Smoking Increases Among College Students
By Barbara A Biedrzycki, RN, MSN, AOCN, CRNP
Summary—Educational level is one of the strongest correlates of nonsmoking status, but the latest research provides shocking data. The prevalence of smoking among college students increased by 27.8% (P<.001) over four years, according to national surveys done in 1993 and 1997. Half of college students are trying to quit, with 18% having tried more than five times in the previous year. The highest absolute increase in the number of cigarettes smoked occurred in those who smoked fewer than nine cigarettes a day.1 Interventions by advanced practice nurses are needed to decrease smoking among college students and to prevent occasional smokers from becoming nicotine-dependent.
The Centers for Disease Control and Prevention in Atlanta reports, "If trends continue, approximately 5 million persons ages <18 years will die eventually from a smoking-attributable disease."2 This tenacious personal and public health dilemma is largely due to the addictive effects of nicotine, a neuroendocrine stimulant, as well as a depressant. (See Table 1) In 1996, U.S. statistics show, 1,226,000 young people under 18 years of age became daily smokers, an increase of 50% over eight years. This occurred even though tobacco use is known to be the No. 1 preventable cause of Americans’ deaths. Furthermore, the earlier in life someone begins smoking, the greater the risk of smoking-attributable diseases.
| Table 1 |
| Drug Addition Criteria and Nicotine Effects |
|
| Source: Holbrook JH. Nicotine addiction.
In: Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison’s Principles
of Internal Medicine. New York: McGraw-Hill;1998:2516.
_______________________________________________________ |
Nicotine causes many compounded effects through catecholamine release and increases serum concentrations of glucose, cortisol, vasopressin, free fatty acids, and b-endorphin. An analysis of cigarette smoke identified more than 4,000 substances, including some that are pharmacologically active, antigenic, cytotoxic, mutagenic, and carcinogenic.3
The increased incidence of children smoking is a highly publicized, serious problem being addressed nationally as a public health concern, but little is known about the smoking trends of college students. Studies show a higher education level correlates with nonsmoking status. One might assume college students would have greater access to educational materials on hazards of smoking as well as assistance with smoking cessation and therefore do not need additional attention. The featured research provides startling results that may affect your practice.
Study Methodology
More than 29,000 randomly selected students in 140 four-year colleges nationwide participated in research to explore smoking trends among college students. In 1993, data on cigarette use was obtained as part of the College Alcohol Study.4 A second survey conducted in 1997, which also focused mainly on alcohol use, sought identical information on demographic and background characteristics, smoking, and other high-risk behaviors. Two additional questions asked how old subjects were when they first smoked a cigarette and the age when they started smoking regularly. Researchers felt confident that the self-report questionnaires did not need a biological measure because past national surveys validated the positive correlation of self-reported smoking status with biological measurements.1
Of the original participating colleges, 130 (93%) chose to be part of the 1997 study. The great response rates (70% in 1993, 60% in 1997) were prompted by sending three mailings within three weeks that included the questionnaire, a postcard reminder, and a repeat questionnaire; ensuring that the survey was anonymous and voluntary; and providing a cash award (monetary amount not disclosed).1
Study Results
Data analysis revealed dismaying facts. Cigarette smoking had increased in 85% of 116 colleges in the study. Only one college reported smoking prevalence significantly decreased. The proportion of students who reported smoking in the previous month increased 28% in the four years between the two studies. The proportion of students who smoked in the previous 12 months increased by 25%. The number of cigarettes smoked daily also increased 6-14%, the larger increase among smokers who consumed fewer than nine cigarettes per day. The proportion of students who quit smoking in the past year decreased by 6%.
The study did provide some encouraging news. Data revealed a decrease in severely nicotine-dependent college students who smoked 20 or more cigarettes a day, and more than 40% of college students in both surveys reported smoking less than one cigarette a day. No association was found between increased smoking prevalence and binge drinking or marijuana use. Interesting data were collected in the 1997 survey on smoking initiation and attempts to quit. (See Table 2,)
| Table 2 | |
| 1997 Smoking Initiation and Quit Data | |
| Event |
|
| First cigarette at >= 19 years of age |
|
| Began regular smoking at >= 19 years of age |
|
| Quit for >= 24 hours in the past year |
|
| Made >= 5 attempts to quit in the past year |
|
|
(Editor’s note: These questions were not asked in 1993.) Source: Wechsler H, Rigotti NA, Gledhill-Hoyt
J, et al. Increased levels of cigarette use among college students. JAMA
1998;280:1677.
|
|
Implications for Practice
Recent stop-smoking efforts focused on educating children and counseling older adults. This study points clinicians in a new direction, toward a generation of college students establishing their independence and lifelong habits. The challenge is not only how to decrease the number of students who start smoking, but how to prevent the sporadic smoker from becoming nicotine-dependent and promote greater quit rates among college students.
Included in the pharmacological arsenal against nicotine addiction are:
• nicotine gum and patch approved for over-the-counter use since 1995 and 1996, respectively;
• nicotine nasal spray, which provides rapid delivery of nicotine;
• nicotine inhaler, a prescription drug available since 1998 that is not really an inhaler because it delivers nicotine buccally;
• and bupropion, an atypical antidepressant with dopa minergic and adrenergic actions approved in 1998 in slow-release preparation for smoking cessation.5
The physical addiction to nicotine is not the only problem. Cigarette use is a complex, learned behavior promoted by strong conditioned cues such as physical activities (after dining or sex), stress (many smokers say smoking "calms their nerves"), and habits (sitting in a favorite chair with an ashtray nearby). When research data show half of college students are trying to quit and 18% tried more than five times in one year, it is obvious that college students desperately need interventions.
Researchers say interventions to prevent the transition from occasional to nicotine-dependent smoking can be strengthened through environmental and policy changes to discourage tobacco use and strong messages that smoking is not the norm.1 Concentrated efforts by advanced practice nurses nationwide could reduce the likelihood a student will start smoking, encourage college students to quit, slow the transition to nicotine dependence, and change health outcomes for the new millennium.
References
1. Wechsler H, Rigotti NA, Gledhill-Hoyt J, et al. Increased levels of cigarette use among college students. JAMA 1998;280:1673-1678.
2. Center for Disease Control and Prevention. Incidence of initiation of cigarette smoking-United States, 1965-1996. MMWR 1998;47:837-840.
3. Holbrook JH. Nicotine addiction. In: Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison’s Principles of Internal Medicine. New York: McGraw-Hill;1998:2516-2519.
4. Wechsler H, Davenport A, Dowdall G, et. al. Health and behavioral consequences of binge drinking in college. JAMA 1994;1672-1677.
5. Hughes JR, Goldstein MG, Hurt RD, et al. Recent advances in the pharmacotherapy of smoking. JAMA 1999;281:72-76.
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