Developing a better understanding of RYO tobacco use among youth is important for advancing population-level tobacco control prevention strategies and cessation programs. We identified that RYO tobacco use is not a negligible problem among Canadian youth smokers, as almost one in four reported currently using RYO tobacco. The high level of RYO use among Canadian youth is cause for concern, especially when one considers that the prevalence of current RYO use was higher among our sample of youth when compared to samples of the Canadian adult population [2
]. Moreover, the surprisingly high prevalence of RYO current users who are female warrants additional study as research has previously suggested that RYO use is dominated by male smokers. It is clear that RYO tobacco prevention and cessation needs to become better integrated into existing surveillance systems and tobacco control initiatives.
To our knowledge, no studies have examined RYO use among youth smokers despite research previously identifying this population as a priority [4
]. However, consistent with the adult literature [2
], we identified that youth who were heavier and more frequent smokers were more likely to smoke RYO tobacco. This finding is cause for concern as research has previously identified that RYO smokers are not only more addicted, but they are also less likely to make quit attempts [2
] or intend to quit in the future [5
]. As such, even though RYO smokers represent a smaller portion of the entire smoking population relative to FM cigarette smokers, knowing that they are more frequent and heavier smokers suggests that they may actually be at increased risk for future smoking related morbidity and mortality [6
]. Additional research is required to tailor appropriate cessation interventions to this high-risk population.
RYO tobacco is not only more affordable than FM cigarettes, but RYO cigarettes can also be rolled thinner than FM cigarettes, saving tobacco and the relative cost per cigarette. This is an important consideration for price sensitive youth smokers, as evidence suggests that even adult smokers will engage in price minimizing behaviours to compensate for increased manufactured cigarette costs, such as purchasing RYO tobacco [15
]. Consistent with previous research on adults [5
], we identified that the disposable income of youth was associated with RYO tobacco use, where RYO tobacco use is more common among youth with less spending money. The importance of income suggests that as long as a discrepancy in the excise tax on FM and fine-cut tobacco exists, smokers may compensate for price increases by shifting from FM to RYO instead of quitting [1
]. Not surprisingly, the provinces in Atlantic Canada identified as having the highest prevalence rates of current RYO use (refer to Figure ), are also the provinces in Canada with the largest difference in the FM:RYO tax ratio in Canada [11
]. These data provide evidence that it should be a public health priority to increase the excise taxes (Federal and Provincial/Territorial taxes) on fine-cut tobacco used for RYO cigarettes to make the cost equivalent to FM cigarettes. However, it is likely that an even larger public health benefit would be observed if fine-cut tobacco should be taxed at a higher rate the FM cigarettes to compensate for the ability RYO smokers have to roll thinner cigarettes using less tobacco [4
Consistent with research among adults showing that the younger age groups are the most likely to use RYO tobacco [4
], we identified that the likelihood of RYO use decreased by grade. Our finding is likely a function of youth in higher grades reporting more disposable income than youth in lower grades; as such, youth in lower grades are more apt to smoke RYO since it is more affordable. However, when one considers that smoking prevalence increased dramatically from grade 9 (21.0%) to grade 12 (50.8%) within the 2008 YSS [19
], there is still a dramatic increase in the absolute number of youth using RYO as grade increases. Another finding consistent with research among adults [2
], was that youth who reported more frequent marijuana use were more than twice as likely to currently use RYO tobacco. Considering the relatively common practice of users manually combining tobacco and marijuana (e.g., blunts) [20
], future research should consider developing a better understanding of the link between RYO tobacco use and marijuana use among youth.
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. It should also be noted that the cross-sectional nature of the design does not allow for causal inferences regarding the association between sociodemographic characteristics and RYO tobacco use. Longitudinal data are required. Moreover, our measure of RYO current use does not differentiate exclusive use from periodic use.