The first national study to report on both cigarette and non-cigarette tobacco use by college students finds that nearly one-half of college students (46 percent) reported using tobacco products in the previous year. The study is reported in the Aug. 9 issue of the Journal of the American Medical Association and was conducted by researchers from the Massachusetts General Hospital (MGH) and the Harvard School of Public Health (HSPH) College Alcohol Study. By including the use of cigars and smokeless tobacco, the study finds a greater prevalence of tobacco use among college students than have previous reports that looked only at cigarette use.
The study, conducted under a grant from The Robert Wood Johnson Foundation, is based on responses from a nationally representative sample of 14,138 college students surveyed in 1999. It involves students at 119 colleges in 39 states. The study survey asked students whether they had smoked a cigarette, cigar, pipe, or used smokeless tobacco in the past 30 days or in the past 12 months. "Current use" was considered as use in the past 30 days, and one third of college students were current tobacco users. The study was released at a JAMA media briefing held in conjunction with the World Conference on Tobacco or Health in Chicago.
"Our findings show that college students are using all types of tobacco products. Essentially, college students are playing with fire, putting themselves at risk of a lifelong addiction to nicotine," said lead author Nancy Rigotti, MD, director of Tobacco Research and Treatment at Massachusetts General Hospital and associate professor of medicine at Harvard Medical School. "All tobacco products - not just cigarettes - can produce nicotine addiction. Young people who are smoking cigars may not think that they are at risk of getting hooked, but they are. Repeated exposure to any tobacco product puts students at increased danger of becoming addicted to nicotine."
Although about 28 percent of both male and female students were current cigarette smokers, total tobacco use was much higher among males (38 percent versus 30 percent). The study shows that the difference is almost entirely due to males' much higher use of cigars. Over one-third of college students have ever smoked a cigar, including more than half of males and one quarter of females. Nine percent had smoked a cigar in the past month.
"Because of male cigar consumption, overall tobacco use rates are higher in male students than in females despite identical rates of cigarette smoking," Rigotti said.
The study finds that more than half (51 percent) of college tobacco users used more than one type of tobacco product in the past year. Cigars and cigarettes were the most frequent combination. The study shows that cigar smoking accounts for the largest share of non-cigarette tobacco use and is most popular among freshmen and sophomores and among male students with a strong interest in fraternities, parties and attending sporting events. Less common are smokeless tobacco and pipes (used by 3.7 and 1.2 percent of students respectively), but students also use these in combination with other tobacco products.
Prior to the early 1990s, cigar smoking in the United States was primarily a behavior of older men. Few young adults and few women smoked cigars. But this pattern has changed dramatically, says the study. Cigar use is now common among college students. The authors note that, after cigar manufacturers stepped up their promotional activities in the early 1990s, cigar consumption increased by 50 percent between 1993 and 1998, reversing a 30-year decline. The authors cite studies in California reporting that cigar use is increasing most rapidly among young adults and is more common among individuals with more education and higher incomes.
"We've left college students exposed to the most addictive drug on the planet by focusing our concern only on those under 18," said Henry Wechsler, PhD, director of the HSPH College Alcohol Study. "We don't do that with alcohol, and we shouldn't do it with tobacco."
The study also found that tobacco use was significantly higher among whites, users of other substances, such as alcohol and marijuana, and among students whose priorities were social rather than educational or athletic. "Use of tobacco products goes along with a generally riskier lifestyle and a strong party orientation," Rigotti said.
On the positive side, most cigar use is occasional, with 90 percent of students who smoke cigars doing so on less than five days in the previous month. In addition, cigarette use for the previous 12 months stabilized in 1999 at 38 percent, after having increased by 28 percent between 1993 and 1997.
According to the study, the college years are a crucial time in the development or abandonment of smoking behavior. Therefore, colleges offer an important opportunity to discourage tobacco use. As a key component to discouraging cigarette and cigar use, the authors recommend making all college buildings, including dormitories and living quarters, smoke-free. "This would protect nonsmokers from second-hand smoke and reduce the visibility of smoking on campus," said Rigotti. "Smoke-free dormitories may discourage new students from taking up smoking, make it easier for current smokers to stop and even reduce fire hazards."
"Curbing tobacco use of all types should be a national priority," Rigotti added. "Tobacco use is rising among young Americans. If this trend continues, it threatens to reverse the decline in U.S. adult smoking that we have witnessed over the past half century."
In addition to Rigotti and Wechsler, Jae Eun Lee, DrPH, of the department of Health and Social Behavior at HSPH was a co-author of the study.
For more information on the Harvard School of Public Health College Alcohol Study, please visit the website at: http://www.hsph.harvard.edu/cas.
HSPH contact: Bob Brustman, 617-432-3952
brustman@hsph.harvard.edu
Journal
JAMA