Predictors of smoking and smokeless tobacco use in college students: a preliminary study using web-based survey methodology

Cigarette smoking and smokeless tobacco (SLT) use are associated with numerous health hazards and economic costs, and rates of tobacco use have recently increased among young adults. In this study, the authors compared predictors of smoking and SLT use among college students (N = 21,410) from 13 Texas universities using a Web-based survey. Results revealed that sex, belonging to a fraternity or sorority, participation in intercollegiate sports, peer influences, and ethnicity predicted smoking and SLT use. Although common factors predicted both lifetime and current smoking and SLT use, patterns of prediction differed across dependent variables. The authors discuss implications for developing tobacco prevention programs targeting specific risk factors salient to the young adult population.     

Trends in point-of-sale tobacco marketing around college campuses: Opportunities for enhanced tobacco control efforts

Objective: Colleges have implemented policies to limit tobacco use on-campus; however, the off-campus environment is often overlooked in tobacco control efforts. We assessed availability, marketing, and promotion of cigarettes, snus, and traditional smokeless tobacco (SLT) in a sample of communities surrounding 11 college campuses in North Carolina and Virginia. Participants: Between January-March of 2011, 2012 and 2013, 481 tobacco-selling retailers, including convenience stores, pharmacies and supermarkets, located near campuses were assessed. Methods: Trained observers completed annual point-of-sale assessments. Results: The percentage of stores selling (81.4% to 58.6%; p < .0001) and advertising snus (80.1% to 53.11%; p < .0001) significantly decreased over time. Convenience stores increased promotions of cigarettes (65.4% to 72.8%; p = 0.04) and SLT (3.1% to 23.3%; p = 0.02). Conclusions: Off-campus environments have abundant tobacco availability and marketing. Colleges should collaborate with state and local tobacco control advocates to address tobacco promotion near campuses to potentially decrease product appeal and access among young adults.     

Smokeless tobacco use among adult males in India and selected states: Assessment of education and occupation linkages

Abstract

This article is an effort to analyze the influence of education and occupation as critical determinants of smokeless tobacco use among adult males in India and its selected states. Global Adult Tobacco Survey (GATS) India 2009–10 data are used to analyze the prevalence of smokeless tobacco use among adult males aged 15 years and above (N = 33,767) by their different education and occupational status. Bivariate and multivariate (Cox proportional survival model) analyses are carried out to assess the linkages of education and occupation with use of smokeless tobacco among adult males. The study suggests that the majority of Indian men are using khaini (18%) and gutkha (13%) (the local terms used for smokeless tobacco). Further, it is observed that education and occupation remain the two important critical predictors of smokeless tobacco use among men. A greater percentage of young men with no education from rural areas use smokeless tobacco (44.3%) than their counterpart group from urban areas. The socioeconomically disadvantaged states, noticeably the east and central (4.992 and 3.218; p < .001) states, record higher prevalence of smokeless tobacco use than other states. Considering the high prevalence of smokeless tobacco use among illiterate and socioeconomically deprived youths, there is an urgent need to sensitize the issue. More concrete efforts to generate awareness on the ill effects of tobacco use among the illiterate and those who are employed in low-profile occupations are needed.     

Longitudinal predictors of cigarette use among students from 24 Texas colleges

ABSTRACT

Objective: The purpose of this study is to examine differences between current and non-current cigarette users, focusing on sociodemographic factors, non-cigarette tobacco product use, parental and friend use, and alcohol and marijuana use; and to identify predictors of cigarette use sixmonths later. Participants: Participants included young adults (n = 4,296) from 24 Texas colleges, participating in a young adult cohort study, beginning in fall 2014. Methods: Mixed effects logistic regressions were conducted accounting for school-level variability. Results: Cigarette users were older, more likely to report use of non-cigarette tobacco products and peer use of cigarettes than non-current users. Wave 1 cigarette and non-cigarette tobacco product use, marijuana use and binge drinking, and peer use all uniquely predicted cigarette use at wave 2. Conclusions: Colleges need prevention programs targeting multiple tobacco products, because non-cigarette tobacco use and other risky behaviors appear to be independent risk factors for cigarette use in young adults.     

Differences in Tobacco Use Among Two-Year and Four-Year College Students in Minnesota

Abstract

Objective: This study compares tobacco use rates among two-year and four-year college students and explores the demographic variables that predicted that behavior. Participants: 9,931 students at 14 two-year and four-year colleges in Minnesota participated. Methods: Students at 11 schools completed an online survey, and students at 3 schools completed a paper survey in 2007. Results: After controlling for sex, age, ethnicity, relationship status, hours of work per week, and number of school credits, attending a two-year college predicted current and daily smoking (odds ratio [OR]) = 1.70, 95% confidence interval [CI] = 1.52–1.89; OR = 3.47, 95% CI = 2.94–4.11) and smokeless tobacco use (OR = 1.65, 95% CI = 1.32–2.06; OR = 1.64, 95% CI = 1.06–2.53). Conclusions: Although two-year college students comprise approximately two fifths of the college student population, surveys of college student tobacco use have focused nearly exclusively on four-year college students. Two-year college students should represent a priority population for tobacco control because attending a two-year college predicts increased tobacco use.     

Canadian Campus Smoking Policies: Investigating the Gap Between Intent and Outcome From a Student Perspective

Abstract

Background: Young adults remain the earliest legal target for the tobacco industry. Against this, the existence of smoking policies would appear to offer some protection to students on campus. However, little research has been conducted into the outcomes of such policies from a student perspective. Methods: The authors conducted 8 focus groups at 4 selected Canadian undergraduate campuses to investigate student perceptions and behaviors resulting from campus smoking policies. Results: Results indicated that student smoking behaviors are minimally impacted by campus smoking policies due to seriously compromised implementation and enforcement. Conclusions: These findings imply that the presence of campus smoking policies and claims of “smoke-free” campuses should not be misinterpreted as achievement and without renewed focus and adequate tobacco control infrastructure, it will remain possible for young adults to initiate and maintain tobacco smoking on campus.     

Screening and Brief Intervention for Tobacco Use by Student Health Providers on College Campuses

Abstract

Objective: This study assessed college students’ reports of tobacco screening and brief intervention by student health center providers. Participants: Participants were 3,800 students from 8 universities in North Carolina. Methods: Web-based survey of a stratified random sample of undergraduates. Results: Fifty-three percent reported ever visiting their student health center. Of those, 62% reported being screened for tobacco use. Logistic regression revealed screening was higher among females and smokers, compared to nonsmokers. Among students who were screened and who reported tobacco use, 50% reported being advised to quit or reduce use. Brief intervention was more likely among current daily smokers compared to current nondaily smokers, as well as at schools with higher smoking rates. Screening and brief intervention were more likely at schools with lower clinic caseloads. Conclusions: Results highlight the need to encourage college health providers to screen every patient at every visit and to provide brief intervention for tobacco users.     

Hookah and Cigarette Smoking Among African American College Students: Implications for Campus Risk Reduction And Health Promotion Efforts

ABSTRACT

Objective: To identify individual and institutional risks and protections for hookah and cigarette smoking among African American (AA) college students. Participants: AA college students (N = 1,402; mean age = 20, range = 18–24 years; 75% female) who completed the Fall 2012 American College Health Association–National College Health Assessment II. Methods: Respondents were stratified into 4 mutually exclusive groups by last-30-day smoking status: cigarette-only use (5.1%), hookah-only use (5.9%), dual use (2.4%), and nonuse (86.6%). Multinomial logistic regression models identified the relative odds of exclusive and dual hookah and cigarette smoking. Results: Current hookah and cigarette smoking rates were comparably low. Age, gender identity, current substance use, interest in tobacco use information, and student population prevailed as risks and protections for hookah and cigarette smoking. Conclusions: Campus health promotion campaigns may need to tailor messages to AA students, particularly those who use substances, to underscore the health risks of hookah and cigarette smoking.     

Preliminary Results of a Longitudinal Study of Collegiate Alcohol Abuse

Abstract

Objective: Hookah smoking is a popular form of tobacco use on university campuses. This study documented use, attitudes, and knowledge of hookah smoking among college students. Participants: The sample included 943 university students recruited between February 2009 and January 2010. Respondents (M age = 20.02) included 376 males, 533 females, and 34 who did not report sex. Methods: An anonymous online questionnaire was completed by respondents. Results: In this sample, 42.9% of college students had tried hookah, and 40% of those individuals had used it in the past 30 days. Students perceived fewer negative consequences of hookah smoking compared with cigarette smoking. Age, sex, racial background, marijuana/cigarette use, and perceptions of side effects were significantly associated with hookah use. Conclusions: University students are misinformed regarding the health consequences of hookah smoking. Programs aimed at education, prevention, and intervention for hookah use are needed to address this growing public health concern.     

Oral Cancer Risk Behaviors Among Indiana College Students: A Formative Research Study

Objectives: In fall 2004, the authors used a survey to assess the knowledge, attitudes, motivations, and behaviors of college students relative to oral cancer prevention to inform development of targeted prevention programming. Participants: A convenience sample of 1,003 undergraduate students at one public university in Indiana participated. Methods: Discriminant function analysis was employed to analyze participants' motivations; perceived risks; individuals who influence participants' alcohol, tobacco, and marijuana use; and factors that facilitate and discourage use. The study sample was divided into users and nonusers to differentiate between groups and predictor (discriminating) variables. Multiple regression analysis was used to determine the extent to which participants' knowledge, attitudes, peer perceptions, sex, age, and ethnicity contributed to participants' combined alcohol, tobacco, and marijuana use behaviors. Results: With 2 exceptions, discriminant function analysis (p < .01) correctly categorized user status (ie, nonusers vs combined users of alcohol and cigarettes; nonusers vs combined users of alcohol, cigarettes, and marijuana) by the predictor variables. Multiple regression analysis to determine whether independent variables predicted combined drug use generated significant (p < .01) results across all combined use behaviors. Conclusions: Multiple oral cancer prevention program options along with additional formative research efforts were suggested by study results.     

The Influence of Tobacco Countermarketing Ads on College Students’ Knowledge,Attitudes, and Beliefs

Abstract

Objective: To determine which antitobacco messages were perceived effective in changing college students’ knowledge, attitudes, and beliefs about tobacco use. Participants: College students (n = 1,020) were surveyed before and after viewing 4 30-second antitobacco advertisements in 1 of 3 theme categories—social norms, health consequences, or tobacco industry manipulation. Methods: An independent samples t test was used to test for differences in the mean responses to the knowledge, attitude, and belief questions at posttest by smoking status and gender. Results: Health consequences ads significantly increased overall knowledge and negative attitudes and beliefs. Conclusion: Findings from this study may help health educators who work in college settings and other young adult settings to include media messages as part of a comprehensive tobacco control program.     

Building a health communication brand for University of Texas System tobacco control

Objective: Despite declining cigarette smoking rates in the US, there is a continued need for tobacco prevention education campaigns to reach young adults. Recognizing the need for improved tobacco control messaging, the University of Texas (UT) System engaged The University of Texas at Austin Center for Health Communication to develop a brand and message that would strengthen tobacco control efforts at its 14 institutions. Methods: This article describes the iterative process involved in creating a brand for tobacco control, including an environmental scan, identifying potential message themes, and creating and refining logos. Results: This article highlights the process of developing a system-wide tobacco control brand. Specifically, the process included coordinating an interdisciplinary team with content and design experts, and presenting ideas to stakeholders for serial feedback and refinement, among others. Conclusions: Ultimately, this project offers a model for other systems of higher education interested in pursuing similar initiatives.     

Cigarette Use Among Young Adults: Comparisons Between 2-Year College Students, 4-Year College Students,and Those Not in College

Abstract

Objective: To examine cigarette smoking among young adults based on education status. Participants: Community-based sample of 2,694 young adults in the United States Methods: The authors compared 3 groups—those not in college with no college degree, 2-year college students/graduates, 4-year college students/graduates—on various smoking measures: ever smoked, smoked in past month, smoked in past week, consider self a smoker, began smoking before age 15, smoked over 100 cigarettes in lifetime, ever tried to quit, and plan to quit in next year. Results: The authors found that for nearly all the smoking measures, the 4-year college group was at lowest risk, the noncollege group was at highest risk, and the 2-year college group represented a midpoint. Differences between groups remain after adjusting for parents’ education and other potential confounding factors. Conclusions: Smoking behaviors clearly differ between the 2-year, 4-year, and no college groups. Interventions should be tailored for each group.     

The Role of Depression and Negative Affect Regulation Expectancies in Tobacco Smoking Among College Students

Objective: Expectancies about nicotine's ability to alleviate negative mood states may play a role in the relationship between smoking and depression. The authors examined the role of negative affect regulation expectancies as a potential mediator of depression (history of depression and depressive symptoms) and smoking among college students. Participants and Methods: As part of a larger study, 315 undergraduate smokers completed a 296-item survey from January to May of 2001 and 2002. Results: Cross-sectional analyses revealed that negative affect regulation expectancies fully mediated the positive relationship between depressive symptoms and level of smoking. Conclusions: Although depressive symptoms are associated with higher levels of tobacco smoking, the expectation that smoking will reduce negative emotions is 1 factor that accounts for this relationship.     

US Public Universities' Compliance With Recommended Tobacco-Control Policies

Abstract

To address the rise in tobacco use among college students, several national health organizations, including the American College Health Association, recommend that colleges enact smoking bans in and around all campus buildings, including student housing, and prohibit the sale, advertisement, and promotion of tobacco products on campus. Key informants at 50 US public universities, one from each state, were interviewed during the 2001/2002 academic year to assess the prevalence of these recommended policies. More than half (54%) of the colleges banned smoking in all campus buildings and student residences, 68% had no tobacco sales on campus, and 32% of the schools' newspapers did not accept tobacco advertising. Regional differences in adoption of these campus tobacco-control policies were present. Although this national sample of public universities had implemented some of the recommended policies, they must take further actions to comply fully with campus tobacco-control guidelines.     

Alcohol Use in Students Seeking Primary Care Treatment at University Health Services

Abstract

Objective: Given the high rate of at-risk drinking in college students, the authors examined drinking behaviors and associated factors in students being seen in student health services for primary care visits from October 30, 2004, to February 15, 2007. Methods: Analyses were based on a Health Screening Survey completed by 10,234 college students seeking general medical treatment. Results: Alcohol use was similar to other studies with 57% (n = 5,840) meeting the National Institute on Alcohol Abuse and Alcoholism criteria for at-risk drinking. Twenty-six percent of the students reported smoking at least once in the last 3 months. Risk factors for at-risk drinking included young age, white males, drinking at a fraternity/sorority house, and use of tobacco. Conclusions: These findings support the widespread implementation of alcohol screening and intervention in university health services.     

Tobacco use among foster youth: Evidence of health disparities

Youth aging out of foster care face a challenging road to independence. Following exposure to myriad risk factors such as abuse, neglect, parental substance use, and severe housing mobility, supportive services decrease upon exit from care, often increasing risk for substance use, homelessness, and unemployment. Although tobacco use is also highly prevalent, little attention has been paid to screening, assessment, and treatment of tobacco use in this vulnerable group. The current study (N = 116) reports on tobacco use prevalence, consequences, and co-occurrence with other substances in a sample of youth (ages 18 to 19) exiting the foster care system. In the face of an overall decrease in tobacco use among general population adolescents and young adults, results suggest disproportionate levels of lifetime, recent, and daily use among foster youth. Prevalence of recent tobacco use (46%) is nearly triple national rates, while daily smoking (32%) is almost four times that of general population young adults. Tobacco users were more likely than non-users to drink (70% vs. 40%) and to smoke marijuana (72% vs. 25%). We strongly encourage researchers and practitioners to increase attention to this tobacco-related health disparity.     

Social Facilitation Expectancies for Smoking: Psychometric Properties of a New Measure

Abstract

Objective: Expectancies about social outcomes for smoking are relevant to college student smokers, who frequently report “social smoking.” A new measure, the Social Facilitation Expectancies (SFE) scale, was developed to assess these beliefs. Participants: The SFE was administered to undergraduate college student smokers (N = 1,096; study completed in May 2011). Methods: Items were scored on a 5-point scale with a summed total score. The sample was randomly split and principle axis factoring and confirmatory factor analysis applied to determine scale structure. The structure was tested across sex and smoking groups and validation analyses were conducted. Results: A 9-item, 1-factor scale was replicated within each group. Higher SFE scores were observed among those with greater smoking experience and higher scores were associated with greater endorsement of other smoking-related beliefs. Conclusions: These preliminary findings provide support for the sound psychometric properties of this measure for use with young adult college students.     

Peers influence the tobacco and alcohol use of Chinese adolescents

This two-wave longitudinal study examined peer selection and influence pertaining to tobacco and alcohol use by adolescents and their friends in a sample of 854 Chinese adolescents (384 girls: mean age = 13.33 years). Participants nominated friends and self-reported their tobacco and alcohol use at seventh and again at eighth grade. Longitudinal social network analyses revealed evidence of friend influence but not selection over smoking and drinking. Boys increased their levels of smoking at rates greater than that of girls, but no sex moderation of either selection or influence was found. In interpreting these results, it is important to understand the gender norms for Chinese boys and girls and the cultural context of tobacco and alcohol use.     

The Cedar Project: Understanding Barriers to Consistent Condom use over Time in a Cohort of Young Indigenous People who use Drugs

ABSTRACT Little information exists on the use of condoms as protective barriers to sexually transmitted infections (STIs) among indigenous people in Canada. This study explores risk factors of inconsistent condom use (during consensual sex) over time among participants in the Cedar Project, a prospective cohort study of indigenous young people living in Vancouver and Prince George, British Columbia, who use drugs. Due to the serial measurements for each study subject, generalized estimating equations modeling with logit link was used to accommodate the temporal correlation within subjects. For young women, inconsistent condom use over time was predicted by having a recent STI (adjusted odds ratio [AOR] = 1.76, 95% confidence interval [CI] [1.12, 2.79]), smoking crack daily (AOR = 1.63, 95%CI [1.02, 2.61]), and having experienced recent sexual abuse (AOR = 2.07, 95%CI [1.20, 3.56]). Among young men, living in Prince George (AOR = 1.63, 95%CI [1.14, 2.39]) and daily crack smoking (AOR = 1.56, 95%CI [1.02, 2.40]) were associated with inconsistent condom use over time. Among participants who used injection drugs, inconsistent condom use was associated with smoking crack daily (AOR = 1.59, 95%CI [1.04, 2.43]) and sharing needles (AOR = 1.78, 95%CI [1.26, 2.51]). The availability and effectiveness of sexual health services must be prioritized for indigenous people, and the design of culturally safe sexual health programs requires the meaningful involvement of young indigenous people.