Key variables

Question 1: Current daily smoker. Students were asked “In the last 12 months, how often did you smoke cigarettes?” Those who reported smoking at least 1 cigarette per day during the last 12 months were identified as daily smokers.

Question 2: Contraband cigarette use. Students were asked: “In the last 12 months, how often did you smoke cigarettes made on Native reserves (such as “DKs”, “Natives”, “Discount” or unbranded cigarettes packaged in a plastic bag)?” “DKs”, “Natives” and “Discount” are prominent brands of US reserve-manufactured cigarettes, while “unbranded cigarettes packaged in a plastic bag” refers to loose cigarettes made on reserves and commonly sold in Ziploc bags (each usually containing 200 cigarettes). Past-year use was defined as smoking at least one whole contraband cigarette in the previous 12 months. Students who reported smoking one or more contraband cigarettes per day were identified as regular contraband smokers.

Response categories for questions 1 and 2 included: 1-2 cigarettes a day, 3-5, 6-10, 11-15, 16-20, more than 20 cigarettes per day. In order to construct a quantitative estimate of consumption, we used the following midpoint estimates for each response category: 1.5, 4, 8, 13, 18 and 25.

We first calculated prevalence of daily cigarette smoking in the survey sample and the prevalence of any contraband tobacco use among those students who were daily smokers. Using mid-points of the consumption ranges, we examined differences in consumption between daily contraband users and non-users and estimated the volume of contraband tobacco used as a proportion of all cigarettes smoked. We fitted a logistic regression model to predict regular contraband usage, adjusting for covariates in table 1.

With the exception of sample sizes, all estimates presented reflect population weights and adjustment for survey design.

Among the 2734 high school students (typically 14–17 years old) included in panel B of the survey, a total of 170 reported daily smoking over the previous year. Among these 170 daily smokers, 51% (95% CI 38% to 64%) reported smoking at least one contraband cigarette daily during the past 12 months, 90% (95% CI 83% to 96%) of daily smokers reported lifetime use, and 84% (95% CI 77% to 93%) past-year use of contraband tobacco. Accounting for cigarettes smoked per day by Ontario high school daily smokers, we estimated that approximately 43% (95% CI 31% to 56%) were contraband cigarettes made on Native reserves. Regular contraband users reported higher Heaviness of Smoking Index4 scores and poorer school performance (table 1). These differences remained statistically significant after adjustment for covariates in table 1 ((OR 1.39, 95% CI 1.04 to 1.86, p=0.03) and (OR 2.59, 95% CI 1.23 to 5.44, p=0.01), respectively).

Our study showed that approximately 50% of Ontario high school daily smokers consumed at least one contraband cigarette per day during the previous year, and that contraband cigarettes made on Native reserves accounted for approximately 43% of the total volume of cigarette consumption in this population—a substantial increase from our previous estimate of 25% derived from the 2006/2007 Canadian Youth Smoking Survey.5 This difference may be due to the survey questions and analytical approaches used. Relatively small sample sizes may have also limited the inferences that can be drawn from these results.

The widespread use of cheap, untaxed Native cigarettes presents a serious challenge to Canadian tobacco control strategies, which have relied primarily on accessibility restrictions and taxation strategies to reduce youth smoking. Given the complex issues surrounding First Nations and American Indian jurisdiction,6 and the possible role of cross-border smuggling in supplying the Canadian contraband market, a concerted US and Canadian effort will be needed to engage First Nations and American Indian communities in the process of meeting FCTC commitments.