Methodology

Design

This study used nationally representative data collected from 71 003 grade 5–12 students as part of the 2006–7 Canadian Youth Smoking Survey (YSS).13 14 In brief, the target population for the YSS consisted of all young Canadian residents in grades 5–12 attending public and private elementary and secondary schools in 10 Canadian provinces; youths residing in the Yukon, Nunavut and the Northwest Territories were excluded from the target population, as were youths living in institutions or on First Nation Reserves, and youths 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. The sample design featured three levels of stratification: province, health region and school level (elementary vs secondary). The sample of schools was selected systematically with probability proportional to school size (73.7% school response rate). The selection of the secondary sampling units (classes) was conducted by field staff who randomly selected one class in the desired grade (61.1% student response rate). (Owing to the healthy New Brunswick en santé initiative, YSS data were collected from an additional 171 schools beyond the original sample target. This is described in more detail in references 13 and 14.)

The survey design and sample weights allow us to produce population-based estimates within this paper. Detailed information on the sample design, methods and survey rates for the 2006–7 YSS are available in print13 14 or online (https://www.yss.uwaterloo.ca/ysssite_app/controller/index.cfm).

Measures

The YSS collected demographic information and data on youth smoking behaviour. Smoking status was defined based on how the respondents answered, “Have you ever smoked a whole cigarette?” (yes, no). Those that answered “yes”, were asked, “Have you ever smoked at least 100 cigarettes in your life?” (yes, no), and “On how many of the last 30 days did you smoke one or more cigarettes” (none, 1 day, 2–3 days, 4–5 days, 6–10 days, 11–20 days, 21–29 days, 30 days). Consistent with the derived variables for classifying smoking using YSS data,13 14 current smokers were defined as those who have smoked at least 100 cigarettes in his/her lifetime and have smoked in the 30 days preceding the survey. Daily smokers were defined as current smokers who reported smoking at least one cigarette per day for each of the 30 days preceding the survey. Occasional smokers were defined as current smokers who reported smoking at least one cigarette during the 30 days preceding the survey but have not smoked every day. Respondents were asked to indicate what brand of cigarette they usually smoke from a list of popular Canadian cigarette brands consumed by youths. Using the response options provided and the list of discount brands provided by the Non-Smokers Rights Association,7 we grouped the respondents’ usual brand of cigarette into one of five categories based on the brand price (premium, discount, native, other, no usual brand), where “premium” represents any brand of cigarettes sold for the traditional price per carton (DuMaurier, Players, Export A), “discount” represents any brand of cigarettes sold for $C10–$C12 less per carton than a premium brand (No 7, Peter Jackson), “native” represents tax exempt cigarettes sold to non-Aboriginals and cigarettes illegally/illegally manufactured and sold as native brands, and “other” represented that their usual brand was not in the list provided (that is, could include other brands of Canadian cigarettes, American brands of cigarettes, or roll-your-own (RYO) tobacco products). Respondents were also asked to report “When you smoke, how often do you share a cigarette with others?” (never, sometimes, usually, always), and “Thinking back over the last 30 days, on the days that you smoked, how many cigarettes did you usually smoke each day?” (a few puffs to 1, 2–3, 4–5, 6–10, 11–20, 21–29, 30 or more). Based on the response distribution the response categories for average cigarettes per day were collapsed (few puffs to 1, 2–3, 4–10, 11 or more). Respondents were also asked to report their sex (boy, girl), grade (5–12), and “Are you an Aboriginal person?” (yes First Nations, yes Métis, yes Inuit, no I am not an Aboriginal person). Responses were collapsed (Aboriginal, non-aboriginal). Respondents were also asked “How much money do you usually get each week to spend on yourself or to save?” ($C0, $C1–5, $C6–10, $C11–20, $C21–40, $C41–100, more than $C100), Based on the response distribution, categories for spending money were collapsed ($C0, $C1–10, $C11 or more). Respondents who reported that they had a usual brand of cigarette were to asked a series of questions related to the question “Why do you smoke the brand of cigarettes that you do?” Respondents were asked to report “yes” for each appropriate reason provided (my friends smoke the same brand, my parents smoke the same brand, I like the packaging, this brand costs less than other brands, I like the image, I like the taste, they are the only ones I can get, they have less tar, for the nicotine buzz).

Analyses

Using data from current smokers, descriptive analyses examining smoking status and cigarette brand preference were performed according to sex, grade, their reasons for smoking a particular brand, weekly spending money, frequency of sharing cigarettes, average cigarettes per day, Aboriginal status and province. We then conducted two logistic regression models to examine characteristics that differentiate current smokers with a usual brand of cigarettes who (a) smoke discount cigarettes versus premium cigarettes, and (b) smoke native cigarettes versus premium cigarettes. Survey weights were used to adjust for non-response between provinces and groups, thereby minimising any bias in the analyses caused by differential response rates across regions or groups (table 1). The statistical package SAS 8.02 was used for all analyses.15

Results

In 2006, 5.8% (188 200) of Canadian youths in grades 5–12 were current smokers. The prevalence of current smoking was higher for males (6.5%) compared to females (4.9%) (χ² = 97.14, df = 1, p<0.001). Among current smokers, the prevalence of occasional and daily smoking was roughly the same (50.5% occasional vs 49.5% daily), although students in higher grades were more likely to be daily smokers than students in lower grades (χ² = 23.3, df = 4, p<.001). The prevalence of daily smoking was highest in Atlantic Canada (61.8%) and lowest in British Columbia (46.6%). Descriptive statistics among Canadian youths who are current smokers in grades 5–12 by smoking status are presented in table 2.

Reasons for smoking a particular brand

The most prevalent reasons for smoking a particular brand of cigarette reported by current smoking youths in 2006 were that they like the taste (55.6%), they cost less (17.0%) and their friends smoke the same brand (15.3%); the least prevalent reasons reported were that they have less tar (2.8%), they are the only ones they can get (3.1%) and because they like the image of the brand (3.2%). Daily smokers were more likely to report that they smoke a particular brand because they cost less (χ² = 55.7, df = 1, p<0.001), whereas occasional smokers were more likely to report that they smoke a particular brand because their friends smoke the same brand (χ² = 5.9, df = 1, p<0.05). Additional analysis revealed that among youths who report that their reason for smoking a particular brand is because they cost less, 24.8% smoke discount cigarettes and 35.9% smoke native cigarettes, whereas 27.7% smoke “other” brands and 11.6% smoke premium cigarettes.

Cigarette brand preference

In 2006, premium cigarettes were the most prevalent brand of cigarette youths report usually smoking (49.4%), however, a substantial number of youths report usually smoking either discount (12.9%, 20,700) or native (9.3%, 15 000) cigarette brands. Interestingly, occasional smokers were more likely to report usually smoking premium cigarettes whereas daily smokers were more likely to report smoking either discount or native cigarettes (χ² = 170.1, df = 4, p<0.001). As shown in figure 1, when examining the distribution of cigarette brand preference by weekly spending money, smokers with $C10 of spending money or less per week appear to be more apt to report smoking native cigarettes, whereas smokers with more than $C10 per week in spending money are more apt to report usually smoking premium cigarettes. As shown in table 3, when examining the distribution of cigarette brand preference by average daily cigarette consumption, heavier smokers appear to be more apt to report smoking native or discount cigarettes (χ² = 218.8, df = 12, p<0.001). As illustrated in figure 2, the majority of youths in the Prairies, British Columbia and Ontario report smoking premium cigarettes. However, the prevalence of youths smoking discount cigarettes was highest among youths in the Prairies and Atlantic Canada, and the prevalence of youths smoking native cigarettes was highest in Ontario and Quebec; the prevalence of youths smoking native cigarettes was the lowest in the Prairies and British Columbia. Interestingly, among youths from Quebec, the most prevalent response for cigarette brand preference was ”other”. When examining cigarette brand preference by Aboriginal status (fig 3), it was identified that 8.7% (11 000) of non-Aboriginal youth smokers report that their usual brand of cigarette is a native brand; 11.6% of Aboriginal youths report usually smoking a native brand.

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Figure 1

Prevalence of different cigarette brand preferences among current smokers* by weekly spending money. Canada, 2006–2007. Source: 2006–2007 Canadian Youth Smoking Survey. *Current smokers include both current occasional smokers and current smokers.

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Figure 2

Prevalence of different cigarette brand preferences among current smokers* by region of Canada. Canada, 2006–2007. Source: 2006–2007 Canadian Youth Smoking Survey. *Current smokers include both current occasional smokers and current smokers.

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Figure 3

Prevalence of different cigarette brand preferences among current smokers* by Aboriginal status. Canada, 2006–2007. Source: 2006–2007 Canadian Youth Smoking Survey. *Current smokers include both current occasional smokers and current smokers.

Factors associated with smoking discount cigarettes vs premium cigarettes

Daily smokers were more likely than occasional smokers to report smoking discount cigarettes. When compared to youths who only smoke a few puffs or one cigarette per day, youths were more likely to smoke discount cigarettes if they reported smoking 2–3, 4–10 or 11 or more cigarettes per day. Conversely, Aboriginal youths were less likely to smoke discount cigarettes than non-Aboriginal youths, as were youths with $C1 to $C10 a week in spending money relative to youths with no weekly spending money.

Factors associated with smoking native cigarettes vs premium cigarettes

Male youths were more likely than female youths to smoke native cigarettes. Daily smokers were also more likely than occasional smokers to report smoking native cigarettes, as were youths who smoke 11 or more cigarettes per day compared to youths who smoke a few puffs or one cigarette per day. Conversely, Aboriginal youths were less likely to smoke native cigarettes than non-aboriginal youths, as were youths with more than $C11 a week in spending money relative to youths with no weekly spending money.

Discussion

The data presented here suggest that discount and native cigarette brands are commonly used by a substantial number of smoking youths in Canada, although premium cigarettes continue to be the brand of choice for almost half of the youth smokers. As expected, discount brands appear to be appealing among smoking youths with less spending money or those who are heavier smokers, and among smoking youths in the Prairies and Atlantic Canada where other discounted cigarette options (that is, native brands) are not widely available.5 Consistent with research findings for adult populations,5 we also identified the prevalence of youth smokers reporting that they usually smoke native cigarettes was highest in Ontario and Quebec, and modest but non-negligible in Atlantic Canada. As expected, smoking youths who had less spending money and were heavier smokers were also more likely to report that they usually smoke native cigarette brands. Such timely and relevant data are important for guiding future tobacco control policy, programming and surveillance activities.

The current findings highlight an important limitation in common tobacco control strategies among youths populations. That is, the consumption of potentially contraband native tobacco products may not be a negligible problem among Canadian youths. In 2006, almost one in 10 Canadian youths who were current smokers reported that they usually smoked a native brand of cigarette. Our finding that heavier smokers were more apt to smoke cheaper native brands is consistent with existing evidence for young adult populations (aged 19–29).5 Among the youths who reported that they usually smoke native brand cigarettes, over a third reported that one of the reasons was because they cost less. Considering that youths don’t have problems accessing cigarettes,16 17 and evidence suggests that native brands may be even easier to access than premium and discount cigarettes in many jurisdictions,5 10 the combination of “easy-to-obtain and cheap” is of particular cause for concern in relation to youth tobacco control. Youth populations are sensitive to the price of tobacco,2 3 4 so it is clear that policies designed eliminate the availability of native tobacco products, or at the very least to increase the price of native tobacco products for all youths (both Aboriginal and non-Aboriginal) should be a critical component of future tobacco control programming; as long as affordable and accessible native brands of cigarettes remain available to youths, existing tax policies will probably be less effective.

In order to address the current problem of native cigarette brands being illegally consumed by non-Aboriginal smokers, the Canadian Coalition for Action on Tobacco has suggests a variety of priorities for action that include supply prohibitions for unlicensed manufacturers and sanctions for licensed manufactures who act unlawfully.18 Interestingly, the emergence and growth of native cigarette brands has hit the tipping point where even the large tobacco manufacturers are developing strategies to take action on reducing the market share of illegal and legal native brands (for example, Imperial Tobacco Canada5). Future research is required to evaluate the impact that future programmes and policies have on the illicit consumption of contraband tobacco products being produced and/or distributed by native manufactures within the Canadian context.

Overall, these findings illustrate that a substantial number of youth smokers in Canada smoke discount brands of cigarettes on a regular basis. Among the youths who reported that they usually smoke discount cigarettes, over a quarter of them reported that one of the reasons was because they cost less. This is consistent with our finding that smokers with less disposable income and heavier smokers were more likely to smoke discount cigarettes. Considering the link between youth smoking and the price of tobacco,2 3 4 it appears that discount brands are a viable and attractive alternative to more expensive premium brand cigarettes for many smoking youths. Interestingly, we identified that the prevalence of smokers using discount brands was the highest in the Prairies and Atlantic Canada; jurisdictions where the cheaper native brands are not yet widely available.5 Future research should monitor the popularity of discount cigarette brands among Canadian youths and across different provinces, especially as other cheaper cigarette options become more widely available. Such ongoing research is critical for future tobacco control prevention programming considering that cigarette manufacturers are likely to continue providing Canadian smokers with these discounted product options owing to their success in the marketplace (for example, according to Rothmans’ 2006 Annual Report, discount brands accounted for over 55% of their total sales volume in 2006).19

Consistent with existing research,20 few youth smokers report not having a usual brand of cigarette. Similarly, we also found that the proportion of smokers reporting no usual brand of cigarette declined among older smokers. However, we did identify that a substantial proportion of youths reported that they usually smoke some ”other” brand of cigarette which was not listed in the 2006 YSS questionnaire. There are a wide variety of potential “other” options, such as other Canadian discount cigarette brands (for example, Canadian Classics or Matinée), roll-you-own tobacco or American cigarette brands (for example, Marlboro or Camel) which would be valuable to monitor. Moreover, additional systematic surveillance of the different types of native cigarettes being consumed by youths (for example, baggies of loose cigarettes or specific native brands such as DKs, Sago and Putters) and where and how non-native youths are accessing these illicit products is required. Such data are important as they can serve as a baseline to compare with future estimates of youth cigarette brand preference which may be impacted by emerging programmes and policies.

This study has several limitations common to survey research. 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. In addition, the findings likely reflect some under-reporting for tobacco use,21 despite efforts to ensure confidentiality and truthful reporting. The prevalence rates for youth smoking discount and native brands of cigarettes in this paper are also very conservative considering we were only able to examine the brand that smokers reported they usually smoke rather than the brand(s) that they may also periodically smoke. This is important as research has previously identified that many smokers consume a wide variety of tobacco products on a periodic basis.22 Owing to limitations with the measures available, we also were unable to determine if the native brands reported by youth smokers were illegal or legal cigarettes manufactured on a First Nations Reserve and/or other brands of cigarettes purchased tax-free on a First Nations Reserve. In addition, the limited number of discount brand options provided to respondents and the high prevalence of youths reporting “other” for their usual brand of cigarette suggests that prevalence rates for discount brands may be underestimated. It is also possible that some premium brands of cigarettes may have also been included in the response option “other”. Data were also unavailable to determine if youths were consuming other forms of contraband tobacco, such as counterfeit tobacco products and tobacco products from other criminal activities. It should also be noted that the cross-sectional nature of the design does not allow for causal inferences regarding the association between brand preference and the correlates examined in this manuscript. Longitudinal data are required to determine the temporal relations among correlates.