Smoking frequency among current college student smokers: distinguishing characteristics and factors related to readiness to quit smoking

College students' preferences for tobacco treatment: a discrete choice experiment

The purpose of this study was to elicit preferences for the 'format' and 'content' of tobacco treatment among college student smokers, using an online discrete choice experiment (DCE) survey. A DCE survey, supplemented with a think-aloud method, was conducted among 54 college students who smoked combustible cigarettes and/or e-cigarettes. Conditional logistic regression models were constructed to determine optimal profiles of treatment. Cutting down nicotine rather than quitting 'cold turkey' (P < 0.001) and two-way communication (P < 0.001) were viewed as the most critical attributes for the intervention 'format'; changing behaviors rather than social groups/peers (P < 0.001) and autonomy (P < 0.001) were viewed as the most critical attributes for the intervention 'content'. Some preferences varied based on smoking subgroups. Combustible cigarette users preferred interventions with a longer time commitment (P < 0.05) and without nicotine replacement therapies (NRTs) (P < 0.001). Think-aloud data supported the DCE findings and further revealed a strong desire for cutting down nicotine and keeping social groups/peers and misconceptions regarding NRTs. Our study findings can guide tobacco treatment tailored to college students. These treatments should be tailored to specific smoker subgroups.

The Role of Mass Media in Influencing the Lifestyle of the Elderly during the COVID-19 Pandemic

The elderly represent one of the categories that was most affected by the pandemic period. The purpose of this research was to analyze the ways in which mass media and very often contradictory information flows influenced the lives and personal communications of the Romanian elderly population during the COVID-19 pandemic. In order to conduct the research, we used a mixed-methods approach. For the quantitative research, we gave a questionnaire to the elderly population of Romania, and for the qualitative research, we conducted interviews. Our quantitative sample included 881 retired persons with an age between 55 and 94 years old; the mean age was 71.48 years old with 6.6 years standard deviation. The elderly described the pandemic period using negative words: fear, loneliness, anxiety, disaster; the channel they mostly watched and trusted was the TV; they were aware of the measures they had to take to protect themselves; they missed most of the meetings with the family and the main problems they had were represented by loneliness, the inability to be with their families or the lack of access to medical services. The elderly's mass media consumption during the pandemic was mostly represented by TV consumption; the information spread by mass media was sometimes contradictory; it influenced their behavior and may have generated feelings of anxiety among them.

Prevalence of Gastroesophageal Reflux Disease (GERD) Among Electronic Cigarette-Smoking University Students in Jeddah, Saudi Arabia

Background Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal tract diseases. Although there is a strong association between smoking and GERD, it is poorly understood until now. Electronic cigarettes (E-cigarettes) are widely used nowadays. So, our study aimed to investigate the prevalence of GERD among all Jeddah university students and its relation to E-cigarette smoking. Methodology A cross-sectional study was conducted among university students of all specialties in Jeddah, Saudi Arabia, using an online questionnaire to collect data distributed in a Google Form (Google LLC, Mountain View, California, United States) from August to November 2022. Results This study included 397 students, 36.5% of whom were from 18 to 20 years old, and the majority were females (69.3%). Of the participants, 43.8% were non-smokers, 13.1% were ex-smokers, and 43.1% currently smoked; of the last, 13.6% smoked tobacco cigarettes, 17.6% smoked hookah, and 35% were current E-cigarette smokers. The study found that among the participants, 19.9% had GERD based on the GerdQ, with females having a significantly higher percentage of GERD. A weak association was found between the prevalence of GERD and smoking cigarettes (p=0.49), hookah (p=0.988 ), and E-cigarettes (p=0.788 ) but this could be attributed to the high BMI. Conclusion E-cigarette smoking is more prevalent among university students in Jeddah than traditional cigarettes or hookah. However, there was no statistically significant link between E-cigarette smoking and GERD. High BMI could be a superadded factor.

Are smoking restrictions at public venues and psychosocial beliefs associated with intentions to quit smoking among smokers in Malaysia?

The Malaysian government reinforced smoking restrictions at public venues to protect nonsmokers from secondhand smoke (SHS) exposure. This study examined whether smokers' reports about smoking restrictions and psychosocial beliefs were associated with quit intentions among Malaysian smokers. Data from 1047 cigarette smokers (103 females and 944 males) aged 18 and older from the 2020 International Tobacco Control (ITC) Malaysia Wave 1 Survey were analyzed with bivariate and multivariable logistic regression models. Most Malaysian smokers (85.2%) reported having quit intentions. Smoking was completely restricted in 34.8% of the nighttime venues, 85.3% of air-conditioned (AC) food and beverage (F&B) venues (restaurants, food courts, coffee shops), 87.3% of non-AC F&B, and 69.4% of indoor workplaces. Smokers who visited nighttime entertainment venues where smoking was fully restricted were less likely to have quit intentions. There was no significant association found with quit intentions for smokers who visited AC and non-AC F&B venues and indoor workplaces where smoking was fully restricted. All five psychosocial beliefs assessed, age, and education were positively associated with quit intentions. Malaysian smokers are interested in quitting and psychosocial beliefs were positively associated with quit intentions. There is a need for the Malaysian government to implement and reinforce comprehensive smoking restrictions in all public venues and indoor workplaces to protect nonsmokers from SHS exposure and to encourage smokers to think about quitting, which may influence their quit intentions.

Trends in the frequency of cigar use among US adults, 1998/99-2018/19

There is limited information on the trend in the frequency of cigar use from the literature. This study aimed to examine the trends of cigar use frequency among U.S. adults. Data were obtained from 1998/99 to 2018/19 Tobacco Use Supplement to the Current Population Survey (n = 21,940). We generated estimates of the cigar use frequency among current cigar users for each survey year for the full sample, as well as by sociodemographic characteristics. Linear regression models were used to test the statistical significance of the linear trend. Additional analyses were conducted among someday users only. Over the study period, the cigar use frequency among current users was stable at approximately 10 days in the past 30 days. In 1998/1999, male current cigar users and someday cigar users reported using cigars for 9.6 and 5.2 days in the past 30 days, respectively, which decreased to 9.2 and 4.7 days in 2018/2019. In contrast, a significant increasing trend was found among female current cigar users and someday cigar users from 8.4 and 4.7 days to 13.6 and 6.2 days from 1998/1999 to 2018/2019. Likewise, we found that the cigar use frequency increased among current cigar and cigarette users over the study period. Overall, cigar use frequency is relatively stable. Over time, cigar use frequency decreased significantly among males, while it increased among females. Our findings further highlight that targeted efforts are needed to reduce the disproportionate use of cigars.

Disparities in the frequency of tobacco products use by sexual identity status

BACKGROUND

Largely absent from the literature are studies examining differences in tobacco use frequency among sexual minority populations versus heterosexuals. The current study examined the frequency of tobacco product use (i.e., cigarette, e-cigarettes and cigars, smokeless tobacco, hookah, and heated tobacco products) among sexual minority students versus heterosexuals (straight).

METHODS

Data from the 2020 National Youth Tobacco Survey (n = 14,531) were analyzed to examine the association between sexual identity (lesbian or gay, bisexual, not sure, and heterosexual or straight) and tobacco use frequency. Negative binomial regression and zero-inflated negative binomial models were used to assess the association between sexual identity and each tobacco use frequency among current and ever users.

RESULTS

Current e-cigarettes users who identified as gay or lesbian used e-cigarette more frequently than heterosexual students. Multivariable count regression analysis showed that the e-cigarette use frequency in the past 30 days was significantly higher for gays or lesbians (IRR 1.45, 95% CI, 1.19-1.76) compared to heterosexuals. Similarly, gay or lesbian students who were current hookah users on average reported 81% more days of hookah use (IRR, 1.81, 95% CI, 1.08-3.03). The frequency of cigarette smoking was also significantly higher among bisexual cigarette smokers. No significant differences were found in other tobacco product use frequencies between sexual minority and heterosexual youths.

CONCLUSION

Sexual identity was associated with tobacco use frequency, especially for e-cigarettes and hookah. Elevated tobacco use among sexual minority groups deserves special consideration among a population group that is highly vulnerable to marketing and advertisement targeting.

Effects of acute distress and tobacco cues on tobacco demand

INTRODUCTION

Cigarette demand, or relative value, can be assessed via analysis of performance on a hypothetical behavioral economic cigarette purchase task (CPT). Substance purchase tasks are highly amenable to manipulation, namely, external stimuli, instructional changes, or acute stressors. In this regard, the current secondary analysis evaluates the role a novel, computerized stress induction paradigm, the Contextual-Frustration Intolerance Typing Task (C-FiTT), plays in eliciting varying levels of stress and resulting demand.

METHOD

Daily smokers (n = 484) completed the C-FiTT wherein they were randomly assigned to one of five distress conditions: combination of task difficulty (low or high difficulty) with neutral or withdrawal cues, and a neutral control group. Tobacco demand was assessed immediately following the distress task using the hypothetical CPT.

RESULTS

The C-FiTT distress-induction task significantly increased key cigarette demand indices, including price at maximum expenditure (Pmax) and first price where consumption was suppressed to zero (breakpoint). Moreover, demand increased with severity of C-FiTT condition, with the high-difficulty condition resulting in significantly higher breakpoint and Pmax, compared to other conditions. C-FiTT condition was not related to a significant increase in Omax, intensity, or elasticity.

DISCUSSION

The novel C-FiTT paradigm produced comparable effects on tobacco demand relative to in vivo withdrawal induction, indicating that the C-FiTT is a viable procedure by which to influence demand. Reduction of internal and external stressors may be effective in lowering motivation for tobacco. These results highlight the importance of state distress in tobacco demand, and offer a potential avenue for intervention.

Quit Experiences among Primary Care Patients Enrolled in a Smoking Cessation Pilot RCT Early in the COVID-19 Pandemic

The impact of the COVID-19 pandemic on US adults' smoking and quitting behaviors is unclear. We explored the impact of COVID-19 on smoking behaviors, risk perceptions, and reactions to text messages during a statewide stay-at-home advisory among primary care patients who were trying to quit. From May-June 2020, we interviewed smokers enrolled in a 12-week, pilot cessation trial providing text messaging and mailed nicotine replacement medication (NCT04020718). Twenty-two individuals (82% white, mean age 55 years), representing 88% of trial participants during the stay-at-home advisory, completed exit interviews; four (18%) of them reported abstinence. Interviews were thematically analyzed by two coders. COVID-19-induced environmental changes had mixed effects, facilitating quitting for some and impeding quitting for others. While stress increased for many, those who quit found ways to cope with stress. Generally, participants felt at risk for COVID-19 complications but not at increased risk of becoming infected. Reactions to COVID-19 and quitting behaviors differed across age groups, older participants reported difficulties coping with isolation (e.g., feeling disappointed when a text message came from the study and not a live person). Findings suggest that cessation interventions addressing stress and boredom are needed during COVID-19, while smokers experiencing isolation may benefit from live-person supports.

Adaptive coping strategies used by people during coronavirus

BACKGROUND

Coronavirus (COVID-19) a worldwide pandemic has significantly affected life of people around the globe. It has also caused various psychological issues among public such as uncertainty, fear, anxiety, and of course stress. Globalization has facilitated it and has added greater complexity to the containment of infection leading to urgent call for public health challenge. Consequently, a multilevel stress coping adjustment process is going on. Hence, it is imperative to explore how people are affected psychologically and how they are coping with it. People are adopting different strategies for coping up from this challenging situation. In this sense, the present study intended to: explore which coping strategies were of relevance for people for adjusting in COVID-19 crises and were sociodemographic factors influencing the coping strategies.

MATERIALS AND METHODS

The research is descriptive study. For the present study, a sample of 475 participants was asked for coping strategies used by them using valid and reliable scales.

RESULTS

Results revealed that positive attitude and trust in God were the most used adaptive coping strategies and sociodemographic variables were playing a significant role in adaptive coping strategies.

CONCLUSION

Hence, understanding and identification of coping strategies and their relationship with demographic variables can help health professionals to direct interventions to control stressors related to the pandemics.

Not really a smoker? A study on the prevalence of and attitudes to occasional social smoking in a third level institution in Ireland

BACKGROUND

Occasional smoking is defined as any smoking occurring on a less than daily basis. Social smoking, i.e. smoking primarily in social contexts, is a sub-group of occasional smoking. Data on occasional cigarette smoking and the subset of social smoking among third level students are limited.

OBJECTIVES

(1) To determine prevalence of occasional/social smoking among third level students in an Irish university; (2) to evaluate students' attitudes to occasional/social smoking, including perceived benefits and harm; (3) to explore when students commenced occasional/social smoking, their reasons and continued smoking habits; and (4) to determine any influence of other factors, e.g. alcohol consumption, on occasional/social smoking.

METHODS

An anonymous online survey was distributed to undergraduates and postgraduates, using SurveyMonkey. Data were analysed in Microsoft Excel.

RESULTS

Of 18,407 students surveyed, 1310 (7.1%) responded;1267 (96.7%) provided adequate data for analysis. Of the 1267 students, 423 (33.4%) self-reported as current smokers of whom 106/1267 (8.4%) self-classified as daily smokers and 317/1267 (25%) as occasional smokers. The 25% of occasional smokers comprised 266/1267 (21%) social smokers and 51/1267 (4%) non-social smokers. Occasional smokers tended to start smoking earlier and think less about quitting than daily smokers. Of 423 current smokers, 386 (97.2%) reported that alcohol increased their smoking habits.

CONCLUSION

Prevalence of self-reported occasional smoking among university students was higher than daily smoking. Most occasional smokers primarily smoked in social contexts. All current smokers reported that alcohol increased cigarette intake. Effective intervention campaigns tailored to determinants of occasional/social smoking are needed as part of induction to third level.

Becoming a tobacco-free campus: A survey of student attitudes, opinions and behaviors

INTRODUCTION

The effectiveness of tobacco-free campus policies in preventing and mitigating tobacco use relies on students’ perceptions, opinions, and adherence to clean-air restrictions. The purpose of this study was to gather data regarding student attitudes, opinions and tobacco use behaviors, one year following implementation of the tobacco-free campus initiative.

METHODS

Data were gathered using an anonymous, online survey of graduate and undergraduate students at a public university, one year following implementation of a tobacco-free campus policy. Survey items included tobacco use behaviors, nicotine dependence, opinions towards the policy, challenges in policy adherence among tobacco users, and awareness of tobacco cessation resources for students. Analysis primarily included descriptive statistics.

RESULTS

Of 108 respondents, only 18 were habitual tobacco users with most using: cigarettes, cigars or cigarillos (38%), vaping (17.8%), hookah (11.9%), and smokeless tobacco (11.9%). Several reported multiple use. Common motives for tobacco use were relaxation and mood regulation. Tobacco users rated a moderate level of difficulty in adhering to the policy. Only half of the total respondents were aware of cessation resources, specifically peer counseling. Most tobacco users (71%) believed that they could quit without assistance.

CONCLUSIONS

Preliminary data show 21.8% prevalence of tobacco use within the sample. Information on student opinions and behaviors, including lower risk perception, dual use, and lack of awareness of cessation resources can inform more effective prevention and mitigation strategies, in addition to the tobaccofree campus policy. Further research is needed to monitor policy adherence and changes in student tobacco behaviors.

Infrequent and Frequent Nondaily Smokers and Daily Smokers: Their Characteristics and Other Tobacco Use Patterns

Introduction

The proportion of smokers who do not smoke daily has increased over time, but nondaily smokers are a heterogeneous group. We compare characteristics and other tobacco product use of infrequent nondaily, frequent nondaily, and daily US adult smokers.

Methods

We analyzed data from the 1998, 2000, 2005, and 2010 National Health Interview Surveys. Current smokers were categorized as daily, infrequent nondaily (smoked 1-12 days in the past 30 days), and frequent nondaily (smoked 13-29 days in the past 30 days) smokers. Multinomial logistic regression analysis was used to analyze the correlates of infrequent nondaily, frequent nondaily, and daily smoking.

Results

Among current smokers, 8.3% were infrequent nondaily, 8.1% were frequent nondaily, and 83.6% were daily smokers. The prevalence of infrequent versus daily smoking increased over time, with a smaller increase among non-Hispanic Blacks than non-Hispanic Whites. The adjusted odds of both infrequent and frequent smoking versus daily smoking differed by age, race/ethnicity, education, poverty status, marital status, region, quit attempts in the past 12 months, and binge drinking. Snuff users (vs. non-snuff users) were 2.4 times as likely to be infrequent than daily smokers. There were also differences in race/ethnicity, education, marital status, region, quit attempts, and snuff use between infrequent versus frequent smokers.

Conclusion

Infrequent smokers differ from both frequent and daily smokers in socio-demographics, quit attempts, and snuff use. The heterogeneity of nondaily smokers should be considered in developing targeted tobacco control and smoking cessation programs.

Implications

Infrequent and frequent nondaily smokers were found to differ from daily smokers in age, race/ethnicity, education, poverty status, marital status, region, and quit attempts and they were different from each other in race/ethnicity, education, marital status, region, and quit attempts. Binge drinkers were more likely to be infrequent smokers and frequent smokers versus daily smokers. Current snuff users were found to have increased odds of infrequent smoking versus daily smoking and versus frequent smoking. These results highlight the importance of acknowledging the differences among nondaily smokers in smoking frequency in developing targeted tobacco control and smoking cessation programs.

Effect of tobacco control policies on intention to quit smoking cigarettes: A study from Beirut, Lebanon

INTRODUCTION

In Lebanon, the tobacco control policy, Law 174, became effective in 2011. Using the International Tobacco Control Policy Evaluation Project (ITC) conceptual model, this study aims to assess the association between exposure to control measures related to the policy and the intention to quit, which is a mediator in the pathway leading to behavioral change (quitting).

METHODS

This is a secondary data analysis of 154 cigarette smokers from a cross-sectional survey that assessed compliance with Law 174 among Beirut residents aged 15–65 years. Data were collected face-to-face, three months after the implementation of indoor public places and tobacco advertisement/promotion bans. Intention to quit smoking was the main outcome. Exposure to policy control measures such as seeing smokers in restaurants, and noticing warning labels on cigarette packs were the explanatory variables. Sociodemographics, past smoking behavior, and psychosocial variables were also considered for their moderating and mediating effects, respectively. Crude and adjusted odds ratios (ORs) were generated. Sobel test was used to check for possible mediation.

RESULTS

Intention to quit was reported by 24% of cigarette smokers. The association between noticing warning labels and having intentions to quit was statistically significant (adjusted OR=6.27). Concerns about influencing children’s smoking behavior had a statistically significant mediation effect on the relationship. After adding the interaction term between noticing the warnings and previous quit attempts, the OR was inflated to 12.92, suggesting a possible interaction.

CONCLUSIONS

This study offers preliminary insight into how Lebanese smokers are influenced by policy related control measures like health warning labels on cigarette packs. Tobacco control policy advocates should push for stronger enforcement of public smoking bans in general. Behavioral intervention should work on the mediator variables to influence smoking behavior and encourage quitting. Further prospective studies modelling quitting as outcome are needed.

Identification of health-related behavioural clusters and their association with demographic characteristics in Irish university students

Background

Students engage in risky health-related behaviours that influence their current and future health status. Health-related behaviours cluster among adults and differently based on sub-populations characteristics but research is lacking for university populations. Examining the clustering of health- related behaviours can inform our initiatives and strategies, while examining cluster members’ characteristics can help target those who can prosper most from health promotion efforts. This study examines the clustering of health-related behaviours in Irish university students, and investigates the relationship with students’ sex, age, field of study and accommodation type.

Methods

An online survey was completed by 5672 Irish university students (51.3% male; 21.60 ± 5.65 years) during 2014. Two-step cluster analysis was used to understand how health-related behaviours (physical activity, smoking, alcohol intake, drug use and dietary habits) cluster among male and female students. Binary logistic regressions were conducted to examine the likelihood of students falling into certain clusters based on their characteristics.

Results

Five cluster groups were identified in males and four in females. A quarter of males were categorised as ideal healthy with older students and those from certain fields of study having a higher likelihood of being classified in a low physical activity and poor diet (OR = 1.06–2.89), alcohol consumption (OR = 1.03–3.04), or smoking and drug use (OR = 1.06–2.73) cluster. Forty-five percent of females were categorised as ideal healthy with older females more likely to be in a low active and smoking cluster (OR = 1.03), and less likely to be in a convenience food cluster (OR = 0.96). Females from certain fields of study were also more likely to be classified in these clusters (OR = 1.59–1.76). Students living away from their family home had in increased likelihood of being in a cluster related to a higher frequency of alcohol consumption (OR = 1.72–3.05).

Conclusion

Health-related behaviours cluster among this population and need to be taken into account when designing multi-health interventions and policies. These findings can be used to target student groups at risk, leading to more efficient and successful health promotion efforts. The addition of modules providing information regarding health-related behaviours are advised in all fields of study.

Tobacco and Alcohol Use Among Youth in Low and Middle Income Countries: A Multi-Country Analysis on the Influence of Structural and Micro-Level Factors

BACKGROUND

The transition from adolescence to adulthood is a critical life phase as it is during this period that substance use and disorders typically emerge and escalate. Globally, few studies have examined the prevalence and correlates of alcohol and tobacco use among youth (ages 15-24). This study seeks to bridge this gap by assessing the influence of structural and micro-level factors on tobacco and alcohol use among youth in Low- and Middle-income countries (LMICs).

METHODS

Data are drawn from the Multiple Indicator Cluster Surveys (MICS) conducted in 29 countries or regions in Eastern Europe, Latin America, Asia and Africa between 2010 and 2015. Analyses focus on lifetime prevalence and age of onset for tobacco and alcohol use.

RESULTS

Descriptive analyses highlight regional variations in the prevalence and age of onset of tobacco and alcohol use: tobacco use is more concentrated among youth in Eastern Europe but alcohol use is generalized across the regions. Using multi-level analyses, we find statistically significant main effects for age, gender, educational attainment, rural residence, marital status and exposure to mass media on tobacco and alcohol use outcomes as well as interaction effects for age, gender and education on tobacco and alcohol use outcomes. Conclusions/importance: These findings highlight the need for structural interventions to control tobacco social marketing, and for gender considerations in tobacco and alcohol use prevention programs and policies.

Correlated Factors with Quitting Attempts Among Male Smokers in Vietnam: A QUITLINE-Based Survey

Despite its decreasing prevalence, cigarette smoking remains the second leading cause of preventable death worldwide. In Vietnam, despite recent smoking cessation efforts, the prevalence of tobacco consumption remains high, particularly among males. In this study, we aim to evaluate the self-efficacy in quitting smoking (i.e., quitting confidence), intention to quit, and identifying associated factors among both rural and urban Vietnamese male populations. A cross-sectional study was conducted on 321 patients (52.7% urban and 47.4% rural inhabitants) who utilized QUITLINE services of Bach Mai Hospital (Hanoi, Vietnam). Socio-economic status, smoking history, cigarette usage data, and intent to quit were assessed. Baseline data were correlated with quitting confidence, to identify significant associated factors. The majority (75.9%) of participants were in the planning phase of cessation, yet 90.8% lacked complete confidence in their quitting ability. Older age, fewer cigarettes per day and previous quitting attempts were associated with quitting confidence (p < 0.05) and plans to quit (p < 0.05). Older smokers and previous quitters were more confident in their ability to quit in the near future and more likely to have made plans to quit. Future smoking cessation efforts should focus on improving self-efficacy, particularly among younger and newer smokers.

Prevalence and characteristics of young adult smokers in the U.S. in the precontemplation stage of smoking cessation

INTRODUCTION

The precontemplation stage of smoking cessation refers to having no intention to quit smoking in the next six months. We aimed to estimate the prevalence of and characteristics associated with the precontemplation stage of smoking cessation among U.S. young adult smokers to inform the development of targeted interventions.

METHODS

We analyzed data in 2017 from the 2013-2014 National Adult Tobacco Survey. Young adult (18-29 years old) daily and non-daily smokers were included (n = 1809). We applied weighted multiple logistic regression models to examine the associations between demographics, tobacco use behaviors, exposure to pro- and anti-tobacco messages, and the precontemplation stage of smoking cessation.

RESULTS

59.0% of U.S. young adult smokers are in the precontemplation stage of smoking cessation. Unemployment was positively associated with being in the precontemplation stage of smoking cessation (AOR = 1.42 95% CI = 1.05, 1.91). Smoking every day (vs. some days), more cigarettes smoked per day, using roll-your-own cigarettes (vs. manufactured cigarettes only), currently smoking cigars, and signing up for promotional offers were positively associated with being in the precontemplation stage of smoking cessation (p < 0.05). Non-Hispanic Black was negatively associated with precontemplation stage (AOR = 0.40, 95% CI = 0.27, 0.59). Not smoking after viewing a health warning on a cigarette pack was negatively associated with the precontemplation stage of smoking cessation (AOR = 0.36, 95% CI = 0.25, 0.51).

CONCLUSIONS

Many U.S. young adult smokers classify as being in the precontemplation stage of smoking cessation. Interventions to motivate these smokers to quit smoking with considerations of their specific characteristics (e.g., being unemployed) are warranted.

Nicotine dependence, internalizing symptoms, mood variability and daily tobacco use among young adult smokers

INTRODUCTION

Cigarette use among young adults continues to rise. As young adults transition to college and assume other adult roles and responsibilities, they are at risk for the development of mental health problems and for the progression of substance use problems. Previous studies suggest that individual differences in negative and positive mood contribute to cigarette use in established college-aged smokers, but less is known whether fluctuations in mood influence daily cigarette use, controlling for trait levels of internalizing symptoms and nicotine dependence.

METHODS

Data for this study came from a sample of college students (N=39, 59% female, mean age 20.4years) who reported regular cigarette use and participated in a 21-day ecological momentary assessment (EMA) study assessing within-individual variation in cigarette use and mood.

RESULTS

A three-level hierarchical linear model accounting for the structure of 1896 occasions of cigarette use nested within days and individuals indicated that within-individual variability in positive mood was associated with cigarette use at each occasion, after taking into account baseline levels of nicotine dependence and internalizing problems.

CONCLUSIONS

Daily shifts in positive moods are importantly associated with consuming cigarettes throughout the day.

Intention to quit smoking and polytobacco use among college student smokers

Little is known about polytobacco use in college students. One nationally representative survey indicated 51.3% of tobacco-using college students used more than one product, which may increase risk of tobacco-related disease and premature death. The purpose of this study was to examine the association of intention to quit smoking (ITQS) cigarettes with polytobacco use status, controlling for frequency of tobacco product use and cigarette smoking intensity as measured by cigarettes per day (CPD). Data are from a larger quasi-experimental study conducted at a large state university in the Southeastern United States. Analysis is based on the combined sample of current smokers from two randomly selected cohorts surveyed two months apart. Polytobacco users (n = 52) were as likely as cigarette-only users (n = 81) to intend to quit smoking. Compared to students who used tobacco products 1–9 days per month, students using 10–29 days per month or daily reported higher ITQS. Higher intensity smokers (>10 CPD) were 71% less likely to indicate ITQS, compared to lower intensity smokers (≤10 CPD) (p = .025). College student polytobacco users were as likely as those using only cigarettes to intend to quit smoking. Interventions are needed to target college student polytobacco users as well as cigarette smokers as both groups may intend to quit. Smokers using 10 or fewer CPD and those who use tobacco products daily or 10–29 days per month may be more motivated to quit than college students who smoke with more intensity but who use tobacco products less frequently.

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44.4% of the sample reported using at least one form of tobacco in addition to cigarettes.

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Polytobacco users were as likely as cigarette-only users to intend to quit smoking (ITQS).

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Significant ITQS predictors were sex, academic status, use frequency, cigarettes per day (CPD).

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Higher intensity smokers (>10 CPD) were 71% less likely than lower intensity (≤10 CPD) to ITQS.

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Students using tobacco 10–29 days/month or daily (vs. 1–9 days/month) reported greater ITQS.

Time Matters: Framing Antismoking Messages Using Current Smokers' Preexisting Perceptions of Temporal Distance to Smoking-Related Health Risks

This study examined the effects of temporal framing used in messages about the future likelihood of developing smoking-related diseases on intention to quit smoking. Based on construal level theory (CLT), a causal model delineating the relationships among four variables-perceived temporal distance, personal relevance, perceived susceptibility, and behavioral intention-was proposed. The model was validated by an online experiment with a sample of 222 current smokers, revealing the effects of perceived temporal distance on behavioral intention via personal relevance and perceived susceptibility. Following the CLT-grounded model, the effects of different temporal frames (near future vs. distant future) on the four variables were tested. The near-future frame featured a risk perceived to be more temporally proximal (i.e., heart attack), and the distant-future frame featured a risk perceived to be more temporally distant (i.e., larynx cancer) among current smokers. Participants exposed to the near-future frame reported significantly shorter perceived temporal distance, greater personal relevance and perceived susceptibility to the risk portrayed in the message, and greater intention to quit smoking than participants exposed to the distant-future frame. Implications for antismoking communications are discussed.

Psychosocial and cessation-related differences between tobacco-marijuana co-users and single product users in a college student population

Limited research has examined psychosocial factors that differ among cigarette users, marijuana users, and co-users and influence their cessation efforts. We examined: 1) sociodemographic, mental health, and other substance use in relation to user category; and 2) associations among these factors in relation to recent quit attempts and readiness to quit among single product versus co-users. We used a cross-sectional design to study college students aged 18-25 from seven Georgia campuses, focusing on the 721 reporting cigarette and/or marijuana use in the past 4months (238 cigarette-only; 331 marijuana-only; 152 co-users). Multinomial logistic regression showed that correlates (p's<0.05) of cigarette-only versus co-use included attending public or technical colleges (vs. private) and not using little cigars/cigarillos (LCCs), e-cigarettes, and alcohol. Correlates of marijuana-only versus co-use included being Black or Hispanic (vs. White), not attending technical school, and not using LCCs and e-cigarettes. Importance was rated higher for quitting cigarettes versus marijuana, but confidence was rated lower for quitting cigarettes versus marijuana (p's<0.001). Co-users were more likely to report readiness to quit and quit attempts of cigarettes versus marijuana (p's<0.001). While 23.26% of marijuana-only and 15.13% of cigarette-only users reported readiness to quit, 41.18% of cigarette-only and 21.75% of marijuana-only users reported recent quit attempts (p's<0.001). Binary logistic regressions indicated distinct correlates of readiness to quit and quit attempts of cigarettes and marijuana. Cessation efforts of the respective products must attend to co-use with the other product to better understand relative perceptions of importance and confidence in quitting and actual cessation efforts.

High school cigarette smoking and post-secondary education enrollment: Longitudinal findings from the NEXT Generation Health Study

The inverse association between smoking and educational attainment has been reported in cross-sectional studies. Temporality between smoking and education remains unclear. Our study examines the prospective association between high school cigarette and smoking post-secondary education enrollment. Data were collected from a nationally representative cohort of 10th graders who participated in the Next Generation Health Study (2010-2013). Ethnicity/race, urbanicity, parental education, depression symptoms, and family affluence were assessed at baseline. Self-reported 30-day smoking was assessed annually from 2010 to 2012. Post-secondary education enrollment was measured in 2013 and categorized as either not enrolled or enrolled in technical school, community college, or 4-year college/university. Multinomial logistic regression was used to evaluate the association between cigarette smoking duration and post-secondary education enrollment (N=1681). Participants who smoked 1, 2, or 3years during high school had lower odds of attending a 4-year college (relative to a no enrollment) than non-smokers (adjusted OR: smoking 1year=0.30, 2years=0.28, 3years=0.14). Similarly, participants who smoked for 2 or 3years were less likely than non-smokers to enroll in community college (adjusted OR: 2years=0.31, 3years=0.40). These associations were independent of demographic and socioeconomic factors. There was a prospective association between high school smoking and the unlikelihood of enrollment in post-secondary education. If this represents a causal association, strategies to prevent/delay smoking onset and promote early cessation in adolescents may provide further health benefits by promoting higher educational attainment.

Attitudinal and behavioral differences between cigarette users who do and do not identify as "smokers"

OBJECTIVE

The current research aimed to understand differences in smoking-related identity among college students and to illustrate the distinct characteristics of nonidentified smokers (NIS).

PARTICIPANTS

Students from 2 colleges in Massachusetts (N = 538; April 2016).

METHODS

Respondents reported by online survey whether or not they had smoked a cigarette in the past 30 days and if they self-identified as smokers. Nonsmokers (NIS) and identified smokers (IS) were then compared on their smoking attitudes and behavior.

RESULTS

NIS made up 12.5% of the sample and 64% of all tobacco users. NIS perceived themselves as less addicted and were more confident in their ability to quit smoking. They also were less likely to smoke alone, buy their own cigarettes, or have friends who smoked.

CONCLUSIONS

College health officials can best motivate NIS to quit smoking by focusing on peer norms and the potential of long-term addiction.

University students' perceived risk of and intention to use waterpipe tobacco

Emerging tobacco product use is increasing. We evaluated factors associated with perceived risk of and intention to use waterpipe tobacco by surveying students at a large university in the southeastern U.S. (N = 667). Proportional odds modeling assessed whether demographic characteristics and social acceptability are associated with perceived risk of waterpipe tobacco use; and if these factors and perceived risk are related to intention to use waterpipe tobacco. Participants who perceived waterpipe tobacco to be more socially acceptable had lower odds of perceiving it as risky (95% confidence interval [CI] 0.50-0.68). Compared with never users, former tobacco users and current users had lower odds of perceiving waterpipe tobacco use as risky (95% CI 0.38-0.80 and 0.28-0.63, respectively). Similarly, students with greater perceived social acceptability scores had higher odds of intending to use waterpipe tobacco (95% CI 1.41-2.63), while those who perceived greater risk had lower odds of intending to use it (95% CI 0.34-0.64). Compared with never users, former users had higher odds of intending to use waterpipe tobacco (95% CI 1.42-7.21). Among those who had ever used waterpipe tobacco, 90% reported 'to socialize' as the most frequent reason for deciding to do so. Findings underscore the need for future prevention efforts.

Identifying "social smoking" U.S. young adults using an empirically-driven approach

The phenomenon of "social smoking" emerged in the past decade as an important area of research, largely due to its high prevalence in young adults. The purpose of this study was to identify classes of young adult ever smokers based on measures of social and contextual influences on tobacco use. Latent class models were developed using social smoking measures, and not the frequency or quantity of tobacco use. Data come from a national sample of young adult ever smokers aged 18-24 (Truth Initiative Young Adult Cohort Study, N=1564). The optimal models identified three latent classes: Class 1 - nonsmokers (52%); Class 2 - social smokers (18%); and Class 3 - smokers (30%). Nearly 60% of the "social smoker" class self-identified as a social smoker, 30% as an ex-smoker/tried smoking, and 12% as a non-smoker. The "social smoker" class was most likely to report using tobacco mainly or only with others. Past 30-day cigarette use was highest in the "smoker" class. Hookah use was highest in the "social smoker" class. Other tobacco and e-cigarette use was similar in the "social smoker" and "smoker" classes. Past 30-day tobacco and e-cigarette use was present for all products in the "non-smoker" class. Young adult social smokers emerge empirically as a sizable, distinct class from other smokers, even without accounting for tobacco use frequency or intensity. The prevalence of hookah use in "social smokers" indicates a group for which the social aspect of tobacco use could drive experimentation and progression to regular use.

Associations between binge drinking frequency and tobacco use among young adults

Tobacco use is greater among young adults who binge drink; yet there is limited research on tobacco use characteristics among different types of binge drinkers based on frequency. We aimed to characterize this relationship among young adults (18-25years old) who used both substances in the past month (smoked ≥1 cigarette, and drank ≥1 alcoholic beverage) using an anonymous online survey. Participants (N=1405, 65.0% male) were grouped based on binge drinking frequency and compared for tobacco use characteristics and demographics using bivariate analyses and multinomial logistic regression. Binge drinking frequency groups were: non-binge drinkers who consumed alcohol (0days; 27.5%); occasional (1-3days; 37.9%); intermediate (4-8days; 21.9%); and frequent (9+days; 12.7%) binge drinkers. Comparing each binge drinking group to non-binge drinkers: Both occasional and frequent binge drinkers smoked more cigarettes per day (p=0.001; p=0.002); frequent binge drinkers reported greater temptations to smoke in positive affective/social situations (p=0.02); intermediate binge drinkers were less likely to have a tobacco abstinence goal (p=0.03) but more likely to have made a serious tobacco quit attempt; all of the binge groups were more likely to be social smokers (all p<0.01). Overall, we also found a high rate of smoking on binge drinking days. Individuals smoked cigarettes on 85.7%±32.9% of days they binge drank. Extent of binge drinking (not just prevalence) is an important factor influencing smoking characteristics in young adults.

Self-focused and other-focused resiliency: Plausible mechanisms linking early family adversity to health problems in college women

OBJECTIVES

This study examined whether self-focused and other-focused resiliency help explain how early family adversity relates to perceived stress, subjective health, and health behaviors in college women.

PARTICIPANTS

Female students (N = 795) participated between October 2009 and May 2010.

METHODS

Participants completed self-report measures of early family adversity, self-focused (self-esteem, personal growth initiative) and other-focused (perceived social support, gratitude) resiliency, stress, subjective health, and health behaviors.

RESULTS

Using structural equation modeling, self-focused resiliency associated with less stress, better subjective health, more sleep, less smoking, and less weekend alcohol consumption. Other-focused resiliency associated with more exercise, greater stress, and more weekend alcohol consumption. Early family adversity was indirectly related to all health outcomes, except smoking, via self-focused and other-focused resiliency.

CONCLUSIONS

Self-focused and other-focused resiliency represent plausible mechanisms through which early family adversity relates to stress and health in college women. This highlights areas for future research in disease prevention and management.

Recruitment and Baseline Characteristics of American Indian Tribal College Students Participating in a Tribal College Tobacco and Behavioral Survey

INTRODUCTION

American Indians (AIs) have the highest cigarette smoking rates of any racial/ethnic group in the United States. Although the overall smoking prevalence in the United States for nonminority populations has decreased over the past several decades, the same pattern is not observed among AIs. The purpose of this observational study was to collect cigarette smoking and related information from American Indian tribal college students to inform tailored interventions.

METHODS

We conducted a repeated cross-sectional survey of American Indian tribal college students, Tribal College Tobacco and Behavior Survey (TCTABS), with a focus on recruiting all incoming freshman at three participating tribal colleges in the Midwest and Northern Plains regions. A total of 1256 students participated in the baseline surveys between April 2011 and October 2014.

RESULTS

The overall smoking prevalence of this sample was 34.7%, with differences by region (Northern Plains-44.0% and Midwest-28%). The majority, 87.5% of current smokers reported smoking 10 or less cigarettes per day, 41% reported smoking menthol cigarettes, 52% smoked Marlboro brand, and the mean age of their first cigarette was 14 years. The majority, 62% had made at least one quit attempt in the past year. The overwhelming majority of respondents, regardless of their smoking status, thought that the current smoking prevalence on campus was greater than 41% and approximately one-third believed that it was as high as 61%.

CONCLUSIONS

Very few studies of smoking have been conducted in this population and results from our study confirm the need for effective interventions.

IMPLICATIONS

AIs have the highest cigarette smoking rates compared to other racial/ethnic groups in the United States. Furthermore, limited studies have examined the epidemiology of cigarette smoking among tribal college students. This study addresses health disparities related to smoking among college students by examining the demographic, cultural, and environmental characteristics of smoking and quitting. Results from this study could lead to the development of a culturally-tailored smoking cessation and prevention program for American Indian tribal college students.

Specific dimensions of impulsivity are differentially associated with daily and non-daily cigarette smoking in young adults

Young adults are at risk for initiation of tobacco use and progression to tobacco dependence. Not every person who smokes cigarettes becomes tobacco dependent, however, and non-daily smoking is becoming more prevalent among those who use tobacco. It is likely that individual differences in psychosocial and behavioral factors influence risk for engaging in non-daily and daily cigarette smoking. The objective of this study was to investigate the associations between impulsivity and smoking status in young adults who vary in frequency of cigarette smoking. Young adult first-year college students between the ages of 18-24 (512) were classified to one of three groups: non-smokers, non-daily smokers, or daily smokers, and impulsivity was assessed using the UPPS-P (negative and positive urgency, lack of premeditation, lack of perseverance, sensation seeking). When all impulsivity dimensions were used simultaneously to predict smoking status, negative urgency predicted increased risk of membership in the daily smoking group and lack of premeditation predicted increased risk of membership in the non-daily smoking group. These results suggest that dimensions of impulsivity may contribute differentially to forms of smoking behavior in young adults.

The Impact of Trying Electronic Cigarettes on Cigarette Smoking by College Students: A Prospective Analysis

OBJECTIVES

We assessed the impact of trying electronic cigarettes (e-cigarettes) on future cigarette smoking in a sample of smokers enrolled in college.

METHODS

In this longitudinal study, first-semester college students at 7 colleges in North Carolina and 4 in Virginia completed a baseline survey and 5 follow-up surveys between fall 2010 and fall 2013. Current cigarette smoking at wave 6 was the primary outcome. Participants (n = 271) reported current cigarette smoking at baseline and no history of e-cigarette use. We measured trying e-cigarettes at each wave, defined as use in the past 6 months.

RESULTS

By wave 5, 43.5% had tried e-cigarettes. Even after controlling for other variables associated with cigarette smoking, trying e-cigarettes was a significant predictor of cigarette smoking at wave 6 (adjusted odds ratio [AOR] = 2.48; 95% confidence interval [CI] = 1.32, 4.66), as were friends' cigarette smoking (AOR = 4.20; 95% CI = 2.22, 7.96) and lifetime use of other tobacco products (AOR = 1.63; 95% CI = 1.22, 2.17).

CONCLUSIONS

Trying e-cigarettes during college did not deter cigarette smoking and may have contributed to continued smoking.

Review of hookah tobacco smoking among college students: policy implications and research recommendations

BACKGROUND

About 30% of college students have smoked hookah tobacco. Although most students perceive this product to be innocuous and non-addictive, hookah tobacco increases the risk for disease and nicotine dependence. Currently, the US Food and Drug Administration (FDA) does not regulate the manufacture, distribution, or sale of hookah tobacco.

OBJECTIVE

Empirical literature pertaining to hookah tobacco smoking is reviewed with a focus on the implications for regulatory policy.

METHODS

PubMed, PsycINFO, and Scopus databases were searched to locate articles published in English. The literature search combined several key words including "hookahs", "college", "advertising", "health effects", and "health policy".

RESULTS

Smoking hookah tobacco may play a role in the initiation of smoking among tobacco-naïve college students and may portend persistent smoking among those who have smoked cigarettes. College students are typically nondaily, social smokers. They do not perceive that their heightened risk for tobacco diseases and nicotine dependence relates to their smoking behavior. However, few public health messages target college-age adults to counter media messages that endorse hookah tobacco smoking.

CONCLUSION

Given that the FDA is not authorized to ban specific tobacco products, policy actions should focus on the development of effective risk communication strategies that target college-age adults and on limiting the accessibility of hookah tobacco products to these adults. Accordingly, a research agenda that would inform these policy actions is proposed.

Loose Cigarette Purchasing and Nondaily Smoking Among Young Adult Bar Patrons in New York City

OBJECTIVES

We examined loose cigarette (loosie) purchasing behavior among young adult (aged 18-26 years) smokers at bars in New York City and factors associated with purchase and use.

METHODS

Between June and December 2013, we conducted cross-sectional surveys (n = 1916) in randomly selected bars and nightclubs. Using multivariable logistic regression models, we examined associations of loose cigarette purchasing and use with smoking frequency, price, social norms, cessation behaviors, and demographics.

RESULTS

Forty-five percent (n = 621) of nondaily smokers and 57% (n = 133) of daily smokers had ever purchased a loosie; 15% of nondaily smokers and 4% of daily smokers reported that their last cigarette was a loosie. Nondaily smokers who never smoked daily were more likely than were daily smokers to have last smoked a loosie (odds ratio = 7.27; 95% confidence interval = 2.35, 22.48). Quitting behaviors and perceived approval of smoking were associated with ever purchasing and recently smoking loosies.

CONCLUSIONS

Loosie purchase and use is common among young adults, especially nondaily smokers. Smoking patterns and attitudes should be considered to reduce loose cigarette purchasing among young adults in New York City.

The relationship between smoking motives and smoking urges experienced in response to a negative affect induction

INTRODUCTION

The present study attempted to further elucidate the relationship between self-reported smoking motives and affect in college students.

METHOD

Smoking motives were measured via self-report, and following a laboratory negative affect (NA) mood induction, urge to smoke was assessed via three questions. Participants were college students (N=84) who reported smoking an average of 8.74 (SD=5.36) cigarettes per day.

RESULTS

Results indicated that smoking motives for Positive Reinforcement and Automaticity significantly predicted participants' responses on two measures of urge to smoke immediately following the NA induction. Positive Reinforcement motives were predictive of urge to smoke, and Automaticity motives were predictive of the number of cigarettes participants stated that they would smoke if cigarettes were provided for free.

CONCLUSIONS

These findings indicate that (1) the association between NA and smoking is perhaps more complex than previously thought; and (2) merely two (Positive Reinforcement, Automaticity) of possibly thirteen smoking motives were identified as predictive of smoking urges. It is particularly surprising that other smoking motives (e.g., Negative Reinforcement) were not significant predictors of urge following the NA induction. Implications for relapse risk and treatment considerations among smokers experiencing elevated NA are considered.

Prevalence and Correlates of Social Smoking in Young Adults: Comparisons of Behavioral and Self-Identified Definitions

INTRODUCTION

Social smoking is an increasingly common pattern among emerging adults. Although distinct patterns have emerged between social smokers and non-social smokers, there is discrepancy about how to define the construct, with inconsistencies between self-identified social smoking and behavioral social smoking. We report prevalence and correlates of young adult smokers who self-identify and behave as social smokers (SELF + BEH), self-identified non-behavioral social smokers (SELF-ONLY), and non-social smokers (NON-SOCIAL).

METHODS

Young adults age 18-25 years who have smoked at least 1 cigarette in the past 30 days (N = 1,811) were recruited through Facebook for a national anonymous, online survey of tobacco and other substance use. Three social smoking items were used to categorize respondents into 1 of 3 smoking groups. Groups were examined for prevalence and differences on demographics, substance use, motivation to quit smoking and thoughts about tobacco abstinence.

RESULTS

SELF-ONLY (46%) was the largest group, followed by SELF + BEH (27%) and NON-SOCIAL (27%). SELF + BEH smoke less frequently, smoke fewer cigarettes per day, are less addicted to cigarettes, have a higher desire to quit, and perceive a lower quitting difficulty compared with SELF-ONLY. SELF + BEH and SELF-ONLY were more likely to be male, be marijuana users, and be addicted to marijuana than NON-SOCIAL. SELF + BEH exhibited a lower frequency of smoking, less cigarettes per day, were less addicted, and had more days co-using alcohol and cigarettes than NON-SOCIAL.

CONCLUSION

Identifying social smokers based on self-identification in addition to behavioral components appears to be important for designing smoking cessation interventions for emerging adults.

Screening and Counseling for Tobacco Use in Student Health Clinics: Reports of Health Care Providers

PURPOSE

To assess tobacco screening and counseling in student health clinics, including facilitators, barriers, and associations with campus- and state-level variables.

DESIGN

We conducted a mixed-methods study with an online survey and qualitative interviews.

SETTING

Study setting was student health clinics on college campuses.

SUBJECTS

Subjects included 71 clinic directors or designees from 10 Southeastern states (quantitative survey) and 8 directors or designees from 4 Southeastern states (qualitative interviews).

MEASURES

Quantitative measures included demographics, screening and counseling practices, clinic-level supports for such practices, perceptions of tobacco on campus, institution size, public/private status, state tobacco farming revenue, and state tobacco control funding. Qualitative measures included barriers and facilitators of tobacco screening and counseling practices.

ANALYSIS

Logistic and linear regression models assessed correlates of screening and counseling. Qualitative data were analyzed using multistage interpretive thematic analysis.

RESULTS

A total of 55% of online survey respondents reported that their clinics screen for tobacco at every visit, whereas 80% reported their clinics offer counseling and pharmacotherapy. Barriers included lack of the following: time with patients, relevance to chief complaint, student self-identification as a tobacco user, access to pharmacotherapy, and interest in quitting among smokers. In multivariable models, more efforts to reduce tobacco use, student enrollment, and state-level cash receipts for tobacco were positively associated with clinic-level supports.

CONCLUSION

This study highlights missed opportunities for screening. Although reports of counseling were higher, providers identified many barriers.

Racial discrimination is associated with distressing subthreshold positive psychotic symptoms among US urban ethnic minority young adults

BACKGROUND

Racial discrimination is related to depression, anxiety, and severe psychological distress, and evidence drawn from studies emanating from the United Kingdom and The Netherlands suggest racial discrimination is also related to clinical psychosis and subthreshold psychotic symptoms in racial and ethnic minority (REM) populations. The present study sought to determine the association between racial discrimination experiences and attenuated positive psychotic symptoms (APPS) in a United States (US) urban, predominantly immigrant and REM young adult population.

METHODS

A cohort of 650 young adults was administered a self-report inventory for psychosis risk [i.e., Prodromal Questionnaire (PQ)], and the Experiences of Discrimination Questionnaire. The PQ allowed the dimensional assessment of APPS, as well as the categorical assessment of a potentially "high risk" group (i.e., 8 or more APPS endorsed as distressing), the latter of which was based on previous validation studies using the structured interview for prodromal syndromes. The relations between self-reported racial discrimination and APPS, and racial discrimination and "high" distressing positive PQ endorsement were determined, while accounting for anxiety and depression symptoms.

RESULTS

Racial discrimination was significantly associated with APPS and with significantly higher odds of endorsing eight or more distressing APPS, even after adjusting for anxiety and depression symptoms.

CONCLUSION

The present study provides preliminary evidence that racial discrimination among US ethnic minorities may be associated with APPS, as well as potentially higher risk for psychosis.

Smoking patterns and their relationship to drinking among first-year college students

INTRODUCTION

Unlike older smokers, young adult smokers frequently engage in light and intermittent smoking. It remains unclear how stable such smoking patterns are over time, as substantial variability exists between these smokers. This study identified subgroups of college student smokers based on the trajectory of their smoking frequency during the first year of college, thereby examining stability versus instability over time. We then tested if the interplay between drinking and smoking differed in the identified groups to determine the relative role drinking may play in intermittent versus more regular smoking.

METHODS

Incoming college students at 3 institutions completed online biweekly surveys of their daily substance use throughout the first year of college. Students who reported smoking at least 1 cigarette during this year (n = 266) were included in analyses (70% female, 74% White).

RESULTS

Group-based trajectory modeling identified 5 groups of smokers, 3 of which maintained their smoking frequency throughout the year (77%), and 2 groups of infrequent smokers showed significant trends (11% increasing, 12% decreasing). Notably, nondaily smoking was maintained at different specific frequencies (e.g., 1 vs. 3 days per week). Identified groups differed in the relationship between drinking and smoking, where cooccurrence was particularly strong among infrequent smokers, and trends in smoking quantity differed between groups.

CONCLUSIONS

While there was a diversity of smoking patterns in the sample, patterns of intermittent smoking remain relatively stable for a majority of students throughout the year. Intervention messages targeting drinking and smoking should be tailored on the basis of smoking frequency.

Alternative tobacco use among college students: who is at highest risk?

OBJECTIVE

To examines smoking status, substance use, sociodemographics, and psychosocial characteristics in relation to alternative tobacco use among college students.

METHODS

Current tobacco use (cigarettes, cigar-like products, hookah, chew, snus) and correlates (sociodemographics, sensation-seeking, attitudes toward tobacco and smokers, social factors) were assessed among students aged 18-25 at 6 Southeastern US colleges using an online survey.

RESULTS

Those who were younger, male, black, cigarette and marijuana users, and demonstrating at-risk psychosocial factors were at increased risk of alternative tobacco product use (p < .001). Among current smokers, never daily nondaily smokers were 3 times as likely as former daily non-daily smokers and daily smokers to use alternative tobacco products (p < .001).

CONCLUSIONS

Important risk factors for alternative tobacco use included important sociodemographic and psychosocial characteristics.

Psychosocial and behavioral characteristics among subgroups of nondaily college student smokers

Nondaily smoking is becoming common in young adults and there appear to be different characteristics associated with past month smoking frequency among nondaily smokers. The present study examines behavioral and psychosocial correlates of smoking among subgroups of nondaily college student smokers (N = 80; 18–25 years of age) attending a large, public university. Nondaily smokers were categorized based on the frequency of days smoked in the past month and were divided into two subgroups: 1–5 days and 6–29 days. A quarter of nondaily smokers considered themselves as a smoker and significantly more 6–29 nondaily smokers were identified as a smoker and smoked more cigarettes per day (CPD). Almost half (45%) of nondaily smokers have attempted to quit smoking completely and 71% of the 6–29 nondaily smokers reported significantly higher quit attempts. The 6–29 nondaily smokers had significantly higher perceived risk related to smoking. Self-efficacy to abstain from smoking was significantly higher for 1–5 nondaily smokers. These results suggest heterogeneity among subgroups of nondaily college student smokers exists in a number of behavioral and psychosocial factors. Prevention and cessation strategies may be improved by considering frequency of nondaily smoking and targeting subgroups differently.

Marijuana and alcohol use and attempted smoking cessation in adolescent boys and girls

BACKGROUND

This study sought to determine the relationship between the frequency of current marijuana and alcohol use and cigarette quit attempts in male and female adolescent smokers.

METHODS

Data from a cross-sectional survey of health behaviors in high-school-aged adolescents were analyzed. Current cigarette smokers (n = 804) who reported use of at least 1 cigarette in the past month were divided into those with and without a history of at least 1 quit attempt (a self-reported episode of trying to "stop smoking"). Logistic regression models were fit to describe the association between the frequency of marijuana/alcohol use and a history of cigarette quit attempts.

RESULTS

Among the total sample, higher-frequency marijuana use (more than 6 times in the past 30 days) and frequent binge drinking (more than 5 days of binge drinking in the past 30 days) decreased the odds of having a past cigarette quit attempt (higher-frequency marijuana: adjusted odds ratio [AOR] = 0.56, 95% confidence interval [CI] = 0.36-0.86; frequent binge drinking: AOR = 0.49, 95% CI = 0.29-0.83). A significant gender interaction was observed for the relationship between higher-frequency marijuana use and a history of cigarette quit attempts (P = .03), with decreased odds in boys (AOR = 0.41, 95% CI = 0.22-0.77) but not in girls (AOR = 0.71, 95% CI = 0.37-1.33).

CONCLUSIONS

Adolescent smokers who report higher-frequency marijuana use or frequent binge drinking have a decreased likelihood of a history of a cigarette quit attempt. The gender-related association between higher-frequency marijuana use and a history of quit attempts suggests that boys with greater substance use may need particularly intensive support to initiate quit attempts.

Perceptions of addiction, attempts to quit, and successful quitting in nondaily and daily smokers

We aimed to qualitatively examine differences in perceptions of addiction, attempts to quit, and successful quitting among nondaily versus daily college student smokers. We conducted 16 focus groups with a total of 73 college student smokers from the southeastern U.S. Focus groups were homogenous in terms of gender, smoking status (nondaily, daily), and type of school (2-year college, 4-year university). Questions centered on perceptions of addiction, their own addiction, what constitutes a quit attempt, and successful quitting. Themes that emerged among all smokers regarding conceptualization of general addiction included physiological and psychological dependence and an inability to quit smoking. In terms of their own addiction, nondaily smokers referenced their ability to quit and sense of choice to smoke as factors indicating a lack of addiction, whereas daily smokers reported dependence symptoms and their inability to control their smoking indicating addiction. Nondaily smokers discussed quit attempts in terms of making the decision to quit and avoiding situational triggers, whereas daily smokers reported taking more behavioral steps toward cessation (e.g., not buying cigarettes, reducing cigarette consumption). With regard to successful cessation, both groups identified losing the desire to smoke as a hallmark. However, nondaily smokers reported that the decision to quit might constitute successful cessation; daily smokers had more strict behavioral criteria such as abstinence for an extended period of time. The different perceptions of one's own addiction, attempting to quit smoking, and successful quitting suggest the need to improve assessments of these factors, particularly among nondaily smokers.

Young adult former ever smokers: the role of type of smoker, quit attempts, quit aids, attitudes/beliefs, and demographics

OBJECTIVE

Young adults who smoke are often nondaily users who either quit or transition into dependent smokers. Further, this age group often has been considered an extension of the adult population. This study aims to examine young adult former ever smokers to understand factors associated with their stopping smoking.

METHOD

Telephone interviews were conducted in 2010 with 4401 young adults in Florida. We examined the association between former ever smokers and sociodemographics, smoking behavior, quit attempts, quit aids, and attitudes/beliefs about smoking.

RESULTS

Thirty-seven percent of young adults were former smokers, 20% were current smokers, and 43% were never smokers. Former smokers were more likely to be female, situational smokers (compared to occasional or established), more likely to have stopped smoking without acknowledging making a quit attempt, less likely to have used a quit aid, and less likely to display pro-tobacco attitudes/beliefs.

CONCLUSION

Young adult former and current smokers have unique patterns of smoking and stopping smoking. Young adults may require novel intervention techniques to promote prevention and cessation based on these unique smoking patterns. Future research is needed to understand motivations to quit smoking among young adults.

Results of a feasibility and acceptability trial of an online smoking cessation program targeting young adult nondaily smokers

Despite increases in nondaily smoking among young adults, no prior research has aimed to develop and test an intervention targeting this group. Thus, we aimed to develop and test the feasibility, acceptability, and potential effectiveness of an online intervention targeting college student nondaily smokers. We conducted a one-arm feasibility and acceptability trial of a four-week online intervention with weekly contacts among 31 college student nondaily smokers. We conducted assessments at baseline (B), end of treatment (EOT), and six-week followup (FU). We maintained a 100% retention rate over the 10-week period. Google Analytics data indicated positive utilization results, and 71.0% were satisfied with the program. There were increases (P < .001) in the number of people refraining from smoking for the past 30 days and reducing their smoking from B to EOT and to FU, with additional individuals reporting being quit despite recent smoking. Participants also increased in their perceptions of how bothersome secondhand smoke is to others (P < .05); however, no other attitudinal variables were altered. Thus, this intervention demonstrated feasibility, acceptability, and potential effectiveness among college-aged nondaily smokers. Additional research is needed to understand how nondaily smokers define cessation, improve measures for cessation, and examine theoretical constructs related to smoking among this population.

Assessment of college and university campus tobacco-free policies in North Carolina

OBJECTIVE

To develop a reliable and efficient method for assessing prevalence and strength of college/university tobacco-related policies.

PARTICIPANTS

North Carolina (NC) public universities, community colleges, and private colleges/universities (N = 110).

METHODS

A census of policies using campus handbooks and Web sites was conducted in March 2011.

RESULTS

The rating tool is reliable and valid. Ninety-nine percent of NC college/university campuses are smoke-free in all indoor areas. The majority (94/110 [85%]) of colleges and universities regulate smoking and/or tobacco in some or all outdoor areas. Less than 20% of campuses had restrictions for industry marketing, promotion, and sales.

CONCLUSIONS

Clean indoor air policies are present at all but 1 NC college/university campus, and a growing number have enacted broad outdoor limits to protect students, faculty, and staff from secondhand smoke. Policy census approaches across all other states would quantify the national tobacco-free college campus policy environment and facilitate adoption of tobacco-free campus policies.