Evaluating the Impact of Changes in School-Based Tobacco Interventions Among Never Smokers Between Year 2 and Year 3 of the COMPASS Study

Objective:To examine how changes in school-based tobacco programming within a school influenced smoking susceptibility and smoking initiation outcomes among a sample of grade 9 to 12 students over time. Methods: This study used longitudinal data from Year 2 and Year 3 of the COMPASS study. The study used school-level data from 79 schools within Ontario using the School Policies and Practices (SPP) questionnaire as well as student-level data on 14965 grade 9 to 12 students who were never smoker individuals at baseline (Year 2) using the COMPASS questionnaire (Cq). This study did not examine individuals who were tried smokers at baseline. Binary logistic regression models were used to examine the impact of changes in tobacco programming within a school had on the relative risk of students’ reverting in smoking susceptibility status, becoming susceptible to smoking or initiating smoking behaviour in Year 3. Results: Between Year 2 and Year 3 of the study,22 schools (out of 79) Ontario schools reported implementing a new tobacco intervention in their school. Out of 22 schools, one school intervention had the desired impact of significantly increasing the likelihood of a susceptible never smoker individual at baseline reverting in smoking susceptibility that corresponded with a reduced risk of smoking initiation. One intervention significantly decreased the likelihood of individuals trying smoking, however these promising effects were only observed among the sample of non-susceptible never smoker individuals at baseline. In contrast, two interventions had the undesirable impact of significantly increasing the likelihood of a student initiating smoking behaviour among non-susceptible never smokers at baseline. Conclusion: The evidence presented here indicates that the majority of school-based tobacco prevention programming do not show promise in reducing adolescent smoking susceptibility and initiation among never smokers. Progress in preventing smoking initiation among never smoker youth will require coordinated and comprehensive efforts from various stakeholders. In addition, there is a need for innovative methods to be used in determining which interventions work, for which target audience, and in what context to guide the formulation of tailored and effective programming

E-cigarette marketing in the UK: evidence from adult and youth surveys and policy compliance studies

Electronic cigarettes (e-cigarettes) are battery-powered devices that heat a liquid, usually containing nicotine, to allow users to inhale the vapour. The evidence so far suggests they are far less harmful than smoking and can help people to quit smoking. However, as e-cigarettes are a relatively new product and their long-term effects are unknown, they should not be used by people who have never smoked, particularly young people. In 2016 and 2017, regulations were introduced to help ensure that e-cigarette advertising is socially responsible. This means protecting young people, minimising conflation between e-cigarettes and tobacco, and preventing uptake of e-cigarettes amongst people who don’t smoke or use nicotine. The Tobacco and Related Products Regulations 2016 (TRPR) set rules on how e-cigarettes can be advertised and prohibited marketing in specific media channels. Subsequently, the UK Advertising Standards Authority (ASA), Committee of Advertising Practice (CAP) Code and Broadcast Committee of Advertising Practice (BCAP) Code, updated in 2017, set out further advertising regulations in CAP Code Rule 22 and BCAP Code Rule 33. The overall aim of this report was to assess compliance with and the impact of the current UK e-cigarette marketing regulations. The UK Government is obliged to review and deliver a report on the TRPR within five years of the legislation being enacted, by May 2021. This report will help to inform the Government’s review. This report brings together two complementary studies to provide a description of e-cigarette advertising spend, advertising content, compliance with advertising regulations, and reported noticing and appeal of e-cigarette marketing. Study A (by the Institute for Social Marketing & Health) consisted of an analysis of e-cigarette advertising expenditure in the UK in 2019 and a detailed content analysis of a sample of advertising taken from the same year. Study B consisted of an analysis of survey data from the International Tobacco Control Policy Evaluation Project (ITC Project), which measured reported noticing of e-cigarette marketing by young people (16 to 19-year-olds) between 2017 and 2019, and adults (aged 18 and older) between 2016 and 2018 in a broad range of marketing channels.Additional co-authors: James F Thrasher, Yoo Jin Cho, Catherine Cowell, Tim Coker, Sarah Bullock, Alizee Froguel, Jyotsna Vohr

E-cigarette marketing in the UK: evidence from adult and youth surveys and policy compliance studies

Electronic cigarettes (e-cigarettes) are battery-powered devices that heat a liquid, usually containing nicotine, to allow users to inhale the vapour. The evidence so far suggests they are far less harmful than smoking and can help people to quit smoking. However, as e-cigarettes are a relatively new product and their long-term effects are unknown, they should not be used by people who have never smoked, particularly young people. In 2016 and 2017, regulations were introduced to help ensure that e-cigarette advertising is socially responsible. This means protecting young people, minimising conflation between e-cigarettes and tobacco, and preventing uptake of e-cigarettes amongst people who don’t smoke or use nicotine. The Tobacco and Related Products Regulations 2016 (TRPR) set rules on how e-cigarettes can be advertised and prohibited marketing in specific media channels. Subsequently, the UK Advertising Standards Authority (ASA), Committee of Advertising Practice (CAP) Code and Broadcast Committee of Advertising Practice (BCAP) Code, updated in 2017, set out further advertising regulations in CAP Code Rule 22 and BCAP Code Rule 33. The overall aim of this report was to assess compliance with and the impact of the current UK e-cigarette marketing regulations. The UK Government is obliged to review and deliver a report on the TRPR within five years of the legislation being enacted, by May 2021. This report will help to inform the Government’s review. This report brings together two complementary studies to provide a description of e-cigarette advertising spend, advertising content, compliance with advertising regulations, and reported noticing and appeal of e-cigarette marketing. Study A (by the Institute for Social Marketing & Health) consisted of an analysis of e-cigarette advertising expenditure in the UK in 2019 and a detailed content analysis of a sample of advertising taken from the same year. Study B consisted of an analysis of survey data from the International Tobacco Control Policy Evaluation Project (ITC Project), which measured reported noticing of e-cigarette marketing by young people (16 to 19-year-olds) between 2017 and 2019, and adults (aged 18 and older) between 2016 and 2018 in a broad range of marketing channels

Examining trends, predictors, and mediators of e-cigarette use and smoking among Canadian youth: Findings from the COMPASS study

Abstract The objectives of this dissertation were to (1) examine trends and predictors of youth e-cigarette use and cigarette smoking, (2) explore potential mediators of the association between initial e-cigarette use and cigarette smoking uptake, and (3) evaluate the impact of Ontario’s introduction of e-cigarette minimum legal sales age (MLSA) laws on youth e-cigarette use. The study objectives were explored in three separate manuscripts using data gathered from a sample of students in two Canadian provinces, Ontario and Alberta, that participated in a school-based study (COMPASS). Using longitudinal data from students in Ontario and Alberta, the first manuscript examined changes in the prevalence of exclusive e-cigarette use, exclusive smoking and dual use of e-cigarettes and cigarettes over time. This manuscript also examined how frequency of e-cigarette use and smoking (i.e., number of days used in the past month) predicted exclusive e-cigarette use, exclusive cigarette smoking and dual use of both products after a one- and two-year follow-up period. Study findings showed an increase in all usage categories over time. Findings also demonstrated some differences in predictors of exclusive e-cigarette use, exclusive smoking and dual use. For instance, frequent e-cigarette use (i.e., use for 4 or more days in past month) was not a significant predictor of exclusive smoking at either follow-up time point, but did predict dual use at both the one- and two-year follow-up. Notably, findings also showed that students who reduced their frequency of e-cigarette use were less likely to report being exclusive e-cigarette users and dual users at the two-year follow-up. The second manuscript investigated whether having one or more smoking friends mediated the association between initial e-cigarette use and cigarette smoking onset among a longitudinal sample of youth who were never smokers at baseline. Longitudinal findings showed that having one or more smoking friends did not mediate the association between e-cigarette use and subsequent cigarette smoking. Similarly, longitudinal results showed that having smoking friends did not mediate the association between e-cigarette use and subsequent dual use of e-cigarettes and cigarettes. Rather, our study findings indicated that smoking friends significantly predicted both e-cigarette use and cigarette smoking among youth. The third manuscript evaluated the influence of an e-cigarette law introduced in Ontario using a quasi-experimental design. In January 2016, Ontario implemented a law restricting the sale of e-cigarettes to those 19 and over. At that time, Alberta did not have a similar law in effect. Using a repeat cross-sectional sample, we examined the impact of Ontario’s law on the school-level prevalence of e-cigarette use among a sample of Ontario schools versus Alberta schools. Furthermore, using a longitudinal sample of students, we evaluated the impact of this law on the individual likelihood of e-cigarette use among students in Ontario versus Alberta schools. Findings based on the repeat cross-sectional sample showed that the changes in the average school-level prevalence of e-cigarette use within the Ontario sample were not significantly different from the changes seen in the Alberta sample. Findings based on the longitudinal sample showed increases in e-cigarette use over time among students in Ontario and Alberta. However, the increase observed among students in Alberta (i.e., where no e-cigarette MLSA law was implemented) was larger than the increase seen among students in Ontario (i.e., where an e-cigarette MLSA law was implemented). The studies examined within this dissertation project contribute towards our understanding of e-cigarette use and cigarette smoking among Canadian youth. Longitudinal findings indicated that having one of more smoking friends is a common risk factor that is associated with both e-cigarette use and cigarette smoking among youth. These findings suggest that the role of peers should be considered within the design of youth-based prevention interventions. Longitudinal findings showed an increase in e-cigarette use over time among youth in our study sample. Longitudinal findings also indicated that Ontario’s introduction of e-cigarette MLSA laws had an impact in attenuating these increases in e-cigarette use, but did not reverse the overall increasing trend in use among youth in our sample. Collectively, our study findings suggest the need for a more comprehensive approach to address the rise in e-cigarette use among Canadian youth

Helping and harming: evaluating school tobacco programs and policies after 4 years in the COMPASS study

Background The school environment is an equitable avenue to change youth health behaviours; however, there is little guidance for school-based programming. Specifically, the types of interventions schools use to prevent smoking uptake and progression are unknown. This analysis explored changes in school-based tobacco control programs and policies and the impact on smoking status. Methods COMPASS is a prospective cohort study that collects hierarchical longitudinal data from students and the schools they attend in Canada. Two cohorts of grade 12 students from 38 schools were identified at baseline (Y1) and three years later (Y4). The prevalence of susceptibility to future smoking, ever smoking, and current smoking among cohorts were compared in Y1 and Y4 in control (no change in tobacco control programing or policies) and intervention schools (reported a change in tobacco control programming or policies at any time during the study). Results Between Y1 and Y4, 33/38 schools reported changing their tobacco control programming or policies; 19 schools made a single change over the study period. Changes to enforcement activities and cessation programming were most common and usually involved external support. Few interventions significantly impacted the prevalence of susceptible never-smokers or ever smokers. The prevalence of grade 12 current smokers significantly increased at 12 schools and decreased at 3 schools. Thirteen interventions resulted in significant increases in students' perceptions of support to resist or quit tobacco. Conclusions Many schools implemented new tobacco control programming over three years with support from external organizations; however, few interventions significantly improved the smoking status of students over the long-term. Nevertheless, schools increased awareness of the issue of smoking by making a change to tobacco control programs or policies, which may support the behaviour of future students. The COMPASS study provides the infrastructure to continually monitor and evaluate school-based activities designed to advance youth health