Tobacco Use Among 18-24 Year Olds in the United States

Elizabeth E. Brait, MSSDepartment of Public Health

MA Tobacco Control ProgramJuly 2005

Challenges and Limitations

• Traditional survey methods not always applicableo Dorms and frats/sororities not usually includedo College population: mostly heterogeneouso 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 researcho Majority of research has focused on college students onlyo 66% of 18-24 year olds are not enrolled in college

Demographics

• 18-24 year Olds in the USA9.6% (~27 million) people in the USA are between 18-24

o 34% or (~9.2 million) FT college studentso 66% or (~17.8 million) Not in college FT

• Smoking Prevalence by Educational Attainmento 34% prevalence rate: 9-11 years of educationo 42%: GEDo 12%: Undergraduate Degree o 7%: Graduate Degree

• Adult Smoking Prevalence by Income Levelo 32.9%: Living below the poverty levelo 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)

The rate of smoking by age between light and heavy smokers

0

10

20

30

40

50

60

70Annual (lifetime)

30 Day

30 Day Daily

30 Day Daily 1/2 Pack+

18 19-20 23-2421-22 25-26 35 4029-3027-28

10

61

4745

19

2933

22

14

34

24

16

3942

31

22

16

29

21

15

26

29

20

1411

20

1613

24

17

13

33

26

16

2320

Tobacco Companies View Smokers Using a Life-Span Model

• Life-span of a smokero “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 oldso Driving psychological characteristicso Physical characteristicso 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 dayso Smokes occasionally in social situations

• Why is this important?o Tobacco companies defined these termso Interests / activities of adolescents and young adultso Similar interestso “A critical time in the progression to establish smoking

behavior”

Developmental and Sociocultural Factors Affecting Young Adult Attitudes Towards Smoking

• Predictors that influence smoking and non-smoking behavior include:o Student/non-student statuso 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 interventiono Smoker and their communityo Role modelso Peers influencing one another (teen-teen / adult-adult)

o Focus on immediate rewardso Enforce ruleso 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 College

0%

10%

20%

30%

40%

50%

60%

Annual 30-Day 30-day Daily 30-day Daily 1/2 Pack+

CollegeOther

Col

lege

Non

-col

lege

The difference between college and non-college is that non-college is smoking up to 3 times more than college as their daily use rates increase.

38.3%

47.7%

26.7%

37.6%

15.9%

31.5%

7.9%

21.9%

Annual 30-Day 30-Day Daily 30-Day daily 1/2 Pack+

Smaller GapWidest Gap

Smoking Prevalence Rates of 18-22 Year Olds By Gender

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

College Males College Females No College Males No College Females

30-Day

30-Day Daily

30-Day daily half a pack or more

30-D

ay

30-D

ay D

aily

30-D

ay D

aily

1/2

Pac

k +

36%

17%

9%

25%

15%

7%

30%

33%

21%

39% 39%

23%

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.