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Smoking among youth has widespread and long-term public health implications. Adolescent patterns of smoking often continue into adulthood," and cessation programs aimed at youth are frequently unsuccessful.2 Moreover, it is estimated that cigarette smoking will account for over 50% of deaths in Canada before the age of 70 for 15-year-old current smokers if they continue to smoke.34 The Ontario Tobacco Strategy, introduced in 1992 as part of the Ontario government's health reform agenda,5 set a goal to reduce the prevalence of smoking among 12-19 year olds in the province to 10% by the year 2000. This report presents trend data from two major school surveys on smoking among Ontario youth, discusses potential causal factors and outlines strategies to address this public health problem.

METHODS

The descriptive analyses, derived from the Ontario Student Drug Use Survey* and the Waterloo Smoking Prevention Projects,' span the years 1981-1997. The Ontario Student Drug Use Survey is a biennially repeated cross-sectional survey of Ontario students enrolled in grades 7, 9, 11 and 13, conducted by the Addiction Research Foundation (now a division of the Centre for Addiction and Mental Health) every two years since 1977. The sample design, comprised of 16 strata, is based on a single-stage cluster sample of classrooms stratified equally by grade level (grades 7, 9, 11 and 13) and proportionally by region (Toronto, Western, Eastern and Northern Ontario).

The 1997 sample consists of 3,990 students from 168 schools (response rate = 77%). Earlier cycles are comparable (number of students: 3,270-4,737; number of schools: 137-227; response rates: 76%84%). Past year smoking means smoking more than one cigarette in the previous 12 months. Daily smoking is one or more cigarettes smoked each day in the previous 12 months. Cigarettes per day is the number of cigarettes smoked daily in the previous 12 months by daily smokers. Calculation of confidence intervals incorporates clustering effects.

In addition to conducting longitudinal surveys for smoking intervention trials, the Health Behaviour Research Group at the University of Waterloo carried out crosssectional surveys of 9th-graders from 24 schools in Southwestern Ontario in 1995, 1996 and 1997. Youth smoking, measured in the spring of each year, was defined as regular use if the respondent usually smoked every week and experimental if the student had not quit but smoked less frequently than once a week. Prevalence rates are provided for regular and experimental smokers combined (current smokers).

RESULTS

Ontario Student Drug Use Survey In 1997, 28% of Ontario students reported cigarette use, a rate that has remained unchanged since 1995 (Figure 1). Between 1981 and 1991, past year smoking among females declined from 35% to 22% (p

Retailer compliance with legislation forbidding sales to minors did not improve from 1996 (74%) to 1997 (69%).? This pattern was evident for all types of establishments, with corner stores the most popular source of cigarettes for minors in 1997, followed by gas stations. The proportion of youth asked for photo identification increased from 39% in 1995 to 45% in 1997,6 but still remains relatively low. Finally, research evidence for an effect of enforcement and retailer compliance on youth smoking is not conclusive.?9

Efforts to reduce youth smoking in Ontario should focus on evidence-based policy initiatives that reinforce existing programming and public education efforts. Young people are particularly responsive to price increases, and a substantial increase in provincial tobacco taxes would reduce both prevalence and consumption.2 Very high levels of vendor compliance may have some impact on prevalence,zl but restricting tobacco sales to government outlets would provide more effective control. Expanding bans on smoking in public places and workplaces to include those heavily frequented by young people, such as restaurants and bars, would reduce the visibility of smoking, in addition to protecting youth from second hand smoke. Since smokers report that relapse is more likely when others around them are smoking,22 such bans are critical to support cessation efforts by young people. These measures, along with support for federal elimination of tobacco sponsorship and plain packaging of cigarettes, would constitute a broad public health strategy that would appropriately address youth smoking in this province.

Received: September 4, 1998 Accepted: February 4, 1999

REFERENCES

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Stone C, Kristeller J. Attitudes of adolescents toward smoking cessation. Am J Prev Med 1992;8:221-24.

Peto R, Lopez AD, Boreham J, et al. Mortality from Smoking in Developed Countries 1950

2000, Indirect estimates from National Vital Statistics. World Health Organization, Imperial Cancer Research Fund, Oxford University Press, 1994.

Villeneuve P, Morrison H. Health consequences of smoking in Canada: An update. Chron Dis Can 1994;15:102-4.

Ontario Ministry of Health. The Ontario Tobacco Strategy Overview. Toronto: Ontario Ministry of Health, 1993.

Adlaf E, Ivis F, Smart R. The Ontario Student Drug Use Survey 1977-1997. Toronto: Addiction Research Foundation, 1997. Manske SR, Brown KS, Cameron AJR. Schoolbased cancer control: A research agenda. Cancer Prevention and Control 1997; 1 (3):196-212. Bondy SJ, Ialomiteanu AR. Smoking in Ontario, 1991 to 1996. Can J Public Health 1997;88(4):225-29.

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Department of Health and Social Services. Prince Edward Island Student Drug Use 1996: Technical Report. Prepared in collaboration with Dalhousie University, PEI Health and Community Services Agency and PEI Department of Education, November 1996. Hall C. Smoking by young men rises to 39%. Based on results from the 1996 Health Survey for England. UKEctrnic Telegraph. Tuesday January 13, 1998, Telegraph Group Limited 1998. University of Michigan. Drug use among American teens shows some signs of levelling after a long rise. Ann Arbor: University of Michigan, 1997. [Available at: www.isr.umich.edu/src/mtf/mfdat97.html].

13. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People, A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994.

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Evidence from time-series data. J Health Economics 1997;16:287-301.

15. Gilpin EA, Pierce JP. Trends in adolescent smoking initiation in the United States: Is tobacco marketing an influence? Tobacco Control 1997;6:122-27.

16. Johnston LD, O'Malley PM, Bachman JG. National Survey Results on Drug Use from the

Monitoring the Nuture study, lp/. Secondary School Students, Volume I. National Institute on Drug Abuse, US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1998. Sweanor D. Tobacco Taxes and Prices in Canada. Toronto: Smoking and Health Action Foundation, 1998.

Nielsen AC. Measurement of retailer compliance with respect to the Tobacco Act & Provincial

Sales-to-Minors legislation. Final Results Wave I. Report prepared for Health Canada's Health Protection Branch, Office of Tobacco Control. Toronto: ACNielsen, 1997.

19. DiFranza JR, Rigotti NA. Policies to Reduce Youth Access to Tobacco. Health Science Analysis Project, Policy Analysis 1 G. Washington, DC: Advocacy Institute, June 1998.

20. Ferrence RG, Garcia JM, Sykora K, et al. Effects of pricing on cigarette use among teenagers and

adults in Canada 1980-1989. Toronto, ON: Addiction Research Foundation, 1991. 21. Forster JL, Wolfson M. Youth access to tobacco: Policies and politics. Annu Rev Public Health 1998;19:203-35.

22. Ashley MJ, Cohen J, Bull S, et al. Smoking in Ontario, Analysis of Data from the "Q&Q"

Study. Prepared for Health Canada and the Ontario Ministry of Health. Toronto, ON: Ontario Tobacco Research Unit, 1997.

Frances M. Hobbs, AmI William Pickett, PhD,12 Roberta G. Ferrence, PhD,/3 K Stephen Brown, PhD,'4 Cheryl Madill, Msc,5 Edward M. Adlaf, PhD3

Ontario Tobacco Research Unit, University of Toronto, Toronto, ON

Department of Community Health and Epidemiology, Queen's University, Kingston, ON

Centre for Addiction and Mental Health,

Addiction Research Foundation Division, Toronto, ON

Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON Department of Health Studies and Gerontology, University of Waterloo, Waterloo, ON