College degree abbreviation

ABBREVIATION. CAS, College Alcohol Study.

Recent trends in tobacco use have focused public health attention on young adults (aged 18-24 years). From 1993 to 2000, the prevalence of smoking by US adults fell in all age groups except young adults. (1) Smoking rates increased among the young adults in Monitoring the Future Surveys during the 1990s. (2) The prevalence of smoking among college students also increased during the 1990s, although college students smoke at lower rates than their noncollege peers. (2-5)

Young adults' pattern of tobacco use, like their prevalence of use, distinguishes them from the general adult population. (6) Young adults smoke fewer cigarettes daily and are less likely to smoke every day than the general population of adults. (3,7) Tobacco use seems to be in transition during young adulthood as the experimental smoking begun during adolescence matures to established use. (7,8) Tobacco industry documents indicate that the industry views young adulthood as a critical time in the progression to established smoking behavior. (9-12) To promote this transition, the industry has studied the social context in which young adults use tobacco products and uses this information to craft its marketing strategies. (9-12) The tobacco industry reaches out to young adults in their social environments by sponsoring promotional events in bars and clubs and on college campuses. (9,11-13) Tobacco industry studies have also identified a group of so-called "social smokers" who smoke mainly in social situations, do not believe that they are addicted to smoking, and are concerned about the social acceptability of their smoking. (14)

Outside of the tobacco industry, little formal attention has been paid to the context in which young adults use tobacco products. Ling and Glantz (10) suggested that such knowledge is a prerequisite for designing effective strategies to discourage tobacco use during the young adult years. Studies of college students reveal that their smoking is strongly associated with alcohol use and attending social events. (4,7,15-17) "Social smoking" is a term commonly used by young smokers to define their behavior. A qualitative study found that many college students describe themselves as "social smokers," by which they mean that their tobacco use is more like a social activity or a component of their social activities rather than a regular behavior characterized by nicotine dependence. (18) These smokers generally believe that they will not continue to smoke after leaving the social college environment. (18)

To our knowledge, the pattern of social smoking has not been studied formally, despite its common usage. Little is known about the prevalence of social smoking or about how this pattern of use relates to usual measures of smoking behavior or to the trajectory of the development of nicotine dependence. It is likely that social smokers have lower cigarette consumption, a higher prevalence of occasional (non-daily) smoking, and less nicotine dependence, but this has not been explored. Whether social smoking is associated with quitting intentions and quitting behavior is not known, and it is not clear whether social smoking is a stable or a transient pattern of tobacco use.

This study explored the prevalence of social smoking, the characteristics of social smokers, and the association between social smoking and quitting intentions and behavior among US college students, who compose approximately one third of all young adults in the United States. (19) The analysis used data from a large, nationally representative random sample of students who attend 4-year colleges and universities. Our goal was to describe this pattern of tobacco use, to explore its role in the development of nicotine dependence, and to inform future efforts to reduce college students' smoking.

METHODS

Sample

In 2001, the Harvard School of Public Health College Alcohol Study (CAS) surveyed a random sample of students who were enrolled in 120 4-year US colleges and universities. The schools were part of a group of 140 schools that were selected in 1993 to create a nationally representative sample of accredited 4-year US colleges and universities for the first CAS. (20) The attrition of 20 schools in 2001 was primarily a result of institutions' inability to provide a sample of students within the time constraints of the survey. Each participating school provided a list of 215 randomly selected students from all full-time undergraduate students who were enrolled during the 2000-2001 school year. Details of the sampling methods have been previously described. (20,21) One college was excluded from the analysis because its response rate was substantially lower than the others, leaving 119 schools.

The 119 colleges in the sample were located in 38 states and the District of Columbia. Sixty-nine percent of the respondents attended public colleges, and 31% attended private colleges, which approximates the US distribution of full-time 4-year college students (67% attend public, and 33% attend private schools). (22) Forty-seven percent of respondents attended large colleges (>10 000 students), 23% attended medium-sized colleges (5001-10 000 students), and 29% attended small colleges (<5000 students). The US national distribution is 37%, 24%, and 40%, respectively. (22) Large colleges are overrepresented in the CAS sample because schools were selected with a probability proportional to size. Sixty-nine percent of respondents attended schools in large- or medium-sized cities, compared with 71% of students nationwide. (22) Thirteen percent of students attended schools with a religious affiliation, compared with 16% nationwide. (22)

Questionnaire and Measures

The questionnaire assessed students' demographic and background characteristics; use of tobacco, alcohol, and other substances; and interests and lifestyle choices. (20) Demographic factors assessed were age, gender, ethnicity, year in school, marital status, and highest level of parental education attained (a proxy for socioeconomic status).

For assessing cigarette use, respondents were asked whether they had smoked a cigarette; response options were "never used," "used but not in the past 12 months," "used but not in the past 30 days," or, "used in the past 30 days." Students who reported any cigarette use in the past 30 days were considered to be current users. Cigarette smokers were asked to report the ages at which they first smoked a cigarette and first started smoking regularly and to specify daily cigarette use and frequency of smoking ("On how many of the past 30 days did you smoke cigarettes?").

For assessing social smoking, students were asked, "In the past 30 days, do you smoke mainly when you are with people, mainly when you are alone, or do you smoke as often by yourself as with others?" Students who stated that they smoked mainly with others rather than alone or equally by themselves and others were defined as social smokers for this analysis.

Degree of nicotine dependence was assessed by asking the time to first morning cigarette. (23) Quit attempts were measured by asking smokers how many times in the past year they attempted to quit and were successful for 24 hours. Intention to quit smoking was measured with the Stages of Change scale, a validated 5-item measure that assesses intention to quit within the next 30 days or 6 months. (24) Smokers were classified into 3 stages: precontemplation (not planning to quit in the next 6 months), contemplation (planning to quit in the next 6 months but not the next 30 days), and preparation (planning to quit in the next 30 days and made a successful 24-hour quit attempt in the past year).

Other items assessed were residence (on-campus vs off-campus), grade point average, an item assessing the importance to a student of participating in 9 activities (athletics, academic work, arts, fraternity or sorority life, parties, religion, community service, political activism, and attending sporting events), and an item assessing the time spent involved in 9 activities (watching television, studying, working for wages, socializing, student organizations, intercollegiate sports, physical activity, volunteer work, and nonacademic computer use).

Mailing and Response Rate