CORE INDICATORS AND MEASURES OF YOUTH HEALTH TOBACCO CONTROL MODULE:

CORE INDICATORS AND MEASURES OF YOUTH HEALTH TOBACCO CONTROL MODULE: Indicators and Questions to use with Youth Respondents and/or School Setting Assessments SUMMARY CIM of Youth Tobacco Control: Summary i

Suggested citation Kroeker C & Manske S on behalf of Youth Excel. (2012, November) Core Indicators and of Youth Health Tobacco Control Module: Indicators and Questions to use with Youth Respondents and/or School Setting Assessments. Waterloo, Ontario: Propel Centre for Population Health Impact, University of Waterloo. Note: This version of the CIM of Youth Tobacco Control replaces all previously published versions. The indicators and measures presented in this report have been updated based on pilot test results. Youth Excel aims to integrate the prevention of cancers with the prevention of other chronic diseases; integrate science, policy and practice to optimize prevention efforts; and catalyze cross-provincial/territorial partnerships to accelerate progress as part of an initiative called CLASP: Coalitions Linking Action and Science for Prevention. Efforts are currently focused on tobacco control, physical activity and healthy eating. Youth Excel is a team of teams including researchers, policy and program leaders from provinces. From 2009 to 2012, provincial teams were led by the following host organizations: NL (Memorial U), PE (U of PEI), NB (UNB), ON (Public Health Ontario), MB (CancerCare Manitoba), AB (U of Alberta), BC (U of Victoria), plus the pan-canadian Joint Consortium for School Health and the University of Waterloo/Canadian Cancer Society s Propel Centre for Population Health Impact, which served as the secretariat. Development of the Core Indicators and of Youth Health was funded by Development of the core indicators and measures described in this report was made possible through a financial contribution from Health Canada, through the Canadian Partnership Against Cancer. The views expressed herein represent the views of Youth Excel and do not necessarily represent the views of the project funder. For more information visit our website www.propel.uwaterloo.ca/youthexcel or email cim@uwaterloo.ca. CIM of Youth Tobacco Control: Summary i

Acknowledgements Development of the Core Indicators and of Youth Tobacco Control was a multi-stage process. Initial development began with a two day workshop, plus pre and post meeting written feedback. The initial refinement stage involved more written feedback and a series of teleconferences. Pilot testing occurred during the Spring of 2012 and refinements were made by a subset of initial contributors. We thank the many individuals and organizations that contributed to the development phase. Major Contributors Rashid Ahmed, Statistician Propel Centre for Population Health Impact University of Waterloo Frankie Best, Project Manager Tobacco Control Program, Chronic Disease/Injury Prevention and Built Environment British Columbia Ministry of Health Services Steve Brown, Director of Biostatistics Propel Centre for Population Health Impact University of Waterloo Philip Davidson, Policy Analyst Cross-Sector Strategic Initiatives Branch British Columbia Ministry of Education Lynn Ann Duffley, Director, Wellness Initiatives Health and Education Research Group University of New Brunswick Murray Kaiserman, Independent Consultant Scott Leatherdale, Scientist & CCO Research Chair Department of Prevention & Cancer Control Cancer Care Ontario Tanya Barnes Matthews, Regional Health Education Consultant, Western Health, Newfoundland Marlien McKay, Manager, Strategic Initiatives, Wellness Branch, New Brunswick Department of Wellness, Culture and Sport Kathy Moran, Epidemiologist Durham Region Health Department, Ontario Donna Murnaghan, Associate Professor School of Nursing, Comprehensive School Health Research Group, University of Prince Edward Island Shawn O Connor, Senior Research Associate Ontario Tobacco Research Unit Melody Roberts, Strategic Advisor Health Promotion, Chronic Disease & Injury Prevention, Public Health Ontario Additional Contributors Kathleen Brennan, Analyst [Health Promotion Chronic Disease Prevention], Sport, Recreation & Healthy Living Division, PEI Department of Health and Wellness Marla Delaney, Manager Prevention and Public Issues Canadian Cancer Society, PEI Division Anne-Marie Holt, Manager Epidemiology & Evaluation Services, Senior Epidemiologist Haliburton, Kawartha, Pine Ridge District Health Unit, Ontario CIM of Youth Tobacco Control: Summary Donna Kosmack, Southwest TCAN Manager South West Tobacco Control Area Network Middlesex London Health Unit, Ontario Mark Latendresse, Senior Epidemiologist Bio- Statistician, Controlled Substances and Tobacco Directorate, Health Canada Andrew Loughead, Manager Tobacco Control and Cessation, Manitoba Healthy Living, Youth and Seniors ii

Kevin McDonald, Manager, Tobacco Control Program, Hamilton Public Health Services, City of Hamilton, Ontario Daniela Panait, Senior Biostatistician Controlled Substances and Tobacco Directorate, Health Canada Joanne Pelley, Manager Health Promotion and Wellness Central Health, Newfoundland Lucille Pica, Chargée de projet Direction des statistiques de santé Institut de la statistique du Québec Ruth Sanderson, Chronic Disease Epidemiologist Public Health Ontario Michèle Tremblay, Médecin Conseil Institut national de santé publique du Québec Allison Watts, PhD Candidate School of Population and Public Health University of British Columbia Staff Support Esther Russell, Project Manager Propel Centre for Population Health Impact University of Waterloo Rebecca Digby, MSc Candidate Department of Health Studies and Gerontology University of Waterloo CIM of Youth Tobacco Control: Summary iii

Summary Use of consistent measures to generate and report comparable indicators can more rapidly advance our knowledge of what types of interventions work in different settings with different populations, and help inform change (for example, program and policy decisions). Adopting core indicators and measures (CIM) can minimize duplication and reduce burden on respondents by coordinating our efforts. Our hope in producing the CIM of Youth Health is that that individuals and organizations in Canada who conduct, or make use of, surveillance and evaluation data will voluntarily and consistently adopt the CIM of Youth Health as they have been developed, each time measurement occurs. There are currently three modules of the CIM of Youth Health: Tobacco Control, Physical Activity & Sedentary Behaviour, and Nutrition. Each module is described in a different report. This report describes the CIM of Youth Tobacco Control and replaces all previously published versions. All indicators and measures described in this report have been updated from the original versions based on pilot test results. Building on past efforts, a group of experts developed two separate sets of core indicators and measures that can be implemented together or independently: 1) for use with youth respondents aged 10-19 ( individual-level ) and 2) for use with school health teams/administrators when assessing aspects of school settings related to tobacco control ( school-level ). Both sets of core indicators and measures were designed to be used with any data collection tool, either as a stand-alone set of measures (questions) or integrated with additional questions and/or topics. The individual-level CIM set contains 10 indicators measured by 9 questions about tobacco use behaviour, tobacco use intentions and exposure to secondhand smoke, plus 5 demographic questions. The individual-level CIM are designed to be used with youth respondents aged 10-19, regardless of their living, working and playing environment(s). For example, implementation of the CIM is not intended to be limited to students attending school. The school-level CIM set contains 9 indicators measured by 7 questions about the existence and enforcement of rules prohibiting tobacco use, extra-curricular activities and community partnerships designed to reduce tobacco use among youth, plus 3 school characteristic variables. The school-level CIM is designed to be used with respondents (as individuals or a team) who can accurately report on various aspects of their school setting. We limited the scope of the school-level CIM to processes, programs and structures which educators and their community partners can reasonably be expected to influence. To balance standardization with flexibility, we have structured the CIM of Youth Tobacco Control so that topics can be assessed independently, but hope that all the indicators associated with a particular topic will be reported publicly (where possible) and that all the measures associated with these indicators will be included in the data collection tool exactly as they appear in this report. Common reporting guidelines are included to facilitate comparison across implementations. The core indicators and measures for youth respondents and school setting assessments are summarized in the tables that follow, and explained in detail in the body of this report. Please see www.propel.uwaterloo.ca/youthexcel for the full report CIM of Youth Tobacco Control: Summary 1

Core Indicators and for Youth Respondents ( Individual-level ) Topics Select those relevant to your data collection objective(s) 1. Reduced susceptibility to experimentation with cigarettes Indicators For each topic selected, report all indicators where possible 1. Proportion of youth who have never had a puff of a cigarette 2. Proportion of youth who have never had a puff of a cigarette who are susceptible to cigarette smoking For each topic selected, include all questions in your data collection tool 1. Have you ever tried cigarette smoking, even just a few puffs? Yes No 2. At any time during the next year do you think you will smoke a cigarette? Definitely yes Probably yes Probably not Definitely not 3. Do you think in the future you might try smoking cigarettes? Definitely yes Probably yes Probably not Definitely not 4. If one of your best friends was to offer you a cigarette would you smoke it? Definitely yes Probably yes Probably not Definitely not 2. Reduced use of cigarettes 1. Proportion of youth who smoked cigarettes a. every day for the past 30 days b. almost every day for the past 30 days c. on some of the past 30 days 2. Proportion of youth who did not smoke cigarettes at all in the past 30 days 1. During the past 30 days, did you smoke a cigarette, even just a few puffs? Yes, every day (30 days) Yes, almost every day (15-29 days) Yes, some days (1-14 days) No (0 days) 3. Reduced use of tobacco products (excluding cigarettes) 1. Proportion of youth who used tobacco (excluding cigarettes) a. every day for the past 30 days b. almost every days for the past 30 days c. on some of the past 30 days 2. Proportion of youth who did not use tobacco (excluding cigarettes) at all during the past 30 days 1. During the past 30 days, did you use any form of tobacco other than cigarettes? (for example, cigars or little cigars or chew) Yes, every day (30 days) Yes, almost every day (15-29 days) Yes, some days (1-14 days) No (0 days) CIM of Youth Tobacco Control: Summary 2

Topics Select those relevant to your data collection objective(s) 4. Increased desire to quit using tobacco 5. Reduced exposure to secondhand smoke Indicators For each topic selected, report all indicators where possible 1. Proportion of youth that want to quit using tobacco a. in the next 30 days b. in the next 6 months 2. Proportion of youth that do not want to quit using tobacco 1. Proportion of youth that report being exposed to secondhand smoke a. Daily b. almost every day c. some days d. never 2. Proportion of youth reporting exposure to secondhand smoke a. in their home in the past 30 days b. on school grounds in the past 30 days c. while at work in the past 30 days d. in a vehicle in the past 30 days For each topic selected, include all questions in your data collection tool 1. Do you want to quit using tobacco (both cigarettes and other tobacco)? I have never used tobacco I have already quit for at least 30 days Yes, within 30 days Yes, within 6 months Yes, but I am not sure when No, I do not want to quit 1. During the past 30 days, how often did you breathe in secondhand smoke, meaning the smoke from someone else s cigarette? If you smoke, do not include your own cigarette smoke in your answer. Every day (30 days) Almost every day (15-29 days) Some days (1-14 days) Never (0 days) 2. During the past 30 days, did you breathe in secondhand smoke, meaning the smoke from someone else s cigarette (If you smoke, do not include your own cigarette smoke in your answer) a. in your home? Yes No I do not have a home (exclude if sample will not contain homeless youth) b. on school grounds? Yes No I do not go to school (exclude if entire sample attends school) c. while at work? Yes No I do not work d. in a vehicle? Yes No I have not been in a vehicle in the past 30 days Demographic Variables Variables For each indicator, report by Include all if possible 1. Age 1. How old are you today? (Response options can be customized for sample) 10 years or younger 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years or older CIM of Youth Tobacco Control: Summary 3

Variables For each indicator, report by 2. Grade Exclude if the entire sample does not attend school Include all if possible 1. What grade are you in? List each relevant grade as a separate response option. If sample may contain youth that do not attend school, include I do not go to school as a response option. 3. Gender 1. Are you OR 2. Are you a Male? Boy? Female? Girl? 4. Disposable income of youth respondent 1. About how much money do you usually get each week to spend on yourself or to save? (remember to include all money from allowances and jobs like babysitting, delivering papers ) Zero $1 to $5 $6 to $10 $11 to $20 $21 to $40 $41 to $100 More than $100 I do not know how much money I get each week 5. Recent immigration 1. Did you move to Canada for the first time in the last 5 years? Yes No I do not know Core Indicators and for School Setting Assessments ( School-level ) Topics Select those relevant to your data collection objective(s) 1. Increased presence and strength of policies prohibiting tobacco use Indicators For each topic selected, report all where possible 1. Proportion of schools that report having policies prohibiting all forms of tobacco use, in all locations 2. Proportion of schools that report having policies prohibiting all forms of tobacco use in the following locations a. On school grounds during school hours b. On school grounds outside of school hours c. Off school grounds but within a specified distance of the boundary d. In school buses or other vehicles used to transport students e. In private vehicles parked on school grounds f. At school events off school grounds continued on next page For each topic selected, include all questions in your data collection tool 1. Policies include management practices, decisionmaking processes, procedures and rules at any level. Does your school have policies that prohibit all forms of tobacco use (for example, cigarette smoking, little cigars, chewing tobacco) in the following locations? a. School grounds during school hours Yes No b. School grounds outside of school hours Yes No c. Off school grounds but within a specified distance of the boundary Yes No d. School buses or other vehicles used to transport students Yes No e. Private vehicles parked on school grounds Yes No f. School events off school grounds Yes No continued on next page CIM of Youth Tobacco Control: Summary 4

Topics Select those relevant to your data collection objective(s) 2. Increased enforcement of policies prohibiting tobacco use Indicators For each topic selected, report all where possible 3. Proportion of schools with policies that prohibit all forms of tobacco use, in all locations, whose policies apply to everyone including students, staff, families and visitors 4. Proportion of schools with policies that prohibit all forms of tobacco use, in all locations, whose policies apply 24 hours per day, 356 days per year. 1. Proportion of schools that have at least one person with responsibility to actively enforce policies prohibiting tobacco use For each topic selected, include all questions in your data collection tool 2. Do these policies apply to everyone including students, staff, families and visitors? Yes No Our school does not have policies that prohibit all forms of tobacco use 3. Do these policies apply 24 hours per day, 365 days per year, even if enforcement is not always feasible? Yes No Our school does not have policies that prohibit all forms of tobacco use 1. Policies include management practices, decisionmaking processes, procedures and rules at any level. * Does your school have at least one person with responsibility to actively enforce policies prohibiting tobacco use, at least while students are in school? Yes No Our school does not have policies prohibiting tobacco use *If definition already included as part of the measures from topic 1, it does not need to be repeated. 3. Health curriculum is supplemented with additional opportunities for learning about tobacco control issues 1. Proportion of schools whose health curriculum is supplemented with opportunities for learning about tobacco use and control issues (e.g. prevention of tobacco use, stopping tobacco use, protection from secondhand smoke) 1. Do students at your school have opportunities to learn about the following tobacco control issues in subjects other than health or physical education, or through programs or activities outside the curriculum? Yes No Prevention of tobacco use Quitting tobacco use Protection from secondhand smoke Advocacy or youth empowerment 4. Schools have partnerships and resources that help students remain or become tobacco free 1. Proportion of schools that have at least one effective partnership to help students remain or become tobacco free continued on next page 1. Effective partnerships are based on effective communication and strong interpersonal relationships, have common goals, value the roles of each member and evolve over time. continued on next page CIM of Youth Tobacco Control: Summary 5

Topics Select those relevant to your data collection objective(s) Indicators For each topic selected, report all where possible 2. Proportion of schools that have at least one effective partnership with an external organization (e.g. NGO, business, government, public health, police) to help students remain or become tobacco free 3. Proportion of schools that have a. funding to help students remain or become tobacco free b. services to help students remain or become tobacco free c. material resources to help students remain or become tobacco free For each topic selected, include all questions in your data collection tool Does your school have at least one effective partnership with the following individuals or groups to help students remain or become tobacco free? Yes No Families Community group(s) or nongovernmental organization(s) Business(es) Government at any level Public health or regional/local health authorities Law enforcement or police 2. Does your school have any of the following supports to help students remain or become tobacco free? Yes No Funding, grants or donations Services (e.g. programs, youth advocacy activities, guest speakers, teacher training, counseling) Material resources (e.g. handouts, signs, equipment) School Characteristic Variables Variable For each indicator, report by Include all or obtain data from other sources 1. Grades taught at the school What grades are taught at your school? Open ended range response OR list each relevant grade as a separate response option 2. Number of students enrolled at the school 3. School socioeconomic status (as indicated by postal code) How many students are enrolled at your school? Open ended response What is your school s postal code? Open ended response CIM of Youth Tobacco Control: Summary 6