Summary of results for the Canadian Student Tobacco, Alcohol and Drugs Survey 2018-19

Background

The 2018-19 Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS), previously called the Youth Smoking Survey (YSS), is the tenth cycle of data collection on student tobacco, alcohol, and drug use. A total sample of 62,850 students in grades 7 to 12 (secondary I through V in Quebec) completed the survey, which ran between October 2018 and June 2019 in ten Canadian provinces. The weighted results represent over 2 million Canadian students. CSTADS 2018-19 collected information on tobacco use, alcohol and drug use, as well as information on bullying and sleep.

A set of detailed tables and definitions used in this report are provided.

Cigarette Use

In 2018-19, 19% of students in grades 7 to 12 (approximately 402,000) had ever tried smoking a cigarette, even just a puff. In grades 7 to 9, 9% of students had ever tried smoking a cigarette and in grades 10 to 12, 29% of students reported the same. These results were unchanged from 2016-17.

In 2018-19, 3% of students in grades 7 to 12 (approximately 59,000 students) were current cigarette smokers, with 1% smoking daily and 2% smoking occasionally. The prevalence of current smoking (3%) was unchanged from 2016-17.

The prevalence of current daily smoking decreased among students in grades 7 to 12 to 0.9% (approximately 19,000 students) from 1.3% in 2016-17. There was a decrease in current daily smoking among students in grades 10 to 12 to 1% from 2% in 2016-17; current daily smoking (0.4%) was unchanged from 2016-17 for grades 7 to 9.  

The average age at which students in grades 7 to 12 first tried smoking, even just a puff, was 13.7 years, unchanged from 2016-17.

Smoking by Province

In 2018-19, the prevalence of having ever tried smoking a cigarette ranged from a low of 15% in Ontario to a high of 35% in Saskatchewan among students in grades 7 to 12. The prevalence of current smoking ranged from a low of 3% in Quebec, Manitoba, Alberta and British Columbia to a high of 8% in Saskatchewan.

Source of Cigarettes

The majority (84%) of students who smoked in the past 30 days obtained their cigarettes from social sources rather than retail sources, an increase from 78% in 2016-17. Social sources include friends, family, and others, regardless of whether the cigarettes were given freely, paid for, or stolen. Accessing cigarettes through social sources was higher among students in grades 7 to 9 (94%) than those in grades 10 to 12 (82%).

Over half of students in grades 7 to 12 (58%) thought it would be “fairly easy” or “very easy” to get a cigarette if they wanted one. About a quarter (27%) of grade 7 to 12 students thought it would be “difficult” or “very difficult” to get a cigarette, and 15% were not sure.

Electronic Cigarettes

E-cigarette prevalence rates have doubled among students in 2018-19 since the last survey in 2016-17. Twenty percent (20%) of students (approximately 418,000) had used an e-cigarette (with or without nicotine) in the past 30 days, an increase from 10% in 2016-17.  Prevalence of past-30-day use of e-cigarettes was not different between male (21%) and female (19%) students, but higher among students in grades 10 to 12 (29%) than those in grades 7 to 9 (11%). Students who have used an e-cigarette (with or without nicotine) in the past 30 days are vaping frequently, with 40% (approximately 165,000 students) reporting daily or almost daily use.

Furthermore, many students are using vaping products that contain nicotine. Among students who used a vaping product in the past 30 days, 90% used a product with nicotine and 57% used a product without nicotine.

Of the students who had used an e-cigarette (with or without nicotine) in the past 30 days, 12% were current smokers, 14% were former smokers, 10% were experimental smokers, 22% were puffers, and 42% indicated that they had never smoked a cigarette, not even a puff.

Sixteen percent (16%) of students (approximately 340,000) had ever tried both cigarettes and e-cigarettes, an increase from 13% in 2016-17. Among students who had tried both cigarettes and vaping products, 41% tried a cigarette first (approximately 139,000 students), 47% (approximately 158,000 students) tried a vaping product first, and the remainder could not remember or provided inconsistent answers. The prevalence of trying an e-cigarette first was higher among students in grades 10 to 12 (49%) than in grades 7 to 9 (40%).

Source of Electronic Cigarettes

The majority of students in grades 7 to 12 who used an e-cigarette in the past 30 days got their e-cigarette from a social source (65%), an increase from 56% in 2016-17. Social sources include friends, family, and others, regardless of whether the cigarettes were given freely, paid for, or stolen. Accessing e-cigarettes through social sources was higher among students in grades 7 to 9 (73%) than those in grades 10 to 12 (62%) and higher among females (74%) than males (58%).

One quarter (25%) of students in grades 7 to 12 who used an e-cigarette in the past 30 days got their e-cigarette from a retail source, unchanged from 2016-17. Retail sources include purchases made in store and/or online. Accessing e-cigarettes through retail sources was higher among students in grades 10 to 12 (29%) than those in grades 7 to 9 (14%) and higher among males (30%) than females (19%).

More than half of the students in grades 7 to 12 (54%) thought it would be “fairly easy” or “very easy” to get an e-cigarette with nicotine if they wanted one, and 58% thought it would be “fairly easy” or “very easy” to get an e-cigarette without nicotine if they wanted one.

Perceived risk of harm of cigarettes and e-cigarettes

Students in grades 7 to 12 were asked how much they think people risk harming themselves when they smoke cigarettes or use an e-cigarette.

Smoking cigarettes on a regular basis was perceived to be a “great risk” by 66% of students and a “moderate risk” by 23%. Risk associated with smoking cigarettes once in a while was lower, with 9% of students considering it a “great risk” and 35% believing it to be a “moderate risk”.

Using an e-cigarette with nicotine on a regular basis was thought to pose a “great risk” of harm by 42% and a “moderate risk” by 32% of students. Six percent (6%) thought they posed “no risk” of harm and eight percent (8%) were unaware how much a person risked harming themselves by using an e-cigarette with nicotine on a regular basis.

Far fewer students thought the use of vaping without nicotine on a regular basis posed serious health concerns, with only 14% reporting such behaviour posed a "great risk" and 27% indicating it posed a "moderate risk".

Use of Any Tobacco Product

Students were asked about their use of the following tobacco products: cigarettes (including menthol), cigars or little cigars/cigarillos, smokeless tobacco, waterpipes, and heated tobacco products.

In 2018-19, 23% of students in grades 7 to 12 (approximately 471,000 students) had ever tried at least one of these products. Less than half as many (8% or approximately 160,000 students) had used at least one tobacco product in the past 30 days, a decrease from 10% in 2016-17. Prevalence of past-30-day use of a tobacco product in 2018-19 was higher among males (9%) than females (7%) and higher among students in grades 10 to 12 (12%) than students in grades 7 to 9 (3%).

Cigarettes (19%) were the tobacco products most commonly ever tried by students in grades 7 to 12, followed by cigars or little cigars/cigarillos (12%), waterpipes (7%), smokeless tobacco (6%), and heated tobacco products (2%). Use of cigarettes (5%) in the past 30 days was more common than use of cigars or little cigars/cigarillos (3%), waterpipes (2%), smokeless tobacco (2%), and heated tobacco products (1%).

Alcohol

Alcohol remains the substance with the highest prevalence of use by Canadian students in grades 7 to 12.

After decreasing through successive cycles of the survey (from 53% in 2008-09), the prevalence of use of alcohol in the past 12 months by students in grades 7 to 12 remains at 44% (approximately 880,000), unchanged from 2016-17. Prevalence of past 12-month use of alcohol was 45% among females compared to 43% among males, also unchanged from 2016-17.

On average, students tried their first alcoholic beverage at 13.4 years of age, unchanged compared to the previous cycle (2016-17). Females were slightly older when they tried their first drink than males (13.6 years versus 13.3 years).

Less than one quarter of students (23%, approximately 481,000) reported high risk drinking behaviour (i.e., five or more drinks on one occasion) in the past 12 months, which was unchanged from 2016-17. Twenty-four percent of males and 23% of females reported drinking five or more drinks on one occasion in the past year, both unchanged from 2016-17.

In 2018-19, 29% of students (approximately 609,000) in grades 7 to 12 reported drinking an energy drink (such as Red Bull® or Rock Star®) in the past 12 months, a decrease from 35% in the previous cycle. The prevalence of students who reported drinking alcohol and an energy drink on the same occasion (separately or mixed together) in the past 12 months was 16% in 2018-19 (approximately 334,000), which was unchanged from 2016-17. Students in grades 7 to 9 reported an increase in the consumption of alcohol and an energy drink in the past 12 months (10%, approximately 102,000) compared to 8% in 2016-17. There was no difference between males and females (both 16%) reporting drinking an energy drink and alcohol on the same occasion in the past year, both unchanged from 2016-17.

For the first time, the 2018-19 survey asked students about their consumption of sweetened high alcohol content beverages (7% alcohol content or higher) (e.g., Four Loko, FCKD UP or Clubtails). Nineteen percent of students (approximately 397,000) reported drinking these beverages in the past 12 months. More females than males reported drinking sweetened high alcohol content beverages (22% and 16%, respectively).

When students were asked how difficult they thought it would be to get alcohol if they wanted some, 66% (approximately 1.4 million) responded that they thought it would be “fairly easy” or “very easy”, a decrease compared to last cycle (69%).

Cannabis

Cannabis, which includes marijuana, hash and hash oil, has the highest prevalence of use after alcohol.

In 2018-19, 18% of students in grades 7 to 12 (approximately 374,000) reported using cannabis in the year preceding the survey, unchanged from 2016-17. Past-12-month use of cannabis by both males and females was 18%, unchanged from the previous cycle. Students in grades 7 to 9 reported an increase in the use of cannabis (7%, approximately 73,000) compared to 6% in 2016-17, whereas cannabis use among students in grades 10-12 remained unchanged at 29%.

The results of the 2018-19 survey showed that grade 7 to 12 students were on average 14.3 years old when they first used cannabis, unchanged from the previous cycle.

Grade 7 to 12 students were asked about their methods of cannabis consumption. Among students who used cannabis, smoking (e.g., a joint, bong, etc.) was the most common method (76%, approximately 356,000), a decrease from 2016-17 (80%). The next most popular methods of cannabis consumption included consumption of edibles (an increase from 34% in 2016-17 to 45%, approximately 209,000), vaporizing/vaping (an increase from 30% to 42%, approximately 191,000), and dabbing (an increase from 22% to 28%, approximately 125,000). Drinking cannabis was the least reported method of consumption among students (15%, approximately 67,000), unchanged from 2016-17. Approximately 26% of students who used cannabis (approximately 115,000) also reported using another method, unchanged from 2016-17.

Students in grades 7 to 12 were asked how much they thought people risk harming themselves when they smoke marijuana or cannabis. Sixteen percent (16%) of the students (approximately 326,000) thought that smoking cannabis once in a while put people at “great risk” of harming themselves, a decrease from 2016-17 (19%). There was also a decrease from 18% to 16% (approximately 329,000 students) that thought there was “no risk”. When asked about smoking cannabis on a regular basis, the prevalence of students who thought that people were at “great risk” of harming themselves was 53% (approximately 1.1 million), unchanged from 2016-17, while students who thought there was “no risk” decreased to 7% (approximately 147,000) compared to 9% last cycle.

In 2018-19, students in grades 7 to 12 were asked how difficult they thought it would be to get cannabis if they wanted it, and 40% (approximately 817,000) reported that they thought it would be “fairly easy” or “very easy” to obtain, unchanged from 2016-17 (39%). Forty-two percent (42%) of students (approximately 855,000) thought it would be “very or fairly difficult” to obtain cannabis if they wanted, a decrease compared to 2016-17 (46%).

New to the 2018-19 survey, students were asked if it has been easier to get cannabis for themselves since cannabis became legal for adults. About four percent of students (approximately 77,000) in grades 7 to 12 indicated that it has been easier; less than one percent indicated it has been harder (approximately 16,000); and 12% (approximately 258,000) indicated it has been “neither easier, nor harder” to obtain cannabis for themselves. Eighty-three percent (83%, approximately 1.7 million) of students never bought or got cannabis.

Fifty-five percent (55%) of students in grades 7 to 12 (approximately 1.1 million) indicated that they had not used either alcohol or cannabis in the past 12 months and 17% of students (approximately 339,000) reported that they had used both substances in the past 12 months. Less than 1% of students (approximately 19,000) indicated that they had used cannabis, but not alcohol in the past year. These were all unchanged from 2016-17.

In the 2018-19 survey, students were asked for the first time about their use of alcohol and cannabis on the same occasion (e.g., at a party, in the same evening, etc.). Twelve percent (12%) of students in grades 7 to 12 (approximately 252,000) reported that they had consumed alcohol and cannabis on the same occasion at least once in the past 12 months.

Illegal and Other Drugs

Past-12-month use of synthetic cannabinoids was reported by 4% of grade 7 to 12 students (approximately 77,000), which was unchanged from the previous cycle.

Past-12-month use of hallucinogens was reported by 3% of students (approximately 73,000), unchanged from 2016-17. 

Problematic Use of Psychoactive Pharmaceuticals

In 2018-19, the prevalence of past-12-month use of psychoactive pharmaceuticals to get high increased to 7% (approximately 137,000 students) from 6% in 2016-17. Psychoactive pharmaceuticals include sedatives/tranquilizers, stimulants and prescription pain relievers.

Among the three classes of psychoactive pharmaceuticals surveyed, the past-12-month use of prescribed pain relievers to get high was 3% (approximately 68,000 students), unchanged from last cycle. There was no change in the prevalence of past-12-month use of oxycodone (1%, approximately 25,000 students). There was a slight increase in past-12-month use of fentanyl (0.7 %, approximately 14,000 students) to get high from 0.5%^{Footnote 1} in 2016-17. The prevalence of past-12-month use of other prescribed pain relievers (e.g., morphine, codeine, Tylenol 3®, etc.) remained unchanged and was reported at 3% (approximately 68,000 students).

In 2018-19, 4% of students in grades 7 to 12 (approximately 91,000) reported using stimulants, including medications used to treat attention deficit hyperactivity disorder (ADHD), to get high over the past 12 months, representing an increase from 3% in last cycle. The use of sedatives/tranquilizers to get high over the past 12 months (2%, approximately 44,000 students) remained unchanged compared to 2016-17.

Students in grades 7 to 12 were asked how much they thought people risk harming themselves when they use prescription medication to get high. Thirty-nine percent (39%) of students (approximately 803,000) indicated that they thought there was a “great risk” of people harming themselves when they use prescription medication to get high once in a while, unchanged from 40% in 2016-17. The perception of “great risk” decreased from 72% in 2016-17 to 69% (approximately 1.4 million) when students were asked about use on a regular basis. The perception of “no risk” of harm when prescription medication is used to get high either once in a while (6%, approximately 117,000 students), or on a regular basis (5%, approximately 97,000 students) were both unchanged compared to 2016-17.

When asked how difficult students felt it would be to get prescription medicine if they wanted it, 23% (approximately 467,000 students) thought it would be “fairly easy” or “very easy” to obtain prescription pain relievers, a decrease from 2016-17 (25%). Twenty-seven percent (27%, approximately 557,000 students) thought the same about the ease of obtaining medication used to treat ADHD, unchanged from the previous cycle.

Problematic Use of Over-the-Counter Medications

Dextromethorphan is an active ingredient found in many over-the-counter cough suppressant cold medicines. In 2018-19, the prevalence of past-12-month dextromethorphan use to get high among students in grades 7 to 12 increased to 6% (approximately 126,000) from 5% in 2016-17. Past-12-month use of Gravol® to get high also increased to 5% (approximately 101,000 students) in 2018-19 from 4% in 2016-17.

The use of sleeping medication available from a drugstore (such as Nytol® or Unisom®) to get high remained unchanged at 4% (approximately 84,000 students) in 2018-19.

Acknowledgement

Health Canada’s Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS), was conducted for Health Canada by the Propel Centre for Population Health Impact at the University of Waterloo.

Reference Information

CSTADS was developed to provide timely, reliable and continual monitoring of tobacco, alcohol and drug use in school-aged youth. CSTADS provides essential input to the development of policies and programs. The next survey is expected to be carried out during the 2020-21 school year.

For more information about the survey and/or its results, please contact Health Canada by e-mail (odss-bssd@hc-sc.gc.ca).