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Chronic Diseases in Canada


Volume 25
Number 3/4
2004

[Table of Contents]

Population and Public Health Branch

Youth attitudes towards tobacco control: A preliminary assessment

Bronwen J Waller, Joanna E Cohen and Mary Jane Ashley

Abstract

The attitudes of Ontario youth toward the sale and price of cigarettes, making smoking against the law, and tobacco company truthfulness were assessed in 2001 and compared to adult attitudes in 2000 and youth attitudes in 2003. Youth were more supportive of restricting cigarette sales and raising prices than adults, and more likely to agree that the government should make smoking against the law, but they were less distrustful of tobacco companies. In 2003, youth were more supportive of sales restrictions and making smoking illegal, and more distrustful of tobacco companies, than in 2001. More comprehensive assessments and continued monitoring of youth attitudes are needed.

Key words: adult; attitudes; cigarettes; tobacco control; tobacco industry; youth

Introduction

Public support for tobacco control is an important underpinning of programs and policies to reduce the health toll of tobacco use. The attitudes of adult Canadians toward tobacco control measures have been examined,1-4 but there are no reports about these attitudes among Canadian youth.

Since youth are often the focus for tobacco control interventions, information on how youth themselves regard these measures and how their attitudes may be changing over time could be informative. As well, evidence of youth support may be a persuasive element in increasing political will to enact strong tobacco control policies.5,6 However, it is necessary to put youth attitudes in context; in particular, how they compare with the attitudes of adults in the same jurisdiction.

We compared the attitudes of youth and adults in Ontario to restrictions on sales and cigarette price increases. Attitudes toward making smoking against the law and distrust of tobacco companies were also assessed, as were changes in youth attitudes over a two-year period.

Methods

Sources of data

Youth data were obtained from the 2001 and 2003 Ontario Student Drug Use Surveys (OSDUS).7,8 Students from grades 7 through secondary school were sampled using a two-stage selection of school and class stratified by region and type of school (n = 3818 in 2001; n = 6616 in 2003). OAC students were excluded from this analysis.

Adult attitude data were obtained from the 'Q2000' study (n = 1607), a population-based telephone survey of Ontario adults 18 years and older, conducted in 2000.9 Respondents were sampled using random digit dialing and random selection of an individual in the home.

Survey questions

The questions examined in the OSDUS were:

  • Do you strongly agree, somewhat agree, somewhat disagree or strongly disagree that there should be fewer places where cigarettes can be sold;
  • Do you strongly agree, somewhat agree, somewhat disagree or strongly disagree that in order to decrease smoking, the price of cigarettes should increase by one dollar per pack (not included in the 2003 OSDUS);
  • Do you strongly agree, somewhat agree, somewhat disagree or strongly disagree that the government should make smoking tobacco against the law; and
  • When it comes to the effects of smoking on health, do you think the tobacco companies always tell the truth, often tell the truth, rarely tell the truth, or never tell the truth.

The only differences in wording in the 'Q2000' survey were in the questions about price ('that the price of cigarettes should increase by at least one dollar per pack'), and making smoking against the law ('that the government should make smoking tobacco illegal').

Data analysis

The 2001 OSDUS and the 'Q2000' were combined into one data set, as were the 2001 and 2003 student surveys. Common variables for primary sampling unit, stratum, and probability weight were created, and the complex survey designs of the merged data sets were taken into account using Stata software.10 To measure support for sales and price policies and making smoking against the law, the "strongly agree" and "somewhat agree" categories were collapsed, and to measure distrust of tobacco companies, the categories "rarely tells the truth" and "never tells the truth" were collapsed.

Design-based F tests were used to compare youth (2001 survey) and adults, and youth in the 2001 and 2003 surveys.11 Youth and adults were also compared within smoking sub-populations. Adults were compared to each grade level of students, from grades 7-12. Due to the multiple tests performed, p<0.01 was set as a stringent level of statistical significance.

Results

Sales and price policies

Overall, youth in Ontario were more supportive than adults of cigarette price increases and sales restrictions (Table 1). Non-smoking youth were more supportive than non-smoking adults. There were no differences between the smoking subgroups. Students in Grades 7-9 were much more supportive of the sales and price options than adults, whereas students in Grades 10-12 had attitudes close to those of adults (Table 2).

 

TABLE 1
Support for tobacco control and perceptions of the tobacco industry among youth (Y) and adults (A) in Ontario, overall and by smoking status*

  % Strongly agree/agree
Overall Non-smokers Current smokers Daily smokers
Y A Y A Y A Y A
There should be fewer places where cigarettes can be sold 78 71 89 77 43 51 36 48
p < 0.001 p <0.0001 ns ns
In order to decrease smoking, the price of cigarettes should increase by $1 per pack 71 62 80 69 39 38 33 32
p < 0.0001 p < 0.0001 ns ns
The government should make smoking against the law 60 31 71 36 24 15 20 16
p < 0.0001 p < 0.0001 p < 0,01 ns
Tobacco companies rarely/never tell the truth 59 79 61 81 53 72 52 70
p < 0.0001 p < 0.0001 p < 0.0001 p < 0.001
* Smoking status was defined using the criteria of each survey. In the Ontario Student Drug Use Survey, a current smoker was defined as someone who smoked at least one cigarette during the past 12 months, while a daily smoker smoked one or more cigarettes a day. A current smoker in the 'Q2000' was defined as someone who smoked daily, almost every day, or occasionally, and a daily smoker was someone who smoked daily or almost every day.
ns = not statistically significant

TABLE 2
 Support for tobacco control and perceptions of the tobacco industry among youth (Y) and adults (A) in Ontario, by school grade (youth)

  % Strongly agree/agree
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade12
Y A Y A Y A Y A Y A Y A
There should be fewer places where cigarettes can be sold 92 71 87 71 80 71 71 71 67 71 69 71
p < 0.0001 p < 0.0001 p < 0.01 ns ns ns
In order to decrease smoking, the price of cigarettes should increase by $1 per pack 83 62 78 62 72 62 66 62 59 62 65 62
p < 0.0001 p < 0.0001 p < 0.01 ns ns ns
The government should make smoking tobacco against the law 79 31 74 31 59 31 51 31 45 31 55 31
p < 0.0001 p < 0.0001 p < 0.0001 p < 0.0001 p < 0.001 p < 0.001
Tobacco companies rarely/never tell the truth 66 79 60 79 61 79 49 79 61 79 60 79
p < 0.001 p < 0.0001 p < 0.0001 p < 0.0001 p < 0.0001 p < 0.0001
ns = not statistically significant

 
   

Making smoking against the law

Youth were overall more likely than adults to agree that the government should make smoking against the law (Table 1). Non-smoking and current smoking youth were also more likely than adults to agree with this statement, but daily smokers were not. Support for this statement was higher for youth across all grades than for adults (Table 2).

Distrust of tobacco companies

Youth overall and in all smoking status subgroups were less distrustful of the tobacco companies than their adult counterparts (Table 1). This differential was also consistent across all grades (Table 2).

Youth attitudes in 2001 and 2003

Youth surveyed in 2003 were more likely to agree that the government should make smoking against the law and were more distrustful of tobacco companies, compared to students surveyed in 2001 (Table 3). The increase in support for fewer cigarette retail outlets over the two-year period approached significance (p = 0.014).

TABLE 3
Support for tobacco control and perceptions of the tobacco industry among youth in Ontario, by year of survey

  % Strongly agree/agree
Year of survey
2001 2003
There should be fewer places where cigarettes can be sold 78 82
ns
In order to decrease smoking, the price of cigarettes should increase by $1 per pack 71 Not asked in the 2003 survey
na
The government should make smoking against the law 60 70
p < 0.0001
Tobacco companies rarely/never tell the truth 59 66
p < 0.001
ns = not statistically significant
na = not applicable

Discussion

We found more overall support among youth than among adults for sales restrictions and price increases. Non-smokers and younger students, in particular, were comparatively more supportive of these policy measures. As well, overall support among youth for sales restrictions increased between 2001 and 2003. However, higher levels of support compared to adults were not found among the older students. If the observed differentials persist as younger youth age into adulthood, this would bode well for the future acceptability of these control measures. Continued monitoring of youth attitudes is needed to determine the sustainability of youth support for these measures with aging.

Overall youth were also more likely than adults to agree that the government should make smoking against the law and the level of agreement among youth increased between 2001 and 2003. This assessment may provide an indication of the rising social unacceptability of smoking, and, if so, the findings are encouraging.12

The lower levels of distrust of the tobacco industry, in youth overall and in all subgroups, compared to adults, may warrant attention. Again, we cannot determine with certainty whether these youth may 'grow into' skepticism about the industry as they age; the by-grade breakdown did not show increasing distrust with higher grade, indicating that lower levels of distrust were not limited to younger ages. However, youth surveyed in 2003 were more distrustful of the tobacco industry than youth surveyed two years earlier. Continued monitoring of youth attitudes toward the tobacco industry is warranted. Tobacco control programs that incorporate a tobacco industry denormalization strategy appear to be effective in decreasing youth smoking.13-17

Adult non-smokers in Ontario1,2 and elsewhere18-20 have been found to be more supportive of tobacco control measures than smokers. This pattern is also evident in youth, as non-smoking youth appear to be particularly supportive of tobacco control measures.

This study has limitations. Students enrolled in schools and present on the day of the survey were sampled. Thus, the views of school dropouts and absentees were not captured. These youth may be at higher risk of smoking and less supportive of tobacco control measures.7-21 As well, the youth and adult surveys used different data collection methods: a written self-report in a classroom and a telephone survey at home, respectively. This may have affected the comparability of findings.

Further, the concepts explored, particularly tobacco industry denormalization and the social unacceptability of smoking, are complex. It is questionable whether they can be examined adequately by single questions. In a study of Ontario adults regarding the tobacco industry and its products, distrust of the industry was just one of eight measures that comprised a reliable tobacco industry denormalization scale.22 Clearly, the findings of this study only provide a preliminary indication of the attitudes of youth to smoking and the tobacco industry. Fuller exploration of these constructs in youth is needed.

Acknowledgements

We would like to thank Dr. Edward Adlaf, of the Centre for Addiction and Mental Health, for his assistance with the Ontario Student Drug Use Surveys. Bo Zhang provided technical assistance. This research was supported by the Ontario Tobacco Research Unit and the Centre for Addiction and Mental Health.

References

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  2. Ashley MJ, Bull SB, Pederson LL. Support among smokers and nonsmokers for restrictions on smoking. Am J Prev Med 1995; 11(5):283-7.
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  9. Northrup DA. Provincial Survey of tobacco use, knowledge about health effects and attitudes towards tobacco control measures. York University, Toronto, ON, Institute for Social Research. 2000.
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  18. Brooks DR, Mucci LA. Support for smoke-free restaurants among Massachusetts adults, 1992-1999. Am J Public Health 2001;91(2): 300-3.
  19. Wakefield M, Miller C, Woodward S. Community perceptions about the tobacco industry and tobacco control funding. Aust N Z J Public Health 1999;23(3):240-4.
  20. McAllister I. Public opinion in Australia on restricting smoking in public places. Tob Control 1995;4:30-5.
  21. United States Department of Health and Human Services. Reducing tobacco use: a report of the surgeon general. Atlanta, GA, U.S. Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2000.
  22. Ashley MJ, Cohen JE. What the public thinks about the tobacco industry and its products. Tob Control 2003;12(4):396-400.

Author References

Bronwen J Waller, Ontario Tobacco Research Unit, University of Toronto, Toronto, Ontario, Canada

Joanna E Cohen, Mary Jane Ashley, Ontario Tobacco Research Unit, and Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada

Correspondence: Joanna Cohen, Ontario Tobacco Research Unit, University of Toronto, 33 Russell Street, Toronto, Ontario M5S 2S1; Fax: (416) 595-6068; E-mail: joanna_cohen@camh.net

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