Examining the impact of a province-wide physical education policy on secondary students' physical activity as a natural experiment.

BACKGROUND: The purpose of this paper is to examine the impact of a province-wide physical education (PE) policy on secondary school students' moderate to vigorous physical activity (MVPA). METHODS: Policy: In fall 2008, Manitoba expanded a policy requiring a PE credit for students in grades 11 and 12 for the first time in Canada. The PE curriculum requires grades 11 and 12 students to complete a minimum of 55 h (50% of course hours) of MVPA (e.g., ≥30 min/day of MVPA on ≥5 days a week) during a 5-month semester to achieve the course credit. STUDY DESIGNS: A natural experimental study was designed using two sub-studies: 1) quasi-experimental controlled pre-post analysis of self-reported MVPA data obtained from census data in intervention and comparison [Prince Edward Island (PEI)] provinces in 2008 (n = 33,619 in Manitoba and n = 2258 in PEI) and 2012 (n = 41,169 in Manitoba and n = 4942 in PEI); and, 2) annual objectively measured MVPA in cohorts of secondary students in intervention (n = 447) and comparison (Alberta; n = 224) provinces over 4 years (2008 to 2012). ANALYSIS: In Study 1, two logistic regressions were conducted to model the odds that students accumulated: i) ≥30 min/day of MVPA, and ii) met Canada's national recommendation of ≥60 min/day of MVPA, in Manitoba versus PEI after adjusting for grade, sex, and BMI. In Study 2, a mixed effects model was used to assess students' minutes of MVPA per day per semester in Manitoba and Alberta, adjusting for age, sex, BMI, school location and school SES. RESULTS: In Study 1, no significant differences were observed in students achieving ≥30 (OR:1.13, 95% CI:0.92, 1.39) or ≥60 min/day of MVPA (OR:0.92, 95% CI: 0.78, 1.07) from baseline to follow-up between Manitoba and PEI. In Study 2, no significant policy effect on students' MVPA trajectories from baseline to last follow-up were observed between Manitoba and Alberta overall (-1.52, 95% CI:-3.47, 0.42), or by covariates. CONCLUSIONS: The Manitoba policy mandating PE in grades 11 and 12 had no effect on student MVPA overall or by key student or school characteristics. However, the effect of the PE policy may be underestimated due to the use of a nonrandomized research design and lack of data assessing the extent of policy implementation across schools. Nevertheless, findings can provide evidence about policy features that may improve the PE policy in Manitoba and inform future PE policies in other jurisdictions.

Evaluation of Daily Physical Activity (DPA) policy implementation in Ontario: surveys of elementary school administrators and teachers.

BACKGROUND: School-based structured opportunities for physical activity can provide health-related benefits to children and youth, and contribute to international guidelines recommending 60 min of moderate-to-vigorous physical activity (MVPA) per day. In 2005, the Ministry of Education in Ontario, Canada, released the Daily Physical Activity (DPA) policy requiring school boards to "ensure that all elementary students, including students with special needs, have a minimum of twenty minutes of sustained MVPA each school day during instructional time". This paper reports on the first provincial study evaluating implementation fidelity to the DPA policy in Ontario elementary schools and classrooms. Using an adapted conceptual framework, the study also examined associations between implementation of DPA and a number of predictors in each of these respective settings. METHODS: Separate cross-sectional online surveys were conducted in 2014 with Ontario elementary school administrators and classroom teachers, based on a representative random sample of schools and classrooms. An implementation fidelity score was developed based on six required components of the DPA policy. Other survey items measured potential predictors of implementation at the school and classroom levels. Descriptive analyses included frequency distributions of implementation fidelity and predictor variables. Bivariate analyses examining associations between implementation and predictors included binary logistic regression for school level data and generalized linear mixed models for classroom level data, in order to adjust for school-level clustering effects. RESULTS: Among administrators, 61.4 % reported implementation fidelity to the policy at the school level, while 50.0 % of teachers reported fidelity at the classroom level. Several factors were found to be significantly associated with implementation fidelity in both school and classroom settings including: awareness of policy requirements; scheduling; monitoring; use of resources and supports; perception that the policy is realistic and achievable; and specific barriers to implementation. CONCLUSIONS: Findings from the surveys indicate incomplete policy implementation and a number of factors significantly associated with implementation fidelity. The results indicate a number of important implications for policy, practice and further research, including the need for additional research to monitor implementation and its predictors, and assess the impacts of study recommendations and subsequent outcomes of a reinvigorated DPA moving forward.

Hookah use prevalence, predictors, and perceptions among Canadian youth: findings from the 2012/2013 Youth Smoking Survey.

PURPOSE: Few national surveys currently assess hookah smoking among youth. This study describes the prevalence, patterns of use, and perceptions about hookah in a nationally representative survey of Canadian grades 9-12 students. METHODS: The Youth Smoking Survey 2012/2013 was administered to 27,404 Canadian grades 9-12 students attending schools in nine Canadian provinces representing 96 % of Canadian population. Relevant dichotomous outcomes included ever use, use in the last 30 days, and the belief that hookah use is less harmful than cigarette smoking. Covariates included smoking status, sex, grade, province of residence, race/ethnicity, and amount of weekly spending money. Logistic regression models were used to examine: covariates related to the odds of ever and last-30-day hookah use; covariates related to perceptions about the harms of hookah smoking; the extent to which perceptions were associated with odds of hookah use; and whether survey year (2010/2011 or 2012/2013) was associated with hookah use, and marginal effects were calculated. RESULTS: In Canada, 5.4 % of students in grades 9-12 currently use hookah and 14.3 % report ever using hookah. In 2012/2013, students had significantly higher odds of using hookah compared to students in 2010/2011 (OR 1.5, 95 % CI 1.2, 2.1). About half of hookah users (51 %) used flavored hookah. Students who believed that hookah use was less harmful than cigarette smoking had significantly higher odds of current hookah use (OR 2.6, 95 % CI 1.9, 3.5), as did students who reported higher amounts of weekly spending money. Current smokers had an 18 % higher predicted probability of currently using hookah compared to non-smokers. CONCLUSIONS: Hookah use among youth is of growing concern in Canada. Findings can be used to inform policy development related to youth hookah smoking.

Smoking intensity and intent to continue smoking among menthol and non-menthol adolescent smokers in Canada.

PURPOSE: Research suggests that menthol cigarette use is associated with nicotine dependence. However, findings on the relationship between menthol smoking status and quantity of cigarettes smoked are less clear. The objective of this paper was to examine whether menthol cigarette smoking is associated with higher smoking intensity and intention to continue smoking among adolescents. METHODS: A nationally representative sample of 4,736 Canadian students in grades 9-12 was drawn from the 2010-2011 Canadian Youth Smoking Survey. Associations between smoking intensity and menthol smoking were examined using linear regression. A logistic regression was used to examine whether menthol smoking increased the odds that a student reported intention to continue smoking. RESULTS: Thirty-two percentage of smokers in grades 9-12 smoked menthol cigarettes in the last 30 days. Unadjusted average number of cigarettes reported by menthol smokers was 6.86 compared with 4.59 among non-menthol smokers (p < 0.001). Multivariable results showed that the average number of cigarettes smoked by menthol smokers was greater than non-menthol smokers (ß = 1.92; 95 % CI = 1.16-2.68). Similar results were found using the total number of cigarettes smoked in the past week. Additionally, menthol smokers had greater odds of reporting intent to continue smoking compared with non-menthol smokers (OR = 2.95; 95 % CI = 2.24-3.90). These results were similar when separate analyses were conducted for established smokers and experimental smokers. CONCLUSIONS: The findings of this study along with existing evidence suggest the need for banning mentholated tobacco products in Canada, in part because of its significant effect on adolescent smoking.

The prevalence of eating behaviors among Canadian youth using cross-sectional school-based surveys.

BACKGROUND: Obesity is a growing public health concern in Canada. Excess weight is particularly a concern among youth given that obesity in youth predicts obesity in adulthood. Eating behaviors, both inside and outside the home have been associated with increased risk of obesity; however, there is little data among Canadian youth to monitor trends. METHODS: The School Health Action, Planning and Evaluation Surveys (SHAPES) were administered in schools. Our study examined 20, 923 students (grades 5-12) from four regions in Canada. The regions were Hamilton and Thunder Bay (both in Ontario), the Province of Prince Edward Island, and the Province of Quebec. RESULTS: Consuming breakfast daily was reported by 70% of grade 5-8 students, and 51% of grade 9-12's. Among students in grade 9-12, 52% reported eating with family members daily, compared with 68% in grade 5-8. Just over half of students in grade 5-8, and 70% in grade 9-12 reported eating at a fast-food place once a week or more. Among grade 5-8 students 68% reported eating in front of the television at least once per week, compared to 76% in grade 9-12. Obese students were more likely to watch TV while eating, and less likely to eat with a family member and eat breakfast. CONCLUSIONS: The findings suggest that only a modest proportion of youth report dietary patterns that have previously been associated with healthy eating and reduced risk of obesity. Later adolescence may be a critical time for intervention in health-related behaviors.

The COMPASS study: a longitudinal hierarchical research platform for evaluating natural experiments related to changes in school-level programs, policies and built environment resources.

BACKGROUND: Few researchers have the data required to adequately understand how the school environment impacts youth health behaviour development over time. METHODS/DESIGN: COMPASS is a prospective cohort study designed to annually collect hierarchical longitudinal data from a sample of 90 secondary schools and the 50,000+ grade 9 to 12 students attending those schools. COMPASS uses a rigorous quasi-experimental design to evaluate how changes in school programs, policies, and/or built environment (BE) characteristics are related to changes in multiple youth health behaviours and outcomes over time. These data will allow for the quasi-experimental evaluation of natural experiments that will occur within schools over the course of COMPASS, providing a means for generating "practice based evidence" in school-based prevention programming. DISCUSSION: COMPASS is the first study with the infrastructure to robustly evaluate the impact that changes in multiple school-level programs, policies, and BE characteristics within or surrounding a school might have on multiple youth health behaviours or outcomes over time. COMPASS will provide valuable new insight for planning, tailoring and targeting of school-based prevention initiatives where they are most likely to have impact.

Flavored tobacco use among Canadian students in grades 9 through 12: prevalence and patterns from the 2010-2011 youth smoking survey.

INTRODUCTION: This study examined patterns of use of flavored tobacco products in a nationally generalizable sample of Canadian students in grades 9 through 12 after the implementation of a national ban on certain flavored tobacco products. METHODS: Data from the 2010-2011 Youth Smoking Survey, a nationally generalizable sample of Canadian students in grades 9 through 12 (n = 31,396), were used to examine tobacco product use. Logistic regression models were used to examine differences in use of flavored tobacco products (cigarettes, pipes, little cigars or cigarillos, cigars, roll-your-own cigarettes, bidis, smokeless tobacco, water pipes, and blunt wraps) by sociodemographic and regional characteristics. RESULTS: Approximately 52% of young tobacco users used flavored products in the previous 30 days. Flavored tobacco use varied by product type and ranged from 32% of cigarette smokers reporting menthol smoking to 70% of smokeless tobacco users reporting using flavored product in the previous 30 days. The percentage of last-30-day users who used flavored tobacco was significantly higher in Quebec than in Ontario and significantly higher among youths who received weekly spending money than among those who received no money. CONCLUSION: More than half of tobacco users in grades 9 through 12 in Canada use flavored tobacco, despite a national ban on certain flavored tobacco products.

Young adult smoking cessation: predictors of quit attempts and abstinence.

We examined young adult smoking cessation behaviors, coding cessation behavior as no attempt, quit attempt (< 30 days), or abstinence (≥ 30 days) during follow-up from July 2005 through December 2008, observed in 592 young adult smokers from the Ontario Tobacco Survey. One in 4 young adults made an attempt; 14% obtained 30-day abstinence. Cessation resources, prior attempts, and intention predicted quit attempts, whereas high self-efficacy, using resources, having support, and low addiction predicted abstinence, indicating that young adult smokers require effective and appropriate cessation resources.

School and community predictors of smoking: a longitudinal study of Canadian high schools.

OBJECTIVES: We identified the most effective mix of school-based policies, programs, and regional environments associated with low school smoking rates in a cohort of Canadian high schools over time. METHODS: We collected a comprehensive set of student, school, and community data from a national cohort of 51 high schools in 2004 and 2007. Hierarchical linear modeling was used to predict school and community characteristics associated with school smoking prevalence. RESULTS: Between 2004 and 2007, smoking prevalence decreased from 13.3% to 10.7% in cohort schools. Predictors of lower school smoking prevalence included both school characteristics related to prevention programming and community characteristics, including higher cigarette prices, a greater proportion of immigrants, higher education levels, and lower median household income. CONCLUSIONS: Effective approaches to reduce adolescent smoking will require interventions that focus on multiple factors. In particular, prevention programming and high pricing for cigarettes sold near schools may contribute to lower school smoking rates, and these factors are amenable to change. A sustained focus on smoking prevention is needed to maintain low levels of adolescent smoking.

A multilevel examination of gender differences in the association between features of the school environment and physical activity among a sample of grades 9 to 12 students in Ontario, Canada.

BACKGROUND: Creating school environments that support student physical activity (PA) is a key recommendation of policy-makers to increase youth PA. Given males are more active than females at all ages, it has been suggested that investigating gender differences in the features of the environment that associate with PA may help to inform gender-focused PA interventions and reduce the gender disparity in PA. The purpose of this cross-sectional study was to explore gender differences in the association between factors of the school environment and students' time spent in PA. METHODS: Among a sample of 10781 female and 10973 male students in grades 9 to 12 from 76 secondary schools in Ontario, Canada, student- and school-level survey PA data were collected and supplemented with GIS-derived measures of the built environment within 1-km buffers of the 76 schools. RESULTS: Findings from the present study revealed significant differences in the time male and female students spent in PA as well as in some of the school- and student-level factors associated with PA. Results of the gender-specific multilevel analyses indicate schools should consider providing an alternate room for PA, especially for providing flexibility activities directed at female students. Schools should also consider offering daily physical education programming to male students in senior grades and providing PA promotion initiatives targeting obese male students. CONCLUSIONS: Although most variation in male and female students' time spent in PA lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy-makers. More research investigating gender differentials in environment factors associated with youth PA are warranted.

Do students' perceptions of school smoking policies influence where students smoke?: Canada's Youth Smoking Survey.

OBJECTIVE: The objective of this study was to explore students' perceptions of school policy characteristics that influence the location of smoking while at school. METHODS: Data were collected from a nationally representative sample of Canadian youth in grades 7-12 as part of the 2006-2007 Youth Smoking Survey. We used multilevel logistic regression to examine how students' perceptions of school policies predicted smoking behavior on and off school grounds in 11,881 students who had ever smoked. Separate analyses were conducted for grades 7-9 and 10-12. RESULTS: In both grades 7-9 and 10-12, perceiving clear rules about smoking decreased the likelihood that a student would smoke on school grounds, while perceiving that a high percentage of peers smoke, that there are school rules about smoking, that students obey the rules, and that students can be fined for smoking increased the likelihood that a student would smoke off school grounds. CONCLUSIONS: Clearly perceived rules about smoking encourage students not to smoke on school grounds; however, perceptions of rules, along with strong enforcement, may displace behavior off of school grounds. Non-smoking policies should be part of a comprehensive approach, that supports cessation.

A multi-level examination of school programs, policies and resources associated with physical activity among elementary school youth in the PLAY-ON study.

BACKGROUND: Given the decline in physical activity (PA) levels among youth populations it is vital to understand the factors that are associated with PA in order to inform the development of new prevention programs. Many studies have examined individual characteristics associated with PA among youth yet few have studied the relationship between the school environment and PA despite knowing that there is variability in student PA levels across schools. METHODS: Using multi-level logistic regression analyses we explored the school- and student-level characteristics associated with PA using data from 2,379 grade 5 to 8 students attending 30 elementary schools in Ontario, Canada as part of the PLAY-Ontario study. RESULTS: Findings indicate that there was significant between-school random variation for being moderately and highly active; school-level differences accounted for 4.8% of the variability in the odds of being moderately active and 7.3% of the variability in the odds of being highly active. Students were more likely to be moderately active if they attended a school that used PA as a reward and not as discipline, and students were more likely to be highly active if they attended a school with established community partnerships. Important student characteristics included screen time sedentary behaviour, participating in team sports, and having active friends. CONCLUSION: Future research should evaluate if the optimal population level impact for school-based PA promotion programming might be achieved most economically if intervention selectively targeted the schools that are putting students at the greatest risk for inactivity.

A multilevel examination of school and student characteristics associated with moderate and high levels of physical activity among elementary school students (Ontario, Canada).

OBJECTIVES: Schools represent an important environment for physical activity (PA) promotion among youth. Schools can promote PA through policies and programs but our understanding of how these school characteristics associate with student PA levels is largely unknown. Developing this understanding is critical for implementing new prevention interventions. The aim of this study was to identify the school- and student-related characteristics associated with moderate and high levels of PA in a sample of Ontario elementary schools. METHODS: Using multi-level logistic regression analyses, we explored the school- and student-level characteristics associated with being moderately and highly active using data collected from administrators and from students in grades 5 to 8 at 30 elementary schools in Ontario. Students' PA levels, sex, grade, and the number of physical education classes per week were linked to school environment data--specifically, a school's chosen implementation model for daily physical activity and whether it offers intramural and interschool PA programming. RESULTS: Findings indicate that there was significant between-school variation for being moderately and highly active. Students were less likely to be moderately or highly active if they attended a school offering interschool PA programming. An important student characteristic positively associated with student PA levels included participating in at least two physical education classes per week. CONCLUSION: The residual differences in PA by school suggest that school-level characteristics facilitate higher levels of student PA beyond individual-level factors. Although most variation in student PA lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy-makers.

The influence of school policies on smoking prevalence among students in grades 5-9, Canada, 2004-2005.

INTRODUCTION: School characteristics may account for some of the variation in smoking prevalence among schools. The purpose of this study was to investigate the relationships between characteristics of school tobacco policies and school smoking prevalence. We also examined the relationship between these characteristics and individual smoking status. METHODS: Tobacco policy data were collected from schools in 10 Canadian provinces during the 2004-2005 school year. Written tobacco policies were collected from each school to examine policy intent, and school administrators were surveyed to assess policy enforcement. Students in grades 5 through 9 completed the Youth Smoking Survey to assess smoking behaviors and attitudes. We used negative binomial regression and multilevel logistic regression to predict the influence of school policies on smoking behavior at the school and student levels. RESULTS: School policies that explicitly stated purpose and goals predicted lower prevalence of smoking at the school and individual levels. Policies that prohibited smoking on school grounds at all times predicted lower smoking prevalence at the school level but not at the individual level. CONCLUSION: For maximum effectiveness, school smoking policies should clearly state a purpose and goals and should emphasize smoking prohibition. These policies can help reduce smoking prevalence among youths and are part of a comprehensive school approach to tobacco control.

Use of contraband cigarettes among adolescent daily smokers in Canada.

Current tobacco-control strategies seek to inhibit and reduce smoking among adolescents. However, such strategies are probably undermined by the contraband tobacco market. Using data from Canada's 2006/2007 Youth Smoking Survey, we found that 13.1% of respondents who were daily smokers reported that contraband cigarettes were their usual brand. They consumed significantly more cigarettes than respondents who smoked other brands. Contraband cigarettes accounted for about 17.5% of all cigarettes smoked by adolescent daily smokers in Canada overall, and for more than 25% in the provinces of Ontario and Quebec.

Integrating research, policy, and practice in school-based physical activity prevention programming: the School Health Action, Planning, and Evaluation System (SHAPES) Physical Activity Module.

The School Health Action, Planning, and Evaluation System (SHAPES) is a data collection and feedback system designed to support population-based intervention planning, evaluation, and field research related to youth. The Physical Activity Module of SHAPES consists of: (a) a machine readable questionnaire to collect physical activity data from all students (grades 6 to 12) in a school, (b) a school administrator questionnaire to assess school policies, programs, and resources related to physical activity, and (c) a school-specific feedback report documenting student behavior and school programs and policies. This SHAPES module provides schools with feedback that enables them to take stock of patterns of activity and obesity within their school, recognize what is (and what is not) in place to support physical activity, and how to plan and evaluate their own prevention efforts. SHAPES enables researchers and stakeholders to identify what interventions work, in what contexts, with what students.

Support for healthy eating at schools according to the comprehensive school health framework: evaluation during the early years of the Ontario School Food and Beverage Policy implementation. / Soutien en faveur de l'alimentation saine dans les écoles conformément à l'approche globale de la santé en milieu scolaire : évaluation au cours des premières années de la mise en oeuvre de la Politique de l'Ontario concernant les aliments et les boissons dans les écoles.

INTRODUCTION: Provincial, national and international public health agencies recognize the importance of school nutrition policies that help create healthful environments aligned with healthy eating recommendations for youth. School-wide support for healthy living within the pillars of the comprehensive school health (CSH) framework (social and physical environments; teaching and learning; healthy school policy; and partnerships and services) has been positively associated with fostering improvements to student health behaviours. This study used the CSH framework to classify, compare and describe school support for healthy eating during the implementation of the Ontario School Food and Beverage Policy (P/PM 150). METHODS: We collected data from consenting elementary and secondary schools in a populous region of Ontario in Time I (2012/13) and Time II (2014). Representatives from the schools completed the Healthy School Planner survey and a food environmental scan (FES), which underwent scoring and content analyses. Each school's support for healthy eating was classified as either "initiation," "action" or "maintenance" along the Healthy School Continuum in both time periods, and as "high/increased," "moderate" or "low/decreased" within individual CSH pillars from Time I to Time II. RESULTS: Twenty-five school representatives (8 elementary, 17 secondary) participated. Most schools remained in the "action" category (n = 20) across both time periods, with varying levels of support in the CSH pillars. The physical environment was best supported (100% high/increased support) and the social environment was the least (68% low/decreased support). Only two schools achieved the highest rating (maintenance) in Time II. Supports aligned with P/PM 150 were reportedly influenced by administration buy-in, stakeholder support and relevancy to local context. CONCLUSION: Further assistance is required to sustain comprehensive support for healthy eating in Ontario school food environments.

INTRODUCTION: Les agences provinciales, nationales et internationales de santé publique reconnaissent l'importance des politiques en matière de nutrition en milieu scolaire, qui contribuent à instaurer des environnements sains respectant les recommandations en matière d'alimentation saine à l'intention des jeunes. Le soutien à l'échelle de l'école d'un mode de vie sain reposant sur les piliers de l'approche globale de la santé en milieu scolaire (milieux social et physique; enseignement et apprentissage; politique de santé en milieu scolaire; partenariats et services) a été positivement associé à des améliorations encourageantes des comportements des élèves en matière de santé. Notre étude a utilisé l'approche globale de la santé en milieu scolaire pour classifier, comparer et décrire le soutien à une alimentation saine lors de la mise en oeuvre de la Politique de l'Ontario concernant les aliments et les boissons dans les écoles (N P/P 150). MÉTHODOLOGIE: Nous avons recueilli des données provenant d'écoles élémentaires et secondaires consentantes d'une zone peuplée de l'Ontario à deux reprises, en 2012-2013 (période I) et en 2014 (période II). Des représentants des écoles ont rempli l'enquête Planificateur des écoles en santé ainsi qu'un document d'analyse environnementale de l'alimentation, qui ont fait l'objet d'une attribution de scores et d'analyses de contenu. Le soutien de chaque école en faveur d'une alimentation saine a été classé comme relevant de la phase « lancement ¼, « prise de mesures ¼ ou « maintenance ¼ du continuum des écoles en santé pour les deux périodes, et comme étant « élevé/en hausse ¼, « modéré ¼, « faible/en baisse ¼ entre la période I et la période II par rapport aux piliers de l'approche globale de la santé en milieu scolaire. RÉSULTATS: Ont pris part à l'enquête 25 représentants scolaires (8 écoles élémentaires et 17 écoles secondaires). La plupart des écoles sont demeurées dans la catégorie « prise de mesures ¼ (n = 20) au cours des deux périodes, avec des niveaux divers de soutien aux piliers de la santé en milieu scolaire. Le milieu physique a fait l'objet du soutien le plus élevé (100% de soutien « élevé/en hausse ¼), le milieu social a fait l'objet du soutien le plus faible (68 % de soutien « faible/en baisse ¼). Seules deux écoles ont atteint la plus haute note (maintenance) au cours de la période II. Les soutiens respectant la N P/P 150 semblent avoir été influencés par l'adhésion de l'administration, le soutien des intervenants et la pertinence du contexte local. CONCLUSION: Une aide supplémentaire est nécessaire pour maintenir une alimentation saine dans les environnements alimentaires des écoles ontariennes.

Prevalence and correlates of electronic cigarette use among Canadian students: cross-sectional findings from the 2014/15 Canadian Student Tobacco, Alcohol and Drugs Survey.

BACKGROUND: Over the past decade, youth tobacco use has declined, and electronic cigarettes (e-cigarettes) have entered the market. The aims of this study were to describe the prevalence of e-cigarette use among youth in Canada, by province, across sociodemographic variables and smoking-related correlates; and to examine associations among e-cigarette use, sociodemographic variables and smoking-related correlates, with adjustment for other factors. METHODS: The 2014/15 Canadian Student Tobacco, Alcohol and Drugs Survey, a biennial, school-based survey, was administered to students in grades 6-12 in all Canadian provinces. Logistic regression models were fitted to estimate odds of ever and past 30-day e-cigarette use by sociodemographic variables and smoking-related correlates. RESULTS: A total of 336 schools from 128 school boards (47% of eligible schools approached) and 42 094 students (66% of eligible students approached) participated in the survey. In Canada, 17.7% (95% confidence interval [CI] 16.4%-18.9%) of students in grades 6-12 reported ever using e-cigarettes, and 5.7% (95% CI 5.2%-6.3%) reported past 30-day use. Substantial variation was observed across provinces. Female students had decreased odds of past 30-day use relative to male students (odds ratio [OR] 0.71, 95% CI 0.59-0.86), whereas current smokers (OR 10.0, 95% CI 6.66-15.02) and experimental smokers (OR 3.61, 95% CI 2.40-5.42) had increased odds relative to never smokers. Students who perceived that access was easy also had increased odds of using e-cigarettes relative to students who perceived that access was difficult (OR 3.86, 95% CI 2.96-5.03). Students who believed that regular use entailed slight risk (OR 0.68, 95% CI 0.52-0.88) and those who did not know risk levels (OR 0.31, 95% CI 0.21-0.46) had decreased odds compared with those perceiving no risk. INTERPRETATION: Our data confirm that many youth used e-cigarettes in the 30 days preceding the survey, although rates were substantially higher among current and experimental smokers than among students who had never tried smoking.

Sex differences in how older students influence younger student smoking behaviour.

The purpose of this study was to examine sex differences in how the smoking behaviour of close friends and older peers at school influence smoking onset and progression among 10,843 grade 9, 10 and 11 students from 29 secondary schools in Ontario, Canada. In lower-risk student populations (i.e., students with no smoking friends or one smoking friend), males and females were both at a similar level of risk for occasional smoking as a function of the smoking rate of older students at their school. Among higher-risk student populations (i.e., students with three or more close friends who smoke), the smoking rate of older students at school did not influence the risk of occasional smoking. The odds of a female student being a regular smoker increased as the prevalence of smoking among older students at her school increased regardless of her close friends' smoking behaviour. However, among male students, the influence of older student smoking at school on the odds of regular smoking was moderated by the number of close friends who smoke. It appears that the prevalence of older student smoking at a school is more influential among younger female students, whereas the smoking behaviour of close friends appears to be more influential among younger male students. This new finding provides unique insight for tailoring and targeting future school-based smoking prevention initiatives.