Are experimental smokers different from their never-smoking classmates? A multilevel analysis of Canadian youth in grades 9 to 12.

INTRODUCTION: Understanding the characteristics of experimental smoking among youth is critical for designing prevention programs. This study examined which student- and school-level factors differentiated experimental smokers from never smokers in a nationally representative sample of Canadian students in grades 9 to 12. METHODS: School-level data from the 2006 Canadian Census and one built environment characteristic (tobacco retailer density) were linked with data from secondary school students from the 2008-2009 Canadian Youth Smoking Survey and examined using multilevel logistic regression analyses. RESULTS: Experimental smoking rates varied across schools (p < .001). The location (adjusted odds ratio [AOR] = 0.66, 95% CI: 0.49-0.89) of the school (urban vs. rural) was associated with the odds of a student being an experimental smoker versus a never smoker when adjusting for student characteristics. Students were more likely to be experimental smokers if they were in a lower grade, reported low school connectedness, used alcohol or marijuana, believed that smoking can help people relax, received pocket money each week and had a family member or close friend who smoked cigarettes. CONCLUSION: School-based tobacco prevention programs need to be grade-sensitive and comprehensive in scope; include strategies that can increase students' attachment to their school; and address multi-substance use, tobacco-related beliefs and the use of pocket money. These programs should also reach out to students who have smoking friends and family members. Schools located in rural settings may require additional resources.

TITRE: Les fumeurs à titre expérimental sont-ils différents de leurs camarades de classe n'ayant jamais fumé? Une analyse multiniveaux des jeunes Canadiens de la 9e à la 12e année. INTRODUCTION: Il est essentiel de comprendre les caractéristiques du tabagisme expérimental chez les jeunes pour élaborer des programmes de prévention. Dans cette étude, nous avons analysé, à partir d'un échantillon représentatif des élèves canadiens de la 9e à la 12e année, les facteurs relatifs aux élèves et les facteurs relatifs aux écoles qui différenciaient les fumeurs à titre expérimental des élèves n'ayant jamais fumé. MÉTHODOLOGIE: Des données relatives aux écoles recueillies dans le cadre du Recensement de 2006 ainsi qu'une caractéristique relative au milieu bâti (densité des détaillants de produits du tabac) ont été reliées à des données relatives aux élèves du secondaire tirées de l'Enquête sur le tabagisme chez les jeunes de 2008-2009 et ont été soumises à une série d'analyses par régression logistique multiniveaux. RÉSULTATS: Le taux de tabagisme expérimental variait d'une école à l'autre (p < 0,001). Après ajustement en fonction des caractéristiques des élèves, on a observé une association entre l'emplacement (rapport de cotes ajusté = 0,66, intervalle de confiance à 95 % : 0,49 à 0,89) de l'école (milieu urbain ou rural) et le risque qu'un élève soit fumeur à titre expérimental plutôt qu'élève n'ayant jamais fumé. Les élèves étaient plus susceptibles d'être fumeurs à titre expérimental s'ils étaient d'un niveau scolaire inférieur, s'ils avaient un faible sentiment d'appartenance à leur école, s'ils consommaient de l'alcool ou de la marijuana, s'ils croyaient que le tabagisme avait un effet apaisant, s'ils recevaient de l'argent de poche chaque semaine et si un membre de leur famille ou un de leurs amis intimes fumait des cigarettes. CONCLUSION: Les programmes de prévention du tabagisme en milieu scolaire doivent à la fois être adaptés au niveau scolaire et exhaustifs, comprendre des stratégies visant à accroître le sentiment d'appartenance des élèves à leur école et tenir compte du phénomène de polyconsommation, des croyances relatives au tabagisme et de l'utilisation qui est faite de l'argent de poche. Ces programmes devraient également cibler les élèves dont un ami ou un membre de la famille fume. Par ailleurs, les écoles situées en milieu rural pourraient avoir besoin de ressources supplémentaires.

Research methods of the Youth Smoking Survey (YSS).

This paper describes the survey development, design and data collection protocol for the 2008/2009 Youth Smoking Survey (YSS) and the changes to the YSS survey and protocols across the 5 survey cycles (1994, 2002, 2004/2005, 2006/2007, 2008/2009). Canada's Youth Smoking Survey is a nationally representative school-based survey of students (grades 6 to 12 in 2008/2009) from randomly sampled public and private schools in the ten provinces. The main objective of the YSS is to provide benchmark data on national smoking prevalence rates for youth. Key features of the 2008/2009 YSS include consistent measures across survey cycles, a survey team of researchers and non-governmental organizations, a link to school and student level measures, provision of tailored feedback reports to schools and publicly available datasets.

Factors related to adolescents' estimation of peer smoking prevalence.

Although adolescents who overestimate peer smoking prevalence are more likely to smoke, little research has focused on the factors associated with why the majority of adolescents overestimate peer smoking rate. The purpose of this study was to examine demographic, social, environmental and behavioural characteristics related to overestimation of peer smoking prevalence among secondary school students. The current study analysed data collected in two Canadian studies that used the Tobacco Module of the School Health Action, Planning and Evaluation System, a school-based questionnaire. One study surveyed 23 458 students (Grades 9-13) in 29 schools during 2001-02, and the other surveyed 25 452 students in 39 schools in 2003. Results of multiple logistic regression indicate that grade, gender, close friends' smoking, seeing smoking at school, family members' smoking, smoking in the home and smoking status have a clear association with overestimation; school smoking rate and susceptibility to smoking show a tentative relationship and warrant further study. Other factors may also be important for prevalence estimation, and further research is needed to identify these factors. Since adolescents tend to overestimate peer smoking prevalence and perceived prevalence is in turn linked to smoking behaviour, interventions should focus on creating realistic perceptions of smoking prevalence.

Effectiveness of a social influences smoking prevention program as a function of provider type, training method, and school risk.

OBJECTIVES: This study determined the effect of provider (nurse or teacher) and training method (workshop or self-preparation) on outcomes of a social influences smoking prevention program. METHODS: One hundred elementary schools were stratified by school risk score (high risk = high smoking rate among senior students) and assigned randomly to conditions: (1) teacher/self-preparation, (2) teacher/workshop, (3) nurse/self-preparation, (4) nurse/workshop, and (5) control. Intervention occurred in grades 6 to 8. Smoking status at the end of grade 8 was the primary endpoint variable. RESULTS: Intervention reduced grade 8 smoking rates in high-risk schools (smoking rates of 26.9% in control vs 16.0% in intervention schools) but not in low-risk schools. There were no significant differences in outcome as a function of training method and no significant differences in outcome between teacher-provided and nurse-provided interventions in high- and medium-risk schools. Although nurses achieved better outcomes than did teachers in low-risk schools, neither provider type achieved outcomes superior to the control condition in those schools. CONCLUSIONS: Workshop training did not affect outcomes. Teachers and nurses were equally effective providers. Results suggest that programming should target high-risk schools.

School-based smoking control: a research agenda.

Within the context of a framework for cancer control, this article reviews evidence and suggests research directions for 3 types of school-based smoking interventions: elementary school prevention, secondary school interventions and interventions linking community and school. Directions for smoking research in elementary schools include improving adoption through the provision of effectiveness criteria, tailoring interventions to schools and training. Monitoring at micro and macro levels may help planning and implementation, but clearer evidence is required of its feasibility. Fundamental research should explore new options to understand why youth do not start smoking. Smoking intervention research at the secondary school level is less well established, with only 1 effectiveness trial reported. We recommend testing models that involve youth in developing their own solutions and examining the interaction of various control measures. Sustainability issues have led researchers to embed school-based smoking interventions in community-wide activities. Intervention research of this sort still needs to determine how to apply approaches (e.g., comprehensive school health) and what the appropriate roles are (such as technical assistance) for community agencies. All research using these school-community approaches needs to include process measures to explain potential failures to obtain significant differences between components. In addition, we call for research on the training of educators and health personnel, to increase the priority given to smoking prevention and improve the implementation of existing programs. Research on policy initiatives that lead to effective training needs to be explored. Finally, we argue that application of the principles incorporated into the cancer control framework (e.g., through participatory research methods) strengthens the research process and results.

Obesity in family practice: is treatment effective?

Obesity is a common condition which has important effects on health status and longevity. This review examines the efficacy of treatments for both moderate and severe obesity. A plan of treatment combining diet, exercise, and behavioral strategies is outlined. Surgery and its complications are reviewed. Eight management issues, including rate of weight loss, self-help groups, and fringe therapies, are presented. Management recommendations are based on a critical review of the weight loss literature.