Smoking initiation among college-aged women: How the transition to college promotes initiation

1. Smoking initiation among college-aged women: How the transition to college promotes initiation Lynda M. Sagrestano, Ph.D. Southern Illinois University Carbondale Presented to the 2003 National Conference on Tobacco or Health, Boston, MA

2. Introduction • Smoking rates declined from the 1970s to the 1990s • Recent increase in smoking rates, especially among 18-25 year olds • Rates particularly high among young white women • DHHS (2003). Health, United States 2002

3. Source: DHHS (2003). Health, United States 2002.

4. Rates of college initiation • Recent evidence suggests that up to 25% of adult smokers initiated during college (e.g., Everett, 1999; Gray, 1993; Hines et al., 1998; Wechsler et al., 1998) • Among nonsmoking high school students, 37% initiate smoking in college (Choi et al., 2003) • Among experimenting high school students, 25% become regular smokers in college (Choi et al., 2003)

5. Factors associated withcollege initiation • Increased marketing to college aged students (Rigotti et al., 2000) • Engaging in other high-risk behaviors (e.g., marijuana, heavy drinking, multiple sex partners) (Emmons et al., 1998) • Weight control and depression associated with smoking (Vickers et al, 2003; Zucker et al., 2001), but not examined in studies of initiation among college students

6. Purpose • Qualitatively assess • Smoking initiation on campus • How to promote quitting on campus • Preventing initiation among new college women

7. Methods • 8 focus groups; women only • 2 groups conducted with each target sample: • Smokers (n = 7) • Non-smokers (n = 13) • Ex-smokers (n = 10) • New smokers (n = 18) • women who began smoking after coming to campus

8. Recruitment • Short in-class survey assessing smoking status and demographics • Selected participants who met criteria for groups (smoker, ex-smoker, new smoker, non-smoker) • Contacted by telephone and scheduled • Incentives: • $20 in McDonald’s Coupons • Pizza/Soda

9. Results

10. Smoking initiation on campus • Social factors • Smoking while drinking (these “go hand in hand”) • Smoking between classes • Smoke with professors • Some profs bum cigarettes! • Smoking in dorms • If smoke-free dorm, smoke outside • Smoking to meet people • Standing outside smoking as a source for forming relationships • Partner who smoked

11. Smoking initiation on campus • Stress reduction • Beginning college/new environment created stress, smoking used to ease that transition • Exam and class stress • Escape from problems • Easy availability • Campus stores • “munch man” selling singles • Absence of parents

12. How to promote quitting on campus • Emphasize long term health consequences • When home witnessed long-term effects on family members; served as deterrent • Long term effects not readily visible on college campus where everyone is “young, energetic, and happy”

13. How to promote quitting on campus • Emphasize dangers of smoking while using birth control pills • Emphasize premature aging effects • Suggest that men may find smoking unattractive in women • Emphasize the financial costs of smoking

14. How to promote quitting on campus • Labeling issues • Those who smoke only in social settings do not label selves as smokers • Do not see the need to think about quitting • Believe they can quit any time, but just do not want to yet • Therefore need to find ways to reach smokers who do not label themselves as such

15. How to promote quitting on campus • Restrict access on campus • Don’t sell in student center • Create a completely smoke free environment • Rather than selected dorms or bars • Fines for violations • Programs that simultaneously emphasize smoking cessation and weight control would be too stressful

16. Impact of media campaigns • Send good messages • Tend to have no impact on smoking habits • Remind them about smoking and trigger them to smoke • Better to send multiple messages targeting different concerns than repeating same message • Best not to sensationalize, as will be dismissed

17. Impact of increasing prices • Most would find a way to continue smoking • Stock up when on sale • Order from Switzerland (illegal) • Buy in states where taxes lower

18. Preventing initiation among new college women • Increasing activities to counter the culture of boredom, hanging out, drinking, and smoking • College sponsored activities • Culture of students engaging in these types of activities (more advertising of activities) • Providing smoke free dorms, bars, and events • Good band at a smoke free bar • If only a few smoke-free venues, would just avoid them; instead, need a completely smoke-free environment (community)

19. Preventing initiation among new college women • Increase price of cigarettes and alcohol • Because use is intertwined, need to deter both • Limit access to tobacco on campus • Ban sales in the student center • Many students pay for cigarettes with point cards that parents fund for purchase of food • Ban sale of singles (e.g., munch man)

20. Preventing initiation among new college women • Pay students who can pass a physical exam proving they have not smoked • Make images of long-term effects of smoking readily available on campus

21. Discussion • The need to intervene with this group is imperative • Focus resources on prevention of initiation in addition to cessation efforts • Give voice to your target group by collecting both qualitative and quantitative data before designing your program • Regional and campus differences in norms

22. References • Choi, W. S., Harris, K. J., Okuyemi, K., & Ahluwalia, J. S. (2003). Predictors of smoking initiation among college-bound high school students. Annals of Behavioral Medicine, 26, 69-74. • Emmons, K. M., Wechsler, H., Dowdall, G., & Abraham, M. (1998). Predictors of smoking among US college students. American Journal of Public Health, 88, 104-107. • Everett, S. A., Husten, C. G., Kann, L., Warren, C. W., Sharp, D., & Crossett, L. (1999). Smoking initiation and smoking patterns among US college students. Journal of American College Health, 48, 55-60. • Gray, N. L. (1993). The relationship of cigarette smoking and other substance use among college students. Journal of Drug Education, 23, 117-124. • Hines, D., Fretz, A. C., & Nollen, N. L. (1998). Regular and occasional smoking by college students: Personality attributions of smokers and nonsmokers. Psychological Reports, 83, 1299-1306. • Rigotti, N. A., Lee, J. E., & Wechsler, H. (2000). US College Students' use of tobacco products. Journal of the American Medical Association, 284, 699-705. • Vickers, K. S., Patten, C. A., Lane, K., Clark, M. M., Croghan, I. T., Schroeder, D. R., et al. (2003). Depressed versus nondepressed young adult tobacco users: Differences in coping style, weight concerns, and exercise level. Health Psychology, 22, 498-503. • Wechsler, H., Rigotti, N. A., Gledhill-Hoyt, J., & Lee, H. (1998). Increased levels of cigarette use among college students: A cause for national concern. Journal of the American Medical Association, 280, 1673-1678. • Zucker, A. N., Harrell, Z. A., Miner-Rubino, K., Stewart, A. J., Pomerleau, C. S., & Boyd, C. J. (2001). Smoking in college women: The role of thinness pressures, media exposure, and critical consciousness. Psychology of Women Quarterly, 25, 233-241.