Findings from Enhanced Surveillance
of Canadian Street Youth, 1999-2003
(November 2007)

Canadian Street Youth and Substance Use

Executive Summary Key Findings Introduction Purpose Methods Analysis Analysis Terms Laboratory Methods Limitations Demographic Profile of E-SYS Participants Substance Use Smoking Alcohol Use Recent Alcohol Intoxication General Drug Use Patterns Non-Injection Drug Use Injection Drug Use Injection Drug Use and Hepatitis C Sexual Behaviours and STIs Implications Conclusions References

4. Substance use

4.1 Smoking

Smoking, a highly addictive habit, is among the leading causes of premature death and morbidity worldwide.¹⁴ Cigarettes kill half of all lifetime users, and tobacco kills more than AIDS, legal and illegal drugs, road accidents, murder and suicide combined.¹⁴ Each year in Canada over 45 000 people die from tobacco-related causes (this includes those exposed to secondhand smoke).¹⁵ Smoking is a major cause of respiratory disease, cancer and circulatory disease. It also has an enormous burden on society, directly and indirectly, in terms of lost economic productivity and health care expenditure.¹⁵

Consistently throughout the three phases of data collection, about 80% of youth reported smoking cigarettes every day. As Figure 1 shows, the proportion of youth who reported smoking daily was very high (84.3% in 1999, 82.5% in 2001 and 78.8% in 2003). The proportion of youth who reported smoking occasionally was 5.7%, 7.2% and 9.2% in 1999, 2001 and 2003, respectively. There were no major differences by age group or gender in the proportions of street youth who reported smoking every day (Figure 2).

Figure 1. Everyday and occasional smoking among street youth

Figure 2. Everyday smoking in street youth by age group and gender

Based on 1999 and 2001 data (the question was not asked in 2003), street youth smoked approximately 15 cigarettes per day (females 14 to 16 and males 16 to 18 cigarettes per day); about 72% of smokers smoked more than 10 cigarettes daily.

Figure 3 compares the proportion of smokers among street youth (E-SYS) vs. the general youth population. The Canadian Tobacco Use Monitoring Survey (CTUMS)¹⁶ is a general population survey that tracks smoking status and amount smoked, especially among those 15 to 24 years old, the age group at most risk of taking up smoking. It shows that overall, the proportion of smokers among youth aged 15 to 24 has dropped to 24% in 2003 from 31% in 1999. Likewise, the Ontario Student Drug Use Survey (OSDUS),¹⁷the longest ongoing provincial survey of student drug use in Canada, reported that smoking rates among students in Ontario are currently on a downward trend. In the general population, youth aged 15 to 19 years reported consuming an average of 11.6 cigarettes per day, with males on the average smoking 2.2 more cigarettes daily (13.8) than their female counterparts (11.6). In contrast, E-SYS has found that rates of smoking among street youth have remained consistently high.

Figure 3. Proportion of smokers in youth aged 15 to 24 in CTUMS and E-SYS

CTUMS=Canadian Tobacco Use Monitoring Survey
E-SYS=Enhanced Surveillance of Canadian Street Youth

As seen in the literature, factors associated with youth tobacco use include low socioeconomic status; use and approval of tobacco use by peers or siblings; smoking by parents or guardians; accessibility, availability and price of tobacco products; perception that tobacco use is normative; lack of parental support or involvement; low levels of academic achievement; lack of skills to resist influences to tobacco use; lower self-image or self-esteem; belief in functional benefits of tobacco use; and lack of self-efficacy to refuse offers of tobacco.^{18, 19} For street youth recruited in E-SYS, having been in jail or in a detention centre and having been expelled from school or having dropped out of school were important factors^§ predicting smoking.