans, and health concerns regarding cigarettes are contributing to the development of new smokeless tobacco (ST) products by the tobacco industry and the repositioning of traditional ST products. The objective of this research was to systematically document the changing advertising strategies and themes of the ST industry. METHODS: Using descriptive content analysis, this study analyzed 17 nationally circulated magazines for ST advertisements (ads) from 1998-1999 and 2005-2006, recording both magazine and advertisement characteristics (e.g., themes, selling proposition, people portrayed, and setting/surroundings.) Ninety-five unique ads were found during the two time periods-occurring with total frequency of 290 ad placements in 816 issues. One hundred ninety-one ads were found in the 2005-2006 sample, while 99 were found in the 1998-1999 magazines. RESULTS: Significant differences in ST ads were identified between time periods and magazine types. A greater percentage of ads were found in the latter time period, and the average number of ads per issue increased (0.24 in 1998-1999 and 0.49 in 2005-2006, p < .001). More recent magazines and general adult magazines contained a greater proportion of flavored products, "alternative to cigarette" messages, and indoor settings when compared with earlier magazines and men's magazines, respectively. CONCLUSIONS: While continuing to advertise in men's magazines with themes appealing to men and "traditional" ST users, the ST industry appears to be simultaneously changing its message placement and content in order to include readers of general adult magazines who may not currently use ST.

Customizing survey instruments and data collection to reach Hispanic/Latino adults in border communities in Texas.

OBJECTIVES: We sought to modify an instrument and to use it to collect information on smoking knowledge, attitudes, beliefs, and behaviors among Hispanics/Latinos, and to adapt survey methods to obtain high participation levels. Methods. Promotoras (outreach workers) conducted face-to-face interviews with 1485 Hispanic adults (July 2007-April 2008). The project team used GeoFrame field enumeration methods to develop a sampling frame from households in randomly selected colonias (residential areas along the Texas-Mexico border that may lack some basic necessities (e.g. portable water), in El Paso, Texas. RESULTS: The revised questionnaire included 36 unchanged items from the State Adult Tobacco Survey, 7 modified items, and 17 new items focusing on possible culturally specific quitting methods, secondhand smoke issues, and attitudes and knowledge about tobacco use that might be unique for Hispanic/Latino groups. The eligibility rate was 90.2%, and the conservative combined completed screener and interview response rate was 80.0%. CONCLUSIONS: Strategic, targeted, carefully designed methods and surveys can achieve high reach and response rates in hard-to-reach populations. Similar procedures could be used to obtain cooperation of groups who may not be accessible with traditional methods.

Surveillance indicators for potential reduced exposure products (PREPs): developing survey items to measure awareness.

BACKGROUND: Over the past decade, tobacco companies have introduced cigarettes and smokeless tobacco products (known as Potential Reduced Exposure Products, PREPs) with purportedly lower levels of some toxins than conventional cigarettes and smokeless products. It is essential that public health agencies monitor awareness, interest, use, and perceptions of these products so that their impact on population health can be detected at the earliest stages. METHODS: This paper reviews and critiques existing strategies for measuring awareness of PREPs from 16 published and unpublished studies. From these measures, we developed new surveillance items and subjected them to two rounds of cognitive testing, a common and accepted method for evaluating questionnaire wording. RESULTS: Our review suggests that high levels of awareness of PREPs reported in some studies are likely to be inaccurate. Two likely sources of inaccuracy in awareness measures were identified: 1) the tendency of respondents to misclassify "no additive" and "natural" cigarettes as PREPs and 2) the tendency of respondents to mistakenly report awareness as a result of confusion between PREPs brands and similarly named familiar products, for example, Eclipse chewing gum and Accord automobiles. CONCLUSION: After evaluating new measures with cognitive interviews, we conclude that as of winter 2006, awareness of reduced exposure products among U.S. smokers was likely to be between 1% and 8%, with the higher estimates for some products occurring in test markets. Recommended measurement strategies for future surveys are presented.

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.

Associations of trying to lose weight, weight control behaviors, and current cigarette use among US high school students.

BACKGROUND: Approximately one-quarter of high school students currently use cigarettes. Previous research has suggested some youth use smoking as a method for losing weight. The purpose of this study was to describe the association of current cigarette use with specific healthy and unhealthy weight control practices among 9th-12th grade students in the United States. METHODS: Youth Risk Behavior Survey data (2005) were analyzed. Behaviors included current cigarette use, trying to lose weight, and current use of 2 healthy and 3 unhealthy behaviors to lose weight or to keep from gaining weight. Separate logistic regression models calculated adjusted odds ratios (AORs) for associations of current cigarette use with trying to lose weight (Model 1) and the 5 weight control behaviors, controlling for trying to lose weight (Model 2). RESULTS: In Model 1, compared with students who were not trying to lose weight, students who were trying to lose weight had higher odds of current cigarette use (AOR = 1.30, 95% CI: 1.15-1.49). In Model 2, the association of current cigarette use with the 2 healthy weight control behaviors was not statistically significant. Each of the 3 unhealthy weight control practices was significantly associated with current cigarette use, with AORs for each behavior approximately 2 times as high among those who engaged in the behavior, compared with those who did not. CONCLUSION: Some students may smoke cigarettes as a method of weight control. Inclusion of smoking prevention messages into existing weight management interventions may be beneficial.

Tobacco use in the Army: illuminating patterns, practices, and options for treatment.

Tobacco use by soldiers has been prevalent throughout the 20th century. Tobacco has been seen as a "right". Additionally, tobacco was viewed as a boost to a soldier's morale and to provide comfort, while reducing stress in austere conditions. Today, tobacco is known to increase healthcare costs, adversely affect readiness, and impact the military members' physical performance. The purpose of this ethnographic study was to describe patterns, practices, and experiences of active duty Army soldiers who use tobacco, have quit using tobacco, and have relapsed after a period of tobacco abstinence. Five themes were uncovered: (1) Experiences associated with use of tobacco, (2) Tobacco use in the Army, (3) Experiences of starting and restarting tobacco, (4) Balancing health risks with tobacco use, and (5) Tobacco use regulations and policies. Findings are consistent with the conclusion that the Army culture supports soldiers' tobacco use.

Reported exposure to pro-tobacco messages in the media: trends among youth in the United States, 2000-2004.

PURPOSE: Document changes from 2000 to 2004 in youth reports of exposure to pro-tobacco messages in the mass media, including images of smoking and tobacco advertising. DESIGN: Comparison of cross-sectional data from three waves of the school-based National Youth Tobacco Surveys conducted in 2000 (N= 33,772), 2002 (N= 23,439), and 2004 (N= 23,540). SETTING: Public and private middle schools and high schools across the United States. SUBJECTS: Students in grades 6 through 12. MEASURES: Smoking status; exposure to images of smoking on television and in movies; exposure to advertisements for tobacco products in stores, on the Internet, and in newspapers and magazines; demographic data. RESULTS: Youth exposure to pro-tobacco messages declined within all media channels studied from 2000 to 2004, except the Internet. Despite these declines, most youth in the United States remain exposed to pro-tobacco messages: 81% saw images of smoking on television or in movies (down from 90%), 85% saw tobacco ads in stores (down from 88%), 50% saw tobacco ads in newspapers and magazines (down from 66%), and 33 % saw tobacco ads on the Internet (up from 22%). CONCLUSION: Despite recent progress in this area, most youth in the United States are still at increased risk of smoking as a result of exposure to pro-tobacco messages in the mass media.

Monitoring polytobacco use among adolescents: do cigarette smokers use other forms of tobacco?

The extent of concurrent use of cigarettes and one or more other tobacco products (polytobacco use) is important to explore because users may be at an increased risk for adverse health effects and nicotine dependency. We determined national population estimates of current cigarette and current polytobacco use for at least 50,000 students from the 2002 and 2004 National Youth Tobacco Surveys. We identified which tobacco products were most often used in conjunction with cigarettes and used multivariate analyses to identify factors associated with polytobacco use. The overall prevalence was 16.0% for current cigarette smoking among all respondents and 15.0% for current cigarette smoking among respondents with complete information on concurrent cigarette and other tobacco product use: 8.1% used cigarettes only, and 6.9% were polytobacco users. Among current male cigarette smokers, 62.0% used other tobacco products; among current female cigarette smokers, 30.9% did. Among current cigarette smokers using one other tobacco product, cigars or smokeless tobacco were the most frequently used products. In multivariate analysis, polytobacco use was associated with being male; being in middle school; residing in the Midwest, South, or West; being able to obtain cigarettes from a retailer; being subject to peer influence; having favorable beliefs about tobacco; being willing to use tobacco promotional items; being exposed to tobacco advertisements; and having higher levels of lost autonomy (an indicator of nicotine dependency). Youth interventions need to broaden their focus to address the use of all tobacco products, paying particular attention to adolescent males and youth living outside of the Northeast.

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.

Military tobacco use: a synthesis of the literature on prevalence, factors related to use, and cessation interventions.

Tobacco use remains the number one cause of preventable morbidity and premature death in the United States. As a result, military leaders are recognizing that tobacco can adversely affect military fitness levels, deployment readiness, and safety and can increase health care costs. Yet military members continue to use tobacco. Tobacco may be viewed as part of the military culture since military members have used tobacco for many decades for pleasure, comfort, and currency and as a morale booster. Most recently, the military has seen an increase in tobacco use among young military members. A number of research studies have examined the prevalence of tobacco and factors related to use in the military, and several have evaluated cessation and prevention interventions. This article provides a brief historical perspective of military tobacco use in the 20th century and a critical review of the literature published between 1991 and 2006 describing prevalence of tobacco use, factors influencing use, and cessation interventions in the military. Recommendations for future research and for interventions are provided.

Exploring use of nontraditional tobacco products through focus groups with young adult smokers, 2002.

INTRODUCTION: In 2002, 16 focus groups with young adult smokers who used or had tried nontraditional tobacco products (e.g., bidis, shisha, herbal cigarettes, kreteks, cigars, herbal smokeless products) were conducted in Dallas, Texas, and Chattanooga, Tennessee, to gain an understanding of the appeal of these products. METHODS: In each city, groups were segmented by race or ethnicity and by educational status. RESULTS: Many consistent themes emerged across the groups. Nontraditional tobacco use is not common among young adult smokers. Although some products such as Black & Mild and Swisher Sweets cigars are used frequently by some groups, other products such as shisha, kreteks, and herbal cigarettes are less well known and infrequently used. Among focus group participants, use of nontraditional tobacco products tends to occur in clubs, during social gatherings, or at times when cigarettes are unavailable. More college students than those who were not in college cited cost and inconvenience of purchasing nontraditional tobacco products as reasons for not using them. All focus group participants agreed that African Americans use cigars more than any other racial or ethnic group. CONCLUSION: Overall, findings suggest that the reasons for trying nontraditional tobacco products did not differ by race or ethnicity. Family members and peers were mentioned as the source of nontraditional tobacco products when first used. Cost, convenience, taste, smell, and strength were given as reasons both for using these products and for discontinuing their use.