Student and school characteristics associated with use of nicotine replacement therapy: A multilevel analysis among Canadian youth

BackgroundResearch indicates that it is common for youths to use nicotine replacement therapy (NRT) despite limited empirical evidence for its effectiveness within this population. Since very little is known about the characteristics associated with NRT use by youth, the current study examined the association between ever and current use of NRT as a function of student characteristics and the characteristics of the schools they attend.MethodsThis study used nationally representative student-level data from 29,296 grade 9 to 12 students who participated in the 2008–2009 Canadian Youth Smoking Survey (YSS). School-level data on the built environment surrounding schools were provided by DMTI-Spatial, and data on school location were provided by the Canadian Census. Two multilevel logistic regression models were used to predict ever use of NRT and current use of NRT as a function of student and school characteristics among current smokers.ResultsOverall, 21.1% of youth smokers in Canada had ever used NRT and 5.1% were currently using NRT. Odds of ever and current NRT use were highest among daily smokers and boys, while youths who had made multiple quit attempts or participated in a quit and win contest were more likely to be ever NRT users. Attending a school located within an urban area increased youths' odds of ever and current NRT use, whereas higher density of pharmacies surrounding a school was inversely associated with current NRT use.ConclusionsCharacteristics of students and the schools they attend were associated with the likelihood of youth smokers using NRT. Significant between-school differences in NRT use exist, however further research is needed to identify which school characteristics account for these differences and understand how youth are accessing NRT.

► First study to examine link between school characteristics and NRT use by youth.
► School environment has independent impact on the odds of a youth smoker using NRT.
► Daily smokers, boys, and youths at urban schools most likely to use NRT.
► Many current NRT users report that they are not attempting to quit smoking.