Cigarette smoking among college students

The rates of college students smoking in the United States have fluctuated for the past twenty years. Majority of lifelong smokers begin smoking habits before the age of 24, which makes the college years a crucial time in the study of cigarette consumption. Cigarette smoking on college campuses has become an important public health issue and there has been increase in campus wide smoking bans and other preventative programs to reduce the rates of students smoking.

Statistics

• 85% of current adult smokers began smoking by the age of 21, which may show how behaviors in college-aged students can predict smoking behavior later in life (American Lung Association).
• Each year, approximately 440,000 deaths are related to cigarette smoking, including smoking on college campuses ^[1].
• An estimated 28.5% of college students are smokers in the United States in relation to the current rate of US adult smoking, which is 20.6% ^[2].
• Throughout the 1980s, studies found rates for adult smoking were gradually declining, while those of adolescents were not ^[3].
• During 1990s cigarette smoking among college students rose from 23% to 31%, but by the year 2000, percentages began to decline ^[3].
• In 2002, 16% of college students smoke on a daily basis versus 32% of their non-college peers J^[4]. Though statistically, college students do not smoke as much as non-college students, smoking on college campuses is a growing trend and public health debate.

Predictors Associated with Youth Tobacco Use

Certain social, economic, and environmental factors can be associated with the prediction of youth and an increased use in tobacco. Risk factors include ^[5]:

• Lower socioeconomic status
• Having parents, close relatives, or guardians that smoke
• Acceptance and positive views of smoking by peers
• Incompletion of higher levels of education
• High availability of and exposure to tobacco products
• Violent behavior

Factors for college smoking in the U.S.

College students in the U.S. also choose to smoke for a variety of reasons including stress, weight loss, social interaction, or just the continuation of a habit.

Stress and Emotion

Students note that smoking cigarettes reduces anxiety, and smoking often occurs after stressful events or in stressful situations. Studies find that depressed college students are more likely to smoke and have a more difficult time quitting than non-depressed college students. 31.9% of college smokers attribute their smoking behavior as a means to alleviate their depression ^[6]. Depression is related to lower self-efficacy, and depressed individuals are considered less able to resist smoking during times of low self esteem, which leads to higher reports of smoking among depressed individuals.

Weight Loss

For women in particular, smoking is a tool for weight loss and weight management ^[7]. Nicotine in cigarettes is a successful appetite suppressant, which contributes to the use of cigarettes as a dieting tool. The pressure to be thin along with a need for social approval drives many young college women to smoke ^[7]. Body-conscious college women are also shown to be at higher risk for the continuation of smoking. Women who discontinue the use of nicotine as an appetite suppressant tend to gain weight initially, and women who are especially concerned with body weight will see this as a reason to continue smoking ^[8]. The media and tobacco advertising play an increasing role in perpetuating the thin body ideal. Studies show the more exposure women have to images of thin women, the lower their body satisfaction, and the more likely they are to want to diet ^[8]. Tobacco companies pay special attention to the concerns of women and weight loss and use this concern to target women in cigarette advertising campaigns.

Field of Study

Some studies suggest even a student’s field of study may cause them to be a smoker. The highest rates of smoking are found in students majoring in Communications, languages, or Cultural Studies ^[9].

Social Activity

Some students smoke as a way to socialize and take study breaks from classes ^[10]. Smoking can also be linked with alcohol use among college students. Alcohol is a contributing factor to smoking, especially on college campuses where alcohol use is so predominant (Nichter et al.). In these situations, smoking is believed to aid in social interactions with members of the opposite sex, which is promoted by tobacco companies in their advertisements involving sexual images of men and women. Smoking after drinking is also reported to as a form of reorientation and an attempt to reduce the drunken state (Nichter). Some smokers enjoy smoking while drinking because it allows normal smokers to partake in smoking without so many negative judgments from peers (Nichter). While smoking is stigmatized during the daily life of a student on campus, it is an acceptable activity at parties, especially when combined with alcohol (Nichter). Suggested interventions are those that target both alcohol and tobacco use (Nichter).

Social Smokers

Today’s smoking culture includes a subpopulation of smokers called “social smokers”. Although there may be different explanations of what a social smoker is, many college students define “social smokers” as those who use tobacco in more social activities and find it essential for socializing, rather than using tobacco on a regular basis, dictated by nicotine dependence ^[10]. Social smokers don’t believe that they are addicted to smoking, or worried about the social acceptability of their smoking habits ^[10]. In a study conducted in 2004, 51% of current college smokers stated that they primarily smoked with other people and in social activities. 71% of occasional smokers smoked in a social situation, compared to daily smokers, 19% of which smoke in social environment. Students who started smoking within the past two years of the study were more than twice as likely to be social smokers than students who had been smoking for a longer period of time prior to the study. Characteristics of social smokers have been found to include more females and non-Hispanic whites, than other demographic characteristics and spent more time socializing with friends, were binge drinkers and had a high importance for the arts. Lastly, social smokers don’t perceive themselves at risk to tobacco related illnesses, nor believe they will ever become nicotine dependent. Since social smokers don’t think they’ll become dependent on nicotine, they don’t plan on quitting during college, but have intentions to quit once they graduate.

Smoking and Perceived Gender Disparities

Studies have shown that there are social differences in the smoking behaviors of males and females in college. In a 2006 study, qualitative analysis data showed that males and females have certain perceptions of their sex or the opposite sex smoking. From both male and female students’ perspectives, there were negative feelings towards women smoking and it was considered “unlady like”. However, if men were smoking, the perception was positive, and they were considered cool or gave off a tough-guy image. In addition to drinking alcohol at parties, male students appeared in control if they had a cigarette in the other hand. Even though there were negative perceptions of female students smoking, smoking at parties is considered more of a female behavior rather than a male behavior. Despite negative perceptions of females smoking, students thought that when females smoke in groups of girlfriends it wasn’t trashy. Rather, when female students smoked in groups of girlfriends it appeared as though individual’s smoking habits were regulated by the group, instead of the individual’s dependence on nicotine. These perceived gender differences are inextricably linked with social environments where smoking and alcohol consumption occur. The perceptions of cigarette smoking in male and female students reflect similar perceptions of alcohol use in college students ^[11].

Targeting by the Tobacco Industry

The tobacco industry is particularly concerned with younger audiences because they constitute the future of smoking and tobacco profits. In an insider document from Philip Morris, the company states: "It is important to know as much as possible about teenage smoking patterns and attitudes. Today's teenager is tomorrow's potential regular customer, and the overwhelming majority of smokers first begin to smoke while still in their teens... The smoking patterns of teenagers are particularly important to Philip Morris." - Philip Morris Companies Inc., 1981 ^[12].

Tobacco advertisements target youth and try to market cigarettes as a way to cope with changing environments (Ling). College is considered a crucial time in the lives of adolescents and is a time for change, experimentation, and discovery, which makes it an ideal time for tobacco companies to advertise and gain future consumers.

Replacement Smokers

The industry refers to new smokers as “replacement smokers” because they are in effect, replacing smokers who have quit or died over the years ^[13]. Young people, including college students, constitute the majority of replacement smokers, and tobacco companies have created marketing campaigns targeting this age group. These advertisements show smoking as modern, hip, cool, fun, and adventurous ^[13]. The Joe Camel cartoon character is famously known as RJ Reynolds’ tool to entice younger audiences towards cigarette smoking.

Alternative Press

Tobacco companies use “alternative press” and brand recognition as another way to advertise toward college-aged students. Companies put their logo on everyday items like towels, clothing, and accessories, and this memorabilia is then given for free during events ^[13]. These logos can also be seen in restaurants and bars, which are places young people frequent. During the 1980s and 1990s, tobacco companies aggressively advertised their products in bars and nightclubs, mostly targeting younger audiences ^[14]. According to insider documents from tobacco companies RJ Reynolds and Philip Morris, tobacco companies had several strategies for targeting youth. They handed out free samples, sponsored parties at bars and fraternities on campuses, and hosted many events in popular spring break towns ^[14]. This aggressive advertising led to a general increase in smoking among young adults aged 18 to 24.

Smoking Bans

Each year, approximately 440,000 deaths and $193 billion in healthcare costs are related to cigarette smoking, including smoking on college campuses ^[15]. Many campuses in the United States are attempting to reduce smoking rates among students by implementing campus-wide smoking bans. Various forms of smoking bans have been around for hundreds of years. The first recorded legislation prohibiting tobacco use was in the Spanish colonies in 1575, passed by the Roman Catholic Church ^[16]. In the United States, smoking bans increased around the early twentieth century and have been increasing ever since. In 1973, Arizona is the first state to pass a comprehensive law restricting smoking in public places in the current era ^[16]. The numbers of smoking bans on college campuses across the country have been increasing. Between 2006 and 2008, the number of smoke-free campuses have quadrupled from 34 to 160 ^[17], but approximately 365 US colleges and universities have implemented some kind of anti-smoking rule, both indoor and outdoor ^[18] as well as around 500 campuses have smoke free policies set in place for their residential housing ^[19]. Smoking bans on college and university campuses have led to debates that bring forward a number of pros and cons. For example, some pros to implementing campus wide smoking bans include creating a healthier environment and dramatically reducing the amount of environmental tobacco smoke (ETS) or secondhand smoke (SHS). On the other hand, some students feel that these smoking bans violate their rights. The tobacco industry agrees that individuals should be able to avoid ETS or SHS, but believe that complete campus-wide bans "go too far". ^[19]

A study from 2005 found that other forms of intervention to decrease the rates of tobacco use on campus, such as restriction of tobacco distribution and restriction of smoking within 20 feet from entrances weren’t as effective as other programs like smoking cessation programs in influencing college students’ smoking behaviors ^[20]. When prevention-oriented education was present on college campuses, students were 23% less likely to smoke compared to their peers who were not exposed to this kind of education ^[20]. In addition to campus wide smoking bans, other interventions include health promotion programs that teach students the benefits of avoiding smoking and environments with smoke and create a general healthy college community ^[21].

References

1. ^ Centers for Disease Control and Prevention. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000-2004. Morbidity and Mortality Weekly Report. November 14, 2008; 57(45):1226-8
2. ^ http://www.uri.edu/smokefree/facts.html
3. ^ ^{a b} Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2006). Monitoring the Future national survey results on drug use, 1975-2005. Volume II: College students and adults ages 19-45 (NIH Publication No. 06-5884). Bethesda, MD: National Institute on Drug Abuse, 302 pp
4. ^ ohnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2006). Monitoring the Future national survey results on drug use, 1975-2005. Volume II: College students and adults ages 19-45 (NIH Publication No. 06-5884). Bethesda, MD: National Institute on Drug Abuse, 302 pp
5. ^ U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994
6. ^ Morrell, H.E.R., Cohen, L.M., McChargue, D.E. (2010) Depression vulnerability predicts cigarette smoking among college students: Gender and Negative reinforcement expectancies as contributing factors. Addictive Behaviors 35. 607-611
7. ^ ^{a b} Zucker, A.N., Harrell, A., Miner-Rubino, K., Stewart, A. J., Pomerleau, C.S., Boyd, C. J. (2001)Smoking in College Women: The Role of the Thinness Pressures, Media Exposure and Crucial Consciousness. Psychology of Women Quarterly 25. 233-241
8. ^ ^{a b} Pomerleau, C.S. et al (1993). The female weight-control smoker: A profile. Journal of Substance Abuse, 5, 391-400
9. ^ Berg, C.J., Klatt, C.M., Thomas, J.L., Ahluwalia, J.S., An, L.C. (2008). The Relationship of Field of Study to Current Smoking Status Among College Students. College Student Journal 43 (3). 744 -754
10. ^ ^{a b c} Moran, S., Wechsler, H., & Rigotti, N. A. (2004). Social Smoking Among US College Students. Pediatrics, 114 (4), 1028-1034
11. ^ Nichter, M., Nichter, M., Lloyd-Richardson, E.E., Flaherty, B., Carkoglu, A., Taylor, N. (2006). Gendered Dimensions of Smoking Among College Students. Journal of Adolescent Research, 215 (21), 215-244
12. ^ Mackay J., & Eriksen M. (2002). The Tobacco Atlas. World Health Organization
13. ^ ^{a b c} http://www.media-awareness.ca/english/resources/educational/handouts/tobacco_advertising/replacement_smoker.cfm
14. ^ ^{a b} Sepe, E., Ling, P.M., Glantz, S.A. (2002). Smooth Moves: Bar and Nightclub Tobacco Promotions that Target Young Adults American Journal of Public Health, 92 (3). 414-419
15. ^ http://www.cdc.gov/mmwr/PDF/wk/mm5844.pdf
16. ^ ^{a b} http://sadireland.com/smoking1.htm
17. ^ http://www.startribune.com/lifestyle/health/34309509.html?elr=KArksUUUU
18. ^ http://www.time.com/time/magazine/article/0,9171,1945356,00.html
19. ^ ^{a b} http://www.usatoday.com/news/nation/2008-10-12-smokingban_N.htm?csp=34
20. ^ ^{a b} http://www.biomedcentral.com/1471-2458/5/74#IDAAO1MHB
21. ^ Martinelli, A. M. (1999). An Explanatory Model of Variables Influencing Health Promotion Behaviors in Smoking and Nonsmoking College Students. Public Health Nursing, 16 (4), 263-269