Cigarette use among young adults: comparisons between 2-year college students, 4-year college students, and those not in college

Rationale, Design, and Baseline Characteristics of Participants in the Health@NUS mHealth Augmented Cohort Study Examining Student-to-Work Life Transition: Protocol for a Prospective Cohort Study

BACKGROUND

Integration of mobile health data collection methods into cohort studies enables the collection of intensive longitudinal information, which gives deeper insights into individuals' health and lifestyle behavioral patterns over time, as compared to traditional cohort methods with less frequent data collection. These findings can then fill the gaps that remain in understanding how various lifestyle behaviors interact as students graduate from university and seek employment (student-to-work life transition), where the inability to adapt quickly to a changing environment greatly affects the mental well-being of young adults.

OBJECTIVE

This paper aims to provide an overview of the study methodology and baseline characteristics of participants in Health@NUS, a longitudinal study leveraging mobile health to examine the trajectories of health behaviors, physical health, and well-being, and their diverse determinants, for young adults during the student-to-work life transition.

METHODS

University students were recruited between August 2020 and June 2022 in Singapore. Participants would complete biometric assessments and questionnaires at 3 time points (baseline, 12-, and 24-month follow-up visits) and use a Fitbit smartwatch and smartphone app to continuously collect physical activity, sedentary behavior, sleep, and dietary data over the 2 years. Additionally, up to 12 two-week-long bursts of app-based ecological momentary surveys capturing lifestyle behaviors and well-being would be sent out among the 3 time points.

RESULTS

Interested participants (n=1556) were screened for eligibility, and 776 participants were enrolled in the study between August 2020 and June 2022. Participants were mostly female (441/776, 56.8%), of Chinese ethnicity (741/776, 92%), undergraduate students (759/776, 97.8%), and had a mean BMI of 21.9 (SD 3.3) kg/m2, and a mean age of 22.7 (SD 1.7) years. A substantial proportion were overweight (202/776, 26.1%) or obese (42/776, 5.4%), had indicated poor mental well-being (World Health Organization-5 Well-Being Index ≤50; 291/776, 37.7%), or were at higher risk for psychological distress (Kessler Psychological Distress Scale ≥13; 109/776, 14.1%).

CONCLUSIONS

The findings from this study will provide detailed insights into the determinants and trajectories of health behaviors, health, and well-being during the student-to-work life transition experienced by young adults.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/study/NCT05154227.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56749.

Factors Associated With Abstinence Among Young Adult Smokers Enrolled in a Real-world Social Media Smoking Cessation Program

OBJECTIVE

Social media platforms are promising to provide smoking cessation support. This study aimed to identify baseline factors associated with cigarette smoking abstinence among young adult smokers enrolled in a real-world social media-based smoking cessation program.

AIMS AND METHODS

We analyzed data from young adult smokers (aged 18-30 years) participating in a publicly available Facebook-based smoking cessation program serving the San Francisco Bay Area. The analytic sample consisted of 248 participants who completed both the baseline and follow-up surveys at 3 months. Multivariable logistic regression analysis determined baseline factors significantly associated with self-reported 7-day cigarette smoking abstinence at 3 months.

RESULTS

Participants were race/ethnically diverse, well-educated, and 47.6% reported LGB + sexual identity. Those who reported dual use of cigarettes and e-cigarettes in the past 30 days (vs. cigarette use only), current alcohol users (vs. non-users), and those aged 25-30 years (vs. 18-24 years) were significantly less likely to report 7-day abstinence at 3 months. Non-daily smokers (vs. daily smokers) and those with high desire to quit smoking (vs. low to moderate desire) were more likely to report abstinence. Results also showed reduction in the percentage of e-cigarette and other tobacco product use among participants.

CONCLUSIONS

Social media interventions may be more effective for young adult non-daily smokers and those with high desire to quit smoking. Smoking cessation programs may help reduce use of other tobacco products among treatment-seeking smokers. Smoking cessation interventions for young adults need to explicitly address dual use of cigarettes and e-cigarettes and use of alcohol.

IMPLICATIONS

Findings of this study highlight the need for future interventions to address dual use of cigarettes and e-cigarettes and use of alcohol to improve cigarette smoking abstinence outcomes. The reduction in the use of other tobacco products among program participants indicates that social media smoking cessation programs may exert a broader positive influence on overall tobacco consumption. The large number of LGB+ smokers participating in the program suggests social media is a promising cessation channel for this hard-to-reach group, warranting further study.

Engaging Students in Advancing Campus Tobacco-Free Policies: A Qualitative Study of California Community Colleges' Efforts

Introduction

Tobacco use remains a serious problem for young adults. Given the large number of young adults attending college, a tobacco-free campus is one strategy to reduce tobacco use. Young adult engagement is recognized as a common strategic practice in tobacco control policy efforts, especially in changing social norms around tobacco use. Community colleges can leverage and engage students in adoption of campus 100% tobacco-free policies. This qualitative study examines the importance of student engagement in advancing 100% tobacco-free policies in community colleges and identifies strategies for campuses to involve students in such efforts.

Methods

We selected 12 community colleges and conducted key informant interviews with campus and community-based organizations that were involved in campus policy adoption efforts. We conducted 33 semistructured interviews and transcribed, coded, and analyzed them by using a thematic analytic framework with inductive and deductive approaches to examine student engagement processes.

Results

Community colleges represented campuses with (n = 6) and without (n = 6) tobacco-free policy and varied by geography (urban vs rural) and student population size. Three main themes emerged: 1) no "wrong door" for students to engage in tobacco control work, 2) a myriad of ways for students to be involved in policy adoption, and 3) benefits of student engagement.

Conclusion

We found that students are doers, allies, and champions in adoption of 100% campus tobacco-free policy. Colleges should leverage their campuses' most important assets - students - to be agents of change and to involve them in the full spectrum of interventions and advocacy.

Health behavior and health needs of first-year medical and health sciences students

Objective: The aim of this study is to evaluate the health behavior and health needs of medical and health sciences students in order to identify areas that need intervention. Materials and Methods: This descriptive study was conducted with 770 first-year university students. The data were collected with a sociodemographic questionnaire, the Youth Risk Behavior Survey and the Eating Attitudes Test. Body mass index was calculated. Results: Although, only 12.7% of the students were overweight or obese, 25.6% of the students perceived themselves to be overweight or obese. The students said that in the last week, 20.9% had breakfast 1 or 3 times, 5.7% ate no fruits at all, and 11.6% ate no vegetables at all. 48.1% of the students did not engage in any physical activity, and 83.2% spent more than 2 hours inactively in front of a screen. It was observed that 22.3% were current smokers. A propensity for eating behaviors disorder was found in 9.0%. Drinking energyboosting sports drinks 1-6 times in the last week (β: 3.286), smoking (β: 1.875) and eating few vegetable dishes in the last week (β: 0.484) were identified as factors that could be associated with a “tendency for eating behavior disorder.” Conclusion: We can conclude that nutritional issues, negative body weight perception, use of tobacco, and sedentary lifestyle are the main intervention and counselling areas for our study group.

Electronic nicotine delivery systems: use, knowledge, and attitudes among diverse college students

ObjectiveThe purpose of this study was to examine Electronic Nicotine Delivery Systems (ENDS) use among nonusers in diverse college students. Participants: Participants were college students enrolled at a Hispanic-Serving University in Chicago, IL, USA in December 2017. Methods: An online survey was administered using questions about ENDS-use behaviors, device characteristics, and knowledge of their own device, and ENDS attitudes. ENDS attitudes included questions about health, susceptibility, and quit characteristics. Results: The prevalence rate of ENDS use was 7%, and 39% of ENDS users identified all device characteristics. Nonusers categorize ENDS as a healthier alternative to cigarettes and as quit devices. Finally, cigarette use, age, health factor, and social proximity are correlated with ENDS susceptibility. Conclusions: These ENDS users lack awareness of their devices and tobacco use plays a key role in ENDS susceptibility. Future studies should continue to study the role ENDS has in dependence and cigarette use.

Examining the heterogeneity of polysubstance use patterns in young adulthood by age and college attendance

Substance use in young adulthood and polysubstance users (PSU), in particular, pose unique risks for adverse consequences. Prior research on young adult PSU has identified multiple classes of users, but most work has focused on college students. We examined PSU patterns by age and college attendance during young adulthood in two nationally representative samples. Using National Epidemiological Survey on Alcohol and Related Conditions (NESARC) Wave 1 and NESARC-III data sets, multigroup latent class analysis (MG-LCA) was employed to examine PSU patterns based on age (18-24 vs. 25-34) and determine whether solutions were similar (i.e., statistically invariant) by college attendance/graduation. Classes were estimated by binary past-year use of sedatives, tranquilizers, opioids/painkillers, heroin, amphetamines/stimulants, cocaine, hallucinogens, club drugs, and inhalants, and past-year frequency of alcohol, cigarette, and cannabis use. PSU patterns are largely replicated across waves. Model fit supported 3-class solutions in each MG-LCA: Low frequency-limited-range PSU (alcohol, cigarettes, and cannabis only), medium-to-high frequency limited-range PSU (alcohol, cigarettes, and cannabis only), and extended-range PSU (ER PSU; all substances). Apart from one model, MG-LCA solutions were not invariant by college attendance/graduation, suggesting important differences between these groups. Except for alcohol, cannabis, and cigarette use frequency, results showed that probabilities of illicit and prescription drug use declined in the older age group. Findings also supported examining college and noncollege youth separately when studying PSU. ER PSU may be uniquely vulnerable to coingesting substances, particularly for nongraduates, warranting future research to classify patterns of simultaneous PSU and identify predictors and consequences of high-risk combinations (e.g., alcohol and opioids). (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Longitudinal Associations Between Use of Tobacco and Cannabis Among People Who Smoke Cigarettes in Real-world Smoking Cessation Treatment

OBJECTIVES

Cannabis use is common among people who use tobacco. However, little is known about the relationship between change in use of tobacco and cannabis over time. We examined the longitudinal associations between use of the two substances in a realworld smoking cessation context.

METHODS

This study analyzed data from a 3-month smoking cessation program delivered via Facebook in the San Francisco Bay Area, USA during 2016-2020. The sample included 487 participants who smoked cigarettes ( Mage = 25.4 years old, 39.6% Male, 40.3% White). The regressors (ie, frequency or number of days during the past 30 days using cigarettes, e-cigarettes, and cigars) and the outcome (ie, frequency of cannabis use) were measured at both baseline and 3-month follow-up. Random-effects modeling examined the longitudinal associations between the regressors and the outcome controlling for alcohol use and baseline demographics.

RESULTS

Participants who increased (or decreased) their frequency of use of cigarettes (β = 0.17, 95% confidence interval [CI] = 0.10, 0.24), e-cigarettes (β = 0.11, 95% CI = 0.05, 0.17), or cigars (β = 0.19, 95% CI = 0.06, 0.32) also increased (or decreased) their frequency of cannabis use after 3 months. Sexual minority participants (vs heterosexuals) (β = 2.12, 95% CI = 0.01, 4.24) and those whose education attainment being high school or less (vs higher education) (β = 3.89, 95% CI = 1.25, 6.53) were more likely to increase their frequency of cannabis use over time.

CONCLUSIONS

The findings indicated positive associations between change in use of tobacco and cannabis use. Promoting cessation among people who use tobacco may help to reduce their cannabis use.

School and Community Factors Associated With the Adoption of 100% Smoke-free Policy by California Community Colleges, 2003-2019

PURPOSE

Smoke- and tobacco-free policy (SFP) is an effective strategy that can reduce tobacco-related health disparities among young adults.

DESIGN

Longitudinal design using administrative, survey, policy data sources, and geocoded tobacco outlet and American Community Survey data.

SETTING

California community colleges (CC) and cities/communities where colleges are located, 2003-2019.

SAMPLE

114 California CCs.

DATA

School-level (i.e., student population and demographics) and community-level data (socio-demographics, local tobacco control policy, tobacco-related norms and availability, and health resources) from 2003 to 2019.

MEASURES

Key outcome is the year CC adopted a 100% SFP.

ANALYSIS

Bivariate and multivariate Cox survival models were used to analyze timing of SFP adoption.

RESULTS

By 2019, 61 out of 114 (53.5%) CCs were 100% SFP. While community smoking prevalence and tobacco availability were not significant, CCs in rural areas were less likely to be smoke-free. CCs located in cities with stronger tobacco policies (hazard ratio (HR) = 1.08, P < .05), which reported higher student health fees (HR = 2.00, P < .05) and received technical assistance for SFP (HR = 4.59, P < .01) were significantly associated with having 100% SFP.

CONCLUSION

Findings suggest that key community factors (strong city tobacco policies) and school and community resources (student health fees, SFP technical assistance) are associated with the presence of 100% SFP at CCs. Resources from the community or within a college might support remaining CCs in becoming 100% smoke-free.

Affirming the Abuse Liability and Addiction Potential of Menthol: Differences in Subjective Appeal to Smoking Menthol Versus Non-Menthol Cigarettes Across African American and White Young Adult Smokers

INTRODUCTION

Menthol cigarettes are popular among young adults and are disproportionately used by African American smokers. Menthol's minty and cooling sensations have been hypothesized to enhance the appeal and reinforcement of smoking; however, differences in menthol's subjective appeal across races have been inconsistent. This secondary data analysis examined differences in subjective appeal for smoking menthol versus non-menthol cigarettes between African American and White young adult smokers.

METHODS

Young adults (ages 18-24) recruited from Amazon Mechanical Turk (December 2018-January 2019) completed an online survey of tobacco use behavior. Past year smokers (n = 1726) answered questions about subjective responses to smoking (reward, satisfaction, throat hit, craving reduction, and aversion).

RESULTS

Significantly more African American (73.2%) compared to White (52.4%) smokers preferred menthol cigarettes (p < .001). Menthol smokers reported greater positive and negative subjective responses to smoking than non-menthol smokers. Positive and negative subjective response were both associated with greater smoking intensity and lower cigarette harm perceptions. Interactions of menthol preference and race on indices of subjective appeal also emerged. African American non-menthol smokers reported lower levels of satisfaction, reward, and craving reduction compared to White non-menthol smokers.

CONCLUSIONS

The relationship between menthol preference and subjective response to smoking differs by race. Menthol is rated as more appealing than non-menthol smoking, and appeal indices were linked to smoking intensity and lower harm perceptions, indicating greater abuse liability of menthol cigarettes. Policies that ban menthol cigarettes may have a particularly positive impact on the cigarette smoking of African American young adult smokers.

IMPLICATIONS

The FDA issued an Advanced Notice of Proposed Rule Making to examine the role menthol in tobacco products to inform regulations to restrict or ban flavors. This study showed that menthol smokers reported greater appeal to smoking than non-menthol smokers; and an interaction of race x menthol preference showed African American non-menthol smokers reported the lowest levels of appeal to smoking. Multiple indices of cigarette appeal were positively correlated with smoking intensity and lower cigarette harm perceptions, highlighting the addiction potential of menthol cigarettes. Findings suggest a menthol cigarette ban could help reduce tobacco use among young adults.

Age of Onset of Susceptibility to Different Tobacco Products Among Non-Susceptible US Young Adults: Findings from the Population Assessment of Tobacco and Health Study Waves 2-4 (2014-2017)

INTRODUCTION

Initiation of tobacco products is increasing in young adulthood. This study prospectively estimated the age of onset of susceptibility to cigarettes, e-cigarettes, hookah, smokeless tobacco, and cigarillos among young adults, which is a cognitive precursor to initiation.

METHODS

Secondary data analyses of the Population Assessment of Tobacco and Health (PATH) study, a nationally representative longitudinal cohort study of US adults. Young adults (18-24 years) who were non-susceptible to each tobacco product (cigarettes, e-cigarettes, hookah, smokeless tobacco, and cigarillos) at waves 2 or 3 were followed-up into waves 3-4 to prospectively estimate the age of onset of susceptibility to each tobacco product. Weighted interval-censored survival methods and interval-censored Cox regression models were implemented to estimate the age of onset of susceptibility, and to estimate differences in the hazard function by sex and by race/ethnicity, while controlling for the total number of other tobacco products ever used at their first wave of participation in PATH.

RESULTS

By age 21, 16.5%, 16.0%, 12.6%, 12.4%, and 5.9% of young adults reported onset of susceptibility to hookah, e-cigarettes, cigarillos, cigarettes, and smokeless tobacco, respectively. Among young adults who were non-susceptible to each tobacco product at waves 2 or 3, the highest increase in onset of susceptibility occurred between ages 18 and 19 for cigarettes, e-cigarettes, and hookah, while the highest increase in onset of susceptibility occurs between ages 22 and 23 for cigarillos. Young adult males had increased risk of onset of susceptibility to cigarillos and smokeless tobacco at earlier ages than young adult females. Differences in onset of susceptibility to each tobacco product were also observed by race/ethnicity among young adults.

CONCLUSIONS

With the changing landscape of tobacco products, monitoring the age of onset of susceptibility of tobacco product use among non-susceptible young adults longitudinally is critical to prevent initiation. Communication and education campaigns tailored to address differences in susceptibility among young adults by tobacco product and sociodemographic factors will be useful.

Campus tobacco control policies and cessation interventions in college students: a commentary calling for research and action to address tobacco-related health disparities

Tobacco-related health disparities (TRHDs) have a significant impact on population health in the USA. Effectively preventing and controlling TRHDs among young adult populations require multiple prevention and cessation points, including within college/university contexts. This commentary addresses current campus tobacco control policies and cessation interventions for U.S. college students, with an emphasis on TRHDs and opportunities for research and research translation to reduce these disparities. This commentary is informed by literature published between 2010 and 2020 regarding (a) prevalence and impact of campus tobacco control policies; and/or (b) behavioral outcomes from cessation interventions for young adults attending colleges. Despite a doubling of college campuses adopting tobacco-free policies from 2012 to 2017, roughly two-thirds continue to operate without such policies. Few policies address alternative tobacco products (e.g., e-cigarettes, cigars/cigarillos, and hookah), and communication about and enforcement of existing policies is extremely limited. A broad range of cessation intervention strategies have targeted individuals in this age group, but with little focus on TRHDs and limited intervention dissemination. Importantly, college students representing populations at risk for TRHDs (e.g., racial/ethnic/sexual/gender minorities, low socioeconomic status) are less likely to be exposed to strong tobacco control policies or supports for cessation. There are untapped opportunities for behavioral medicine approaches to reduce TRHDs in college settings. Research findings regarding multilevel (policy, community-level, and individual-level) interventions must be translated to policy/practice in order to address tobacco use, particularly among vulnerable college student populations.

Tobacco Magazine Advertising Impacts Longitudinal Changes in the Number of Tobacco Products Used by Young Adults

PURPOSE

The present study examined the longitudinal associations between exposure to tobacco advertisements in magazines popular among young adults and changes in the number of tobacco products used by young adults.

METHODS

Participants were 4,824 students from 24 Texas colleges participating in a longitudinal study. Tobacco advertisements in 11 magazines, collected from 2015 to 2017, were objectively assessed and young adults self-reported the frequency of reading each magazine on five biannual surveys from 2015 to 2017. The objective and self-reported measures were multiplied to create a tobacco advertisement exposure score. Growth curve models were used to determine if exposure to tobacco advertisements in magazines predicted changes in the number of tobacco products used across the 2-year period, controlling for sociodemographic factors, ever tobacco use, recall of tobacco advertisements on the internet, and personality characteristics.

RESULTS

Young adults with more exposure to tobacco advertisements reported a slower decline in the number of tobacco products they used across time.

CONCLUSIONS

Tobacco advertising in magazines contributes to the continuation of single-product and polyproduct use among young adults. Findings highlight the need for additional federal regulations limiting advertisements for all types of tobacco products in magazines, particularly those popular among young adults, the youngest legal targets of the tobacco industry.

Same-day use of cigarettes, alcohol, and cannabis among sexual minority and heterosexual young adult smokers

OBJECTIVE

Sexual minority (SM) young adults have higher rates of substance use than heterosexuals, but little is known about daily use of multiple substances, which confer numerous health risks for this population. Using daily diary data from a smartphone-based study, we examined the associations between sexual identity (i.e., SM vs. heterosexual) and patterns of same-day multiple substance use (i.e., cigarettes and alcohol, cigarettes and cannabis, alcohol and cannabis, and all 3 substances).

METHOD

Young adult smokers (N = 147, aged 18-26, 51.7% female, 41.5% SM, 40.8% White) reported consecutive daily assessments on substance use over 30 days. We used generalized estimating equations to examine associations between sexual identity and patterns of same-day multiple substance use, controlling for demographic factors and psychological distress.

RESULTS

Of 2,891 daily assessments, 16.7% reported same-day use of cigarettes and alcohol, 18.1% cigarettes and cannabis, 1.5% alcohol and cannabis, and 15.0% use of all 3 substances. SM participants (vs. heterosexuals) had significantly greater odds of reporting days with use of cigarettes and cannabis [Adjusted Odds Ratio (AOR) = 2.05, 95% Confidence Interval (CI) [1.04, 4.01]] and use of all three substances (AOR = 2.79, 95% CI [1.51, 5.14]) than days with single substance use or no use.

CONCLUSIONS

These findings warrant tailored interventions addressing multiple substance use among SM young adults and temporally accurate measures of multiple substance use patterns. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Using Peer Crowd Affiliation to Address Dual Use of Cigarettes and E-Cigarettes among San Francisco Bay Area Young Adults: A Cross Sectional Study

Given the emerging tobacco landscape, dual use of cigarettes and e-cigarettes has increased among young adults, but little is known about its associated factors. Peer crowds, defined as macro-level connections between individuals with similar core values (e.g., "Hip Hop" describing a group that prefers hip hop music and values strength, honor, and respect), are a promising way to understand tobacco use patterns. We examined associations between peer crowds and tobacco use patterns by using data from a cross sectional survey of 1340 young adults in the San Francisco Bay Area in 2014. Outcomes were the past 30-day use of: neither cigarettes nor e-cigarettes; cigarettes but not e-cigarettes; e-cigarettes but not cigarettes; and both cigarettes and e-cigarettes. Peer crowds included Hipster, Hip Hop, Country, Partier, Homebody, and Young Professional. Multinomial regression analysis indicated that peer crowds were significantly associated with different tobacco use patterns. Compared to Young Professionals, Hip Hop and Hipster crowds were more likely to dual use; Hipsters were more likely to use e-cigarettes only, and Country participants were more likely to smoke cigarettes only. These findings suggest that tobacco control campaigns and cessation interventions should be tailored to different young adult peer crowds and address poly-tobacco use.

Personality and impulsivity as predictors of tobacco use among emerging adults: A latent class analysis

The tobacco industry markets their products toward emerging adults (18-29), with the goal of increasing use among this age group. To inform prevention efforts, researchers are investigating how specific demographic and psychological traits may predict tobacco initiation and continuation. Participants were 578 incoming university freshmen from the Appalachian region. Participants provided information on demographics, personality traits, impulsivity characteristics, lifetime use of cigarettes and electronic cigarettes (ECIGs), and current use of cigarettes, ECIGs, small cigars/cigarillos, large cigars, smokeless tobacco, and waterpipe. Latent class analysis identified tobacco-use classes and regressions identified psychological predictors of class membership. Participants were Nonusers, Experimenters, and Polytobacco Users. Lower agreeableness and conscientiousness as well as higher extraversion and neuroticism were associated with being Experimenters or Polytobacco Users. Lower impulsivity was associated with being Nonusers. Distinct types of emerging adults belong to each tobacco use class, suggesting that individual differences be incorporated in prevention efforts.

Reasons for Transition From Electronic Cigarette Use to Cigarette Smoking Among Young Adult College Students

PURPOSE

Longitudinal studies indicate that e-cigarette use among youth and young adults is associated with cigarette smoking initiation. The purpose of this study was to identify reasons why nonsmoking young adults transition from e-cigarette use to cigarette smoking.

METHODS

The study used concept mapping (CM), a mixed-method participatory approach. Fifty-five college students who endorsed initiation of e-cigarettes before cigarettes (lifetime e-cigarette uses ≥ 100 and ≥ 100 cigarettes in lifetime) completed at least one part of the study. In an online program, participants brainstormed (n = 54) statements describing reasons for transition from e-cigarette use to cigarette smoking, sorted statements (n = 46) into conceptually similar categories, and rated (n = 47) how true each statement was for them.

RESULTS

Participants generated 60 unique statements, and multidimensional scaling analysis generated eight thematic clusters characterizing reasons for transition which included the following: "Sharing with Others," "Psychological Coping," "Cigarette Appeal," "Reinforcing Effects of Cigarettes," "Accessibility," "Social Influence," "Vaping Stigma," and "Vaping Deficiencies." Participants rated "Sharing with Others" and "Psychological Coping" highest (most true) and "Vaping Deficiencies" lowest (least true). For college students, the ability to share cigarettes with peers and access cigarettes from peers and smoking for stress/anxiety management were among the top reasons for transition.

CONCLUSIONS

Results suggest that tailored prevention efforts aimed at reducing cigarette smoking uptake among college students who use tobacco as a means for psychological coping or social facilitation may be warranted. Furthermore, regulatory decisions aimed at limiting cigarette appeal, reinforcing effects, and accessibility may be relevant to reducing transition.

Waterpipe tobacco use in college and non-college young adults in the USA

BACKGROUND

Waterpipe tobacco smoking (WTS or 'hookah') is common among adolescents and college students in the USA. However, there has not yet been a large-scale, nationally representative study independently examining WTS among young adults who are not in college.

OBJECTIVE

This study sought to examine associations between attitudes, normative beliefs, certain socio-demographic factors and current WTS among young adults not in college and compare them to young adults in college.

METHODS

A total of 3131 US adults ages 18-30 completed an online survey about WTS behaviour, attitudes, normative beliefs and relevant socio-demographic factors. Multivariable logistic regression was used to examine independent associations between these variables and current WTS stratified by student status.

RESULTS

Ever WTS was reported by 29% of young adults not in college and by 35% of those in college, and current use rates were 3 and 7%, respectively. Multivariable models demonstrated that positive attitudes and perceived peer acceptability of WTS were significantly associated with increased current WTS for both young adults not in college [adjusted odds ratio (AOR) = 2.72; 95% CI: 2.00-3.71 and AOR = 2.02; 95% CI: 1.50-2.71, respectively] and young adults in college (AOR = 3.37; 95% CI: 2.48-4.58 and AOR = 2.05; 95% CI: 1.49-2.83, respectively). The magnitude of these associations was not significantly different when comparing individuals in college and not in college.

CONCLUSIONS

Among young adults, WTS is common in non-college-based populations as well as in college-based populations. Therefore, prevention programming should extend to all young adults, not only to those in college.

Smoke-Free Home and Vehicle Policies Among Community College Smokers

BACKGROUND

Personal smoke-free policies (home and vehicle) reduce secondhand smoke exposure, improve health, and increase quitting among smokers. Overall, 83.0% and 78.1% of Americans report smoke-free homes and vehicles, respectively. However, little is known about such policies among 2-year community college (CC) students, who represent a large, diverse population with higher smoking rates and less negative attitudes toward smoking than 4-year college students.

METHODS

Prevalence of, and factors associated with, personal smoke-free policies were examined for 2,475 CC smokers enrolled in a national trial of web-assisted tobacco intervention.

RESULTS

Few students had smoke-free home policies (20.7%), smoke-free vehicles (17.0%), both smoke-free home and vehicle policy (4.2%), or any policy (home or vehicle; 31.2%). In logistic regression models, having children was associated with a smoke-free home or any policy but not with a smoke-free vehicle, and among participants who had children, only 20% reported a smoke-free home, and only 15% had a smoke-free vehicle. In addition, not living with other smokers, living with parents or roommates/siblings (vs. alone), smoking later than 30 minutes after awakening, believing that smoking affects the health of others, and confidence in quitting were associated with presence of a smoke-free home or any policy; no variables were significantly associated with presence of a smoke-free vehicle.

CONCLUSIONS

CC students represent a priority population for intervention regarding smoke-free homes and vehicles. Such intervention can decrease exposure of others, including children, and potentially increase the likelihood of quitting in this high-risk population.

Contingency management for college student smokers: The role of drinking as a moderator and mediator of smoking abstinence during treatment

INTRODUCTION

Contingency management (CM) is effective for promoting smoking abstinence; however, moderators and mediators of CM treatment efficacy in young adult populations are under-explored. We leveraged fine-grained data from a large randomized controlled trial: 1) to determine whether early attainment of sustained abstinence mediated the effect of treatment on abstinence; 2) to test whether heavy drinking moderated the effect of treatment on abstinence; and 3) to test a serial mediation model of the effects of drinking during early treatment on sustained smoking abstinence.

METHODS

College student smokers (N=110) were randomized to receive either CM treatment or noncontingent reinforcement (NR) over a 21-day treatment period. All participants received $5 for providing twice-daily breath carbon monoxide (CO) samples. In CM, additional money was provided for samples that indicated smoking reduction (Initial Phase; first 7days), and for samples ≤5ppm (Abstinence Phase; following 14days).

RESULTS

CM treatment led to greater sustained abstinence relative to NR. Longer sustained abstinence in the Initial Phase partially mediated the effect of treatment on sustained abstinence in the Abstinence Phase. Heavier pretreatment drinkers had shorter periods of sustained abstinence in the Abstinence Phase; this effect was greater in CM. A serial mediation model determined that increased drinking during the Initial Phase led to decreased sustained abstinence, which then led to decreased sustained abstinence in the Abstinence Phase.

CONCLUSIONS

These data provide a greater understanding of how heavy drinking and early sustained abstinence may affect success during treatment in young adults undergoing contingency management treatment for smoking.

''Quit & Win'' Contests Among College Students: Predictors of Long-Term Smoking Abstinence

PURPOSE

To determine smoking abstinence rates and predictors of abstinence among college students enrolled in a campus-based Quit & Win contest.

DESIGN

Pre-post measure with no comparison group.

SETTING

Contests conducted on seven college campuses in 2007.

SUBJECTS

Subjects (N = 484) were 23.7 ± 6.8 years of age, 61% female, 16.3% nonwhite, and smoked 12.5 ± 7.8 cigarettes per day on 28.0 ± 4.8 days in the past month.

INTERVENTION

Participants abstinent for the 30-day contest were eligible for a lottery-based prize. Assessments were completed at baseline, end of contest, and 6 months after enrollment.

MEASURES

The 6-month survey assessed retrospective abstinence during the contest period and the prior 6 months and 7- and 30-day point prevalence abstinence at the time of the survey.

ANALYSIS

Chi-square test was used to compare baseline characteristics among participants from 2-versus 4-year schools. Smoking abstinence was assessed by participant self-report. Both a simple imputation method (i.e., missing = smoking) and completers-only analyses were conducted. Stepwise logistic regression was used to determine baseline predictors of abstinence.

RESULTS

Thirty-day abstinence rate was 52.5% during the contest month and 20.5% at the 6-month follow-up. Baseline intention to stay quit (odds ratio [OR] = 1.56, p = .01), cigarettes smoked per day (OR = .67, p = .04), and 2-year (vs. 4-year) college (OR = 1.65, p = .05) predicted abstinence at 6 months.

CONCLUSION

Intention to stay quit even without winning a prize, a measure of intrinsic motivation, predicted both short- and long-term abstinence.

Post-High School Changes in Tobacco and Cannabis Use in the United States

BACKGROUND

The transition from high school into young adulthood is a critical developmental period with many young people going to college, moving residence, and entering the work force for the first time. The NEXT Generation Health Study (NEXT) is a nationally representative longitudinal study of adolescent health behaviors. Previous NEXT research has found that the post-high school environment is associated with changes in alcohol use.

OBJECTIVES

The current study investigated the impact of school status, residential status, and work status on cannabis and cigarette use among post-high school participants.

RESULTS

Living in a dorm/fraternity/sorority was associated with an increased prevalence in cannabis use while attending a 4-year college was associated with a decreased prevalence in cigarette use.

CONCLUSIONS

Some aspects of the post-high school environment are related to cannabis and cigarette use. Differences in the social circumstances of cigarette and cannabis use and recent campaigns in colleges to reduce smoking may explain some of these trends.

Graduating into Lower Risk: Chlamydia and Trichomonas Prevalence among Community College Students and Graduates

BACKGROUND

Community colleges enable youth from economically disadvantaged and minority populations to access college and may enable social mobility including improved health outcomes. However, educational health disparities studies rarely assess the health outcomes for community college graduates.

METHODS

Chlamydia and trichomonas prevalence were assessed with nucleic acid based tests in a nationally representative sample of 6233 high school graduates (ages 18-25) from five educational levels: young adults without post-secondary credentials who were not enrolled in college, community college students, 4-year college students, associate's degree, and bachelor's degree. To reduce confounding between educational attainment and STI status, we used full matching to balance on 22 measures of demographics, socioeconomic status, educational factors, and sexual risk-taking. Estimates of associations between educational attainment and STI status were obtained from multivariate regression in the full (n=6233) and matched (n=1655) samples.

RESULTS

Four-year college students (adjusted incidence rate ratio (IRR) = 0.41, 95% CI [0.27, 0.61], p<0.001), associate's degree holders (IRR = 0.38 [0.15, 0.98], p=0.05), and bachelor's degree holders (IRR = 0.45 [0.23, 0.90], p=0.02) were less than half as likely to test positive for chlamydia than non-college-enrolled high school graduates in multivariate regression. After full matching, associate's degree holders were also less likely to test positive for chlamydia (IRR 0.46 (0.23, 0.85), p=0.03) than community college students. Four-year college students (IRR = 0.52 [0.24, 1.12], p=0.10) and associate's degree holders (IRR = 0.34 [0.12, 0.97], p=0.04) were half as likely to test positive for trichomonas than nonstudents/non-graduates in multivariate regression but did not differ after full matching.

CONCLUSIONS

Community college students come from populations with greater health risks than 4-year college students, but community college graduation may reduce the likelihood of chlamydia infection. STI interventions can meet the needs of young adults who access college through community college by partnering with community college health clinics to encourage continued STI prevention, testing, and treatment after the intervention ends. Public health studies that use inclusive educational attainment measures that incorporate sub-baccalaureate credentials will better capture health disparities.

Physiological health parameters among college students to promote chronic disease prevention and health promotion

This study aimed to provide physiologic health risk parameters by gender and age among college students enrolled in a U.S. Midwestern University to promote chronic disease prevention and ameliorate health. A total of 2615 college students between 18 and 25 years old were recruited annually using a series of cross-sectional designs during the spring semester over an 8-year period. Physiologic parameters measured included body mass index (BMI), percentage body fat (%BF), blood serum cholesterol (BSC), and systolic (SBP) and diastolic (DBP) blood pressure. These measures were compared to data from NHANES to identify differences in physiologic parameters among 18–25 year olds in the general versus college-enrolled population. A quantitative instrument assessed health behaviors related to physical activity, diet, and licit drug use. Results suggest that average physiologic parameters from 18 to 25 year olds enrolled in college were significantly different from parameters of 18–25 year olds in the general population. Generally, men reported higher percentiles for BMI, SBP, and DBP than women, but lower %BF and BSC percentiles than women at each age. SBP and DBP significantly increased with age and alcohol use. Students in the lowest (5th) and highest percentiles (95th and 75th), for most age groups, demonstrated DBP, BMI, and %BF levels potentially problematic for health and future development of chronic disease based on percentiles generated for their peer group. Newly identified physiologic parameters may be useful to practitioners serving college students 18–25 years old from similar institutions in determining whether behavior change or treatment interventions are appropriate.

Health behaviors of culturally diverse inner-city community college students

OBJECTIVE

To determine the prevalence of risk behaviors related to cigarette use, alcohol use, nutrition, physical fitness, and sexual behavior.

PARTICIPANTS

Participants were 1,075 students attending an urban community college during the Spring 2012 semester.

METHODS

Data were collected in randomly selected classes using the American College Health Association National College Health Assessment II (ACHA-NCHA II) paper survey and analyzed using Statistical Package for the Social Sciences (SPSS) version 22 for frequencies and chi-square test of independence.

RESULTS

The sample population reported poor diet, low rates of physical activity, high rates of overweight/obesity, low rates of condom use for vaginal sex, multiple sexual partners, and unintentional pregnancy. Protective health behaviors included low rates of cigarette smoking and alcohol use, high rates of condoms use for anal sex, and high rates of human immunodeficiency virus (HIV) testing.

CONCLUSION

Students are at high risk for health problems related to poor diet, lack of exercise, and risky sexual behaviors. Additional research is recommended to determine the most effective intervention strategies.

Abstinence rates among college cigarette smokers enrolled in a randomized clinical trial evaluating Quit and Win contests: The impact of concurrent hookah use

OBJECTIVE

To examine baseline characteristics and biochemically verified 1-, 4-, and 6-month tobacco quit rates among college students enrolled in a Quit and Win cessation trial, comparing those who concurrently smoke both hookah and cigarettes with those who deny hookah use.

METHODS

Analyses were conducted on data from 1217 college students enrolled in a Quit and Win tobacco cessation randomized clinical trial from 2010-2012. Multivariable logistic regression (MLR) analyses examined group differences in baseline characteristics and cotinine verified 30-day abstinence at 1, 4, and 6-month follow-up, adjusting for baseline covariates.

RESULTS

Participants smoked 11.5(±8.1) cigarettes per day on 28.5(±3.8) days/month, and 22% smoked hookah in the past 30days. Hookah smokers (n=270) were more likely to be male (p<0.0001), younger (p<0.0001), report more binge drinking (p<0.0001) and score higher on impulsivity (p<0.001). MLR results indicate that hookah users, when compared to non-users, had a 36% decrease in odds of self-reported 30-day abstinence at 4-months (OR=0.64, 95% CI=0.45-0.93, p=0.02) and a 63% decrease in odds in biochemically verified continuous abstinence at 6-months (OR=0.37, CI=0.14-0.99, p=0.05).

CONCLUSION

College cigarette smokers who concurrently use hookah display several health risk factors and demonstrate lower short and long-term tobacco abstinence rates.

Assessment of heart disease knowledge and risk factors among first-generation Filipino Americans residing in Southern Nevada: A cross-sectional survey

Objective

Filipino Americans are the second largest Asian subgroup in the United States and heart disease is their leading cause of death. Despite this, they remain an invisible minority and experience health disparities in cardiovascular health. Prior to implementing and designing health promotion programs, it is important to assess their level of knowledge about heart disease and to identify their risk factors.

Purpose

We examined the baseline knowledge of heart disease among first-generation Filipino Americans and the risk factors prevalent among them.

Method

A convenience sample of 300 Filipino Americans aged 35-75 years completed the Heart Disease Fact Questionnaire to assess their knowledge of heart disease and a researcher-developed questionnaire to assess the heart disease risk factors. Data were collected in Southern Nevada in the fall of 2011. Descriptive statistics, correlations, and multiple regression were used for data analysis.

Result

The sample had an average knowledge score of 82.81% out of a maximum correct score of 100%. The risk factors prevalent among them included: hypertension (47.7%), diabetes (14%), dyslipidemia (27.7%), overweight (36.7%), abdominal obesity (80.6%), smoking (11.7%), and lack of exercise (48%).

Conclusion

Heart disease is the leading cause of death among Filipino Americans. In this study, Filipino Americans had adequate knowledge of heart disease but many reported having risk factors. Understanding the behavioral determinants of heart disease knowledge and specific risk factors is helpful in designing effective health prevention strategies. Early screening targeting the younger generation is also important to help detect the risk factors in their earliest stages. The screening results may also induce individuals to take action.

Spit for Science: launching a longitudinal study of genetic and environmental influences on substance use and emotional health at a large US university

Finding genes involved in complex behavioral outcomes, and understanding the pathways by which they confer risk, is a challenging task, necessitating large samples that are phenotypically well characterized across time. We describe an effort to create a university-wide research project aimed at understanding how genes and environments impact alcohol use and related substance use and mental health outcomes across time in college students. Nearly 70% of the incoming freshman class (N = 2715) completed on-line surveys, with 80% of the students from the fall completing spring follow-ups. 98% of eligible participants also gave DNA. The participants closely approximated the university population in terms of gender and racial/ethnic composition. Here we provide initial results on alcohol use outcomes from the first wave of the sample, as well as associated predictor variables. We discuss the potential for this kind of research to advance our understanding of genetic and environment influences on substance use and mental health outcomes.

Current Methods in Health Behavior Research Among U.S. Community College Students: A Review of the Literature

The majority of health behavior research involving college students in the United States has focused on 4-year college students. Two-year or community college students have been less studied, although a significant proportion of U.S. undergraduates, primarily those from disadvantaged socioeconomic and/or racial/ethnic background, are enrolled in community colleges. Thus, there is a need to enhance health behavior and health promotion research among community college students. This study systematically reviewed 42 published, peer-reviewed health behavior studies conducted among U.S. community college students in order to determine the current state of research in the area with regard to behaviors studied, research designs used, recruitment and data collection strategies practiced, rates of student participation, and characteristics of the participants represented. Findings identified the methodological limitations of current research and suggested optimal recruitment and data collection methods suitable for various research needs. Findings are discussed in the context of enhancing health behavior research among U.S. community college students.

Nondaily smoking patterns in young adulthood

PURPOSE

Many young adult smokers routinely smoke less than daily. Prospective, longitudinal data are needed to describe and predict the influences on smoking patterns among nondaily young adult smokers.

METHODS

Latent class growth analysis was used to examine developmental trajectories and predictors of nondaily cigarette smoking among young adults aged 18 to 21 in the Upper Midwestern United States.

RESULTS

There were three distinct groups of nondaily smokers during young adulthood (n=519). College status, previous quit attempts, attitudes toward the meanings of cigarettes, and situational factors influencing smoking were significant predictors of group membership.

CONCLUSIONS

Nondaily smoking in young adulthood may result in several discrete patterns of smoking between age 18 and 21. Predictors that differentiate smoking trajectories may be useful to promote cessation or reduction in young adult smoking.

Should college campuses become tobacco free without an enforcement plan?

Tobacco-free campuses are a great public health initiative. Healthy People 2020 and Healthy Campus 2020 address tobacco use and young adults including college students. Sources indicate that of the more than 6,000 colleges and universities in the United States, less than 800 are either smoke free or tobacco free. An increasing number of college campus policy makers in the United States are implementing smoke-free or tobacco-free policies, including procedures for violators of these policies. However, without a clearly defined and actionable enforcement component, these policies serve little purpose. This has become a policy enforcement issue that campus leaders should address. Should colleges and universities become tobacco free, if enforcement is not implemented? College and university administrators should demonstrate leadership by having violators of tobacco-free campus policies held to the same standard as those who violate other policies.