Trends in smoking initiation in Canada: Does non-inclusion of young adults in tobacco control strategies represent a missed opportunity?

Abstract

OBJECTIVES: Young adults face high prevalence rates for smoking. Recent evidence suggests that many people initiate smoking during young adulthood, but little is currently known about trends in initiation rates for this age group.

METHODS: We examined rates of initiation to first cigarette (FC) and daily smoking (DS) during youth (5–17 years) and young adulthood (18–25 years) using nationally representative data from the 2001, 2003, 2005, 2007, 2009, 2011 and 201 3 cycles of the Canadian Community Health Survey. We included all participants aged 25–26 to obtain seven mutually exclusive retrospective cohorts (n = 16216). We used logistic regression to examine four correlates of smoking - sex, education, poverty status, and immigration status–and whether these factors modify time trends in smoking.

RESULTS: We found that initiation rates decreased during youth (p< 0.001 for FC, p = 0.02 for DS) but not during young adulthood (p = 0.94 for FC, p = 0.28 for DS). We found that men and respondents with fewer educational credentials had relatively higher odds of initiating during young adulthood. Trends in young adulthood stayed constant across subgroups. Trends in youth were modified by education: participants who did not complete high school had no decrease in initiation to FC and DS while those with post-secondary education experienced a decrease in both outcomes.

CONCLUSION: Tobacco control has failed to address smoking initiation during young adulthood. Given the considerable amount of initiation that occurs during this period, practitioners and policy-makers should direct more of their planning toward young adults.

Résumé

OBJECTIFS: Des données récentes suggèrent que plusieurs jeunes adultes continuent de s’initier à la cigarette à partir de 18 ans. Il existe peu de données probantes sur les tendances en matière d’initiation tabagique.

MÉTHODE: Nous avons examiné les taux d’initiation à la première cigarette (PC) et au tabagisme quotidien (TQ) chez les jeunes (5–17 ans) et les jeunes adultes (18–25 ans) en utilisant les données de 2001, 2003, 2005, 2007, 2009, 2011 et 201 3 de l’Enquête sur la santé dans les collectivités canadiennes. Nous avons utilisé tous les participants âgés de 25–26 ans afin d’obtenir sept cohortes rétrospectives mutuellement exclusives. Nous avons ensuite examiné quatre corrélats de l’initiation tabagique–le sexe, l’éducation, le statut de pauvreté et le statut d’immigrant–et si ces facteurs modifiaient les tendances temporelles.

RÉSULTATS: Les taux d’initiation ont diminué au cours de la période <18 (p < 0,001 pour PC, p = 0,02 pour TQ), mais pas au cours de la période 18–225 (p = 0,94 pour PC, p = 0,28 pour TQ). Pendant cette période, nous avons constaté que les hommes et les répondants moins diplômés avaient un risque plus élevé d’initier et que ces tendances étaient constantes dans tous les sous-groupes. Les tendances au cours de la période <18 étaient cependant différentes selon le niveau d’éducation: les participants qui n’ont jamais terminé leurs études secondaires n’ont apprécié aucune diminution comparativement à ceux qui ont fait des études postsecondaires.

CONCLUSION: La lutte contre le tabagisme n’a pas influencé l’initiation tabagique qui se produit à l’âge du jeune adulte. Les décideurs gagneraient donc à les intégrer davantage dans leur planification.

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Correspondence to Thierry Gagné MSc.

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Acknowledgements: Access to the master files of the Canadian Community Health Survey was facilitated by the Canadian Initiative on Social Statistics jointly administered by the Social Sciences and Humanities Research Council of Canada, the Canadian Institutes of Health Research (CIHR), and Statistics Canada. The data were analyzed in the Research Data Centre at UBC-Vancouver.

Funding: T.C. was funded through a PhD scholarship from the Fonds de recherche du Québec - Santé during the project. T.C. was also supported financially by the Québec Ministère de la Science, l’Enseignement Supérieur et la Recherche and the CIHR-lnstitute of Population and Public Health during the project.

Conflict of Interest: None to declare.

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Gagné, T., Veenstra, G. Trends in smoking initiation in Canada: Does non-inclusion of young adults in tobacco control strategies represent a missed opportunity?. Can J Public Health 108, e14–e20 (2017). https://doi.org/10.17269/CJPH.108.5839

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Key Words

  • Smoking
  • young adult
  • socioeconomic factors
  • Canada

Mots Clés

  • tabagisme
  • jeunes adultes
  • facteurs socioéconomiques
  • Canada