Of the 28 843 respondents in grades 9 to 12 who answered the item about Aboriginal status, 2620 (9.1%) identified themselves as Aboriginal: 1408 (53.7%) were First Nations, 962 (36.7%) were Métis and 250 were Inuit (9.5%). presents the sample characteristics of the Aboriginal and non-Aboriginal youth in our sample by sex.
Weighted characteristics of Aboriginal youth living off-reserve and non-Aboriginal youth, by sex
Overall, 24.9% of the Aboriginal respondents reported that they were current smokers, 2.6% were former smokers, and 72.4% were nonsmokers (). The corresponding proportions among the non-Aboriginal respondents were 10.4%, 1.5% and 88.0%. The prevalence of smoking was higher among female than among male Aboriginal youth (27.1% v. 22.9%; p = 0.03). Among the respondents who reported having never smoked, 33.4% of Aboriginal youth and 29.0% of non-Aboriginal youth were identified as being susceptible to future smoking.
Among current smokers, 65.6% of Aboriginal youth and 74.3% of non-Aboriginal youth reported having tried to quit smoking. More female Aboriginals than male Aboriginals reported having made one or more attempts to quit (70.9% v. 60.1%; p = 0.007).
The use of tobacco products other than cigarettes among the Aboriginal and non-Aboriginal respondents is shown in . More Aboriginal youth than non-Aboriginal youth reported ever or currently using each type of tobacco product. Use of cigarillos or little cigars was especially higher among Aboriginal youth (44.1% v. 29.8%), as was the use of flavoured cigarettes (41.9% v. 27.0%).
Figure 1: Use of tobacco products among 2620 Aboriginal youth living off-reserve and 26 223 non-Aboriginal youth in grades 9 to 12. Current use of flavoured cigarettes is not shown because it was not included in the survey. Source: 2008/09 Youth Smoking Survey. (more ...)
Exposure to second-hand smoke
Exposure to second-hand smoke was more prevalent among the Aboriginal than the non-Aboriginal respondents (). For instance, 37.3% of Aboriginal and 19.7% of non-Aboriginal youth reported exposure to second-hand smoke at home every day or almost every day; 51.0% of Aboriginal and 30.3% of non-Aboriginal youth reported exposure to second-hand smoke in cars on one or more days in the last week.
Exposure to second-hand smoke among Aboriginal youth living off-reserve and non-Aboriginal youth, by sex
More female Aboriginals than male Aboriginals reported having been exposed to secondhand smoke in cars (54.0% v. 48.1%; p = 0.02).
Alcohol and drug use
Most of the respondents reported having tried alcohol (88.5% of Aboriginal and 84.2% of non-Aboriginal youth) (). The average age at which they first tried alcohol was significantly lower among Aboriginal youth than among non-Aboriginal youth (mean 12.5 [standard deviation (SD) 2.3] v. 13.1 [SD 2.3] years). Among those who ever tried alcohol, Aboriginal youth had a higher prevalence of binge drinking (91.9% v. 85.2% among non-Aboriginals).
Use of alcohol and drugs among Aboriginal youth living off-reserve and non-Aboriginal youth, by sex
The prevalence of marijuana use was significantly higher among the Aboriginal youth than among the non-Aboriginal youth (62.0% v. 41.1%); the highest prevalence was among Aboriginal females (64.1%). The prevalence of illicit drug use (excluding marijuana) was also higher among Aboriginal youth (34.8% v. 20.6%); again, female Aboriginals had the highest prevalence (39.8%).
Effect of Aboriginal status on key outcome variables
For the logistic regression analysis to determine whether Aboriginal status predicted being a current smoker versus a nonsmoker (excluding former smokers), we controlled for sex, grade, weekly spending money and geographic region. We found that Aboriginal youth were more likely than non-Aboriginal youth to be current smokers (odds ratio [OR] 3.30, 95% confidence interval [CI] 2.65–4.10). Among respondents who had never tried smoking (not even a puff) and controlling for the same variables, Aboriginals were no more or less likely than non-Aboriginals to be susceptible to future smoking (OR 1.20, 95% CI 0.91–1.58). Among current smokers, Aboriginals were less likely than non-Aboriginals to have ever made an attempt to quit (OR 0.65, 95% CI 0.43–0.96).
In the remaining analyses, we controlled for sex, grade, geographic region, weekly spending money and smoking status (binary coded as current smoker v. nonsmoker, with former smokers excluded). We found that Aboriginal youth were more likely than non-Aboriginal youth to report being exposed to second-hand smoke at home every day or almost every day (OR 2.31, 95% CI 1.90–2.81). Aboriginal youth were also more likely to report being exposed to second-hand smoke in cars on one or more days in the last seven days (OR 2.04, 95% CI 1.62–2.57). Aboriginals were more likely than non-Aboriginals to have ever tried marijuana (OR 2.06, 95% CI 1.64–2.57) and other illicit drugs (OR 1.59, 95% CI 1.25–2.02). Aboriginal youth were no more or less likely than non-Aboriginal youth to have drunk alcohol in the year before the survey (never had a drink / only had a sip v. all other categories) (OR 1.05, 95% CI 0.86–1.29); they were more likely than non-Aboriginal youth to have engaged in binge drinking in the past year (OR 1.41, 95% CI 1.09–1.83).
We found a consistent pattern in the data from the 2008/09 Youth Smoking Survey whereby Aboriginal youth living off-reserve in Canada were at significantly increased health risk as a function of their behavioural profile compared with non-Aboriginal youth. Aboriginal youth were more likely than non-Aboriginal youth to be current smokers, to report regular exposure to second-hand smoke, to have tried marijuana and other illicit drugs and to engage in binge drinking. Among current smokers, Aboriginal youth were less likely than non-Aboriginal youth to have tried to quit smoking. Among the Aboriginal youth, females had higher rates of current smoking, exposure to second-hand smoke, illicit drug use and frequency of drinking alcohol compared with males.
Self-identified Aboriginals comprise the fastest growing population in Canada.14
However, there is a paucity of research on the use of tobacco, alcohol and illicit drugs among Aboriginal youth in this country. Our results show that, consistent with previous studies involving Aboriginals living on reserve, Aboriginal youth living off-reserve are at increased health risk. Previous research summarizing tobacco, alcohol and illicit drug use among adolescents in Canada has not examined such use among Aboriginal youth and therefore may have underestimated the health risk to this population.
The differences that we observed between male and female Aboriginal youth in our study could be explained by differences in age. The female Aboriginal youth were older on average than the male Aboriginal youth and the non-Aboriginal youth. Because youth are more likely to engage in risky behaviours as they get older, additional research is required to understand why female Aboriginal youth appear to be at increased risk for tobacco use and other risky behaviours.
Our study has limitations. The data were self-reported, which may be subject to recall bias, and we were unable to use biological measures to confirm responses. However, we have no reason to believe that recall should differ between Aboriginal and non-Aboriginal youth. For socioeconomic status, we used a proxy measure based on the respondents’ reported weekly spending money rather than parental or household income measures. Household income measures are not included in the Youth Smoking Survey because it is unclear whether adolescents are able to accurately report household income.
Implications for policy and research
The high prevalence of smoking and use of other substances among Aboriginal youth living off-reserve highlights the need for culturally appropriate smoking cessation and substance prevention programs that target Aboriginal youth. Because previous research has shown the comorbid use of alcohol, tobacco and marijuana to be prevalent among Canadian youth,10
it may also be warranted to develop and evaluate prevention efforts targeting Aboriginal youth that address multiple risk factors. Such strategies should address the unique strengths and needs of Aboriginal youth, as was done with programs successfully adopted in other domains (e.g., the treatment of solvent abuse).15,16
Most of the Aboriginal youth who identified themselves as current smokers, particularly females, reported that they had tried to quit at least once previously. This finding suggests that Aboriginal youth are interested in quitting but have not been successful and that they may require additional support to stop smoking. Primary care physicians and other health practitioners should be encouraged to screen for smoking status, particularly among Aboriginal youth. Health practitioners should also provide information to parents regarding the harmful effects of exposure to second-hand smoke and the benefits of having a smoke-free home. There is also a need for tobacco control policies and programs that address exposure to second-hand smoke among Aboriginal youth.
Current national estimates of smoking, and alcohol and illicit drug use among youth underestimate the prevalence of these behaviours among Aboriginal youth living off-reserve. Our findings highlight the need for culturally appropriate prevention and cessation policies and programs for this at-risk population.