Tobacco Use by College Students:New findings from the 2001

Harvard College Alcohol Surveys

Nancy Rigotti, MD, Henry Wechsler, PhD Susan Moran, MD, Nicola Majchrzak, MPH, MSW

National Conference on Tobacco or Health, 2002

Funded by the Robert Wood Johnson Foundation and

the Massachusetts Department of Public Health

Questions to be Addressed

How many college students use tobacco? Is it changing?

Which students use tobacco and what is their pattern of use?

What are points of intervention to reduce tobacco use in college students?

What do students think of potential policies?

Harvard College Alcohol Study (CAS)

• National sample of 140 4-year U.S. colleges

• Random sample of students at each college

• Mailed survey– 1993: N=15,103 (70% response rate)– 1997: N=14, 251 (60% response rate)– 1999: N=14,138 (60% response rate)– 2001: N=10,904 (52% response rate)

How many college students use tobacco and is it changing?

Question 1:

Current Tobacco UseUS College Students - 1993-2001

Harvard College Alcohol Survey

22.3

28.5

32.9

28.529.8

25.7

0

5

10

15

20

25

30

35

1993 1997 1999 2001

Total Tobacco

Cigarettes

* *

• 28% increase 1993-1997• 7.5% decline 1999-2001

* Not assessed

%

Why the rise?

• Cohort Effect?Adolescent smoking rates rose in the 1990s. These teens are now young adults.

• Increased initiation?Adults aged 18-24 are the youngest legal targets for tobacco industry marketing.

Why the decline?

• Cohort Effect?Adolescent smoking rates have declined since 1999. These teens are entering college.

• Tobacco control efforts? Increased tobacco excise taxes?

Spread of campus smoking restrictions?

Counteradvertising campaigns?

Students Overestimate Tobacco Use Prevalence on Campus

2001 Massachusetts College Alcohol Study

28

55

0

10

20

30

40

50

60

Actual Prevalence Students' Estimate

%

Which students use tobacco and what is their pattern of use?

Question 2:

Current Cigarette Smoking by Gender

Harvard College Alcohol Survey

28.0 27.325.6 25.4

0

5

10

15

20

25

30

35

40

Males Females

% 1999

2001

• Males = Females 1999 - 2001

• Whites > Non-Whites, 1999 - 2001

Current Cigarette Smoking by Race

Harvard College Alcohol Survey31

21 21

12

28

2119

11

0

5

10

15

20

25

30

35

Whites Asian Hispanic Black

1999

2001

%

Which Students Smoke Cigarettes? Multivariate Analyses (1999 CAS)

• Women = Men• Whites > Non-Whites• Users of other tobacco products• Binge drinkers• Marijuana users• Students who rate parties as very important• Students for whom athletic participation is not

important• Students with lower GPA

Patterns of Cigarette SmokingHarvard College Alcohol Survey, 2001

• Initiation– Only 6% of smokers started after age 18

– But 14% of current smokers started smoking regularly after age 18

• Cessation– 54% of current smokers tried to quit in past year

– But low current interest in quitting• 58% are not thinking about quitting

• 26% plan to quit in next 6 months

• 16% plan to quit in next 30 days

Cigarette Smoking is ...

• Occasional– 65% of current smokers do not smoke daily

• Light– 70% smoke <10 cigarettes / day

– 21% smoke 10-20 cigarettes / day

– 9% smoke > 1 pack per day

• Social– 51% smoke more often with others than when alone

Harvard College Alcohol Survey, 2001

Which smokers are social smokers?Multivariate analysis

2001 Harvard College Alcohol Survey

• Women > Men • Occasional smokers > Daily smokers• Students who were not regular smokers before

entering college• Binge drinkers• Students who rate socializing as very important• Students who spend more time involved in student

organizations

Characteristics of Social Smokers Harvard College Alcohol Survey, 2001

59

56

4

58

65

39

58

54

31

0 20 40 60 80

Not ThinkingAbout

Quitting

Past Year QuitAttempt

NicotineDependence

All

Non-Social

Social

What are points of intervention to reduce tobacco use in

college students?

Question 3:

No smoking in college buildings, including residences

No tobacco advertising on campus or in publications

No tobacco donations or sponsorship of campus events

No sampling or distribution of tobacco products

No tobacco sales on campus

Tobacco Control Policies Recommended for U.S. Colleges

American College Health Association and

American Cancer Society

Benefits of Smoke-Free Dorms

• Protect nonsmokers from passive smoke

• Reduce a fire hazard

• Promote a nonsmoking campus norm– Discourage tobacco use initiation– Discourage progression of occasional smoking

to regular use– Boost success of smokers trying to quit

Prevalence of Smoke-free Dorms Harvard College Alcohol Survey, 2001

39% of students live in university housing

23% want smokefree

59% smokefree

(36% in 1999)

18% do not want smokefree

Student Smoking Status by Housing Type Harvard College Alcohol Study, 1999

79 78

1017

0102030405060708090

100

Smoked RegularlyBefore Age 19

Did Not SmokeRegularly Before

Age 19

Smoke FreeHousing

UnrestrictedHousing

p<0.0001

p=NS

Smoke-free dorms may protect nonsmokers from becoming regular smokers in college

% Current Cigarette Smoking

Tobacco Industry Promotions at Bars/clubs and Campus Social Events

• New tobacco industry marketing strategy to target young adults– Makes tobacco use part of young adults’ social lives

– Links alcohol and tobacco use

– Reinforces brand visibility

– Generates names for databases for future marketing

• Goal - Encourage young adults’ transition to becoming regular smokers

Student Exposure to Tobacco Promotions in Bars and on Campus

2001 Harvard College Alcohol Survey

8.5

6.8

3.2

0.0

2.0

4.0

6.0

8.0

10.0

Any Promotion Bar / Club Campus Event

%

Students at 118 of 119 colleges reported attending an event at which free cigarettes were distributed

Exposure to Tobacco Promotions and Current Smoking

National College Alcohol Survey, 2001

Effects unchanged in a multivariate analysis adjusted for bar/club or campus event attendance, age, gender, race, binge drinking, college response rate

43

24

7872

24

12

01020304050607080

All Smokedregularlybefore 19

Did notsmoke

regularlybefore 19

Exposed

Not Exposed

% Current Smokers

P<.001P<0.001

What do students think of potential policies?

Question 4:

Support for Smoke-free Policies2001 College Alcohol Survey

18

45

52

62

85

85

51

75

77

0 20 40 60 80 100

On-CampusBars

In StudentResidences

All CampusBuildings

All

Non-Smokers

Smokers

Support for Bans on …2001 College Alcohol Survey

28

53

51

70

77

78

59

71

71

0 20 40 60 80 100

Tobacco Saleson Campus

On-CampusAds

PartySponsorships

All

Non-Smokers

Smokers

Conclusions

• Tobacco use in college students declined after 1999 but remains higher in 2001 than in 1993

• Tobacco use patterns are in transition during college, providing opportunities for prevention and cessation

• Student support for tobacco control policies is strong, even among smokers

• Smoke-free policies may discourage tobacco use

• Tobacco promotional events encourage tobacco use