This presentation is about Tobacco use among 18-24 year olds in college and not in college, so why is this important: Findings have shown that 18-24 year olds have the highest smoking prevalence among all adult sub-groups. There have been noticeable increases with this age group as a whole 18-24 year olds have higher smoking prevalence rates than other adult age sub-groups What happens in this age group tends to impact younger kids
Traditional survey methods not always applicable because: Dorms, Frats/Sororities not usually included College population is very heterogeneous and lacks significant diversity Telephone surveys tend to rely on home phones. Many 18-24 year olds use cell phones Age changes among the college population: According to the 2003 census, the college population is about 50% ages 18-24 year olds and 50% ages 25+ Limitations in research on tobacco use among 18-24 year olds Majority of research has focused on college students only 66% of 18-24 year olds are not enrolled in college and lack a common venue, such as a college campus (non-college 18-24 years olds tobacco prevalence rate is significantly higher)
2003, Census reported that in 2000 9.6% (27 million people) in the US were between 18-24 year Olds: 34% (9.2 million) were FT college students 66% (17.8 million) were not in college FT Adult Smoking Prevalence by Educational Attainment CDC MMWR Weekly, reported in May 28, 2004 issue that those with: 9-11 years of education have a 34% prevalence rate GED: 42% Undergraduate Degree 12% Graduate Degree: 7% Clearly, there is a relationship between education and smoking prevalence. Adult 18+ Smoking Prevalence by Income Level CDC, Current Estimates for Adult Cigarette Smoking in the US, 2004 reported: Living below the poverty level: 32% Living above the poverty level: 22.2%
CDC reported in 2004: 18-24 year old smoking prevalence rate was 28.5% Among 18-24 year old males (32%) Among 18-24 year old females(24.6%) Highest among all adult age sub-groups. Other studies found that the recent increases were due to “young adults initiating regular tobacco use in large groups, which were connected to tobacco promotional events College campuses saw an increase in tobacco sponsorships, sponsorships at frats/sororities, and at local bars where 18-24 year olds frequent Less is known about non-college 18-24 year olds because of the difficulty in studying this group Majority of smokers start smoking during adolescents prior to age 18 Socio-demographic factors associated with smoking prevalence: Higher % among freshmen and Juniors, or those in a transition Lower rates were found at private, commuter, more competitive, religious, and western schools Students who smoked were more likely to binge drink, smoke marijuana, have multiple sexual partners, lower grades, and prioritize parties and socializing with friends
The Color bars represent: age and % Prevalence rate for three rates of smoking (30-day, Daily, Daily ½ pack+) Monitor the Future (2001) This graph shows that: That the overall smoking rate decreases with age and is reflected across the age groups The difference between the lighter (annual) and heavier smokers (1/2 pack a day or more) decreases with age Light smoking occurs most in all age groups Heaviest smoking occurs the least in all age groups 18 year olds smoke more in the lightest smoking group (annual smoking) and they smoke least in the heaviest smoking group (1/2 pack+ per day) Or: There are 6 times more light smokers, than heavy smokers in 18 year olds There are 3.2 times more light smokers, than heavy smokers among 19-20 years old There are 3 times more light smokers, than heavy smokers among 21-22 years old There are 3 times more light smokers, than heavy smokers among 23-24 years old There are 2 times more light smokers, than heavy smokers among 25-26 years old There are 2 times more light smokers, than heavy smokers among 35 years old There are 2 times more light smokers, than heavy smokers among 40 year old
Lifespan Model of Smoker: “ A critical time in the progression to establish smoking behavior” (Moran, Susan., et al, 2004) Researchers Ling and Glantz, 2002 reported that Tobacco companies began to define smokers on along at spectrum - That starts with onset of a cigarette during adolescence Which transitions in progressive stages up to age 25, At this point, the young adult has become a daily pack a day+ smoker Evidence from tobacco industry retrieved documents from 1990’s, revealed that: Tobacco companies had been researching 18-24 year olds for decades, paying specific interest in understanding 18-24 year old – in particular they focused on Driving psychological characteristics (i.e. predominately related to group identification, experimentation, self-image enhancement, stress, boredom) Physical characteristics (i.e. flavor, pharmacological effects of nicotine, especially in times of stress, to act as a reliever) Behaviors they experience (i.e. life transitions, stress, anxiety) Tobacco companies used this knowledge to target 18-24 year olds for: New smoker initiation and recruitment Maintaining engagement among current smokers
The terms Someday smoker and Social Smoker were defined by Tobacco companies They began to recognize that social smoking is an outlet for initiation and continued used and was to exploited in targeting new smokers and maintaining old smokers. The tobacco companies research focused on: Interests & activities of adolescents and young adults Identified that there were some similarities between these groups, in spite of age differences Both groups were in a time of transition, usually accompanied with stress Findings show that some social smokers don’t see themselves as smokers at all
University of St. Thomas (St. Paul. MN) focuses on developmental and socio-cultural factors affecting young adult attitudes towards smoking ( Alvi, Shahid, et. al, Presented at the National Tobacco Conference May 2005 ) They found predictors that influence smoking and non-smoking behavior include: Student/non-student status Locations where young adults spend their time Education level Employment status Gender and age Autonomy (live independently or with family) The identified implications for intervention which use Role models Peers influencing one another (teen-teen / adult-adult) Focus on immediate rewards The enforcement of rules Look for transitions which tend to be windows of opportunity
Monitor the Future (2001) showed that the: College 18-22 year olds smoke less than non-college Rate decreases with both groups as smoking goes from light to heavy Rate decreases quicker with non-college The gap between college and non-college gets wider as smoking increases The gap difference (the gap between 18-24 year olds in college and not in college) shows that: Almost, 25% more annual smokers are not in college 41% more 30-day smokers are not in college There are 2 times more 30-day daily smokers not in college than in college There are almost 3 times more 30-day daily ½ pack + smokers not in college than in college
The main differences that this graph shows is: College females smoke less than college males, but non-college females smoke more than non-college males. There is a clearer decrease in smoking as the smoking rate increases in the college groups only When comparing college males/females there are significant differences in lighter smoking, than daily or heavy smoking Comparing non-college males/females there are some difference between light and daily smoking.
Create policies that: Follow recommended best practices Prevent easy access for smoking, one way to do this is to limit where people are allowed to smoke Encourage cessation and quitting by having free resources available on college campuses that are advertised Student involvement.
The primary problem is among 18-24 Year olds not in college , in particularly among non-college females. For colleges that want to address smoking, they should: Identify what has been effective for college cessation and prevention programs Identify factors that facilitate the adoption of recommended tobacco control policies (For example, setting up a task force to perform thorough assessments of what the circumstance is, what resources exist, what are the needs, and who is supporting the change) Identify factors that impede the adoption of recommended tobacco control policies (For example, when smoking is not a priority by the stakeholders and college president, lack of buy-in or support, rushing into things before looking at the situation thoroughly) Some questions to keep in mind when designing programs / interventions include: How does the quitting motivation for social smokers differ from other young adult smokers? What socio-demographic and behavioral characteristics are associated with change in smoking behavior for young adults? Many social smokers do not view themselves as smokers Are there tobacco control policies and interventions aimed at young adults that may be delaying or deferring initiation of habitual smoking rather than preventing it. Such as, employment status, education level Some programs have been identified as either too broad or don’t meet all the needs of the groups they are trying to serve, or they inadvertently encourage smoking rather than discourage smoking (ie counter marketing)
Tobacco Consumption between 18-24 (2005)
Tobacco Use Among 18-24 Year Olds in the United States Elizabeth E. Brait, MSS Department of Public Health MA Tobacco Control Program July 2005
Challenges and Limitations• Traditional survey methods not always applicable o Dorms and frats/sororities not usually included o College population: mostly heterogeneous o Telephone surveys tend to rely on home phones o Many 18-24 year olds use cell phones• Age changes among the college population• Limitations in research o Majority of research has focused on college students only o 66% of 18-24 year olds are not enrolled in college
Demographics• 18-24 year Olds in the USA 9.6% (~27 million) people in the USA are between 18-24 o 34% or (~9.2 million) FT college students o 66% or (~17.8 million) Not in college FT• Smoking Prevalence by Educational Attainment o 34% prevalence rate: 9-11 years of education o 42%: GED o 12%: Undergraduate Degree o 7%: Graduate Degree• Adult Smoking Prevalence by Income Level o 32.9%: Living below the poverty level o 22.2%: Living above the poverty level
Tobacco Use Prevalence Rates• Prevalence rate: 28.5% (2004)• Majority of smokers start smoking prior to age 18• Gender differences• Socio-demographic factors• Influence of tobacco industry presence• Less known about non-college group
Cigarette Smoking Prevalence Rates of High School Seniors, College Students, and Adults through Age 40 (Monitor The Future, 2001) 70 Annual (lifetime) 61 30 Day 60 30 Day Daily 30 Day Daily 1/2 Pack+ 50 47 45 42 39 40 33 34 33 29 31 29 29 30 26 26 24 24 23 22 22 21 19 20 20 20 20 16 16 17 15 16 16 14 14 13 13 10 11 10 0 18 19-20 21-22 23-24 25-26 27-28 29-30 35 40 The rate of smoking by age between light and heavy smokers
Tobacco Companies View Smokers Using a Life-Span Model• Life-span of a smoker o “A critical time in the progression to establish smoking behavior” (Moran, Susan., et al, 2004) o Cigarette smoking onset begins during adolescence and transitions in progressive stages to establish smoking behavior through age 25• Tobacco companies researched 18-24 year olds o Driving psychological characteristics o Physical characteristics o Behaviors they experience• Tobacco companies targeted 18-24 year olds
The Importance of Social Smoking Among Adolescents and 18-24 Year Olds• What is a someday smoker and a social smoker? o Smokes only on some days o Smokes occasionally in social situations• Why is this important? o Tobacco companies defined these terms o Interests / activities of adolescents and young adults o Similar interests o “A critical time in the progression to establish smoking behavior”
Developmental and Sociocultural FactorsAffecting Young Adult Attitudes Towards Smoking • Predictors that influence smoking and non-smoking behavior include: o Student/non-student status o Locations where young adults spend their time o Education level o Employment status o Gender and age o Autonomy (live independently or with family) • Implications for intervention o Smoker and their community o Role models o Peers influencing one another (teen-teen / adult-adult) o Focus on immediate rewards o Enforce rules o Transitions are also a window of opportunity
Profile of 18-24 Year Old Smokers Not in College • Report being stuck: Experiencing higher levels of stress, anxiety, and lack skills, and know-how to becoming unstuck • Have behavioral obstacles that may keep them one foot stuck in adolescence • May still live with their families • Tend to work low wage jobs, unemployed • May be pregnant or parenting • Experience a continuous transition, while college students have an easier time moving forward along the developmental spectrum into adulthood
Cigars, Smokeless Tobacco, and Pipes• Adolescents have high cigar smoking rates• Median age of initiation: 17 for males / 18 for females• More popular among college students• Male students smoked cigars 2-3 times more than females
Drug and Alcohol and Tobacco Users• 18-22 not in college use marijuana up to 2 times more than college students• 18-22 year old in college use alcohol slightly more than non-college 18-22 year olds
Smoking Prevalence Rates of 18-22 Year Olds in College and Not in College60% Smaller Gap Widest Gap50% 47.7% 38.3%40% 37.6% 31.5%30% 26.7% College Other20% Non-college 15.9% 21.9% College10% 7.9% 0% Annual 30-Day 30-day Daily 30-day Daily 1/2 Pack+ Annual 30-Day 30-Day Daily 30-Day daily 1/2 Pack+The difference between college and non-college is that non-college is smoking up to 3times more than college as their daily use rates increase.
Smoking Prevalence Rates of 18-22 Year Olds By Gender 45% 30-Day 30-Day Daily 40% 30-Day daily half a pack or more 39% 39% 35% 36% 33% 30% 30% 25% 25% 20% 23% 21% 30-Day Daily 1/2 Pack + 15% 17% 15% 30-Day Daily 10% 9% 30-Day 5% 7% 0% College Males College Females No College Males No College Females There is a clearer decrease in smoking, as the smoking rate increases in the college groups only
Recommendations for College and University Policies Create policies that: • Follow recommended best practices for college campus tobacco policy outlined by the American Cancer Society of New England • Prevent easy access for smoking • Encourage cessation and quitting • Student involvement
Recommendations for 18-24 Year Olds Not in College • Try to identify a common venue that brings these young adults together • Keep in mind this group often has additional complicated issues that need to be considered (e.g. unemployment, substance abuse, poverty, poor education, pregnant, parenting, lack of support system, developmental and mental health) • Use interventions that are flexible and able to adapt to multiple personalities, needs, and life styles
In conclusion: Where do we go from here?• 18-24 Year Olds Not in College• Identify the factors that facilitate or impede the adoption of recommended tobacco control policies• How does quitting motivation for social smokers differ from other young adult smokers?• What socio-demographic and behavioral characteristics are associated with change in smoking behavior for young adults?• Are there tobacco control policies and Interventions aimed at adolescents that may be delaying or deferring initiation of habitual smoking rather then preventing it.