Occasional smoking in college: Who, what, when and why?
Highlights
► We conducted focus groups of college students that occasionally smoke. ► Most participants did not identify as smokers. ► Participants minimized their own personal health risks of smoking. ► Participants engage in impression management of smoking in various social settings.
Introduction
Despite recent trends for decreasing prevalence of cigarette use among adults (Centers for Disease Control & Prevention, 2009) and children under 18 (Johnston, O'Malley, Bachman, & Schulenberg, 2010), over one-third of young adults (ages 18–25) are current smokers (defined as any cigarette smoking in the past 30 days) (Substance Abuse & Mental Health Services Administration, 2010). Varying estimates are found within college populations; SAMHSA survey data from 2009 estimate that 27% of college students are current smokers (Substance Abuse & Mental Health Services Administration, 2010) while Monitoring the Future survey data from 2009 estimate the rate to be lower (18%) (Johnston et al., 2010). Many young adult smokers believe they will eventually quit (Hines, Fretz, & Nollen, 1998) and are confident in their ability to do so (Sutfin, Reboussin, McCoy, & Wolfson, 2009). Yet the mean age for smoking initiation in the United States is 17.5, and for initiation of daily smoking is 20.7 (Substance Abuse & Mental Health Services Administration, 2010), which provides clear evidence that young adulthood is a vulnerable developmental period in which recently initiated smokers are susceptible to long-term dependence.
Young adult smokers, including college students, are diverse in their smoking patterns and range from daily heavy cigarette smokers to infrequent puffers (Sutfin et al., 2009). The most predominant group of young smokers is those who smoke occasionally. For example, 65% of college student tobacco users are occasional smokers (Moran, Wechsler, & Rigotti, 2004). Most college students who smoke occasionally have lower rates of dependence (Ames et al., 2009) and smoke in a narrow range of situational contexts; such as on weekends, while drinking alcohol, and socially around other smokers (Moran et al., 2004, Shiffman et al., 2009, Sutfin et al., 2009). Several studies demonstrate the potential risks for progressing to more ingrained smoking patterns and chronic nicotine dependence by occasional smoking college students. For example, studies that follow longitudinal trajectories for occasional smokers in college estimate that 25–50% quit, 35–50% maintain occasional smoking patterns long term, and 15–25% progress to daily smoking (Kenford et al., 2005, Wetter et al., 2004, White et al., 2009).
The increasing proportion of college student smokers who occasionally smoke and associated risks of occasional smoking further underscore the importance of understanding the choices behind this pattern of smoking. Population-based survey research has offered a quantitative characterization of the population, including psychosocial correlates and risk factors (Nguyen and Zhu, 2009, Pierce et al., 2009, Trinidad et al., 2009, White et al., 2009). One challenge of survey research among occasional smokers is that many do not consider themselves smokers (Berg et al., 2009, Berg et al., 2010, Thompson et al., 2007), which may bias recruiting and subject reporting. This assessment difficulty speaks to the need for a complementary approach to understand who occasional smokers are and what factors underlie their smoking behavior. In contrast to quantitative approaches, qualitative methods offer an opportunity to discern a deeper understanding of the driving forces for occasional smoking, yet few studies have taken this approach.
Studies that have taken a qualitative approach to examine young adult occasional smoking have demonstrated a wide range of psychosocial influences on smoking behavior, including gender (Amos & Bostock, 2007), ethnic, family, and community influences (Mermelstein, 1999). College smokers in particular report smoking occasionally with the expressed purpose of alleviating stress and/or to increase concentration, clear their mind, reward themselves, and strengthen friendships (Nichter, Nichter, Carkoglu, & T.E.R.N., 2007), but they are also cognizant of how smoking is negatively perceived among others on campus (Thompson et al., 2007) and often do not identify themselves as smokers (Berg et al., 2010). Many of these smokers report pressure to quit smoking (Thompson et al., 2007), yet peer pressure and social affiliation are reported as major reasons to smoke (Amos and Bostock, 2007, Mermelstein, 1999). Such varied and inconsistent motivational influences on occasional smokers are but one example of the complex factors that drive occasional smoking by young adults, and the challenge to understand this pattern of smoking. We sought to build upon the literature of young adult occasional smoking with a focus on the role that smoking plays in daily activities and interpersonal relationships. Utilizing focus group methodology, this study was principally aimed to understand the personal motivations and forces that influence college-level occasional smoking to better inform cessation strategies for this vulnerable population.
Section snippets
Overview
We conducted eight focus groups at two universities (4 groups each) in the Southeast; School 1 is a moderately sized private university (approximately 4500 undergraduates; 76% Caucasian), and School 2 is a historically black public university (6000 undergraduates; 91% African American). Our intent was not to make institutional or racial comparisons (though we do highlight differences where they exist), but merely to increase sample diversity. Focus groups were held on each campus in a
Demographics and smoking history
Sample characteristics are shown in Table 1. Most focus group participants from School 1 were male (60%), average age of 20, white (83%), and had smoked approximately 25% of days over each of the prior week and month. Focus group participants from School 2 were predominantly female (78%), average age of 20, non-white (91%), and had smoked approximately 40% of days over the prior week and month. Approximately 30% of the School 1 participants had smoked daily in the past versus 40% from School 2.
Discussion
The purpose of the present study was to further examine, using a qualitative approach, self-identity and motivational forces for occasional smoking by college students. Our findings are similar to the few existing qualitative studies of young occasional smokers regarding their self-identity as smokers and opinions on occasional smoking (Berg et al., 2010, Thompson et al., 2007). Novel findings of the current study include the degree to which occasional smokers engage in impression management,
Role of funding sources
The research presented in this article was supported in part by pilot research funding from the Cancer Center Support Grants at Hollings Cancer Center at the Medical University of South Carolina (P30 CA138313) and the Comprehensive Cancer Center of Wake Forest University (P30 CA012197). Dr. Carpenter was supported by a Career Development Award from NIDA (K23 DA020482). None of the funding sources had a role in the study design, collection, analysis or interpretation of the data, writing the
Contributors
Drs. Carpenter and Sutfin designed the study and wrote the protocol. Dr. Sutfin conducted data collection. All authors performed data analysis. Amy Brown wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.
Conflict of interests
All authors declare that they have no conflicts of interest.
Acknowledgments
The authors wish to thank Maria Parries, Caroline Kimes, Shannon Golden and Shellie Ellis for assistance with focus group implementation, coordination and coding.
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