Factors associated with different cigarette access behaviours among underage smoking youth who usually smoke contraband (native) cigarettes.
Leatherdale, Scott T. ; Ahmed, Rashid ; Vu, Mary 等
Point-of-sale access restrictions have been developed to prevent
under-age youth from purchasing tobacco, (1,2) yet they are often
ineffective. (3-5) It is common for youth to obtain cigarettes through
retailers or through social sources such as family, friends and
strangers. (3,4,6-8) Under-age youth obtain cigarettes relatively
easily, even with access restrictions. We also know that although
smoking rates have declined in recent years, (9) the recent emergence of
contraband cigarettes is cause for concern. According to the Royal
Canadian Mounted Police (RCMP), there are currently four major types of
contraband tobacco available in the Canadian market: 1)
unlawfully/lawfully manufactured Canadian products or US products
smuggled into Canada; 2) diverted tax-exempt tobacco products; 3)
counterfeit tobacco products; and 4) tobacco products from other
criminal activities (i.e., cargo thefts, store thefts, etc.). (10) At
the present time, two of the larger sources of contraband tobacco in
Canada are: native manufacturers that either unlawfully or lawfully
manufacture products in Canada or in the US and then smuggle them into
Canada; and tax-exempt cigarettes designated for purchase by Aboriginals
on First Nations Reserves that are illegally diverted to the general
population. (10) Not only are contraband cigarettes more affordable for
youth smokers (which is important given the association between the
price of cigarettes and youth smoking prevalence (11), but they also
appear to undermine access restrictions. (12) For instance, research
suggests that strategies that effectively restrict commercial access to
cigarettes can increase the reliance youth have on social sources of
contraband cigarettes. (13) Considering the extremely low price and the
apparent ease with which youth smokers access these products, (14-16) we
need to better understand how youth smokers access contraband
cigarettes.
Social Cognitive Theory (17) suggests that social, personal and
behavioural characteristics would be associated with how youth access
cigarettes. This has been supported with empirical research.
(3,6,7,13-22) For instance, youth smokers commonly report getting
cigarettes from friends or strangers. (6,7,13,18,19) We also know that
youth who believe it is difficult to obtain tobacco from retailers are
more apt to use social sources such as family members, (20) whereas
heavier smokers are more likely to buy their own from a store.
(3,12,21,22) The current study seeks to explore if characteristics from
these three domains are associated with the cigarette access behaviour
of Canadian youth who smoke contraband cigarettes.
METHODS
This exploratory study used nationally representative data
collected from 41,886 students in grades 9 to 12 as part of the 2006-07
Canadian Youth Smoking Survey (YSS). (9) In brief, the target population
for this paper consisted of all young Canadian residents in grades 9 to
12 attending public and private secondary schools in 10 Canadian
provinces; youth residing in the Yukon, Nunavut and the Northwest
Territories were excluded from the target population, as were youth
living in institutions or on First Nation Reserves, and youth attending
special schools or schools on military bases. The sample design
consisted of a two-stage stratified clustered design with schools as
primary sampling units and classes as secondary sampling units. All of
the students in the selected classes were surveyed during class time and
participants were not provided compensation. The survey design and
sample weights allow us to produce population-based estimates in this
paper. Active information with passive consent was used to reduce
demands on schools and to increase student participation rates. The
researcher informed the parents of the students via mail, and asked them
to call a toll-free number if they refused their child's
participation. The University of Waterloo Office of Research Ethics and
appropriate School Board and Public Health Ethics committees approved
all procedures, including passive consent. Detailed information on the
2006-07 YSS is available in print9 or online (www.yss.uwaterloo.ca).
Consistent with previous research,12,16 current smokers were asked
to indicate "What brand of cigarette do you usually smoke?" A
list of popular Canadian cigarette brands consumed by youth was listed
and respondents indicated their usual brand. From this list, we were
able to identify youth smokers who usually smoke contraband cigarettes
based on respondents stating that their usual brand of cigarette was
"cigarettes from First Nations/Native Brands". Also consistent
with previous research, (3) respondents were asked "Where do you
usually get your cigarettes?" A list of sources was provided and
respondents indicated their usual source. Responses were grouped into
three categories: buys them from a store, gets them from a family
member, gets them from a friend or stranger. Correlate measures for
socio-demographic, personal and behavioural characteristics are
consistent with previous research. (9,12,16)
Using data from current smokers who usually smoke contraband
cigarettes, descriptive analyses examining cigarette access behaviour
were performed according to social, personal and behavioural
characteristics. We then conducted three series of logistic regression
models to examine factors that differentiate our three different access
behaviours: Series 1 examined all of the socio-demographic
characteristics; Series 2 examined all of the personal characteristics;
and Series 3 examined all of the behavioural characteristics. We do not
present the results of a final model examining the significant
characteristics from Series 1 to 3 due to the large effect sizes from
variables in Series 2. Survey weights were used in the descriptive
statistics to adjust for differential response rates across regions or
groups. The statistical package SAS 8.02 was used for all analyses. (23)
RESULTS
In 2006, 10.2% (n=167,900) of Canadian youth in grades 9 to 12 were
current smokers and 7.9% (n=13,300) reported that their usual brand of
cigarettes was contraband. Among these youth, the majority reported that
they usually got their cigarettes from a friend or stranger (54.8%),
whereas 26.4% reported usually getting them from a family member and
18.8% usually buying their own from a store. Descriptive statistics by
cigarette access behaviours are presented in Table 1.
Girls were more likely to report getting cigarettes from a friend
or stranger, whereas boys were more likely to report buying their
cigarettes from a store ([chi square] = 12.39, df=2, p<0.01).
Similarly, youth in grades 9 and 10 were more likely to report getting
cigarettes from a friend or stranger, whereas youth in grades 11 and 12
were more likely to report buying cigarettes from a store ([chi square]
= 6.30, df=2, p<0.05). Youth were more likely to get cigarettes from
a family member if their parents smoked the same brand ([chi square] =
78.39, df=2, p<0.001). Youth who were heavier smokers were more
likely to buy cigarettes from a store compared to youth who were lighter
smokers ([chi square] =17.71, df=2, p<0.001). Results of the logistic
regression models examining socio-demographic characteristics are
presented in Table 2, personal characteristics in Table 3, and
behavioural characteristics in Table 4.
Factors associated with buying cigarettes from a store
In terms of socio-demographic characteristics, boys were more
likely than girls to buy cigarettes from a store, as were Aboriginal
youth and youth with five or more close friends who smoke. In terms of
personal characteristics, youth who reported that a reason for smoking
their usual brand was because they like the taste were more likely to
buy cigarettes from a store, whereas youth were less likely to report
buying cigarettes from a store if they reported that a reason for
smoking their usual brand was because those were the only cigarettes
they could get. In terms of behavioural characteristics, youth were less
likely to report buying cigarettes from a store if they have asked a
stranger to buy them cigarettes in the last 30 days.
Factors associated with getting cigarettes from a family member
In terms of socio-demographic characteristics, youth were more
likely to get cigarettes from a family member if they were Aboriginal or
had a parent who smokes. In terms of personal characteristics, youth who
reported that a reason for smoking their usual brand was because their
parents smoke the same brand were substantially more likely to get
cigarettes from a family member, whereas youth were less likely to
report getting cigarettes from a family member if they reported that a
reason for smoking their usual brand was because their friends smoke the
same brand. In terms of behavioural characteristics, youth were more
likely to get cigarettes from a family member if they smoked 11 or more
cigarettes per day or had asked a stranger to buy the cigarettes in the
last 30 days, whereas youth were less likely to report getting
cigarettes from a family member if they reported that they sometimes
share cigarettes.
Factors associated with getting cigarettes from a friend or
stranger
In terms of socio-demographic characteristics, youth were less
likely to report getting cigarettes from a friend or stranger if they
were a boy, Aboriginal, or if they had a parent who smokes. In terms of
personal characteristics, youth were more likely to get cigarettes from
a friend or stranger if they reported that a reason for smoking their
usual brand was because their friends smoke the same brand or the brand
costs less than others. Conversely, youth were less likely to get
cigarettes from a friend or stranger if they reported that a reason for
smoking their usual brand was because their parents smoke the same brand
or they like the taste. In terms of behavioural characteristics, youth
were more likely to report getting cigarettes from a friend or stranger
if they sometimes or usually or always share cigarettes with others,
whereas they were less likely to get cigarettes from a friend or
stranger if they smoke 11 or more cigarettes per day.
DISCUSSION
The data presented here suggest that Canadian youth commonly access
contraband cigarettes from friends, family members, and directly from
retailers. The results highlight two emerging concerns. First, a
substantial number of youth smokers report accessing their contraband
cigarettes from a family member, especially if their parent also smokes
contraband cigarettes. Second, it appears that a considerable number of
tobacco retailers are providing under-age smoking youth with access to
contraband cigarettes. Ongoing surveillance of the contraband cigarette
use among youth and how youth access contraband cigarettes is required
for guiding future tobacco control activities.
These results suggest that any attempts to reduce youth access to
contraband tobacco must encompass restrictions on retailers, and
policies designed to discourage family members and other social sources
from providing youth with contraband cigarettes. However, given the
challenges of developing policies to regulate the behaviour of family
and social sources, it may be more feasible to begin with policies aimed
at changing the behaviour of retailers. Our finding that youth commonly
report getting contraband cigarettes from retailers suggests that there
is an immediate need to impose and enforce strict regulations and
penalties for retailers who sell contraband cigarettes. For instance, it
may be timely to evaluate the effectiveness of new licensing strategies
that would allow regulatory bodies to remove the license of retailers
caught illegally selling any tobacco products (especially contraband) to
minors. It may also be timely to consider moving toward a system of
designated sales outlets run by the government as a mechanism to
continually reduce the number of tobacco retailers that provide
under-age youth with access to cigarettes. This type of approach may be
especially timely as the Canadian Convenience Stores Association (CCSA)
is currently trying to advance their own agenda to reduce the
availability of contraband tobacco: 2010 Contraband Objective (refer to
www.10-2010contrabandobjective.com). Considering that the current CCSA
president has previously worked as a public relations representative for
two tobacco companies (Benson & Hedges (currently Rothman's
Benson & Hedges) and Imasco Ltd. (Imasco controlled Imperial Tobacco
at that time)), there is an urgent need for this issue to be led by the
public health community and not a group with ties to the tobacco
industry.
The most alarming finding was that a large number of youth report
accessing contraband tobacco from family members. For instance, it was
almost inevitable that a smoking youth reported usually getting
contraband cigarettes from a family member if they also reported that
their parent smokes contraband cigarettes. This is consistent with
research on non-contraband tobacco from the UK which identified that
smoking youth commonly reported acquiring contraband cigarettes from
their parents. (13) Although it would be difficult to restrict social
access from parents through legislation, there appears to be a dire need
to identify effective means to curb the practice of parents providing
their children with contraband cigarettes. A recent report on better
practices in contraband tobacco control suggests that public awareness
campaigns may have some impact by clearly outlining to consumers which
cigarettes are illegal, (24) however, our data suggest that such
campaigns should also consider highlighting the social responsibility of
parents to not provide contraband tobacco to their children. Parents
need to clearly understand how their actions can facilitate tobacco use
progression among their children, and understand that they are modelling
participation in an illicit behaviour.
This study also identified that Aboriginal youth were more likely
than non-Aboriginal youth to either buy their own contraband cigarettes
or get their cigarettes from a family member. Under Canadian law, First
Nations people purchasing cigarettes on reserves are exempt from federal
sales tax and provincial tobacco tax; however, Aboriginal youth
purchasing tobacco off-reserve would be subject to paying tobacco taxes.
(10) Since the YSS does not collect data from students located on
reserves, this suggests that the native brand cigarettes used by
Aboriginal youth in our study would be considered contraband products,
and also suggests that tailored policies and interventions may be
required to prevent retailers and family members from providing
Aboriginal youth with contraband tobacco products.
Although youth commonly access non-contraband cigarettes from
friends, (13,19) we identified that having smoking friends was actually
associated with an increased likelihood of youth buying their own
cigarettes. However, among youth who also reported that a reason they
smoke contraband cigarettes was because their friends smoke the same
brand, their likelihood of getting contraband cigarettes from friends
increased dramatically. Considering that youth who reported frequently
sharing cigarettes were also more likely to report usually getting their
cigarettes from friends suggests that we need to develop a better
understanding of how youth access and exchange contraband tobacco within
their social networks. This may be especially important as the Royal
Canadian Mounted Police (RCMP) have recently stated that youth are
becoming increasingly involved in organized crime through the
distribution of contraband tobacco. (10)
Although the response rate was high and the data were weighted to
help account for non-response, the findings are nevertheless subject to
sample bias. The findings also likely reflect some underreporting for
contraband tobacco use considering we were only able to identify smokers
of contraband tobacco based on the brand that smokers reported they
usually smoke rather than the brand(s) that they may also periodically
smoke. Similarly, our measures are specific to how youth report usually
accessing tobacco, rather than how they may also sporadically access
tobacco. The cross-sectional design does not allow for causal inferences
regarding the associations examined in this paper. Longitudinal data are
required to determine the temporal relationships among correlates.
Acknowledgements: The authors thank the Propel Centre for
Population Health Impact and the Interdisciplinary Capacity Enhancement
Program at the University of Waterloo for providing support for this
project. Dr. Leatherdale is a Cancer Care Ontario Research Chair in
Population Studies. The 2006-2007 Youth Smoking Survey is a product of a
pan-Canadian capacity-building project that includes Canadian tobacco
control researchers from all provinces and provides training
opportunities for university students at all levels. Production of this
paper has been made possible through a financial contribution from
Health Canada. The views expressed herein do not necessarily represent
the views of Health Canada.
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Received: June 17, 2010
Accepted: October 2, 2010
Author Affiliations
Scott T. Leatherdale, PhD, [1-3] Rashid Ahmed, MSc, [2] Mary Vu,
BSc [4]
[1] Department of Population Studies and Surveillance, Cancer Care
Ontario, Toronto, ON
[2] Propel Centre for Population Health Impact, Canadian Cancer
Society / University of Waterloo, Waterloo, ON
[3] Dalla Lana School of Public Health, University of Toronto,
Toronto, ON
[4] Department of Health Studies and Gerontology, University of
Waterloo, Waterloo, ON
Correspondence: Dr. Scott T. Leatherdale, Department of Population
Studies and Surveillance, Cancer Care Ontario, 620 University Avenue,
Toronto, ON M5G 2L7, Tel: 416-971-9800, ext. 3237, Fax: 416-971-7554,
E-mail: scott.leatherdale@cancercare.on.ca
Conflict of Interest: None to declare.
Table 1. Descriptive Statistics for the Sample of Youth
(Grades 9 to 12) Who Usually Smoke Contraband
Cigarettes by Their Usual Source of Cigarette
Access, 2006-2007, Canada
Buys Gets Them Gets Them
Them From From a From a
a Store Family Friend
Member or Stranger
(n=2,281), (n=3,195), (n=6,632),
%* %* %*
Socio-demographic
characteristics
Sex
Boy 25.4 24.6 50.0
Girl -- 29.0 64.3
Grade
9 & 10 -- 26.4 57.6
11 & 12 22.5 26.4 51.1
Aboriginal status
Non-Aboriginal 13.2 21.8 65.0
Aboriginal -- 43.1 --
Spending money
[less than or equal to]
$20 per week -- 23.1 62.5
[greater than or equal
to] $20 per week 21.7 25.4 52.9
Parent(s) smoke(s)
No -- -- 64.1
Yes 15.8 31.7 52.5
Sibling(s) smoke(s)
No / I have no siblings 18.9 61.4 19.7
Yes 16.8 52.8 30.4
Friend smoking
<5 friends smoke -- 27.8 63.4
[less than or equal to] 5
friends smoke 22.2 28.2 49.6
Reasons for smoking a
particular brand
My friends smoke the same
brand
No 20.8 26.3 52.9
Yes -- -- 62.3
My parents smoke the same
brand
No 20.5 17.4 62.1
Yes -- 82.8 --
Costs less than other
brands
No 25.1 26.2 48.7
Yes -- 26.6 59.4
I like the taste
No 13.9 26.6 59.5
Yes -- -- 37.0
They are the only ones I
can get
No 22.2 23.6 54.2
Yes -- 38.6 57.3
For the nicotine buzz
No 18.9 24.6 56.5
Yes -- -- --
Behavioural characteristics
Average number of
cigarettes per day
[less than or equal to]
10 16.1 23.3 63.6
[greater than or equal
to] 11 25.9 38.6 35.5
Asked a stranger to buy
cigarettes
No 19.4 22.3 58.3
Yes -- -- 30.9
Frequency of sharing
cigarettes
Never -- -- --
Sometimes -- 20.3 62.8
Usually or always -- 31.4 51.0
Ever tried marijuana
No -- -- --
Yes 14.9 28.5 56.6
* weighted population estimate
-- estimate not reportable due to small cell size
Table 2. Logistic Regression Analyses Examining Socio-demographic
Characteristics Associated with Cigarette Access Behaviour
Among Youth (Grades 9 to 12) Who Usually Smoke Contraband Cigarettes,
2006-2007, Canada
Adjusted Odds Ratio ([dagger])
(95% CI)
Model 1
Usually Buys Them
From a Store
Sex Girl 1.00
Boy 3.53 (1.46, 8.56) **
Grade 9 & 10 1.00
11 & 12 0.78 (0.38, 1.60)
Aboriginal status Non-Aboriginal 1.00
Aboriginal 3.93 (1.88, 8.22) ***
Spending money [less than or
equal to] $20
per week 1.00
>$20 per week 2.06 (0.98, 4.34)
Parent(s) smoke(s) No 1.00
Yes 0.56 (0.27, 1.16)
Sibling(s) smoke(s) No 1.00
Yes 0.76 (0.36, 1.61)
Friend smoking <5 friends smoke 1.00
[less than or
equal to] 5
friends smoke 2.31 (1.02, 5.26) *
Model 2
Usually Gets Them From
a Family Member
Sex Girl 1.00
Boy 1.16 (0.63, 2.15)
Grade 9 & 10 1.00
11 & 12 1.34 (0.74, 2.42)
Aboriginal status Non-Aboriginal 1.00
Aboriginal 2.49 (1.26, 4.91) **
Spending money [less than or
equal to] $20
per week 1.00
>$20 per week 0.75 (0.41, 1.36)
Parent(s) smoke(s) No 1.00
Yes 3.57 (1.76, 7.27) ***
Sibling(s) smoke(s) No 1.00
Yes 1.09 (0.59, 2.00)
Friend smoking <5 friends smoke 1.00
[less than or
equal to] 5
friends smoke 0.86 (0.47, 1.58)
Model 3
Usually Gets Them From
a Friend or Stranger
Sex Girl 1.00
Boy 0.49 (0.28, 0.86) *
Grade 9 & 10 1.00
11 & 12 0.88 (0.50, 1.53)
Aboriginal status Non-Aboriginal 1.00
Aboriginal 0.17 (0.08, 0.33) ***
Spending money [less than or
equal to] $20
per week 1.00
>$20 per week 0.80 (0.46, 1.38)
Parent(s) smoke(s) No 1.00
Yes 0.49 (0.28, 0.87) *
Sibling(s) smoke(s) No 1.00
Yes 1.02 (0.59, 1.77)
Friend smoking <5 friends smoke 1.00
[less than or
equal to] 5
friends smoke 0.68 (0.39, 1.19)
([dagger]) Odds ratios adjusted for all other variables in the table.
Model 1: 1 = Usually buys them from a store (n=43), 0 = Does not
usually buy them from a store (n=256).
Model 2: 1 = Usually gets them from a family member (n = 83), 0 =
Does not usually get them from a family member (n = 216).
Model 3: 1 = Usually gets them from a friend or someone else (n = 173),
0 = Does not usually get them from a friend or someone else (n=126).
*p<0.05 **p<0.01 ***p<0.001
Table 3. Logistic Regression Analyses Examining How Reasons for Smoking
a Particular Brand Are Associated With Cigarette Access Behaviour Among
Youth (Grades 9 to 12) Who Usually Smoke Contraband Cigarettes,
2006-2007, Canada
Adjusted Odds Ratio ([dagger)]
(95% CI)
Model 1
Usually Buys Them
From a Store
My friends smoke the same brand No 1.00
Yes 0.53 (0.22, 1.30)
My parents smoke the same brand No 1.00
Yes 0.68 (0.21, 2.17)
Costs less than other brands No 1.00
Yes 0.69 (0.37, 1.28)
I like the taste No 1.00
Yes 3.88 (2.00, 7.51) ***
They are the only ones I can get No 1.00
Yes 0.17 (0.04, 0.71) *
For the nicotine buzz No 1.00
Yes 0.91 (0.26, 3.17)
Model 2
Usually Gets Them From
a Family Member
My friends smoke the same brand No 1.00
Yes 0.08 (0.02, 0.36) ***
My parents smoke the same brand No 1.00
Yes 96.61 (21.84, 427.44) ***
Costs less than other brands No 1.00
Yes 1.03 (0.56, 1.89)
I like the taste No 1.00
Yes 0.63 (0.28, 1.39)
They are the only ones I can get No 1.00
Yes 1.44 (0.66, 3.13)
For the nicotine buzz No 1.00
Yes 1.59 (0.55, 4.66)
Model 3
Usually Gets Them From
a Friend or Stranger
My friends smoke the same brand No 1.00
Yes 7.07 (2.79, 17.92) ***
My parents smoke the same brand No 1.00
Yes 0.01 (0.003, 0.05) ***
Costs less than other brands No 1.00
Yes 1.72 (1.02, 2.89) *
I like the taste No 1.00
Yes 0.46 (0.25, 0.86) *
They are the only ones I can get No 1.00
Yes 2.07 (0.96, 4.47)
For the nicotine buzz No 1.00
Yes 1.24 (0.44, 3.47)
([dagger]) Odds ratios adjusted for all other variables in the table
and for gender and grade.
Model 1: 1 = Usually buys them from a store (n=64), 0 = Does not
usually buy them from a store (n=348).
Model 2: 1 = Usually gets them from a family member (n=117), 0 = Does
not usually get them from a family member (n=295).
Model 3: 1 = Usually gets them from a friend or stranger (n=231), 0 =
Does not usually get them from a friend or stranger (n=181).
*p<0.05 **p<0.01 ***p<0.001
Table 4. Logistic Regression Analyses Examining Behavioural Factors
Associated With Cigarette Access Behaviour Among Youth (Grades 9 to 12)
Who Usually Smoke Contraband Cigarettes, 2006-2007, Canada
Adjusted Odds Ratio
([dagger])
(95% CI)
Model 1
Usually Buys Them
From a Store
Average number of [less than
cigarettes per day or equal to] 10 1.00
[greater than
or equal to] 11 1.91 (0.93, 3.90)
Has asked a stranger
to buy them cigarettes No 1.00
in the last 30 days Yes 0.20 (0.05, 0.73) *
Frequency of sharing Never 1.00
cigarettes with others
Sometimes 0.44 (0.17, 1.16)
Usually or
always 0.43 (0.15, 1.20)
Ever tried marijuana No 1.00
Yes 0.45 (0.17, 1.22)
Model 2
Usually Gets Them
From a Family Member
Average number of [less than
cigarettes per day or equal to] 10 1.00
[greater than
or equal to] 11 2.34 (1.30, 4.22) **
Has asked a stranger
to buy them cigarettes No 1.00
in the last 30 days Yes 3.00 (1.37, 6.55) **
Frequency of sharing Never 1.00
cigarettes with others
Sometimes 0.30 (0.12, 0.74) **
Usually or
always 0.49 (0.20, 1.21)
Ever tried marijuana No 1.00
Yes 1.39 (0.49, 3.91)
Model 3
Usually Gets Them
From a Friend or
Stranger
Average number of [less than
cigarettes per day or equal to] 10 1.00
[greater than
or equal to] 11 0.33 (0.19, 0.58) ***
Has asked a stranger
to buy them cigarettes No 1.00
in the last 30 days Yes 0.69 (0.30, 1.57)
Frequency of sharing Never 1.00
cigarettes with others
Sometimes 6.33 (2.26, 17.70) ***
Usually or
always 4.43 (1.56, 12.59) **
Ever tried marijuana No 1.00
Yes 1.26 (0.52, 3.06)
([dagger]) Odds ratios adjusted for all other variables in the table
and for gender and grade.
Model 1: 1 = Usually buys them from a store (n=57), 0 = Does not
usually buy them from a store (n=328).
Model 2: 1 = Usually gets them from a family member (n=113), 0 = Does
not usually them from a family member (n=272).
Model 3: 1 = Usually gets them from a friend or stranger (n=215), 0 =
Does not usually get them from a friend or stranger (n=170).
*p<0.05 **p<0.01 ***p<0.001
