Smoker Self-Identification Versus Recent Smoking Among College Students

doi:10.1016/j.amepre.2008.11.010

American Journal of Preventive Medicine

Volume 36, Issue 4, April 2009, Pages 333-336

https://doi.org/10.1016/j.amepre.2008.11.010 Get rights and content

Background

College students who engage in occasional or social cigarette smoking are less likely to identify themselves as smokers and to attempt to quit. This analysis aimed to determine: (1) the correlates of denying being a smoker among students reporting smoking in the past 30 days and (2) if denying this label was related to not attempting to quit smoking in the past 12 months.

Methods

A total of 9931 students at 14 colleges completed a random sample survey in 2007.

Results

Of 2255 students reporting having smoked a cigarette in the past 30 days, 50.7% responded No to Do you consider yourself a smoker. Logistic regression indicated that, after controlling for the number of smoking days in the past 30, being younger (OR=0.94, p<0.001); being male (OR=1.59, p=0.009); attending a 4-year (versus 2-year) college (OR=1.73, p=0.004); and consuming alcohol in the previous 30 days (OR=2.14, p=0.03) were correlates of denying being a smoker. Logistic regression indicated that denial was related to not attempting to quit in the past 12 months (OR=1.72, p<0.001), after controlling for the number of smoking days, age, gender, type of school, and other health factors.

Conclusions

Half of college smokers deny being smokers, particularly those who are younger, male, attending 4-year colleges, and alcohol consumers. Denying being a smoker was associated with not attempting to quit smoking. Therefore, traditional methods of ascertaining smoking status may not be valid in this population. Healthcare providers should more specifically ask students about recent smoking behavior. Further research is needed to develop interventions targeting smoking among this population.

Introduction

Young adulthood is a critical transition period for cigarette use,1, 2, 3, 4, 5 often involving escalation in smoking⁶ or late-onset smoking.⁷ This is compounded by tobacco-industry efforts targeting young adults.8, 9, 10 In 2006, the rate of past-30-day smoking for those aged 18–25 years was 35.6%–40.2%,¹¹ including a rate of 28.4% among college students.¹¹ Those who continue to smoke beyond their teen years commonly progress to regular cigarette use.⁶ Thus, encouraging early cessation is crucial to decrease the risk of smoking-related illnesses.12, 13 One third of young adults aged 18–24 years attend college,¹⁴ offering an important opportunity to intervene.

More than half of college smokers engage in social smoking, which has been defined as smoking mainly in the presence of others rather than alone.¹⁵ Social smokers¹⁶ and occasional smokers¹⁷ are more likely to be male and attend 4-year versus 2-year colleges.15, 18 This group may not identify as smokers, may be less ready to quit, and may discount personal health consequences.15, 16, 17, 19 However, occasional smoking is associated with increases in adverse respiratory conditions and other health problems.¹⁹

Only one study²⁰ has examined how students respond to smoking-status assessments, documenting that 56.5% denied being smokers despite having smoked in the previous 30 days. Of these “deniers,” three fifths called themselves social smokers. Younger students and those smoking at lower rates were more likely to deny being smokers and to identify as social smokers.

The current study aimed (1) to identify the correlates of denying being a smoker among students reporting smoking in the past 30 days and (2) to determine if denying this label was related to not attempting to quit smoking in the past 12 months. It was hypothesized that a lower level of smoking, alcohol consumption, more poor mental-health days, being younger, being male, and attending a 4-year college would be related to denying being a smoker, which would be related to not attempting to quit.

Section snippets

Recruitment and Participants

In 2007, a student health surveillance survey was administered to students at 14 colleges and universities in Minnesota.¹⁸ The University of Minnesota IRB approved this study.

Measures

Participants reported the number of days in the past 30 days that they had smoked tobacco (0, 1–2, 3–5, 6–9, 10–19, 20–29, or all 30 days) and if they considered themselves smokers. Those who had smoked in the past 30 days were included in the analyses and classified as (1) those identifying as smokers and (2) those

Participant Characteristics

Of the 24,018 students invited to participate, 9931 completed the survey (41.6% response rate); 2255 (22.7%) reported smoking in the past 30 days. The majority of recent smokers were female, non-Hispanic white, and attending 4-year colleges (Table 1).

Bivariate Analyses

Those denying the label of smoker (versus those identifying as smokers) were younger (21.95±4.30 vs 25.64±7.72, p<0.001); male (60.22% vs 39.28%, p<0.001); attending 4-year colleges (62.43% vs 37.57%, p<0.001); smoking on fewer days in the past 30

Discussion

Present findings indicate that lower smoking levels, being younger, being male, attending a 4-year college, and drinking alcohol were important correlates of denying being a smoker. Moreover, it is important to note that, after controlling for smoking level, individuals who denied being a smoker were much less likely to attempt to quit. These findings are consistent with previous literature5, 6, 7, 15, 18 and have important implications for research and clinical practice.

Half of those who

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Idiosyncratic definitions of social smoking proliferate in the literature, making cross-study comparison challenging. This project investigated and differentiated four distinct classifications of social smoking using traditional modeling techniques as well as a multilayer perceptron artificial network, a novel machine learning approach suited for heterogeneous, multidimensional data.
One hundred thirty-three adults recruited from a college in the Pacific Northwest and from Amazon Mechanical Turk, age 18 to 25 (48% men; 37% women; 8% nonbinary; 73% white; 24% Hispanic or Latinx), completed a set of self-report measures assessing common variables associated with cigarette use. Participants also completed a well-validated audio simulation (Smoking-Simulated Intoxication Digital Elicitation) depicting social smoking contexts and reported their willingness to use cigarettes or alcohol in these contexts.
Across three of the four social smoking definitions, social smokers consistently scored lower on measures of dependence, frequency, quantity, willingness to smoke, and all use motives than nonsocial smokers. The area under the curve for all four models ranged from excellent to outstanding discrimination within the training set. Frequency of days smoked in the past month was the most important predictor for three of the classification models with a relative importance of 100%.
The social smoking definitions demonstrated great variability across common cigarette use variables between groups, except for one. The machine learning approach successfully differentiated all four classifications. Recommendations are made for which social smoker classifications to use in subsequent research to maximize appropriate endorsement by the target population.
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Of 1089 respondents, 242 (22%) were identified as phantom smokers. Phantoms smoked half as many cigarillos per week as identified smokers (M = 4.75, SD = 5.11 vs. M = 11.33, SD = 0.88, p < .001) and phantoms were more likely to smoke only when sharing (39.7% vs 21.8%, p < .001). While 59.5% of identified smokers also smoked cigarettes, only 33.5% of phantoms did so (p < .001). Most phantom smokers (83.8%) were unconcerned about addiction. Phantoms also expressed greater confidence in their ability to quit (M = 4.40, SD = 0.98) than did identified smokers (M = 3.72, SD = 1.25, p < .001).
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Improving understanding of additional contributors to adopting the identity of “smoker” could provide insight into areas for intervening on harmful health behaviors among NDS engaging in poly-tobacco use or co-morbid substance use. Nearly all studies examining cigarette smoker identity among NDS draw from community-based or college-recruited convenience samples (Berg et al., 2009; Choi et al., 2010; Guillory et al., 2017; Romero et al., 2014), or state-level data (Leas et al., 2015; Lee et al., 2013). Currently, we do not know how frequency of NDS and use of other combusted products collectively influence self-reported smoker identity in a nationally-representative sample of U.S. smokers.
Identifying as a ‘smoker’ has been associated with many cigarette smoking-related behaviors, including less frequent and intense cigarette use. Additional smoking behaviors (e.g., use of cannabis or cigars) also may contribute to self-identification as a ‘smoker’. This study compared correlates of identifying as a ‘smoker’ and measurement strategies for non-daily cigarette consumption among young-adult intermittent and light daily smokers. Using data from Wave 1 of the PATH Study, different measurements of past 30-day non-daily cigarette use were evaluated. Weighted logistic regression models were used to compare associations with self-identification as a smoker among 18–24 year-old intermittent and light daily smokers (n = 1531). Use of other smoked products (combustible tobacco, cannabis) and other documented correlates of smoker identity were evaluated. As frequency of monthly smoking increased, self-identification as a smoker increased (1–5 days = 24%, 6–19 days = 48%, 20–29 days = 78%, light daily smokers = 93%, daily smokers using >5 cigarettes per day = 99%). Self-reported smoking status 12 months ago significantly contributed to current identification as a smoker. Smoking cigars daily or using cannabis in the past 30 days were each positively associated with smoker identity. Different measurement approaches to non-daily cigarette use offer different advantages in terms of interpretability and granularity of information. Compared to daily smokers, non-daily smokers exhibit significant variability in identifying as a smoker, and systematic correlates of smoker identification are apparent. These findings may serve to enhance understanding of non-daily smokers and potential targets for intervention among this growing subpopulation of tobacco users.
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To 1) estimate changes in the prevalence of daily and non-daily cigarette smoking among current (past 30-day) daily, non-daily, and non-cannabis users in the United States (U.S.) population; 2) examine time trends in current (past 30-day) cigarette smoking in daily, non-daily, and non-cannabis users ages 12+ from 2002 to 2015.
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Brief reportSmoker Self-Identification Versus Recent Smoking Among College Students

Background

Methods

Results

Conclusions

Introduction

Section snippets

Recruitment and Participants

Measures

Participant Characteristics

Bivariate Analyses

Discussion

Prev Med

Smoking, drinking, and drug use in young adulthood: the impacts of new freedoms and new responsibilities

The natural history of drug use from adolescent to the mid-thirties in a general population sample

Am J Pub Health

Smoking initiation and smoking patterns among U.S. college students

J Am Coll Health

Preventing tobacco use among young people: a report of the Surgeon General

Developmental trajectories of cigarette smoking and their correlates from early adolescence to young adulthood

J Consult Clin Psychol

The natural history of cigarette smoking from adolescence to adulthood in a midwestern community sample: multiple trajectories and their psychosocial correlates

Health Psychol

Long-term trends in adolescent and young adult smoking in the U.S.: metapatterns and implications

Am J Public Health

Receptivity to tobacco advertising and promotions among young adolescents as a predictor of established smoking in young adulthood

Am J Public Health

How effective are tobacco industry bar and club marketing efforts in reaching young adults?

Tob Control

Results from the 2006 national survey on drug use and health: national findings

Mortality in relation to smoking: 50 years' observations on male British doctors

BMJ

Helping young adult smokers quit: the time is now

Am J Public Health

Brief report
Smoker Self-Identification Versus Recent Smoking Among College Students