Murnaghan, D., MacDonald, J.A., Munro-Bernard, M., and Carruthers, S. Are We Forgetting Pieces of the Puzzle in Promoting Healthy School Communities? Alarming Changes in Patterns of Substance Use: Prince Edward Island and Canada Murnaghan, D., MacDonald, J.A., Munro-Bernard, M., and Carruthers, S. 2017 Healthy School Communities National Forum Ottawa, ON ● November 2-3, 2017

Presentation Outline Comprehensive approaches to school health What have the school/youth health priorities been in PEI? In Canada? Missing pieces of the school health puzzle Emerging differences between Prince Edward Island and Canadian students’ substance use behaviours Lessons learned and future directions

Comprehensive School Health Approaches

School Health Priorities: Locally and Nationally Healthy Eating Physical Activity Childhood Obesity Bullying

When it comes to school health… Are we forgetting some pieces of the puzzle?

Canadian Student Tobacco, Alcohol and Drugs Survey The Canadian Student Tobacco Alcohol and Drugs Survey collects biennial substance use (tobacco, alcohol, and drug) data from Canadian students in grades 7-12. It is funded by Health Canada and conducted by the Propel Centre at the University of Waterloo, in cooperation with provincial collaborators across the country.   Nationally, ~48 000 students per cycle have participated since 2008. PEI has had an average sample size of ~3 000 participants. In 2014-15, 2 256 students from 53 PEI schools were surveyed, among a total of 42 094 students from 336 schools across Canada. I’m going to share with you some trend data from 4 survey cycles between 2008 and 2014. In particular, I’m going to focus on some emerging and notable differences in substance use behaviours between Prince Edward Island and Canadian students. www.cstads.ca

Tobacco Trends: 2008/09 – 2014/15 The following figures all highlight behaviours for which PEI results in 2014/15 were statistically significantly higher than the Canadian average in 2014/15. In all of these figures, the blue line represents PEI and the red line represents Canada. Here we see the pattern of current smoking rates in PEI and Canada since 2008. PEI’s rate of ‘current smokers’ has been holding constant over time, while the average Canadian rate has been showing a steady decline. This represents a worrying trend: smoking rates in PEI appear to have reached a plateau over the past couple cycles, while current smoking rates in other provinces have been dropping over time. 14/15 - Confidence Intervals PE - 6.6% (5.5 – 7.8) CAN - 3.4 (2.8 – 4.0)

Tobacco Trends: 2008/09 – 2014/15 In this graph — youth who have ‘ever tried’ smoking—we see the same trend. PEI’s rate of ‘ever triers’ has been holding constant around 25%, while the national incidence of youth ‘ever trying’ cigarettes has significantly decreased since 2012. 14/15 - Confidence Intervals PE - 25.5% (23.7 - 27.2) CAN – 17.6% (16.1 – 19.0)

Tobacco Trends: 2008/09 – 2014/15 The story is similar here, where we see reported rates of ‘any tobacco product’ over the past 30 days. Use of ‘any tobacco product’ among PEI youth increased between 2012 and 2014, while decreasing across the country. There is also a significant and widening gap between rates of use in PE and CA in 2014. 14/15 - Confidence Intervals PE - 16.1% (14.9 - 17.2) CAN - 10.3% (9.4 - 11.2)

Alcohol Trends: 2008/09 – 2014/15 In terms of reported rates of binge drinking in the past 12 months, PEI students held relatively constant – but given the drop in binge drinking across the country, reported behaviour in 2014 that was significantly higher than above the national average (32.2% vs. 23.7%). 14/15 - Confidence Intervals PE - 32.2% (30.3 - 34.1) CAN - 23.7% (22.0 - 25.3)

Cannabis Trends: 2008/09 – 2014/15 This figure displays cannabis use in the past 12 months. In 2008 and 2010, Island students rated below the national average for cannabis use, however, the trend now seems to have flipped. In 2014, PEI’s rate of cannabis use was significantly higher than the national average, which has been gradually declining over time. 14/15 - Confidence Intervals PE - 24.8% (22.5 - 27.0) CAN - 16.5% (15.3 - 17.7)

PEI: Divergent Pattern of Substance Use From 2012/13 to 2014/15, PEI students reported significant increases in their past 30 day use of: Menthol cigarettes Little cigar/cigarillos Any tobacco products In addition, PEI students showed a significant increase in the reported rate of alcohol use in the past 12 months. So, we really have two stories here... 1) For the previous six measures, PEI reported rates of use in 20214 that were statistically above the national average. 2) In addition to that, for the four measures shown here (past 30 day use of menthol cigarettes; little cigars/cigarillos; any tobacco products; and alcohol use in the past 12 months), reported rates of use within PEI itself increased significantly from 2012 to 2014. The CSTADS data in 2014/15 revealed that we are reporting above-average rates of substance use on 9 different measures in PEI. Even more alarming, within our provinces, we saw an increase in use from the previous cycle for several of the behaviours measured. To put this in perspective: We have complete 2012 and 2014 CSTADS data for 7 of 10 provinces in 2012 and 2014 (~NB, QC, MB). PEI is the only province of whose rates of substance use INCREASED over those 2 years. Every other province stayed the same or saw their rates decrease.

The Missing Piece: Lessons Learned Targeted vs. comprehensive approaches to addressing youth health behaviours Holistic, whole child and whole school approaches Creating a culture of wellness (schools and communities) Upstream determinants of changing youth health behaviours (i.e., the PEI context) We believe that addressing the concerning trend in PEI’s youth substance use will require a multi-faceted approach: - Take tobacco seriously again. It’s not over for our youth. - Update the message: For many years, the message was that smoking causes lung cancer. Now, we’ve got evidence that – especially for youth - the effects of smoking extend far beyond lung health. It’s now being shown that nicotine impacts brain development, for example. Cannabis use in youth is being shown to have similar effects, so perhaps we need to capitalize on this new information – and an upcoming focus on cannabis use - to update our tobacco messaging. –Examine practices (policies/programs) that have been effective in other provinces. We need to look at what other provinces are doing, which may be contributing to a different trajectory of risk behaviours among their youth population. - We would argue that there needs to be an investment of provincial resources that allows for a sustained, long-term approach to youth substance use that is complementary to any federally-driven areas of focus (no longer an either/or behaviour focus). In addition, we would advocate for policies that address some of the root causes – the social determinants of health that I mentioned earlier – of the health behaviour trends we’re seeing in PEI’s youth and adult population.

The Missing Piece: Tobacco and Substance Use .Critical Action is Needed to Address PEI’s Changing trend in Youth substance use Are there youth in other provinces or particular areas of Provinces at risk? We believe that addressing the concerning trend in PEI’s youth substance use will require a multi-faceted approach: - Take tobacco seriously again. It’s not over for our youth. - Update the message: For many years, the message was that smoking causes lung cancer. Now, we’ve got evidence that – especially for youth - the effects of smoking extend far beyond lung health. It’s now being shown that nicotine impacts brain development, for example. Cannabis use in youth is being shown to have similar effects, so perhaps we need to capitalize on this new information – and an upcoming focus on cannabis use - to update our tobacco messaging. –Examine practices (policies/programs) that have been effective in other provinces. We need to look at what other provinces are doing, which may be contributing to a different trajectory of risk behaviours among their youth population. - We would argue that there needs to be an investment of provincial resources that allows for a sustained, long-term approach to youth substance use that is complementary to any federally-driven areas of focus (no longer an either/or behaviour focus). In addition, we would advocate for policies that address some of the root causes – the social determinants of health that I mentioned earlier – of the health behaviour trends we’re seeing in PEI’s youth and adult population.

Where Do We Go From Here? Comprehensive and sustained approach to Youth Health and Substance Use Include students, schools, families, and communities. Take Tobacco Use seriously Comprehensive and sustained approach to Substance Use Effects of smoking are far reaching beyond link to lung cancer Nicotine impacts brain development Cannabis use in Youth impacts brain development We believe that addressing the concerning trend in PEI’s youth substance use will require a multi-faceted approach: - Take tobacco seriously again. It’s not over for our youth. - Update the message: For many years, the message was that smoking causes lung cancer. Now, we’ve got evidence that – especially for youth - the effects of smoking extend far beyond lung health. It’s now being shown that nicotine impacts brain development, for example. Cannabis use in youth is being shown to have similar effects, so perhaps we need to capitalize on this new information – and an upcoming focus on cannabis use - to update our tobacco messaging. –Examine practices (policies/programs) that have been effective in other provinces. We need to look at what other provinces are doing, which may be contributing to a different trajectory of risk behaviours among their youth population. - We would argue that there needs to be an investment of provincial resources that allows for a sustained, long-term approach to youth substance use that is complementary to any federally-driven areas of focus (no longer an either/or behaviour focus). In addition, we would advocate for policies that address some of the root causes – the social determinants of health that I mentioned earlier – of the health behaviour trends we’re seeing in PEI’s youth and adult population.

Dean, School of Nursing Thompson Rivers University Thank You! Donna Murnaghan, PhD, RN Co-Principal Investigator, Comprehensive School Health Research Group University of Prince Edward Island Dean, School of Nursing Thompson Rivers University (250) 852-7288 dmurnaghan@tru.ca http://cshr.discoveryspace.ca/