A closer look at smoking among young adults: where tobacco control should focus its attention

Characteristics associated with smoking in a Hispanic college student sample

This study examined the smoking related behaviors of Hispanic young adult college students as part of a larger study that assessed characteristics of Hispanic smokers in a metropolitan area on the U.S./México border. One hundred seventy-four English-speaking Hispanic college students completed questionnaires that assessed tobacco use, drug/alcohol use, body mass index, weight concerns, acculturation, depressive symptoms, and expired carbon monoxide level. Of the 74 smoking participants (42.5% of the sample), 77% reported light or intermittent smoking. Univariate analyses and a backward elimination logistic regression model were used to compare smokers' and nonsmokers' characteristics. Significant univariate differences between smokers and nonsmokers were higher reported weekly alcohol use and ever use of marijuana. Logistic regression findings indicated smokers reported heightened odds of being younger, lower acculturation, ever use of drugs, and weekly drinking. These results suggest a drug and alcohol use component is important to cessation interventions targeted toward Hispanic college student smokers.

Sources, locations, and predictors of environmental tobacco smoke exposure among young children from inner-city families

INTRODUCTION

The purpose of this study was to determine the levels, sources, and locations of and influential factors for exposure to environmental tobacco smoke (ETS) among pediatric patients from inner-city families.

METHOD

Descriptive and associative analysis of ETS exposure in children 6 to 10 years of age was performed with survey data collected at Children's Hospital of Michigan through mothers' report and children's urine cotinine.

RESULTS

The sample included 397 participants, 82.4% of whom were African American. Urine cotinine levels were correlated with reported ETS exposure and 71% of children with urine cotinine levels > 10 ng/mL. The mean duration of ETS exposure was 14.3 minutes (SD = 11.0) in the past week and 58.9 minutes (SD = 50.8) in the past month. Smoking parents (∼30%), grandparents (∼30%), and non-family members (∼28%) were the major ETS sources, and relatives' homes (∼40%), the children's own homes (∼24%), automobiles (∼15%), and friends' homes (∼11%) were the main ETS locations. Child ETS exposure was inversely correlated with having a non-single mother, maternal education, income, use of prenatal preventive care, and satisfactory parenting.

DISCUSSION

ETS exposure in inner-city children was prevalent. Findings of this study may aid pediatric practitioners and public health workers in providing targeted interventions.

Effects of tobacco-related media campaigns on smoking among 20-30-year-old adults: longitudinal data from the USA

OBJECTIVE

Young adults in the USA have one of the highest smoking prevalence rates of any age group, and young adulthood is a critical time period of targeting by the tobacco industry. The authors examined relationships between potential exposure to tobacco-related media campaigns from a variety of sponsors and 2-year smoking change measures among a longitudinal sample of US adults aged 20-30 years from 2001 to 2008.

METHODS

Self-report data were collected from a longitudinal sample of 12,931 US young adults from age 20 to 30. These data were merged with tobacco-related advertising exposure data from Nielsen Media Research. Two-year measures of change in smoking were regressed on advertising exposures.

RESULTS

Two-year smoking uptake was unrelated to advertising exposure. The odds of quitting among all smokers and reduction among daily smokers in the 2 years between the prior and current survey were positively related to anti-tobacco advertising, especially potential exposure levels of 104-155 ads over the past 24 months. Tobacco company advertising (including corporate image and anti-smoking) and pharmaceutical industry advertising were unrelated to quitting or reduction.

CONCLUSION

Continued support for sustained, public health-based well-funded anti-tobacco media campaigns may help reduce tobacco use among young adults.

Participant- and study-related characteristics predicting treatment completion and study retention in an adolescent smoking cessation trial

PURPOSE

To determine which factors predict smoking cessation treatment completion and retention among adolescents.

METHODS

In a multisite, randomized, controlled trial, the efficacy of motivational interviewing was compared with structured brief advice for smoking cessation and reduction in adolescents (n = 355) aged 14-18 years (55% female, 45% black, 12% Hispanic). Treatment spanned 12 weeks, with follow-up assessments at 24 weeks. Treatment completion was defined as completion of all five counseling sessions. Study retention was defined as completing the 24-week assessment. Participant and study variables served as predictors of treatment completion and retention.

RESULTS

In all, 79% of participants completed all five counseling sessions and the same percent completed the 24-week assessment. Black race, precontemplation stage to cut back, and shorter length of time between the baseline assessment and the first counseling session were significantly associated with treatment completion. For every 7.5-day delay in starting treatment after the baseline visit, there was a 50% decrease in the odds of completing all five treatment sessions. Retention at 24 weeks was predicted by black race, younger age, greater maternal education, expectations of graduating college, and structured brief advice intervention.

CONCLUSIONS

High rates of treatment completion and study retention can be achieved in a multisession, behavioral intervention for adolescent smoking cessation. Findings suggest that treatment should begin soon after the intake session to maximize treatment completion. Enhanced efforts to retain older adolescents and youth with lower academic goals and lower family income will be important in future studies.

The Minnesota Adolescent Community Cohort Study: design and baseline results

The Minnesota Adolescent Community Cohort (MACC) Study is a population-based, longitudinal study that enrolled 3,636 youth from Minnesota and 605 youth from comparison states ages 12 to 16 years in 2000-2001. Participants have been surveyed by telephone semi-annually about their tobacco-related attitudes and behaviors. The goals of the study are to evaluate the effects of the Minnesota Youth Tobacco Prevention Initiative and its shutdown on youth smoking patterns, and to better define the patterns of development of tobacco use in adolescents. A multilevel sample was constructed representing individuals, local jurisdictions and the entire state, and data are collected to characterize each of these levels. This paper presents the details of the multilevel study design. We also provide baseline information about MACC participants including demographics and tobacco-related attitudes and behaviors. This paper describes variability in smoking prevalence and demographic characteristics for local units, and compares MACC participants to the state as a whole.

Smoking-cessation interventions for U.S. young adults: a systematic review

CONTEXT

Studies have demonstrated the importance of quitting smoking before age 30 years to avoid tobacco-related mortality but little attention has been paid to developing evidence-based smoking-cessation interventions for young adults, as distinct from adolescents and older-aged adults. The objective of this study was to conduct a systematic review of smoking-cessation interventions for U.S. young adults (aged 18-24 years).

EVIDENCE ACQUISITION

Electronic searches were conducted in CINAHL, the Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus, and Sociological Abstracts to identify eligible interventions through August 31, 2009. Two independent coders critically evaluated the methodology and findings of all retrieved articles. Data analysis was conducted in 2010.

EVIDENCE SYNTHESIS

Twelve RCTs and two nonrandomized studies met the inclusion criteria; these studies varied with respect to sample size, intervention, outcomes assessed, and smoking measures. Pooled results for two studies based on social cognitive theory indicated that they were effective in promoting short-term abstinence at 1-3-month follow-up and 4-6-month follow-up. Four studies had a significant positive impact on smoking cessation: two in the short term and two at 6 months or more.

CONCLUSIONS

There is limited evidence demonstrating efficacy of smoking-cessation interventions for U.S. young adults. There were no pharmacologic interventions included in this review. Promising interventions were brief, with extended support via telephone and electronic media. Further high-quality studies using standardized smoking measures and additional studies outside the college setting are needed to identify and tailor effective smoking-cessation interventions for at-risk young adults in the U.S.

Are age of smoking initiation and purchasing patterns associated with menthol smoking?

AIMS

The purpose of this study was to examine the relationship between age of cigarette smoking initiation and cigarette purchasing patterns on menthol smoking among current smokers.

DESIGN

Secondary analyses were conducted using logistic regression with balanced replicated weights.

SETTING

Data from the 2003 and 2006/07 Tobacco Use Supplement (TUS) to the Current Population Survey (CPS), collected by the National Cancer Institute, the Centers for Disease Control and Prevention and the Census Bureau, formed the basis for this investigation.

PARTICIPANTS

A total of 66,145 current smokers who participated in the TUS CPS administration in 2003 and 2006/07 were examined.

MEASUREMENTS

Demographic characteristics (gender, race/ethnicity, age, education and income), smoking frequency, purchase type (pack, carton, or both), age of initiation and menthol cigarette use were assessed.

FINDINGS

One-quarter of the sample smoked menthol cigarettes; most purchased their cigarettes by the pack when rather than by the carton; average age of cigarette smoking initiation was 18 years; and females, ethnic/racial minorities and younger participants were more likely to smoke menthol cigarettes compared with males, whites or older respondents. Other demographic factors associated with menthol cigarette use among current smokers included a high school education (the prevalence of menthol use among this cohort was greater than either those with less education or those with more). The multivariate logistic model only marginally revealed that age of smoking initiation predicted menthol smoking: findings are suggestive that the longer the delay of initiation the more likely that an individual smoked menthol cigarettes [odds ratio (OR) = 1.01; 95% confidence interval (CI): 1.00-1.01]. In addition, relative to those who purchased cigarettes by the pack, smokers who purchased cigarettes by the carton were less (OR = 0.86; 95% CI: 0.81-0.91) likely to be menthol smokers.

CONCLUSIONS

Menthol smokers in the United States are more likely to be female, younger, from ethnic minority groups, and to have a high school education. The findings that menthol smokers in the U.S. tend to start smoking later than smokers of other types of cigarettes are suggestive only and require further study.

The relationships between menthol cigarette preference and state tobacco control policies on smoking behaviors of young adult smokers in the 2006-07 Tobacco Use Supplements to the Current Population Surveys (TUS CPS)

AIM

To examine relationships between the preference for menthol cigarettes and young adult smoking behaviors, including the extent to which state tobacco control policies moderate these relationships.

DESIGN

Cross-sectional design using secondary data from the 2006-07 Tobacco Use Supplements to the Current Population Surveys (TUS CPS) surveys appended with 2006 state-policy data.

SETTING

United States nationally representative survey.

PARTICIPANTS

A total of 2241 young adult daily smokers and 688 young adult non-daily smokers.

MEASUREMENTS

The two dependent variables of smoking behaviors were smoking first cigarette within 30 minutes of waking (TTF) and number of cigarettes smoked per day (cpd). Primary independent variables included menthol brand preference and state tobacco control policies (youth access laws, clean indoor air laws and cigarette excise taxes), adjusting for controls.

FINDINGS

Among daily smokers, there were no significant associations between menthol brand preference and TTF or cpd. However, lower educational attainment, not being in the labor force and the lack of home smoking rules were associated positively with shorter TTF, being white and the lack of home smoking rules were associated positively with cpd. Among daily smokers, state excise taxes were associated negatively with higher cpd. Among non-daily smokers, menthol brand preference was associated positively with shorter TTF, but associations did not vary with state tobacco control policies. Menthol brand preference was not associated significantly with cpd, but male gender, unmarried status and the lack of home smoking rules were associated positively with greater cpd among non-daily smokers.

CONCLUSIONS

Young adult non-daily smokers who preferred menthol cigarettes were significantly more dependent than those who preferred non-menthol cigarettes, as shown through the shorter TTF. Associations between menthol brand preference and smoking behaviors did not vary with state tobacco control policies.

Auricular acupressure combined with multimedia instruction or alone for quitting smoking in young adults: A quasi-experimental study

BACKGROUND

Smoking plays a disease-related risk factor and is however the principal cause of preventable death. Many studies support the use of combined rather than single interventions to stop smoking.

OBJECTIVE

This study aimed to evaluate the effects of auricular acupressure combined with multimedia instruction in comparison with auricular acupressure alone on smoking cessation in young adults.

METHOD

A quasi-experimental research design was used and participants were assigned to experimental groups according to their preference. Group 1 received the 10-week program with auricular acupressure plus multimedia instruction; Group 2 received auricular acupressure alone. Thirty-two participants were in each group were recruited from universities in Taiwan. The physical and psychological data were collected right before and after the program.

RESULTS

This study demonstrated the effects of smoking cessation on physical and psychological factors in each group. Statistical between-group differences existed in psychological factors of smoking cessation self-efficacy and nicotine dependence, but not in physical factors of carbon monoxide and cotinine.

CONCLUSIONS

This study adds to the body of research on the benefits of using auricular acupressure combined with or without multimedia instruction for smoking cessation in adolescents. The combined intervention was more effective especially in increasing smoking cessation self-efficacy and decreasing nicotine dependence. Further study is suggested adding control groups such as placebo in order to understand a single effect of smoking cessation.

Abstinence and relapse rates following a college campus-based quit & win contest

OBJECTIVE

To conduct and evaluate Quit & Win contests at 2 2-year college and 2 4-year university campuses.

PARTICIPANTS

During Spring semester, 2006, undergraduates (N = 588) interested in quitting smoking signed up for a Quit & Win 30-day cessation contest for a chance to win a lottery prize.

METHODS

Participants (N = 588) completed a baseline survey, provided a urine sample to verify smoking status before joining the contest, and completed a follow-up survey at contest end to assess abstinence. Participants reporting continuous 30-day abstinence were surveyed again 2 weeks post contest to assess relapse.

RESULTS

Participants smoked an average of 9.8 +/- 6.7 cigarettes/day on 26.7 +/- 5.7 days/month. Among participants completing a follow-up survey (74%), 72.1% reported abstinence during the entire contest period (Intent-to-Treat Analysis = 53.2%). 55.3% of those abstinent at the end of contest had resumed smoking 2 weeks post contest.

CONCLUSIONS

Campus Quit & Win contests appear feasible, acceptable, and effective at facilitating short-term abstinence. Further research is needed to identify strategies to prevent postcontest relapse.

Young adult smoking: what factors differentiate ex-smokers, smoking cessation treatment seekers and nontreatment seekers?

The present study investigated demographic and psychosocial correlates of smoking status and predictors of smoking cessation among young adults, ages 18-30 years old. Young adults (n=294) completed a self-report survey regarding their health habits and smokers were offered the opportunity to enroll in a smoking cessation program. Substitute reinforcers were greater among ex-smokers compared to nontreatment-seeking smokers, treatment-seeking smokers who did participate in a smoking cessation program and treatment-seeking smokers who did not subsequently participate in a smoking cessation program. Greater complementary reinforcers and delay discounting rates differentiated nontreatment-seeking smokers from ex-smokers and treatment-seeking smokers who subsequently attended a smoking cessation program. Nontreatment seekers were less likely to have higher depression symptoms than ex-smokers. Treatment seekers who did not attend a smoking cessation program tended to live in a household with another smoker, to not be college educated, and to be non-white. Young adult smokers who increased their substitute reinforcers across treatment were almost two times more likely to be quit at treatment end. These results highlight variables that may be important to consider in recruitment strategies and treatment components for smoking cessation interventions for young adult smokers.

A prospective study of cigarette smoking initiation during college: Chinese and Korean American students

OBJECTIVE

The present study was a prospective investigation of baseline influences on initial smoking and transition to established smoking among college students who had not smoked prior to college.

DESIGN

Included were 267 participants in a longitudinal study of tobacco use. Students of Chinese (52%) or Korean (48%) descent were enrolled during their freshman year in college. Data for the present study were collected during four annual in-person interviews.

MAIN OUTCOME MEASURES

(1) Initial use of a cigarette reflected having first smoked a cigarette (more than a puff) during college. (2) Established smoking was defined as having smoked at least 100 cigarettes.

RESULTS

Over the course of the study, 25% of baseline never-smokers tried their first cigarette, and 9% became established smokers. Overall, men were significantly more likely to experiment and progress to established smoking. Baseline alcohol and drug use, behavioral undercontrol, and parental smoking predicted smoking experimentation but not established smoking. Students of Korean ethnicity were more likely to become established smokers. However, acculturation was not a significant predictor of experimentation or established smoking after accounting for the effects of other predictors.

CONCLUSION

These findings suggest a need for efforts to prevent smoking uptake among Asian American college students.

Dietary patterns and home food availability during emerging adulthood: do they differ by living situation?

OBJECTIVE

The objective of the present work was to cross-sectionally examine and compare dietary behaviours and home food environments by young adults' living situation.

DESIGN

Using data from Project EAT (Eating Among Teens)-II, a large diverse youth cohort originally sampled in Minnesota, linear regression was used to examine self-reported meal frequency, dietary intake and home food availability outcomes by living situation (i.e. living with parents, renting an apartment/house or living on a college campus).

SUBJECTS

Young adults (n 1687), mean age 20.5 years.

RESULTS

Results suggested that young adults living with their parents or in rented apartments/houses had less frequent meals, poorer dietary intake and less healthy home food availability compared with those living on campus. These findings were evident even after controlling for sociodemographic factors (e.g. race/ethnicity, socio-economic status), particularly among females.

CONCLUSIONS

Although few emerging adults consume diets that are consistent with national recommendations, those living with parents and in rented apartments/houses may represent particularly at-risk groups. These differences in dietary factors across living situations appear to exist beyond the sociodemographic differences in these populations. Effective nutrition and healthy eating promotion strategies are needed for young adults.

Early exposure to movie smoking predicts established smoking by older teens and young adults

OBJECTIVE

Movie smoking exposure is a strong predictor of smoking initiation by adolescents; however, we do not know whether it is a long-term predictor of established smoking. We conducted a prospective study to determine whether movie smoking exposure during early adolescence predicts established smoking in older teens and young adults.

DESIGN

We assessed movie smoking exposure and smoking status through a written school-based survey in 1999, when participants were 10 to 14 years of age. We enrolled 73% (n = 2603) of those who had never tried smoking in a follow-up study. In 2006-2007, we conducted telephone interviews with 69% (n = 1791) of the cohort to ascertain current smoking status. The primary outcome was established smoking, defined as having smoked >100 cigarettes. Mean age at follow-up was 18.7 years.

RESULTS

Thirteen percent (n = 235) progressed from never smoking to established smoking during the follow-up period. Eighty-nine percent (n = 209) of established smokers smoked during the 30 days before the survey. Even after controlling for a wide range of baseline characteristics, the relative risk for established smoking increased by one third with each successive quartile of movie smoking exposure. Those in the highest quartile for baseline movie smoking exposure were twice as likely to be established smokers at follow-up compared with those in the lowest quartile.

CONCLUSIONS

Movie smoking exposure significantly predicted progression to established smoking in long-term follow-up. We estimate that 34.9% of established smoking in this cohort can be attributed to movie smoking exposure.

The Impact of Survey and Response Modes on Current Smoking Prevalence Estimates Using TUS-CPS: 1992-2003

This study identified whether survey administration mode (telephone or in-person) and respondent type (self or proxy) result in discrepant prevalence of current smoking in the adult U.S. population, while controlling for key sociodemographic characteristics and longitudinal changes of smoking prevalence over the 11-year period from 1992-2003. We used a multiple logistic regression analysis with replicate weights to model the current smoking status logit as a function of a number of covariates. The final model included individual- and family-level sociodemographic characteristics, survey attributes, and multiple two-way interactions of survey mode and respondent type with other covariates. The respondent type is a significant predictor of current smoking prevalence and the magnitude of the difference depends on the age, sex, and education of the person whose smoking status is being reported. Furthermore, the survey mode has significant interactions with survey year, sex, and age. We conclude that using an overall unadjusted estimate of the current smoking prevalence may result in underestimating the current smoking rate when conducting proxy or telephone interviews especially for some sub-populations, such as young adults. We propose that estimates could be improved if more detailed information regarding the respondent type and survey administration mode characteristics were considered in addition to commonly used survey year and sociodemographic characteristics. This information is critical given that future surveillance is moving toward more complex designs. Thus, adjustment of estimates should be contemplated when comparing current smoking prevalence results within a given survey series with major changes in methodology over time and between different surveys using various modes and respondent types.

Association of smoking in adolescence with abdominal obesity in adulthood: a follow-up study of 5 birth cohorts of Finnish twins

OBJECTIVES

We studied the association of adolescent smoking with overweight and abdominal obesity in adulthood.

METHODS

We used the FinnTwin16, a prospective, population-based questionnaire study of 5 consecutive and complete birth cohorts of Finnish twins born between 1975 and 1979 (N = 4296) and studied at four points between the ages of 16 and 27 years to analyze the effect of adolescent smoking on abdominal obesity and overweight in early adulthood.

RESULTS

Smoking at least 10 cigarettes daily when aged 16 to 18 years increased the risk of adult abdominal obesity (odds ratio [OR]=1.77; 95% confidence interval [CI] = 1.39, 2.26). After we adjusted for confounders, the OR was 1.44 (95% CI = 1.11, 1.88), and after further adjustment for current body mass index (BMI), the OR was 1.34 (95% CI = 0.95, 1.88). Adolescent smoking significantly increased the risk of becoming overweight among women even after adjustment for possible confounders, including baseline BMI (OR = 1.74; 95% CI = 1.06, 2.88).

CONCLUSIONS

Smoking is a risk factor for abdominal obesity among both genders and for overweight in women. The prevention of smoking during adolescence may play an important role in promoting healthy weight and in decreasing the morbidity related to abdominal obesity.

The role of peer e-mail support as part of a college smoking-cessation website

BACKGROUND

Helping young smokers to quit early in life substantially reduces the risk of later morbidity and mortality due to tobacco use. The RealU study demonstrated the efficacy of a smoking-cessation website for college students that incorporated both individually tailored feedback and peer e-mail support. The relationship between peer e-mail support and cessation outcomes among intervention participants is examined here.

METHODS

This study was conducted at the University of Minnesota Twin Cities from Fall 2004 through Spring 2005. During the intervention period, peer-support students (E-pals) wrote weekly e-mails to intervention group participants (n=257) encouraging healthy behaviors including smoking abstinence. Ten survey items assessed perceived E-pal supportiveness. The number of e-mails replies sent by the participants to their E-pal was tracked as a measure of e-mail engagement. The primary outcome was self-reported 30-day abstinence at the end of the intervention period.

RESULTS

Over the course of the intervention, participants sent an average of 4.6 (SD=3.6) e-mails to their E-pals. Perceived E-pal support was significantly correlated with e-mail engagement (p<0.001). At Week 30, 40.5% of individuals in the RealU intervention group (104/257) reported not smoking any cigarettes in the prior 30 days. Bivariate analyses indicated that 30-day abstinence was related to both perceived support from the E-pal (p<0.001) and e-mail engagement (p<0.001). Multivariate analyses indicated that after controlling for age and baseline-level smoking, e-mail engagement remained a significant predictor of 30-day abstinence (p<0.001).

CONCLUSIONS

Greater peer engagement via e-mail was associated with increased smoking abstinence and reduced frequency of smoking. These findings suggest that online peer support may be an important strategy when delivering Internet-assisted cessation programs to young adults.

The RealU online cessation intervention for college smokers: a randomized controlled trial

OBJECTIVES

To determine the efficacy of providing online cessation intervention for college smokers.

METHODS

This is a two-group randomized controlled trial. The intervention group received $10 weekly incentives to visit an online college life magazine that provided personalized smoking cessation messages and peer email support. Evaluation assessments occurred at baseline and 8, 20, and 30 weeks after enrollment. The primary outcome is self-reported 30-day abstinence at week 30. Carbon monoxide (CO) breath testing was performed for participants reporting 30-day abstinence at week 30.

RESULTS

Five-hundred and seventeen college smokers at the University of Minnesota were enrolled via internet health screening (control=260, intervention=257) in the fall of 2004. Intervention participants completed an average of 18.9 (SD 2.5) of 20 weekly website visits over the course of the study. The rate of 30-day abstinence at week 30 was higher for the intervention compared to the control group (41% vs. 23%, p<0.001). CO testing showed low rates of under-reporting. There was no difference in self-reported 6-month prolonged abstinence measured at week 30.

CONCLUSION

Providing personalized smoking cessation messages as part of a general interest online college life magazine increased 30-day abstinence by the end of this two semester intervention.

Variability of healthcare practitioner intervention among 18- to 24-year-old tobacco users

A survey of 184 young, rural, tobacco users found that healthcare professionals often assessed tobacco use, although there was significant variability by professional type (physician vs. dentist) and tobacco service (advise vs. referral). Females reported significantly higher levels of receiving tobacco services (advice to quit) than males.

Smoking prevalence and awareness among undergraduate and health care students

Approximately 10,000 undergraduates from 12 Texas colleges and universities and 350 health care students completed a Web-based survey assessing the prevalence and awareness of cigarette smoking. There were few differences between health care and undergraduate students on trying smoking or quitting smoking. Health care students reported lower rates of current smoking than undergraduate students, even though both groups demonstrated similar knowledge of tobacco-related health risks. Gender differences are discussed. Findings suggest that tobacco awareness programs should continue to target young adults as an at-risk population, and that health care training programs should place a greater emphasis on tobacco cessation.