Core Indicators and Measures Ofyouthhealth

CORE INDICATORS AND MEASURES
OFYOUTHHEALTH

TOBACCOCONTROL MODULE:

Indicators and Questions touse with
Youth Respondents

November 2012

Excerpt from Core Indicators and Measures of Youth Tobacco Control: Indicators and Questions to use with Youth Respondents and/or in School Setting Assessments (November 2012). Full report available at 1

This document is an excerpt from

Kroeker C & Manske Son behalf of Youth Excel.(2012, November) Core Indicators and Measuresof 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 November 2012 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 isateam 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 Measuresof 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 or email .

Acknowledgements

Development of the Core Indicators and MeasuresofYouth 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

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

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

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 CIMof YouthHealthas 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-levelCIM 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 CIMof 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 measuresassociated 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 this excerpt and explained in detail in the full report.
Core Indicators and Measures for Youth Respondents (“Individual-level”)

Topics
Select those relevant to your data collection objective(s) / Indicators
For each topic selected, report all indicators where possible / Measures
For each topic selected, include all questions in your data collection tool

Reduced susceptibility to experimentation with cigarettes

/ 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 / 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

Reduced use of cigarettes

/ 1.Proportion of youth who smoked cigarettes

every day for the past 30 days
almost every day for the past 30 days
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)

Reduced use of tobacco products (excluding cigarettes)

/ 1.Proportion of youth who used tobacco (excluding cigarettes)

every day for the past 30 days
almost every days for the past 30 days
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)

Increased desire to quit using tobacco

/ 1.Proportion of youth that want to quit using tobacco

in the next 30 days
in the next 6 months

2.Proportionof youth that do not want to quit using tobacco / 1.Do you want to quit using tobacco (both cigarettes and other tobacco)?
I have never used tobacco
I have already quitfor 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

Reduced exposure to secondhand smoke

/ 1.Proportion of youth that report being exposed to secondhand smoke

Daily
almost every day
some days
never

2.Proportion of youth reporting exposure to secondhand smoke

in their home in the past 30 days
on school grounds in the past 30 days
while at work in the past 30 days
in a vehicle in the past 30 days

/ 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.
Everyday (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)

in your home?  Yes  No  I donot have a home

(exclude if sample will not
contain homeless youth)

on school grounds?  Yes  No  I donot go to school

(exclude if entire sample
attends school)

while at work?  Yes  No  I donot work
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 / Measures
Include all if possible

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

Grade
Exclude if the entire sample does not attend school

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.

Gender

Are you… OR 2. Are you a…

 Male?  Boy?
 Female?  Girl?

Disposable income of youth respondent

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

Recent immigration

Did you move to Canada for the first time in the last 5 years?

 Yes
 No
 I do not know

Common Reporting Guidelines

Standardization is the key benefit of using CIM as it ensures comparability across implementations. However, flexibility is also important as there is no need for an implementer to collect data that is not relevant to their specific objectives. To balance these needs, we have structured the CIMof Youth Tobacco Control so that the “topics” can be assessed independently, but hope that all the indicators associated with a particular topicwill be reported publicly (where possible) and that all the measures (questions) associated with these indicators will be included in the data collection tool exactly as they appear in this report. As more and more people use the measures (questions) as presented, without modification, and report the indicators publicly where possible, we can build a better understanding of the impact of different policy or program contexts.

The following sub-sections provide details on how to calculate and report the indicators in a common way, as well as what survey design variables and methodological information must be made available to facilitate comparisons across implementations. It is by following these guidelines that the true benefit of using core indicators and measures will emerge.

1.1Calculating Indicators and Subgroups for Youth Respondents (“Individual level”)

The table below provides details on how to calculate the indicators, and how to use the demographic variables to facilitate comparisons across implementations.

Indicators / Measures
See below for demographic questions / Calculations / What to Report
Topic1: Reduced susceptibility to experimentation with cigarettes
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 / 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 continued on next page
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 / Indicator 1 = “no” to question 1.
Indicator 2 = “no” to question 1 AND any response other than “definitely not” to questions 2, 3 and 4. / Indicators 1 and 2
Indicators 1 and 2 by Age
If sample contains ages 10-19 inclusive, report Indicators 1 and 2 by each age separately AND by the following age groups: 10-14 years AND 15-19 years
If sample is not inclusive of ages 10-19 (e.g. ages 12-17 only), report indicators 1 and 2 by each age separately.
Indicators 1 and 2 by Grade
Report each grade separately. If applicable, report “I do not go to school” also.
Indicators 1 and 2 by Gender
Report by gender
continued on next page
Indicators 1 and 2 by Disposable Income of Youth Respondent
Use median split or report ordinal categories. Remove “I do not know” from denominator.
Indicators 1 and 2 by Recent Immigration
Remove “I do not know” from denominator.
Topic2: Reduced use of cigarettes
1.Proportion of youth who smoked cigarettes

every day for the past 30 days
almost every day for the past 30 days
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?