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Objectives: The school environment is an ideal setting to introduce policies to prevent smoking behaviour. However, there may be variability in the strength of school board and secondary school tobacco policies, which may affect student smoking behaviours. This study assessed the strength of a sample of school board and secondary school tobacco policies and examined the association with student smoking behaviours., Methods: Tobacco policies from school boards (n = 21/26) and secondary schools (n = 43/81) that participated in the COMPASS study during 2015-2016 were obtained online. A standardized instrument was used to assess the strength of school board and secondary school tobacco policies on four domains. Using the sample of students from schools with identified policies (n = 22,696), separate multilevel regression models examined the association between school policy scores and a student's susceptibility to smoking, ever smoking, current smoking, and perceived support of the school environment., Results: The mean school board tobacco policy score was 13.7/40 and the mean secondary school tobacco policy score was 11.3/40. Students were significantly less likely to report current smoking (OR 0.95, 95% CI 0.91-0.99) and more likely to report a supportive school environment (OR 1.06, 95% CI 1.04-1.08) with each four-unit (i.e., 10%) increase in school tobacco policy score., Conclusions: The vast majority of school board and secondary school tobacco policies were missing components and therefore could not be considered comprehensive. Stronger school tobacco policies may help to reduce student current smoking behaviours.

Introduction: Within tobacco prevention programming, it is useful to identify youth that are at risk for experimenting with various tobacco products and e-cigarettes. The susceptibility to smoking construct is a simple method to identify never-smoking students that are less committed to remaining smoke-free. However, the predictive validity of this construct has not been tested within the Canadian context or for the use of other tobacco products and e-cigarettes., Methods: This study used a large, longitudinal sample of secondary school students that reported never using tobacco cigarettes and noncurrent use of alternative tobacco products or e-cigarettes at baseline in Ontario, Canada. The sensitivity, specificity, and positive and negative predictive values of the susceptibility construct for predicting tobacco cigarette, e-cigarette, cigarillo or little cigar, cigar, hookah, and smokeless tobacco use 1 and 2 years after baseline measurement were calculated., Results: At baseline, 29.4% of the sample was susceptible to future tobacco product or e-cigarette use. The sensitivity of the construct ranged from 43.2% (smokeless tobacco) to 59.5% (tobacco cigarettes), the specificity ranged from 70.9% (smokeless tobacco) to 75.9% (tobacco cigarettes), and the positive predictive value ranged from 2.6% (smokeless tobacco) to 32.2% (tobacco cigarettes). Similar values were calculated for each measure of the susceptibility construct., Conclusions: A significant number of youth that did not currently use tobacco products or e-cigarettes at baseline reported using tobacco products and e-cigarettes over a 2-year follow-up period. The predictive validity of the susceptibility construct was high and the construct can be used to predict other tobacco product and e-cigarette use among youth., Implications: This study presents the predictive validity of the susceptibility construct for the use of tobacco cigarettes among secondary school students in Ontario, Canada. It also presents a novel use of the susceptibility construct for predicting the use of e-cigarettes, cigarillos or little cigars, cigars, hookah, and smokeless tobacco among secondary school students in Ontario, Canada., (© The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Youth e-cigarette use is common worldwide, but the profile of e-cigarette users compared with tobacco users is unclear. This study examines how sport participation and activity levels among youth differ between e-cigarette users and smokers., Methods: Using Canadian data from 38977 grade 9 to 12 students who participated in Year 3 (2014-15) of the COMPASS study, logistic regression models were used to examine the likelihood of sport participation and activity level based on e-cigarette use and smoking status. Pearson's chi-square tests were used to examine subgroup differences by gender., Results: E-cigarette users are more likely to participate in intramural, competitive, and team sports compared to non-users. Current and former smokers are less likely to participate in those sports than non-smokers. Youth e-cigarette users are more likely than non-users to meet the physical activity guidelines. Current smokers are more likely than non-smokers to undertake physical activity at least 60 min daily but less likely than non-smokers to tone at least 3 times per week. Youth e-cigarette users are less likely than non-users to be sedentary less than 2 h daily. Gender differences among males and females show that male e-cigarettes users drive the general relationship., Conclusion: Results suggest that e-cigarette users are more likely to engage in physical activity compared to non e-cigarette users. Youth e-cigarette users are more likely to be physically active while the opposite is true for smokers. Although e-cigarettes may be less harmful to health compared to cigarette smoking, the increased uptake among youth of differing profiles should be considered in prevention efforts., Implications: These results highlight the importance of addressing e-cigarette use in youth who undertake health promoting behaviors. Prevention efforts should not focus only on youth who may undertake riskier health habits; e-cigarette prevention programs should go beyond the domain of tobacco control., (© The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The influence of e-cigarette use on smoking initiation is a highly controversial issue, with limited longitudinal data available for examining temporal associations. We examined e-cigarette use and its association with cigarette-smoking initiation at 1-year follow-up within a large cohort of Canadian secondary school students., Methods: We analyzed data from students in grades 9-12 who participated in 2 waves of COMPASS, a cohort study of purposefully sampled secondary schools in Ontario and Alberta, Canada, at baseline (2013/14) and 1-year follow-up (2014/15). We assessed cigarette smoking and e-cigarette use at baseline and follow-up using self-completed surveys. We used generalized linear mixed-effects models to examine correlates of past 30-day e-cigarette use at baseline and smoking initiation between waves within the longitudinal sample., Results: Past 30-day e-cigarette use increased from 2013/14 to 2014/15 (7.2% v. 9.7%, p < 0.001), whereas past 30-day cigarette smoking decreased slightly (11.4% v. 10.8%, p = 0.02). Among the 44 163 students evaluated at baseline, past 30-day e-cigarette use was strongly associated with smoking status and smoking susceptibility. In the longitudinal sample ( n = 19 130), past 30-day use of e-cigarettes at baseline was associated with initiation of smoking a whole cigarette (adjusted odds ratio [OR] 2.12, 95% confidence interval [CI] 1.68-2.66) and with initiation of daily smoking (adjusted OR 1.79, 95% CI 1.41-2.28) at follow-up., Interpretation: E-cigarette use was strongly associated with cigarette smoking behaviour, including smoking initiation at follow-up. The causal nature of this association remains unclear, because common factors underlying the use of both e-cigarettes and conventional cigarettes may also account for the temporal order of initiation., Competing Interests: Competing interests: None declared., (© 2017 Joule Inc. or its licensors.)

Background: Our group recently completed a randomized controlled trial, evaluating the efficacy of providing 5 weeks of free nicotine replacement therapy (NRT; in the form of the nicotine patch) by expedited postal mail without behavioral assistance to regular adult smokers interested in receiving it. The findings revealed that mailed provision of nicotine patches resulted in more than a doubling of quit rates at a six-month follow-up compared to a no intervention control group. While this trial provided evidence for the effectiveness of mailed nicotine patches in promoting cessation, the findings speak only to the short term effectiveness of this approach. As relapse to smoking is known to occur beyond the 6 month period, it is important to evaluate whether the net benefit of NRT in naturalistic settings can be maintained long-term. The present study aims to perform a 5-year follow-up survey of participants in the original trial to evaluate the long-term effectiveness of mailed NRT., Methods/design: Trained interviewers will contact participants in the randomized controlled trial 5 years post-enrollment. A total of 924 participants will be eligible to be contacted. Interviewers will first assess participants' smoking status and their level of nicotine dependence. Participants reporting not currently smoking will be asked whether they have smoked tobacco, even a puff, in the last 30 days (primary outcome measure: 30-day point prevalence abstinence), past 6 months (secondary outcome measure: prolonged 6-month abstinence), and since the 8-week follow-up survey (secondary outcome measure: > 4 year continuous abstinence). Interviewers will be blind to experimental condition at the time the primary outcome measure will be assessed. It is hypothesized that participants who received nicotine patches at baseline will display significantly higher quit rates at the 5-year follow-up as compared to participants who did not receive nicotine patches at baseline., Discussion: If the study finds that the mailed distribution of free NRT is effective at promoting long-term cessation, it would provide further evidence to move forward with policies designed to make NRT treatment readily and freely available to smokers who request it., Trial Registration: ClinicalTrials.gov : NCT01429129 , Registered 2 September 2011; NCT03097445 , Registered 25 March 2017.

Introduction: The purpose of this study was to examine the correlates of current smoking among off-reserve First Nations and Métis adults, two Aboriginal Canadian groups that are at higher risk to smoke and more likely to suffer from chronic health conditions relative to their non-Aboriginal counterparts. A particular focus was on culturally specific factors and their associations with current smoking., Methods: We used data from Statistics Canada's, 2012 Aboriginal Peoples Survey to investigate the correlates of smoking among 12,720 First Nations and Métis adults. Sequential binary logistic regression models were estimated to examine associations between smoking and culturally specific, demographic, geographic, socioeconomic and health-related variables., Results: Overall, 39.4% were current smokers. Multivariate results found that those who had hunted, fished or trapped within the last year were more likely to be smokers. In addition, respondents who were exposed to an Aboriginal language at home or outside the home were more likely to be smokers. Current smoking was significantly associated with being aged 35 to 49 years, living in a small population center, low income, low education, unemployment, being unmarried, low ratings of self-perceived health, heavy drinking and low body mass index. Respondents aged 65 years and older and those living in British Columbia were less likely to smoke., Discussion: The results of this study suggest that it may be useful to consider cultural characteristics, particularly language in efforts to reduce the prevalence of manufactured tobacco use among First Nations and Métis adults. Interventions should also consider demographic, geographic and socioeconomic variables, in addition to co-occurring health-risk behaviors., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objectives: Youth smoking and obesity may both be mediated by weight control behaviors and experiences of bullying. This study examines associations between smoking and obesity among youth, and explores whether associations are mediated by weight loss attempts or bullying experiences., Methods: Data from 24,173 grade 9 to 12 students in the COMPASS study (2012-13) were used to examine the prevalence of self-reported smoking, weight status, attempting to lose weight, and being a victim of bullying. Generalized linear mixed effects models were used to examine correlates of smoking., Results: Among youth, 11% reported currently smoking, 20% were overweight or obese, 42% reported attempting to lose weight, and 18% reported being bullied. Girls who reported attempting to lose weight had higher odds of smoking (OR = 1.42, p = .0039), and students who reported being bullied had higher odds of smoking (OR = 1.85, p < .0001). Both variables were significantly associated with smoking independent of weight status., Conclusions: For girls, weight loss attempts were associated with smoking. For both sexes, being bullied was associated with smoking, independent of weight status. Programs attempting to reduce smoking among youth should consider the effects of weight control behaviors and bullying irrespective of weight status.

Objective: To examine the correlates of current smoking among Métis aged 18 years and older, with a particular focus on culturally-specific factors. Cultural factors included spirituality, knowledge of an Aboriginal language, membership in a Métis organization and attendance at Métis cultural events. Demographic, geographic, socio-economic and health-related variables were also considered., Methods: Data from 6,610 adult Métis aged 18 years and older who responded to the 2006 Aboriginal Peoples Survey and Métis supplement were used to examine the correlates of current smoking using sequential binary logistic regression modelling., Results: Overall, 39.9% of adult Métis respondents in the sample were current smokers. Adult Métis who reported a high level of spirituality were less likely to be current smokers. Those who spoke an Aboriginal language, or lived in a house where an Aboriginal language was spoken, were more likely to be current smokers. Being a member of a Métis organization and attending cultural events were not independently associated with current smoking. Métis with higher household income, greater education, higher self-perceived health, and greater physical activity participation were less likely to be current smokers, whereas those who reported heavy alcohol consumption were more likely to be current smokers., Conclusions: The results of this study suggest that interventions aimed at reducing smoking among adult Métis might be more successful if they include some connection to spirituality. It is also evident that co-occurring risk behaviours, in addition to demographic and socio-economic factors, are important considerations when developing interventions to reduce smoking among this population.

Background: Evaluating the interrelationship of health behaviors could assist in the development of effective public health interventions. Furthermore, the ability to identify cognitive mediators that may influence multiple behavioral changes requires evaluation., Purpose: To evaluate covariation among health behaviors, specifically alcohol consumption, leisure-time physical activity, and smoking, and examine whether mastery acts as a mediating social-cognitive mechanism that facilitates multiple health behavior change in a longitudinal analysis., Methods: In 2010, secondary data analysis was conducted on the first seven cycles of the Canadian National Population Health Survey. Data collection began in 1994-1995 and has continued biennially. At the time of this analysis, only seven cycles of data (2006-2007) were available. Parallel process growth curve models were used to analyze covariation between health behaviors and the potential mediating effects of perceived mastery., Results: Increases in leisure-time physical activity were associated with reductions in tobacco use, whereas declines in alcohol consumption were associated with decreases in tobacco use. Covariation between alcohol consumption and leisure-time physical activity did not reach statistical significance. For the most part, mastery was unsuccessful in mediating the interrelationship of multiple behavioral changes., Conclusions: Health behaviors are not independent but rather interrelated. In order to optimize limited prevention resources, these results suggest that population-level intervention efforts targeting multiple modifiable behavioral risk factors may not need to occur simultaneously., (Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.)

Background: Smoking susceptibility has been found to be a strong predictor of experimental smoking. This paper examined which student- and school-level factors differentiated susceptible never smokers from non-susceptible never smokers among a nationally representative sample of Canadian students in grades 9 to 12., Methods: Student-level data from the 2008-2009 Canadian Youth Smoking Survey were linked with school-level data from the 2006 Census, and one built environment characteristic (the density of tobacco retailers surrounding schools). These data were examined using multilevel logistic regression analyses., Results: The likelihood of a never smoker being susceptible to smoking significantly varied across schools (p=0.0002). Students in this study were more likely to be susceptible never smokers if they reported low self-esteem, held positive attitudes towards smoking, used alcohol or marijuana, had close friends who smoked, and came from homes without a total ban on smoking. The school location (rural versus urban), the socioeconomic status of the neighbourhood surrounding a school, and the density of tobacco retailers that were located within 1-km radius of each school were not associated with students' smoking susceptibility., Conclusion: These findings underscore the continued need to develop school-based tobacco use prevention policies and/or programs that enhance students' self-esteem, address tobacco use misinformation and substance use, and include strategies targeting friends who smoke, and students who come from homes without a total ban on smoking., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: In order to understand the factors that differentiate adolescents who have tried smoking from those who have become established smokers, this study examined which student- and school-level factors differentiated current smokers from experimental smokers among a nationally representative sample of Canadian secondary school students., Method: Student-level secondary data from the 2008-2009 Canadian Youth Smoking Survey was linked with school-level data from the 2006 Census and one built environment characteristic, and examined using multilevel logistic regression analyses., Results: The current smoking rates varied (P<0.001) across schools. The number of tobacco retailers surrounding the schools was associated with current smoking when adjusting for student characteristics. Additionally, students were more likely to be current smokers if they were: male, in higher grades, believed that smoking can help when they are bored, reported low school connectedness, used marijuana, had a sibling or close friend who smoked, and had no smoking bans at home., Conclusions: These study findings suggest that school anti-smoking strategies need to target males, increase students' attachment to their school, address tobacco-related beliefs, and include interventions targeting smoking siblings and friends. The government should consider zoning restrictions to limit sales of tobacco products near schools., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Substance use and weight gain among youth increase the risk for future disease. As such, the purpose of this study is to examine how many Canadian youth are currently failing to meet substance use and weight gain related public health guidelines., Methods: Data from the 2010-11 Youth Smoking Survey were used to examine grade 9 to 12 students meeting seven different guidelines by sex and by grade., Results: Among Canadian youth, 8.8% were current smokers, 18.8% were current marijuana users, 25.5% were current binge drinkers, 22.5% were considered overweight or obese, 31.2% did not meet physical activity guidelines, 89.4% exceeded sedentary behaviour guidelines, and 93.6% reported inadequate fruit and vegetable intake. The mean number of risk factors per student was 2.9 (±1.2); only 0.5% of youth reported having none of the risk factors., Conclusion: Students rarely met all seven public health guideline examined, and the vast majority of actually reported having two or more modifiable risk factors for disease.

Introduction: Although cigarette use among Canadian youth has decreased significantly in recent years, alternative forms of tobacco use are becoming increasingly popular. Surveillance of youth tobacco use can help inform prevention programs by monitoring trends in risk behaviors. We examined the prevalence of bidi and hookah use and factors associated with their use among Canadian youth by using data from the 2010-2011 Youth Smoking Survey (YSS)., Methods: We analyzed YSS data from 28,416 students (2006-2007) and 31,396 students (2010-2011) in grades 9 through 12 to examine prevalence of bidi and hookah use. We conducted multivariate logistic regression analyses of 2010-2011 YSS data to examine factors associated with bidi and hookah use., Results: From 2006 through 2010, prevalence of hookah use among Canadian youth increased by 6% (P = .02). Marijuana use emerged as a consistent predictor of bidi and hookah use. Males, youth of black, Latin, or other descent, and youth of Asian descent were more likely to use bidis (odds ratio [OR], 1.5; OR, 15.6; OR, 14.9) or hookah (OR, 1.3; OR, 2.4; OR, 1.5). Current cigarette smokers were more likely than nonsmokers to be current users of bidis (OR, 6.7) and hookahs (OR, 3.0), and occasional and frequent alcohol drinkers were also more likely than nondrinkers to be current hookah users (OR, 2.8; OR, 3.6)., Conclusion: Although bidi use has not changed significantly among Canadian youth, the increase in hookah use warrants attention. Understanding the factors associated with use of bidis and hookahs can inform the development of tobacco use prevention programs to address emerging at-risk youth populations.

Patterns of smoking can vary among youth smokers. The purpose of this study was to examine three different patterns of smoking among youth (daily smoking, smoking sporadically on weekdays and weekends, and smoking during weekdays only), and to examine the sociodemographic characteristics that are associated with each smoking pattern in a representative sample of Canadian youth smokers. Data were collected as part of the 2010/2011 Youth Smoking Survey (YSS) from 31,396 students in grades 9 to 12 from secondary schools in 9 Canadian provinces. Data from the YSS were used to assess smoking behaviors and sociodemographic factors that are associated with smoking patterns among youth. We used logistic regression models to examine factors associated with week day only and some day smoking patterns relative to daily smoking patterns. Results indicate that among current youth smokers, the majority are daily smokers (62.0%), followed by some day (23.5%) and week day only (13.5%) smokers. Students who smoke some days were more likely than daily smokers to share cigarettes with others; however, they were less likely than daily smokers to have a parent, step-parent or guardian who smokes cigarettes and less likely to have close friends who smoke cigarettes. Conversely, students who smoke week days only were less likely than daily smokers to have a sibling who smokes cigarettes. These data suggest that the school environment continues to play an important role in reducing youth smoking rates in Canada, especially among youth who only smoke week days. The high percentage of week day only smokers suggests that current school-level tobacco control initiatives may be insufficient for preventing youth smoking onset., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The purpose of this study was to determine whether there is a growing inequity in tobacco use, susceptibility to future smoking, and quit attempts among Off-Reserve Aboriginal (ORA) youth in Canada relative to Non-Aboriginal youth. Current smoking, susceptibility to future smoking and quit attempts were examined among a nationally representative sample of ORA and Non-Aboriginal Canadian youth. Data are from cross-sectional surveys of 88,661 respondents in Grades 6 to 9 across the 2004, 2006 and 2008 survey waves of the Youth Smoking Survey (YSS). At each wave, ORA youth were more likely to be current smokers (overall OR = 3.91, 95% CI 3.47 to 4.41), to be susceptible to future smoking (overall OR = 1.37, 95% CI 1.27 to 1.48), and less likely to have ever made a quit attempt compared to Non-Aboriginal youth (overall OR = 0.74, 95% CI 0.57 to 0.96). Although susceptibility to future smoking declined for Non-Aboriginal youth, the prevalence of susceptibility remained stable among ORA youth. The percentage of ORA youth reporting making a quit attempt increased, however, current smoking rates among ORA youth did not decline. These findings suggest that the disparity in susceptibility to future tobacco use among ORA and Non-Aboriginal youth has increased over time. Despite increased rates of quit attempts, current smoking rates remain significantly higher among ORA youth. Tobacco control programs for Aboriginal youth should be a public health priority.

Introduction: The objective of the study was to determine the brand distribution of premium, discount, and native cigarette brands and to identify the factors associated with smoking these brands among a nationally representative sample of Canadian youth smokers., Methods: Data from 3,137 current smokers in Grades 9-12 participating in the 2008-2009 Youth Smoking Survey (YSS) were used to examine the prevalence and factors associated with different cigarette brand preferences., Results: The most prevalent brand of cigarette smoked was premium cigarettes (44.7%), followed by discount cigarettes (33.7%), and to be native cigarettes (7.3%). There was significant variability in brand preference by province with the majority of youth in Atlantic Canada and Quebec smoking a discount brand of cigarettes and higher prevalence rates of native cigarette use in Ontario and Quebec. Respondents were more likely to smoke discount cigarettes if they were female, daily smokers, or if they only had $1-20 a week in spending money. Respondents were more likely to smoke native cigarettes if they were Aboriginal, heavier smokers, or if they reported having no weekly spending money., Conclusions: A significant proportion of students from Grade 9 to 12 in Canada smoke cigarettes that are more affordable than premium brands and it appears that the market share for these more affordable cigarette options has increased in recent years. Given that the price of cigarettes is an important determinant in youth smoking behavior, it is critical to develop and continue to enforce tobacco control strategies designed to eliminate access to cheaper sources of cigarettes among youth populations.

Background: Despite the apparent decline in the popularity of roll-your-own (RYO) cigarettes over the past few decades, RYO tobacco products are widely available and used by a substantial number of adult smokers. Considering research has yet to examine the prevalence of RYO tobacco use among youth populations, this manuscript examines the prevalence of RYO tobacco use and factors associated with RYO use in a nationally representative sample of youth smokers from Canada., Methods: This study used data collected from 3,630 current smokers in grades 9 to 12 as part of the 2008-09 Canadian Youth Smoking Survey (YSS). Descriptive analyses of the sample demographic characteristics, smoking status, cigarettes per day, weekly spending money, and frequency of marijuana use were examined by RYO tobacco ever use and RYO tobacco current use. Two logistic regression models were used to examine factors associated with RYO tobacco ever use and RYO tobacco current use., Results: We identified that 51.2% of current smokers were RYO ever users and 24.2% were RYO current users. The prevalence of RYO current users was highest in Atlantic Canada (40.1%) and lowest in Quebec (12.3%). RYO current users were more likely to be male (OR 1.27), to be daily smokers (OR 1.75), to use marijuana once a month or more (OR 2.74), and to smoke 11 or more cigarettes per day (OR 6.52). RYO current users were less likely to be in grade 11 (OR 0.65) or grade 12 (OR 0.40) and less likely to have between $20 to $100 (OR 0.44) or more than $100 (OR 0.45) of disposable income., Conclusions: Developing a better understanding of RYO tobacco use among youth is important for advancing population-level tobacco control prevention strategies and cessation programs. We identified that RYO tobacco use is not a negligible problem among Canadian youth. Ongoing research is needed to continue monitoring the prevalence of RYO use among youth and the factors associated with its use, but to also monitor if this more affordable tobacco product is being targeted to price sensitive youth smokers.

The current study examined the prevalence of alcohol, tobacco and drug use and comorbid use of these substances among 45,425 students in grades 7 to 12 as part of the 2008-09 Canadian Youth Smoking Survey. The results of this paper suggest that alcohol, tobacco, marijuana and illicit drugs are currently used by a substantial number of youth in Canada, and that comorbid use is also very widespread among users. Alcohol was the most prevalent substance used by youth and it was rare to find youth who had used tobacco or drugs without also currently using alcohol. By grade 12, the majority of students were current users of alcohol, tobacco or drugs. Future research should consider developing a better understanding of how to prevent substance use among this population., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Substance use is common among youth; however, our understanding of co-morbid tobacco, alcohol and marijuana use remains limited. The school-environment may play an important role in the likelihood a student engages in high risk substance use behaviors, including co-morbid use., Purpose: This study aims to: (i) describe the prevalence of co-morbid substance use behaviors among youth; (ii) identify and compare the characteristics of youth who currently use a single substance, any two substances, and all three substances; (iii) examine if the likelihood of co-morbid use varies by school and; (iv) examine what factors are associated with co-morbid use., Methods: This study used nationally representative data collected from students in grades 9 to 12 (n = 41,886) as part of the 2006-2007 Canadian Youth Smoking Survey (YSS). Demographic and behavioral data were collected including, current cigarette, alcohol and marijuana use. Results. 6.5% (n = 107,000) reported current use of all three substances and 20.3% (n = 333,000) of any two substances. Multi-level analysis revealed significant between school variability in the odds a student used all three substances and any two substances; accounting for 16.9% and 13.5% of the variability, respectively. Co-morbid use was associated with sex, grade, amount of available spending money and perceived academic performance., Conclusions: Co-morbid substance use is high among youth; however, not all schools share the same prevalence. Knowing the school characteristics that place particular schools at risk for student substance use is important for tailoring drug and alcohol education programs. Interventions that target the prevention of co-morbid substance use are required.

Understanding factors associated with youth cigarette access behaviours can provide insight into the development of more effective means of preventing youth from accessing cigarettes. This cross-sectional study used self-reported data collected from 41,886 students in grades 9 to 12 who participated in the 2006-07 Youth Smoking Survey to examine the student- and school-level characteristics that differentiate youth smokers who usually access cigarettes from a social source versus buying their own from retailers. Multi-level regression analyses revealed significant between-school variability in the odds of a smoking student reporting that they usually buy their own cigarettes. Important student-level characteristics associated with how youth usually access their cigarettes included binge drinking and being asked for age or photo identification when purchasing cigarettes from a retailer. Future studies should further explore the school- and student-level characteristics associated with youth cigarette access behaviour., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Introduction: In Canada, nicotine replacement therapy (NRT) is a best practice for adult smoking cessation, but it is not recommended for use among youth smokers. The purpose of this study was to determine the prevalence of NRT use among youth smokers in Canada and examine factors associated with its use., Methods: Data from 41,886, Grade 9-12 students who participated in the 2006-2007 Youth Smoking Survey were used to determine prevalence of NRT use. Logistic regression models were conducted to examine the association between NRT use by smoking status, demographic characteristics, and exposure to tobacco control programs., Results: In 2006-2007, 20.4% of current and former youth smokers in Canada had ever used NRT and 7.4% were currently using NRT. Among ever and current NRT users, 17.7% and 23.7%, respectively, had never tried to quit smoking. Odds of NRT use were highest among current smokers, older youths, boys, youths who had made multiple quit attempts, and youths with no disposable income. Participation in cessation counseling was significantly associated with increased NRT use, whereas attending antismoking classes in school was inversely associated with using NRT., Conclusions: A substantial number of Canadian youth use NRT, despite restrictions on its sale to this population. This study identifies characteristics associated with youths using NRT. Research is needed to elucidate mechanisms by which characteristics identified in this study affect NRT use. For example, it may be important to understand whether attending smoking cessation counseling induces NRT use in youths or vice versa.

Objectives: The current study team sought to understand smokeless tobacco (SLT) usage trends among youth, using nationally representative data collected as part of the Canadian Youth Smoking Survey (YSS) between 2004 and 2008., Methods: Descriptive analyses of SLT ever use among respondents in grades 6 to 9 were examined according to year of data collection (2008, n = 31,249; 2006, n = 34,050; and 2004, n = 23,362). Using the 2008 data from respondents in grades 6 to 12 (n = 51,922), logistic regression models were used to examine characteristics associated with SLT ever use and current use., Results: Between 2004 and 2008, the prevalence of youth in grades 6 to 9 reporting they have ever tried SLT significantly decreased by 30.8%. In 2008, male students were more likely than females to have tried SLT (OR 4.87, 95% CI 4.34-5.45) or to currently use SLT (OR 4.96, 95% CI 4.12-5.96). There are regional differences in prevalence of SLT use across Canada, with the highest rates in western provinces and the lowest in Quebec. Current smokers were also more likely to use SLT (OR 11.86, 95% CI 10.22-13.76) compared to non-smokers. Older students are more likely to report ever use or current use of SLT., Conclusion: The findings from this study demonstrate that in Canada, adolescent SLT use is primarily an issue with males and there are significant regional differences. Ongoing monitoring of SLT is encouraged considering the tobacco industry's recent investments and product development and increased use in countries like the United States.

Data from 29,296 students in grades 9-12 as part of the 2008-2009 Youth Smoking Survey were used to examine the prevalence of cigar, cigarillo, and little cigar use and factors associated with their use. Among Canadian youth in grades 9-12, 12.9% reported current use of cigarillos or little cigars, and 8.1% reported current use of cigars. The characteristics of youth most likely to use either cigars or cigarillos and little cigars were being male, being in grade 11 or 12, being a daily or occasional cigarette smoker, having more than $20 of weekly spending money, and having ever tried flavored tobacco. Our findings suggest that cigars, cigarillos, and little cigars are used by a substantial number of Canadian youth, many of whom do not smoke cigarettes. As such, current national prevalence estimates of youth smoking may be underestimated, and existing tobacco control prevention programs and policies may be overlooking a large population of at-risk youth.

Purpose: To examine the prevalence and associated factors of bidi and hookah use among Canadian youth., Methods: Data from 41,886 grade 7 to 12 youth were used to examine factors associated with bidi and hookah use., Results: Youth who are current or former cigarette smokers, have tried marijuana or alcohol, were more likely to use bidi or hookah., Conclusions: Results suggest bidi and hookah use may be an emerging issue in tobacco control among youth. Findings also support an integrated approach where future prevention efforts should address multiple risk behaviors., (Copyright © 2011 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: The purpose of this study was to explore school and individual characteristics associated with smoking susceptibility among a nationally representative sample of Canadian youth who were never-smokers., Methods: Using data from the 2006-07 Youth Smoking Survey, multi-level logistic regression modeling was used to examine if student-level and school-level characteristics were associated with smoking susceptibility among grade 9 to 12 never-smokers., Results: In 2006, 88.2% of Canadian youth in grades 9 to 12 were considered never-smokers, of whom 28.2% (n=255,840) were considered to be susceptible to future smoking. Significant between-school random variation in smoking susceptibility was identified, although the school-level smoking rate was not significantly associated with the risk of an individual student being susceptible. At the student level, smoking susceptibility was associated with having a sibling who smokes, having 1 or 2 close friends who smoke, having ever used alcohol or marijuana, being female and being in grade 9. Parental smoking and exposure to smoking in a car or in the home were not significantly associated with smoking susceptibility., Conclusion: One way to prevent smoking onset among youth is to interfere with the development of susceptibility to smoking in non-smoking youth population. We found that over 1 in 4 Canadian youth who were never-smokers in 2006 were considered susceptible to smoking in the future. Ongoing tobacco control prevention initiatives are crucial for reducing the prevalence of smoking susceptibility among non-smoking Canadian youth.

Background: Despite the high prevalence of smoking among Aboriginal youth, there is a paucity of research related to tobacco use and other risk behaviours among Aboriginal youth living off-reserve in Canada. We used data from the national Youth Smoking Survey to characterize non-traditional tobacco use, exposure to second-hand smoke, and alcohol and drug use among Aboriginal youth living off-reserve. We examined whether these youth were at increased health risk compared with non-Aboriginal youth., Methods: We examined cigarette smoking behaviour, use of other tobacco products, use of alcohol and other drugs, and exposure to second-hand smoke among 2620 Aboriginal youth living off-reserve and 26,223 non-Aboriginal youth in grades 9 to 12 who participated in the 2008/09 Youth Smoking Survey., Results: The prevalence of current smoking among the Aboriginal youth was more than double that among non-Aboriginal youth (24.9% v. 10.4%). Aboriginal youth also had a higher prevalence of regular exposure to second-hand smoke at home (37.3% v. 19.7%) and in cars (51.0% v. 30.3%). Aboriginal youth were more likely than non-Aboriginal youth to be current smokers, to be regularly exposed to second-hand smoke, to have tried marijuana and other illicit drugs, and to engage in binge drinking. They were less likely than non-Aboriginal youth to have tried to quit smoking., Interpretation: Current national estimates of smoking, and alcohol and illicit drug use among youth underestimate the prevalence of these behaviours among Aboriginal youth living off-reserve. Our findings highlight the need for culturally appropriate prevention and cessation policies and programs for this at-risk population.

Objectives: Given that little is known about how youth access contraband cigarettes, the current study seeks to examine factors associated with how underage smoking youth report usually accessing contraband cigarettes., Methods: This study used nationally representative data collected from 41,886 students (grades 9 to 12) as part of the 2006-07 Canadian Youth Smoking Survey (YSS). Using data from current smokers who report that their usual brand of cigarettes is contraband, three logistic regression models were used to examine factors associated with buying cigarettes from a store, getting cigarettes from a family member, or getting cigarettes from friends or strangers., Results: In 2006, 7.9% (n = 1 3,300) of Canadian youth who were current smokers reported that their usual brand of cigarettes was contraband. Among these youth, the majority reported that they usually get their cigarettes from a friend or stranger (54.8%), whereas 26.4% report usually getting them from a family member and 18.8% usually buying their own from a store. Boys were more likely to buy contraband cigarettes from a store, whereas youth with a parent who smokes contraband cigarettes were substantially more likely to get contraband cigarettes from a family member and youth with friends who smoke contraband cigarettes were substantially more likely to get contraband cigarettes from a friend or stranger., Conclusion: Ongoing surveillance of contraband cigarette use among youth and how youth access contraband cigarettes is required for guiding future tobacco control policy and programming activities.

Unlabelled: Pharmacists may be effective health care practitioners to deliver smoking cessation interventions. This paper examines the short-term outcomes of smokers randomized to one of two models of a pharmacist-led smoking cessation intervention., Methods: An open-label pragmatic randomized trial compared two models of a pharmacist-led behavioral intervention [Group A (3-sessions) vs. Group B (1-session)] in conjunction with 5 weeks of nicotine replacement therapy (NRT). Ninety-eight pharmacies in Ontario, Canada delivered the intervention. Baseline demographic and smoking behavior data were recorded, as were intervention characteristics. Self-reported, 7-day point prevalence quit rates were obtained 5-week postintervention start date., Results: 6,987 individuals participated; 51.4% (n = 3588) randomized to Group A; 48.6% (n = 3399) to Group B. Approximately, 50% of Group A participants completed all three sessions. Quit rates were significantly higher among Group A, 3-session completers (27.7%; n = 478) compared to Group B participants (18.0%; n = 604). Multivariable results suggest that even when controlling for possible confounders and clustering across pharmacies, Group A participants who completed all three sessions were more likely to quit compared to Group B [OR = 1.72 (95% CI: 1.53, 1.94)]., Conclusions: Cessation outcomes are higher among participants completing three intervention sessions compared to one session; however, many do not return for follow-up sessions.

Data from the Canadian Youth Smoking Survey (n = 27,030 in 2006; n = 16,705 in 2004; n = 11,757 in 2002) were used to examine changes in the prevalence and comorbid use of alcohol, tobacco, and marijuana over time and examine if demographic factors and binge drinking are associated with comorbid substance use among youth. Alcohol was the most prevalent substance used, and it was rare to find youth who had used tobacco or marijuana without also having tried alcohol. Youth who reported binge drinking were substantially more likely to also have tried tobacco and/or marijuana. These data suggest that multi-substance prevention programs are required for youth populations.

Purpose: The present study examines second-hand smoke (SHS) exposure and the beliefs youth have about being exposed to SHS in their home and in cars and explores changes in exposure and beliefs over time., Methods: Nationally representative data from the 2006 Youth Smoking Survey (YSS) were used to examine youth exposure to smoking and beliefs about smoking in the home and car among 71,003 Canadian youth in grades 5-12. Gender-specific logistic regression models were conducted to examine if being exposed to smoking at home or in the car were associated with the beliefs youth have about either smoking around kids at home or smoking around kids in cars., Results: In 2006, 22.1% of youth in grades 5-12 were exposed to smoking in their home on a daily or almost daily basis and 28.1% were exposed to smoking while riding in a car at least once in the previous week. The majority of youth reported that they do not think smoking should be allowed around kids at home (88.3%) or in cars (88.4%). Youth exposed to smoking in the home or in cars reported missing substantially more days of school in the previous month because of their health. Among both male and female youth, being an ever smoker, living in a house where someone smokes inside daily, and having ridden in a car with someone who was smoking cigarettes in the past seven days were all associated with being more likely to report that smoking should not be allowed around kids at home or in cars. Compared to their male counterparts, female youth with at least one parent who smokes were more likely to report that smoking should not be allowed around kids at home or in cars. As rates of SHS exposure in the home and car decreased between 2004 and 2006, the prevalence of youth who reported that they do not think smoking should be allowed around kids at home or in cars also decreased over the same period of time., Conclusions: These results highlight that Canadian youth are frequently exposed to SHS in their homes and in cars despite the fact that the vast majority of youth do not think smoking should be allowed around kids in those locations. Considering the health and social consequences associated with SHS exposure, it may be a timely opportunity to move forward with programs and policies designed to prevent individuals from smoking around youth in these locations.

Research has yet to examine how physical activity, body mass index (BMI) and concerns about weight among youth populations are associated with susceptibility to smoking among never smokers. The Physical Activity Module of the School Health Action, Planning and Evaluation System (SHAPES) was completed by 25,060 students in grades 9 to 12 within 76 secondary schools in Ontario (Canada) to examine how being overweight, weight concerns, and physical activity are associated with susceptibility to smoking in a large sample of youth. Among the 14,795 students who were never smokers, 3,809 (25.8%) were classified as susceptible to future smoking and 10,986 (74.2%) were classified as non-susceptible to future smoking. Smoking susceptibility was negatively associated with being highly active or at risk of overweight and positively associated with perceptions of being slightly overweight or slightly underweight. Students who report 1 or more hours of screen or phone time per day were also more likely to be susceptible. This is the first study to identify that susceptibility to future smoking among never smokers is associated with physical activity, overweight and concerns about weight. This is valuable new insight for tailoring and targeting future school-based tobacco control and/or physical activity programming to youth populations.

The authors characterized marijuana smoking among young adult Canadians, examined the co-morbidity of tobacco and marijuana use, and identified correlates associated with different marijuana use consumption patterns. Data were collected from 20,275 individuals as part of the 2004 Canadian Tobacco Use Monitoring Survey. Logistic regression models were conducted to examine characteristics associated with marijuana use behaviors among young adults (aged 15-24). Rates of marijuana use were highest among current smokers and lowest among never smokers. Marijuana use was more prevalent among males, young adults living in rural areas, and increased with age. Young adults who were still in school were more likely to have tried marijuana, although among those who had tried, young adults outside of school were more like to be heavy users. Males and those who first tried marijuana at an earlier age also reported more frequent marijuana use. These findings illustrate remarkably high rates of marijuana use and high co-morbidity of tobacco use among young adult Canadians. These findings suggest that future research should consider whether the increasing popularity of marijuana use among young adults represents a threat to the continuing decline in tobacco use among this population.

Background: Current tobacco access restrictions are ineffective because youth can find noncompliant retailers or social sources from which to get cigarettes., Purpose: The purpose of this study is to examine characteristics related to the cigarettes access behaviors of underage smoking youth., Methods: Data were collected from 20,297 students (Grades 9-12) attending 29 secondary schools in Ontario, Canada in 2001. Multilevel logistic regression analyses were used to examine how tobacco retailers surrounding schools, school smoking rates, and student characteristics were related to smokers buying their own cigarettes, getting someone else to buy their cigarettes, or getting their cigarettes from friends., Results: Among underage smokers, 34.3% usually buy their own cigarettes, and 42.1% report that they are never asked for their age when trying to buy cigarettes. The more tobacco retailers there were surrounding a school, the more likely smokers were to buy their own cigarettes and the less likely they were to get someone else to buy their cigarettes. Students' smoking habits were also related to their cigarette access behaviors., Conclusions: Tobacco retailer density surrounding schools is related to student cigarette access behaviors. Selective enforcement of youth access laws in retail outlets in close proximity to schools might help to prevent underage youth from smoking.

Cluster analysis modeling was used to identify distinct smoking taxonomies among 4,473 smokers from 29 secondary schools (2000-2001) in Ontario, Canada. Analyses revealed a two-cluster solution (4,349 [97.2%] situational smokers and 124 [2.8%] ubiquitous smokers). Different psychosocial characteristics influenced the smoking behavior of these unique groups. Our findings are substantially different from the traditional definitions for non-daily and daily smoking used in the literature, which typically impose rules about smoking frequency or volume when defining smoking status. These findings suggest that more robust taxonomies of youth smoking are required in future tobacco control research. The study's limitations are noted.

The purpose of this study was to examine how social models for smoking are related to smoking susceptibility among a sample of non-smoking elementary school students. The Tobacco Module of the School Health Action, Planning and Evaluation System (SHAPES) was administered to 6,431 students (grades 6 to 8) in 57 elementary schools in the province of Ontario, Canada. Multi-level logistic regression analysis was used to examine how smoking friends, parents, and the prevalence of smoking among grade 8 students at a school were related to smoking susceptibility among the 2,478 non-smoking grade 6 and 7 students. Findings indicate that non-smoking grade 6 and 7 students are more likely to be susceptible to smoking if they have (a) smoking friends, (b) a mother who smokes, or (c) two or more close friends who smoke and attend a school with a relatively high smoking rate among the grade 8 students. Sub-populations of non-smoking youth may be at increased risk for smoking because of the elementary school they attend. Future school-based smoking prevention programs might benefit from targeting prevention programming activities to the schools that are putting students at the greatest risk for smoking.

The purpose of the present study was to examine characteristics that predict interest in school-based cessation programs among 3136 youth smokers with intentions to quit smoking. The majority of youth smokers report that they would not join a school-based smoking cessation program. However, improving awareness of these types of programs among students is important as sub-populations of youth smokers were more likely to be interested in school-based cessation initiatives when aware that such programs exist. Future school-based cessation intervention outcomes might be improved if programs are targeted to the youth that are most likely to use them, if more youth can be made aware of existing programs, and if the benefits of participating in such programs can be more adequately conveyed to youth smokers.

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.

Background: To examine if the recommended taxonomies for the stages of youth smoking onset are aligned with the beliefs of smoking youth., Methods: The SHAPES Tobacco Module was administered to 23,047 students (grades 9 to 13) in a convenience sample of 29 secondary schools during the 2000-2001 school year in the province of Ontario, Canada. Cross-tabs were used to compare a student's self-perceived smoking status to their smoking status as determined with the currently recommended stage taxonomies for smoking behaviour., Results: The majority of students classified as regular smokers (52.4%) and experimental smokers (98.9%) did not actually consider themselves to be smokers. Self-reported smoking status appeared to be relatively consistent for the never smoker and established smoker categories., Conclusions: Additional research is required to develop stage taxonomies that are aligned with the self-perceptions of non-established youth smokers.

Objective: To examine how student beliefs about tobacco industry behaviour and marketing practices were related to occasional and regular smoking among 9th to 12th graders. These findings can provide insight for developing new tobacco industry denormalization messages for youth smoking populations., Methods: Cross-sectional data were collected from 14,767 grade 9 to 12 students attending 22 secondary schools within one Public Health Region of Canada using the Tobacco Module of School Heath Action, Planning and Evaluation System (SHAPES). Logistic regression analyses were used to determine if different beliefs about tobacco companies were able to differentiate never smokers from occasional smokers, and occasional smokers from regular smokers., Results: Occasional and regular smoking behaviour was significantly related to student beliefs about tobacco companies doing good things in the community, manipulating young people to think smoking is cool, advertising to youth, and using athletes and sports sponsorships to get young people to smoke., Conclusions: This study identified that beliefs about tobacco industry behaviour and marketing practices were related to youth smoking behaviour. In order to address the unique needs of smoking youth, discussions for future tobacco industry denormalization campaigns should consider messages tailored to focus on corporate social responsibility, sport and cultural event sponsorship and industry manipulation.

Background: This study examined how older smoking peers at school and the smoking behaviour of friends and family members are related to youth smoking., Methods: Multi-level logistic regression analysis was used to examine correlates of ever smoking in a sample of 4286 grade 6 and 7 students from 57 elementary schools in Ontario, Canada (2001)., Results: Each 1% increase in the smoking rate among grade 8 students increased the odds that a student in grades 6 or 7 was an ever smoker versus never smoker [OR 1.05, 95% CI 1.02 to 1.08]. A low-risk student (no family or friends who smoke) was almost three times more likely to try smoking if he/she attended an elementary school with a relatively high prevalence of senior students who smoke than if he/she attended a school with a low prevalence of senior students who smoke., Conclusion: Low-risk grade 6 and 7 students are at significantly greater risk of smoking if they attend an elementary school with a relatively high prevalence of smoking among senior students. Prevention programs should target both at-risk schools and at-risk students.

Objectives: To examine how older smoking peers at school and the smoking behavior of friends and family members are related to youth smoking., Methods: The School Smoking Profile was used to collect data on tobacco use and determinants of tobacco use from 22,091 students from 29 secondary schools in Ontario, Canada. Correlates of occasional and regular smoking were examined using multilevel logistic regression analyses., Results: Students are at increased risk for smoking if they (a) have smoking friends, (b) have smoking family members, and (c) attend a school with a relatively high senior-student smoking rate., Conclusion: These findings suggest that prevention programs should target both at-risk schools and at-risk students.

Purpose: To examine how social models in the school environment and individual student characteristics are related to smoking susceptibility., Methods: Using data from the School Smoking Profile Project, multi-level logistic regression analysis was used to identify school and student characteristics related to smoking susceptibility among 6679 never smokers from 29 secondary schools in Ontario, Canada., Results: If a nonsmoking student attended a school where there was student smoking on the school periphery, he or she was less likely to be susceptible to smoking (OR 0.71, 95% CI 0.57-0.89). A significant contextual interaction between the smoking on the school periphery and friends' disapproval of smoking was identified (beta = 0.68 [0.23], p < .01]; students with friends who disapprove of smoking were more likely to be susceptible to smoking if they attended a school with student smoking on the school periphery., Conclusion: Nonsmoking students who attend a school with student smoking on the school periphery are at an increased risk for being susceptible to smoking if they have friends who disapprove of smoking. Future school-based smoking prevention programs might benefit from targeting both individual students and entire schools with programming activities.

Background: Understanding the different ways underage youth access tobacco is required in order to develop more effective tobacco access restrictions. The purpose of this study was to examine characteristics that predict whether underage smoking youth buy their own cigarettes, buy their cigarettes from friends, or get someone else to buy their cigarettes., Methods: Logistic regression analyses were used to examine the predictors of three different tobacco access behaviours among 737 occasional smoking and 2,050 regular smoking youth., Results: Most smoking youth were asked their age less than half of the time when trying to buy cigarettes. Occasional smokers usually buy their cigarettes from a friend (59.5%) and the majority of regular smokers usually buy their own cigarettes (59.8%). Occasional smokers were less likely to buy their own cigarettes (OR 0.85) and more likely to ask someone else to buy their cigarettes (OR 1.24) the more frequently they were asked their age on purchase attempts. Regular smokers were also less likely to buy their own cigarettes (OR 0.70) and more likely to buy their cigarettes from someone else (OR 1.51) or a friend (OR 1.18) the more frequently they were asked their age on purchase attempts., Interpretation: Point-of-sale restrictions are insufficient to prevent youth from acquiring cigarettes because youth commonly access cigarettes from social sources. A more comprehensive approach for restricting access is required that targets both underage youth and individuals who purchase tobacco for underage youth.

This study examined how perceptions of student smoking in the school environment and the actual smoking rate among senior students at a school are related to smoking onset. Multilevel logistic regression analysis was used to examine correlates of ever smoking in a sample of 4,286 grade 6 and 7 students from 57 elementary schools in Ontario, Canada. Students are at increased risk for smoking if they (a) often see students smoking near their school, (b) report that students at their school smoke where they are not allowed, and (c) attend a school with a relatively high senior student smoking rate. Each 1% increase in the smoking rate among grade 8 students increased the odds that a student in grades 6 or 7 was an ever smoker versus never smoker (odds ratio, 1.05; 95% confidence interval, 1.02-1.08). A low-risk student (no family or friends who smoke) was over twice as likely to try smoking if he/she attended a high-risk school. Prevention programs should target both at-risk schools and at-risk students, and strongly enforced policies preventing students from smoking on or near school property should be implemented.

Background: Current research on the etiology of tobacco use has largely focused on identifying the influential psychosocial characteristics of individual students; the influences of characteristics in the school environment are generally ignored. The purpose of this study was to simultaneously examine how school and individual student characteristics were related to smoking onset., Method: Multilevel logistic regression analysis was used to examine how the senior student smoking rate at a school and the psychosocial characteristics of students were able to differentiate tried-once smokers from experimental smokers in a sample of 4850 grade 9, 10, and 11 students from the School Smoking Profile (SSP) project., Results: Each 1% increase in smoking rate among high school seniors increased the odds that a junior student was an experimental smoker vs. a tried-once smoker (OR 1.07, 95% CI 1.03-1.12). A significant contextual interaction was identified where the senior student smoking rate at a school moderates the negative influence of having close friends who smoke. Influential student characteristics were also identified., Conclusions: The smoking prevalence of older students at a school is directly related to smoking onset among younger students at that school. Prevention programs should target schools that put students at-risk.

Previous research indicates that the disproportionate distribution of income within society is associated with aggression and violence. Although research has been conducted identifying the relationship between income inequality and bullying victimization and perpetration, little is known about possible mediators. We investigated the association between income inequality and bullying perpetration and victimization among adolescents participating in the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behavior (COMPASS) study. We identified whether school connectedness and psychosocial well-being mediated the relationship between income inequality and bullying behavior. This study used pooled cross-sectional data from 147,748 adolescents aged 13 to 18 from three waves (2015-2016, 2016-2017, 2017-2018) of the COMPASS study from 157 secondary schools in British Columbia, Alberta, Ontario, and Quebec (Canada). The Gini coefficient was calculated based on the school Census Divisions (CD) using the Canada 2016 Census and linked with student data. We used multilevel modeling to investigate the relationship between income inequality and self-reported bullying victimization and perpetration, while controlling for individual-, school-, and CD-level characteristics. A standard deviation increase in Gini coefficient was associated with increased odds for bullying victimization and perpetration. Findings were observed among girls; however, inequality was only associated with perpetration among boys. We identified social cohesion and psychosocial well-being as potential mediators. To counter the adverse effects of income inequality, school-based interventions designed to increase school connectedness and student psychosocial well-being should be implemented to protect against bullying.

This study examined whether student tobacco, alcohol, marijuana use, and sedentary behaviour were associated with the educational outcomes of health-related absenteeism, truancy, and academic motivation in a nationally representative sample of Canadian youth. Descriptive analyses indicate a high proportion of students missed school due to health, and skipped class in the last month. Truancy increased with age, and male students are more likely to skip class and be less academically motivated. Logistic regression models showed significant associations exist between substance use and all three educational outcomes. These findings support the need for coordinated action and funding in student health promotion. (Contains 5 tables and 1 figure.)

Background: Although schools are considered opportune settings for youth health interventions, a gap between school health research and practice exists. COMPASS, a longitudinal study of Ontario and Alberta secondary students and schools (2012-2021), used integrated knowledge translation to enhance schools' uptake of research findings. Schools received annual summaries of their students' health behaviors and suggestions for action, and were linked with COMPASS knowledge brokers to support them in making changes to improve student health. This research examines the factors that influenced schools' participation in knowledge brokering and associated outcomes. Methods: School- and student-level data from the first 3 years of the COMPASS study (2012-2013; 2013-2014; 2014-2015) were used to examine factors that influenced knowledge brokering participation, school-level changes, and school-aggregated student health behaviors. Results: Both school characteristics and study-related factors influenced schools' participation in knowledge brokering. Knowledge brokering participation was significantly associated with school-level changes related to healthy eating, physical activity, and tobacco programming, but the impact of those changes was not evident at the aggregate student level. Conclusions: Knowledge brokering provided a platform for collaboration between researchers and school practitioners, and led to school-level changes. These findings can inform future researcher-school practitioner partnerships to ultimately enhance student health.