Association between contraband tobacco and illicit drug use among high school students in Canada.

A particularly challenging issue to tobacco cessation efforts is the availability of contraband cigarettes. While studies have linked contraband tobacco to smoking initiation and poor cessation outcomes, little is known about its association with illicit drug use among adolescents. We examine the association between contraband tobacco and illicit drug use among adolescent students using a national representative sample of 2,136 current smoker students in grades 9-12 from the 2010-2011 Youth Smoking Survey. About 31 % of adolescent current smokers in grades 9-12 use contraband cigarettes. Prevalence in the use of illicit drugs ranged from 9 to 37 %, with MDMA being the most commonly used drug. Adjusted logistic regression revealed that smokers of contraband cigarettes, when compared with non-contraband cigarette smokers, were more likely to use cocaine (OR 2.14; CI 1.29-3.56), heroin (OR 7.92; CI 3.00-20.91), amphetamines (OR 4.25; CI 2.07-8.74), MDMA (OR 2.00; CI 1.25-3.19), hallucinogens (OR 2.18; CI 1.34-3.55), and ketamine (OR 3.48; CI 1.61-7.54). This paper adds to the existing evidence of the negative effects of contraband tobacco by showing that adolescent contraband smokers are more likely to use illicit drugs. Given the addictive nature of these drugs and the potential for such behavior to spill over into adulthood, more efforts should be invested in addressing this problem.

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.

Is alcohol mixed with energy drinks consumption associated with susceptibility to smoking?

OBJECTIVE: This paper examines whether adolescent students in Canada who have never smoked but who drink alcohol mixed with energy drinks (AmED) are more susceptible to smoking than those who do not consume AmED. METHODS: A nationally representative sample of 15,875 never-smoking students in grades 9 to 12 from the 2010-2011 Canadian Youth Smoking Survey is used. The association between AmED and susceptibility to smoking is examined using a logistic regression. RESULTS: About 28% of the never-smoking adolescents in grades 9 to 12 are susceptible to smoking, and 13% report using AmED. Results of the adjusted logistic regression analysis show a statistically significant positive association between consuming AmED and susceptibility to smoking. Never-smoking students who reported using AmED are more susceptible to smoking when compared with those who have not consumed AmED (OR=1.89; 95% CI=1.71-2.10). Similar results are obtained when the analysis is stratified by gender. CONCLUSIONS: The consumption of AmED is associated with higher odds of smoking susceptibility among Canadian adolescents. AmED use could be a potential marker for smoking susceptibility among never-smoking adolescents.

Binge drinking and marijuana use among menthol and non-menthol adolescent smokers: findings from the youth smoking survey.

INTRODUCTION: Research has shown that smoking menthol cigarettes induces smoking initiation and hinders cessation efforts especially among youth. The objective of this paper is to examine the association between menthol cigarette smoking and substance use among adolescent students in Canada. METHODS: A nationally representative cross-sectional sample of 4466 Canadian students in grades 7 to 12 from the 2010-2011 Youth Smoking Survey is analyzed. A bivariate probit model is used jointly to examine the association of menthol smoking status with binge drinking and marijuana use. RESULTS: 32% of the current smokers in grades 7 to 12 smoke mentholated cigarettes, 73% are binge drinkers and 79% use marijuana. Results of the bivariate probit regression analysis, controlling for other covariates, show statistically significant differences in the likelihood of binge drinking and marijuana use between menthol and non-menthol smokers. Menthol cigarette smokers are 6% (ME=0.06, 95% CI=0.03-0.09) more likely to binge drink and 7% (ME=0.07, 95% CI=0.05-0.10) more likely to use marijuana. CONCLUSION: Smoking menthol cigarettes is associated with a higher likelihood of binge drinking and marijuana use among Canadian adolescents. Banning menthol in cigarettes may be beneficial to public health.

The effect of graphic cigarette warning labels on smoking behavior: evidence from the Canadian experience.

INTRODUCTION: There is a substantial literature that graphic tobacco warnings are effective; however, there is limited evidence based on actual smoking behavior. The objective of this paper is to assess the effect of graphic cigarette warning labels on smoking prevalence and quit attempts. METHODS: A nationally representative sample of individuals aged 15 years and older from the Canadian National Population Health Survey 1998-2008 is used. The sample consists of 4,853 individuals for the smoking prevalence regression and 1,549 smokers for quit attempts. The generalized estimating equation (GEE) model was used to examine the population-averaged (marginal) effects of tobacco graphic warnings on smoking prevalence and quit attempts. To assess the effect of graphic tobacco health warnings on smoking behavior, we used a scaled variable that takes the value of 0 for the first 6 months in 2001, then increases gradually to 1 from December 2001. RESULTS: We found that graphic warnings had a statistically significant effect on smoking prevalence and quit attempts. In particular, the warnings decreased the odds of being a smoker (odds ratio [OR] = 0.875; 95% CI = 0.821-0.932) and increased the odds of making a quit attempt (OR = 1.330, CI = 1.187-1.490). Similar results were obtained when we allowed for more time for the warnings to appear in retail outlets. CONCLUSION: This study adds to the growing body of evidence on the effectiveness of graphic warnings. Our findings suggest that warnings had a significant effect on smoking prevalence and quit attempts in Canada.

The relationship between job stress and body mass index using longitudinal data from Canada.

OBJECTIVE: This paper examines the effect of job stress, as measured by the job strain model (high job demands and low job control) on an individual's body mass index (BMI) using data from the Canadian National Population Health Survey. METHODS: We use panel data estimation methods to account for unobserved individual-level heterogeneity to better examine the relationship between job-related stress and BMI. RESULTS: Results from the fixed effects and random effects models show no statistically significant difference in BMI levels between individuals in jobs with high/medium strain compared to jobs with low strain. However, in the cross-sectional OLS model, job stress has a positive and significant effect on BMI. These analyses control for socio-demographic factors, lifestyle behavior, workplace social support, occupational and provincial fixed effects. The results suggest that the mixed findings in the previous studies may in part be due to unobserved characteristics that cannot be controlled for using standard cross-sectional analysis. CONCLUSION: This study results suggest the need for further longitudinal evidence in order to have a better understanding of the relationship between job stress and body weight.

The association between workplace smoking bans and self-perceived, work-related stress among smoking workers.

BACKGROUND: There is substantial empirical evidence on the benefits of smoking bans; however, the unintended consequences of this anti-smoking measure have received little attention. This paper examines whether workplace smoking bans (WSB's) are associated with higher self-perceived, work-related stress among smoking workers. METHODS: A longitudinal representative sample of 3,237 individuals from the Canadian National Population Health Survey from 2000 to 2008 is used. Work-related stress is derived from a 12-item job questionnaire. Two categories of WSB's, full and partial, are included in the analysis, with no ban being the reference category. Analysis also controls for individual socio-demographic characteristics, health status, provincial and occupational fixed-effects. We use fixed-effects linear regression to control for individual time-invariant confounders, both measured and unmeasured, which can affect the relationship between WSB's and work-related stress. To examine the heterogeneous effects of WSB's, the analysis is stratified by gender and age. We check the robustness of our results by re-estimating the baseline specification with the addition of different control variables and a separate analysis for non-smokers. RESULTS: Multivariate analysis reveals a positive and statistically significant association between full (ß = 0.75, CI = 0.19-1.32) or partial (ß = 0.69, CI = 0.12-1.26) WSB's, and the level of self-perceived, work-related stress among smoking workers compared to those with no WSB. We also find that this association varies by gender and age. In particular, WSB's are significantly associated with higher work stress only for males and young adults (aged 18-40). No statistically significant association is found between WSB's and the level of self-perceived work-related stress among non-smoking workers. CONCLUSION: The results of this study do not imply that WSB's are the main determinant of self-perceived, work-related stress among smokers but provides suggestive evidence that these may be positively related.

Eating behavior and obesity in Canada: evidence from panel data.

BACKGROUND: Although a growing body of research has examined the association between food prices and the availability of fast food restaurants on weight outcomes, there is limited empirical evidence on the direct effect of eating behavior on body weight. OBJECTIVE: The effect of eating behavior on obesity prevalence among Canadians is examined. METHODS: A nationally representative sample from the Canadian National Population Health Survey (2000-2008) with 29 722 observations is used. Obesity prevalence is estimated by a linear probability model using cross-sectional and panel estimation methods. Separate regressions are estimated for males and females. RESULTS: Multivariate analyses suggest that eating behavior has a statistically significant effect on obesity prevalence. In particular, individuals who reported excellent, very good, and good eating behavior have a lower risk of obesity compared with those with fair or poor eating behavior. Although cross-sectional and panel data methods produce consistent results, the cross-sectional model overestimates the effect of eating behavior on the risk of obesity. This highlights the importance of controlling for unobserved individual factors that may affect how eating behavior is related to body weight. CONCLUSION: Evidence is found showing that eating behavior is an important determinant of obesity prevalence. The findings suggest that improving the eating behavior of individuals would help reduce excessive body weight and its induced health risks.

Disparities in the frequency of fruit and vegetable consumption by socio-demographic and lifestyle characteristics in Canada.

BACKGROUND: The health benefits of adequate fruit and vegetable (F&V) consumption are significant and widely documented. However, many individuals self-report low F&V consumption frequency per day. This paper examines the disparities in the frequency of F&V consumption by socio-demographic and lifestyle characteristics. METHOD: This study uses a representative sample of 93,719 individuals from the Canadian Community Health Survey (2007). A quantile regression model is estimated in order to capture the differential effects of F&V determinants across the conditional distribution of F&V consumption. RESULTS: The conditional and unconditional analyses reveal the existence of a socioeconomic gradient in F&V consumption frequency, in which the low income-education groups consume F&V less frequently than the high income-education groups. We also find significant disparities in F&V consumption frequency by demographic and lifestyle characteristics. The frequency of F&V consumption is relatively lower among: males, those in middle age, singles, smokers, individuals with weak social interaction and households with no children. The quantile regression results show that the association between F&V consumption frequency, and socio-demographic and lifestyle factors varies significantly along the conditional F&V consumption distribution. In particular, individual educational attainment is positively and significantly associated with F&V consumption frequency across different parts of the F&V distribution, while the income level matters only over the lower half of the distribution. F&V consumption follows a U-shaped pattern across the age categories. Those aged 30-39, 40-49 and 50-59 years consume F&V less frequently than those aged 18-29 years. The smallest F&V consumption is among the middle aged adults (40-49). CONCLUSIONS: Understanding the socio-demographic and lifestyle characteristics of individuals with low F&V consumption frequency could increase the effectiveness of policies aimed at promoting F&V consumption. The differential effects of individual characteristics along the F&V consumption distribution suggest the need for a multifaceted approach to address the variation in F&V consumption frequency.

Psychosocial working conditions and the utilization of health care services.

BACKGROUND: While there is considerable theoretical and empirical evidence on how job stress affects physical and mental health, few studies have examined the association between job related stress and health care utilization. Using data from the Canadian National Population Health Survey from 2000 to 2008, this paper examines the association between stressful working conditions, as measured by the job strain model, and the utilization of health care services. METHODS: A zero inflated negative binomial regression is used to examine the excess health care utilization due to job strain. Separate regressions are estimated for both males and females since studies have shown gender differences in health care utilization. RESULTS: Estimates for the whole population show that high or medium job strain has a positive and statistically significant association with the number of visits to both a general practitioner (GP) and a specialist (SP). On average, the number of GP visits is up to 26% more (IRR = 1.26, 95% CI = 1.19-1.31) for individuals with high strain jobs compared to those in the low job strain category. Similarly, SP visits are up to 27% more (IRR = 1.27, 95% CI = 1.14-142) for the high strain category. Results are quantitatively similar for males and females, save for medium strain. In general, findings are robust to the inclusion of workplace social support, health status, provincial and occupational-fixed effects. CONCLUSION: Job strain may be positively associated with the utilization of health care services. This suggests that improving psychosocial working conditions and educating workers on stress-coping mechanisms could be beneficial for the physical and mental health of workers.

The effect of job stress on smoking and alcohol consumption.

This paper examines the effect of job stress on two key health risk-behaviors: smoking and alcohol consumption, using data from the Canadian National Population Health Survey. Findings in the extant literature are inconclusive and are mainly based on standard models which can model differential responses to job stress only by observed characteristics. However, the effect of job stress on smoking and drinking may largely depend on unobserved characteristics such as: self control, stress-coping ability, personality traits and health preferences. Accordingly, we use a latent class model to capture heterogeneous responses to job stress. Our results suggest that the effects of job stress on smoking and alcohol consumption differ substantially for at least two "types" of individuals, light and heavy users. In particular, we find that job stress has a positive and statistically significant impact on smoking intensity, but only for light smokers, while it has a positive and significant impact on alcohol consumption mainly for heavy drinkers. These results provide suggestive evidence that the mixed findings in previous studies may partly be due to unobserved individual heterogeneity which is not captured by standard models.