Measuring Tobacco Use Among Young Adults: Previously Unrecognized Smokers in Minnesota

1. Measuring Tobacco Use Among Young Adults: Previously Unrecognized Smokers in Minnesota Presented at the National Conference on Tobacco or Health Chicago, IL May 6, 2005

2. Presented by: Pete Rode, MAMinnesota Department of Healthpeter.rode@health.state.mn.us, 651-296-6036 Co-presenters • Blue Cross Blue Shield of Minnesota • Nina Alesci, MPH • Steven Foldes, Ph. D. • Minnesota Department of Health • Ann Kinney, Ph. D. • Minnesota Partnership for Action Against Tobacco • Jessie Saul, Ph.D. • Barbara Schillo, Ph.D. • University of Minnesota • Michael Davern, Ph. D.

3. Financial Support • U.S. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (Grant U1A/CCU516950 awarded to Minnesota Department of Health) • Blue Cross and Blue Shield of Minnesota • Minnesota Partnership for Action Against Tobacco

4. Outline • Adult definition of current smoker used in many surveys undercounts number of smokers 18-24 years old • This study documents: • Extent of undercount • Characteristics of those who have been missed • Purpose: to sharpen our picture of young adults who smoke

5. Pivotal Role of Young Adults • Smoking rates are high and appear to be increasing • Tobacco industry intensifies marketing to young adults, its youngest legal targets (Pamela Ling, Stanley Glantz and others)

6. Pivotal Role of Young Adults • Smoking patterns continue to change and evolve during the transition from adolescence to adulthood • Tobacco industry knows this • “the ten years following the teenage years is the period during which average daily consumption per smoker increases to the average adult level” (Tobacco industry document) • Overall success for tobacco prevention in future depends in part on success with young adults

7. Understanding young adult smoking is complicated by research discontinuities • Studies of teen and adult smoking rely on • Different modes of data collection (classroom paper & pencil vs. telephone or face-to-face interviewing) • Different definitions of current smoking • This study explores impact of different definitions on knowledge of young adult smoking

8. The adolescent research tradition • Current smoker is someone who has smoked at anytime in past 30 days • Youth Risk Behavior Survey, Youth Tobacco Survey, Monitoring the Future • Typical question: “During the past 30 days, on how many days did you smoke cigarettes?” • Intent: measure the earliest stages of smoking uptake

9. The adult research tradition • Current smoker is someone who has • Smoked 100+ cigarettes in lifetime, AND B) Now smokes “every day” or “some days” • Behavior Risk Factor Surveillance System (BRFSS); National Health Interview Survey • No 30-day time frame

10. The adult research tradition • Key questions: • “Have you smoked at least 100 cigarettes in your entire life” • [IF YES] “Do you now smoke cigarettes everyday, some days, or not at all?” • Intent: focus on more established smokers, those who have gone beyond the beginning or experimental stage

11. Young adults are caught in the middle • Standard adult definition used when young adults interviewed for BRFSS and NHIS • Some variant of 30-day adolescent definition used in studies of college students (Harvard College Alcohol Study, National College Health Risk Behavior Survey)

12. Our Research Goals • Measure the full range of young adult smoking behavior—make sure everyone is counted • How many current smokers are missed by the adult definition, and who are they? • Solution: incorporate both adult and adolescent definitions of smoking into the survey for young adults

13. Data Source—2003 Minnesota Adult Tobacco Survey • Telephone interviews conducted between November 2002 and June 2003 • Final dataset of 8,821 interviews of adults 18 and over • Oversample of young adults, final dataset includes 1,205 persons 18-24 years old, non-college as well as college youth • Overall response rate of 56.5% (CASRO)

14. TYPES OF CURRENT SMOKERS DISCUSSED IN THIS REPORT • Established smokers: smoked 100 or more cigarettes in lifetime and now smoke “every day” or “some days” • “Previously unrecognized” smokers: smoked on one or more of past 30 days but do not meet criteria for established smokers • Young Adult (YA) smokers: Either of the above

15. CURRENT SMOKING RATE FOR MN YOUNG ADULTS IS 39% (178,000) (146,000) (32,000)

16. Most unrecognized smokers are occasional smokers:Percent smoking 1-5 days of past 30 days

17. Most unrecognized smokers are occasional smokersAverage number of cigarettes smoked per day, on the days they smoked:

18. Most unrecognized smokers do not think of themselves as smokers:Percent not considering themselves to be a smoker

19. Few unrecognized smokers show signs of addiction:Percent smoking 1st cigarette within 30 minutes of waking up

20. Most unrecognized smokers started smoking later than established smokers:Age at first cigarette (cumulative percent)

21. One-fourth of unrecognized smokers use other tobacco products:Percent using other forms of tobacco in past 30 days

22. Unrecognized smokers rely on other smokers to get their cigarettes:Percent getting most of their cigarettes from another smoker

23. Many unrecognized smokers live with other smokers:Percent living with another adult who smokes

24. Unrecognized smokers are less likely (than est. smokers) to be surrounded by other usersPercent reporting that about half or more of people close to them use tobacco

25. Unrecognized smokers engage in binge drinking just as much as established smokersPercent who had five or more drinks on at least one occasion in past 2 weeks

26. Demographics • Percentage of unrecognized smokers is higher among: • College students • Resident of Twin Cities metro area • But differences not statistically significant

27. Are unrecognized smokers “social smokers”? • Quite likely, but we didn’t ask additional questions needed to determine this • “Social smoker”—smoke mainly when they are with other people (Moran, Wechsler & Rigotti) • “Socially cued smoker”—go to bars, nightclubs or casinos at least monthly and smoke more in these venues (Trotter, Wakefield & Borland) • “When drinking at a party or with a large group of people”—most frequently mentioned situation in which college students smoke (Blue Cross study)

28. Discussion • Smoking rate for young adults is higher than previously thought • 18% of YA smokers missed by standard adult definition • 32,000 undetected smokers in MN; close to 2 million nationally?

29. Discussion • It could be argued that “unrecognized” smokers are not very important. They add very little to overall volume of smoking. • Smoking patterns among young adults are unsettled, evolving. • Look to future behavior, not just present behavior • Some will quit or remain very low-level smokers; others will escalate into regular smoking and addiction.

30. Discussion • Forces favoring escalation • Under-estimate addictiveness of nicotine • May see health/addiction messages as irrelevant • Surrounded by many other young adults who smoke • Tie in with the social scene—parties, bars • Tobacco industry advertising and promotions • Stresses, transitions and image creation in young adult life

31. Conclusions • Include question on smoking in last 30 days in all adult surveillance surveys and smoking studies • Seamless, longitudinal studies of transitions • From adolescence to young adults • From college to post-college • From young adult years to mid-adult years

32. To obtain more information • Copies of reports based on 2003 Minnesota Adult Tobacco Survey are available at • http://www.health.state.mn.us/divs/hpcd/tpc/TobaccoReports.html