Sunday Azagba

The Effect of Graphic Cigarette Warning Labels on Smoking Behavior: Evidence from the Canadian Experience

INTRODUCTION There is a substantial literature that graphic tobacco warnings are effective; however, there is limited evidence based on actual smoking behavior. The objective of this paper is to assess the effect of graphic cigarette warning labels on smoking prevalence and quit attempts. METHODS A nationally representative sample of individuals aged 15 years and older from the Canadian National Population Health Survey 1998-2008 is used. The sample consists of 4,853 individuals for the smoking prevalence regression and 1,549 smokers for quit attempts. The generalized estimating equation (GEE) model was used to examine the population-averaged (marginal) effects of tobacco graphic warnings on smoking prevalence and quit attempts. To assess the effect of graphic tobacco health warnings on smoking behavior, we used a scaled variable that takes the value of 0 for the first 6 months in 2001, then increases gradually to 1 from December 2001. RESULTS We found that graphic warnings had a statistically significant effect on smoking prevalence and quit attempts. In particular, the warnings decreased the odds of being a smoker (odds ratio [OR] = 0.875; 95% CI = 0.821-0.932) and increased the odds of making a quit attempt (OR = 1.330, CI = 1.187-1.490). Similar results were obtained when we allowed for more time for the warnings to appear in retail outlets. CONCLUSION This study adds to the growing body of evidence on the effectiveness of graphic warnings. Our findings suggest that warnings had a significant effect on smoking prevalence and quit attempts in Canada.

An emerging adolescent health risk: caffeinated energy drink consumption patterns among high school students.

OBJECTIVE To examine the prevalence, patterns, and correlates of energy drink use among adolescents, and determine whether more frequent use of energy drinks is associated with poorer health and behavioral outcomes. METHODS Data were from a 2012 cross-sectional survey of 8210 students in grades 7, 9, 10 and 12 attending public schools in Atlantic Canada. Multinomial logistic regression analysis was used to examine correlates of energy drink use patterns, including substance use, sensation seeking, risk of depression, and socioeconomic status. RESULTS Nearly two-thirds of survey respondents (62%) reported consuming energy drinks at least once in the previous year, with about 20% reporting use once or more per month. Sensation seeking, depression, and substance use were all higher among energy drink users relative to non-users, and in higher frequency users relative to lower frequency users. CONCLUSIONS The prevalence of energy drink consumption among high school students was high. The association of energy drinks with other potential negative health and behavioral outcomes suggests that use of these products may represent a marker for other activities that may negatively affect adolescent development, health and well-being.

Disparities in the frequency of fruit and vegetable consumption by socio-demographic and lifestyle characteristics in Canada

BackgroundThe health benefits of adequate fruit and vegetable (F&V) consumption are significant and widely documented. However, many individuals self-report low F&V consumption frequency per day. This paper examines the disparities in the frequency of F&V consumption by socio-demographic and lifestyle characteristics.MethodThis study uses a representative sample of 93,719 individuals from the Canadian Community Health Survey (2007). A quantile regression model is estimated in order to capture the differential effects of F&V determinants across the conditional distribution of F&V consumption.ResultsThe conditional and unconditional analyses reveal the existence of a socioeconomic gradient in F&V consumption frequency, in which the low income-education groups consume F&V less frequently than the high income-education groups. We also find significant disparities in F&V consumption frequency by demographic and lifestyle characteristics. The frequency of F&V consumption is relatively lower among: males, those in middle age, singles, smokers, individuals with weak social interaction and households with no children. The quantile regression results show that the association between F&V consumption frequency, and socio-demographic and lifestyle factors varies significantly along the conditional F&V consumption distribution. In particular, individual educational attainment is positively and significantly associated with F&V consumption frequency across different parts of the F&V distribution, while the income level matters only over the lower half of the distribution. F&V consumption follows a U-shaped pattern across the age categories. Those aged 30-39, 40-49 and 50-59 years consume F&V less frequently than those aged 18-29 years. The smallest F&V consumption is among the middle aged adults (40-49).ConclusionsUnderstanding the socio-demographic and lifestyle characteristics of individuals with low F&V consumption frequency could increase the effectiveness of policies aimed at promoting F&V consumption. The differential effects of individual characteristics along the F&V consumption distribution suggest the need for a multifaceted approach to address the variation in F&V consumption frequency.

Psychosocial working conditions and the utilization of health care services

BackgroundWhile there is considerable theoretical and empirical evidence on how job stress affects physical and mental health, few studies have examined the association between job related stress and health care utilization. Using data from the Canadian National Population Health Survey from 2000 to 2008, this paper examines the association between stressful working conditions, as measured by the job strain model, and the utilization of health care services.MethodsA zero inflated negative binomial regression is used to examine the excess health care utilization due to job strain. Separate regressions are estimated for both males and females since studies have shown gender differences in health care utilization.ResultsEstimates for the whole population show that high or medium job strain has a positive and statistically significant association with the number of visits to both a general practitioner (GP) and a specialist (SP). On average, the number of GP visits is up to 26% more (IRR = 1.26, 95% CI = 1.19-1.31) for individuals with high strain jobs compared to those in the low job strain category. Similarly, SP visits are up to 27% more (IRR = 1.27, 95% CI = 1.14-142) for the high strain category. Results are quantitatively similar for males and females, save for medium strain. In general, findings are robust to the inclusion of workplace social support, health status, provincial and occupational-fixed effects.ConclusionJob strain may be positively associated with the utilization of health care services. This suggests that improving psychosocial working conditions and educating workers on stress-coping mechanisms could be beneficial for the physical and mental health of workers.

Is alcohol mixed with energy drinks consumption associated with susceptibility to smoking

OBJECTIVE This paper examines whether adolescent students in Canada who have never smoked but who drink alcohol mixed with energy drinks (AmED) are more susceptible to smoking than those who do not consume AmED. METHODS A nationally representative sample of 15,875 never-smoking students in grades 9 to 12 from the 2010-2011 Canadian Youth Smoking Survey is used. The association between AmED and susceptibility to smoking is examined using a logistic regression. RESULTS About 28% of the never-smoking adolescents in grades 9 to 12 are susceptible to smoking, and 13% report using AmED. Results of the adjusted logistic regression analysis show a statistically significant positive association between consuming AmED and susceptibility to smoking. Never-smoking students who reported using AmED are more susceptible to smoking when compared with those who have not consumed AmED (OR=1.89; 95% CI=1.71-2.10). Similar results are obtained when the analysis is stratified by gender. CONCLUSIONS The consumption of AmED is associated with higher odds of smoking susceptibility among Canadian adolescents. AmED use could be a potential marker for smoking susceptibility among never-smoking adolescents.

Fruit and Vegetable Consumption and Body Mass Index A Quantile Regression Approach

Background: Empirical evidence on the relationship between consumption of fruits and vegetables and body weight is inconclusive. Previous studies mostly use linear regression methods to study the correlates of the conditional mean of body mass index (BMI). This approach may be less informative if the association between fruit and vegetable consumption and BMI significantly varies across the BMI distribution. Objective: The association between fruit and vegetable consumption and the BMI is examined using quantile regression. Methods: A nationally representative sample of 11,818 individuals from the Canadian Community Health Survey (2004) is used. A quantile regression model is estimated to account for the potential heterogeneous association between fruit and vegetable intake and BMI at different points of the conditional BMI distribution. The analyses are stratified by gender. Results: The multivariate analyses reveal that the association between fruit and vegetable intake and BMI is negative and statistically significant for both males and females; however, this association varies across the conditional quantiles of the BMI distribution. In particular, the estimates are larger for individuals at the higher quantiles of the distribution. The ordinary least squares (OLS) model overstates (understates) the association between FV intake and BMI at the lower (higher) half of the conditional BMI distribution. Conclusion: Findings of the standard models that assume uniform response across different quantiles of BMI distribution may be misleading. The findings of this paper suggest that increasing the intake of fruits and vegetables may be an effective dietary strategy to control weight and mitigate the risk of obesity.

Physical Inactivity Among Older Canadian Adults

BACKGROUND In spite of the substantial benefits of physical activity for healthy aging, older adults are considered the most physically inactive segment of the Canadian population. This paper examines leisure-time physical inactivity (LTPA) and its correlates among older Canadian adults. METHODS We use data from the Canadian Community Health Survey with 45,265 individuals aged 50-79 years. A logistic regression is estimated and separate regressions are performed for males and females. RESULTS About 50% of older Canadian adults are physically inactive. Higher odds of physical inactivity are found among current smokers (OR = 1.52, CI = 1.37-1.69), those who binge-drink (OR = 1.24, CI = 1.11-1.39), visible minorities (OR = 1.60, CI = 1.39-1.85), immigrants (OR = 1.13, CI = 1.02-1.25), individuals with high perceived life stress (OR = 1.48, CI = 1.31-1.66). We also find lower odds of physical inactivity among: males (OR = 0.89, CI = 0.83 to 0.96), those with strong social interaction (OR = 0.71, CI = 0.66-0.77), with general life satisfaction (OR = 0.66, CI = 0.58-0.76) and individuals with more education. Similar results are obtained from separate regressions for males and females. CONCLUSIONS Identifying the correlates of LTPA among older adults can inform useful intervention measures.

Cigarette taxes and smoking participation: evidence from recent tax increases in Canada.

Using the Canadian National Population Health Survey and the recent tax variation across Canadian provinces, this paper examines the impact of cigarette taxes on smoking participation. Consistent with the literature, we find evidence of a heterogeneous response to cigarette taxes among different groups of smokers. Contrary to most studies, we find that the middle age group—which constitutes the largest fraction of smokers in our sample—is largely unresponsive to taxes. While cigarette taxes remain popular with policy makers as an anti-smoking measure, identifying the socio-demographic characteristics of smokers who respond differentially to tax increase will help in designing appropriate supplementary measures to reduce smoking.

Disparities in tobacco use by sexual orientation among high school students.

OBJECTIVE This study examined whether cigarette use is associated with sexual orientation among high school students. METHODS Data were from a 2012 cross-sectional survey of 5994 students in grades 9, 10 and 12 attending public schools in Atlantic Canada. Multilevel logistic regression analysis was used to examine differences in cigarette use by sexual orientation. RESULTS Lesbian, gay and bisexual adolescents (LGB) reported higher prevalence (22%) of daily cigarette use compared with heterosexuals (11%). Multilevel logistic regression analysis, controlling for standard covariates, found that LGB adolescents were more likely to be daily smokers than non-LGB adolescents (odds ratio 2.00, 95% confidence interval 1.50-2.68). Bisexual adolescents were at least twice more likely to be a smoker compared with heterosexual adolescents. CONCLUSIONS Prevalence of cigarette use was significantly higher among LGB adolescent students. Our results join a growing body of evidence indicating that sexual minorities are at heightened risk of tobacco use. Smoking cessation measures that specifically target this group may be beneficial given that there is no one size fits all approach.

School Connectedness and Susceptibility to Smoking Among Adolescents in Canada

INTRODUCTION Smoking susceptibility in early adolescence is strongly predictive of subsequent smoking behavior in youth. As such, smoking susceptibility represents a key modifiable factor in reducing the onset of smoking in young people. A growing literature has documented a number of factors that influence susceptibility to smoking; however, there is limited amount of research examining associations of susceptibility to smoking and school connectedness. The current study examines whether school connectedness has an independent protective effect on smoking susceptibility among younger adolescents. METHODS A nationally representative sample of 12,894 Canadian students in grades 6-8 (11-14 years old), surveyed as part of the 2010-2011 Youth Smoking Survey, was analyzed. Multilevel logistic regression models examined unadjusted and adjusted associations between school connectedness and smoking susceptibility. The impacts of other covariates on smoking susceptibility were also explored. RESULTS Approximately 29% of never-smokers students in grades 6-8 in Canada were susceptible to future smoking. Logistic regression analysis, controlling for standard covariates, found that school connectedness had strong protective effects on smoking susceptibility (odds ratio [OR] 0.91, 95% CI 0.89-0.94). CONCLUSIONS The finding that school connectedness is protective of smoking susceptibility, together with previous research, provides further evidence that improving school conditions that promote school connectedness could reduce risky behavior in adolescents. While prevention efforts should be directed at youth of all ages, particular attention must be paid to younger adolescents in the formative period of 11-14 years of age.