Tobacco Use by College Students: New findings from the 2001 Harvard College Alcohol Surveys

1. Tobacco Use by College Students:New findings from the 2001Harvard 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

2. 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?

3. 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)

4. How many college students use tobacco and is it changing? Question 1:

5. Current Tobacco UseUS College Students - 1993-2001Harvard College Alcohol Survey % * Not assessed * * • 28% increase 1993-1997 • 7.5% decline 1999-2001

6. 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.

7. 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?

8. Students Overestimate Tobacco Use Prevalence on Campus2001 Massachusetts College Alcohol Study %

9. Which students use tobacco and what is their pattern of use? Question 2:

10. Current Cigarette Smoking by GenderHarvard College Alcohol Survey • Males = Females 1999 - 2001

11. Current Cigarette Smoking by RaceHarvard College Alcohol Survey % • Whites > Non-Whites, 1999 - 2001

12. 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

13. 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

14. 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

15. Which smokers are social smokers?Multivariate analysis2001 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

16. Characteristics of Social Smokers Harvard College Alcohol Survey, 2001

17. What are points of intervention to reduce tobacco use in college students? Question 3:

18. No smoking in college buildings, including residencesNo tobacco advertising on campus or in publicationsNo tobacco donations or sponsorship of campus eventsNo sampling or distribution of tobacco productsNo tobacco sales on campus Tobacco Control Policies Recommended for U.S. Colleges American College Health Association and American Cancer Society

19. 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

20. Prevalence of Smoke-free DormsHarvard College Alcohol Survey, 2001 39% of students live in university housing 23% want smokefree 59% smokefree (36% in 1999) 18% do not want smokefree

21. Student Smoking Status by Housing Type Harvard College Alcohol Study, 1999 % Current Cigarette Smoking p=NS p<0.0001 Smoke-free dorms may protect nonsmokers from becoming regular smokers in college

22. 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

23. Student Exposure to Tobacco Promotions in Bars and on Campus2001 Harvard College Alcohol Survey % Students at 118 of 119 colleges reported attending an event at which free cigarettes were distributed

24. Exposure to Tobacco Promotions and Current SmokingNational College Alcohol Survey, 2001 % Current Smokers P<0.001 P<.001 Effects unchanged in a multivariate analysis adjusted for bar/club or campus event attendance, age, gender, race, binge drinking, college response rate

25. What do students think of potential policies? Question 4:

26. Support for Smoke-free Policies2001 College Alcohol Survey

27. Support for Bans on …2001 College Alcohol Survey

28. 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