Increased Levels of Cigarette Use Among College Students
Abstract & Commentary
Synopsis: Rates of cigarette smoking among college students increased between 1993 and 1997.
Source: Wechsler H, et al. JAMA 1998;280:1673-1678.
Several independent surveys have documented the fact that smoking rates have been increasing among adolescents since the early 1990s. However, little study has been completed on smoking among college students.
Wechsler and associates used the data collected from the Harvard School of Public Health College Alcohol Study surveys of 1993 and 1997 to determine smoking rates among college students at the time of these two surveys and to compare the data.
One hundred forty colleges participated in the 1993 survey and 130 participated in the 1997 survey. The schools were randomly selected with correction for school subtypes and geographic distribution. A random sample of 230 students was obtained from each school, except for the small schools, where 108 students were chosen. Data from schools with low participation rates were dropped.
The questionnaire that was used was largely concerned with the use of alcohol. However, smoking and other high-risk behaviors were the focus of some questions. Students were encouraged to respond to questionnaires with cash awards. Despite the monetary inducement, the response rate declined from 70% in 1993 to 60% in 1997.
When the data were analyzed, Wechsler et al found that there had been a 27.8% increase in smoking among college students between the two surveys. This increase was observed at 99 of the 116 colleges in the final sample. Most of the increase was in light smokers, with a 16% decrease noted in students who smoked one pack or greater a day. Smoking was highest in Caucasian students, non-seniors, students at public colleges, and less competitive schools. Smoking was lowest in the western part of the United States.
Comment by Kenneth Noller, MD
I am troubled by the results of this survey. For many years, it has been shown repeatedly that the level of education is negatively associated with smoking. That is, the better educated an individual, the less likely that individual will smoke. For example, smoking among professionals with degrees beyond a basic college education is extremely low. In contrast, smoking rates among poor, urban adolescents and individuals who have not completed a high school education is disproportionately high, and most antismoking efforts in the United States have been aimed at these groups.
Now we have data to suggest that college students are also increasing cigarette consumption. Perhaps we have been negligent in our efforts to discourage tobacco use in this group since it has been assumed that they are at low risk for initiating and continuing smoking because of their education.
Since cigarette smoking is the leading preventable cause of serious medical illness in the United States at the present time, we, as physicians, have a duty to discourage all of our patients from smoking. This article suggests that we should not forget to include college students in our efforts.
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