PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
Am J Prev Med. Author manuscript; available in PMC 2010 May 1.
Published in final edited form as:
PMCID: PMC2700137
NIHMSID: NIHMS113251

Young Adult Smoking Behavior

A National Survey

Abstract

Background

Young adults have the highest smoking rate of any age group in the U.S., and new strategies to decrease young adult smoking are needed. The objective of the current study was to identify psychographic and demographic factors associated with current smoking and quitting behaviors among young adults.

Methods

Attitudes, social groups, and self-descriptors, including supporting action against the tobacco industry, advertising receptivity, depression, alcohol use, and other factors associated with smoking were tested for associations with smoking behaviors in a 2005 cross-sectional survey of 1528 young adults (aged 18–25 years) from a web-enabled panel. Analyses were conducted in 2007.

Results

Being older was associated with current smoking, whereas having some higher education and being African American or Hispanic were negatively associated with smoking. Supporting action against the tobacco industry was negatively associated with smoking (AOR=0.34 [95% CI=0.22, 0.52]). Perceived usefulness of smoking, exposure to smokers, increased perceived smoking prevalence, receptivity to tobacco advertising, binge drinking, and exposure to tobacco advertising in bars and clubs were associated with smoking. Supporting action against the tobacco industry was associated with intentions to quit smoking (AOR= 4.43 [95% CI=2.18, 8.60]).

Conclusions

Young adults are vulnerable to tobacco-industry advertising. Media campaigns that denormalize the tobacco industry and appeal to young adults appear to be a powerful intervention to decrease young adult smoking.

Introduction

Smoking prevention efforts have almost entirely concentrated on primary prevention in adolescents aged ≤ 18 years despite the fact that young adults (aged 18–24 years) have long been a top priority for the tobacco industry.16 Smoking prevention efforts aimed at both adolescents and those aged >18 years are important because the process of smoking initiation takes several years, extending well into young adulthood.710 Many adolescent experimenters and occasional smokers either quit smoking or progress to addiction as young adults.1,1113 Social and nondaily smoking patterns are common among young adults,1418 so not all of them progress to addiction, but a substantial proportion of the young adult population remains at risk for future smoking.19,20 Recent data suggest that at least 20% of smokers became regular smokers as young adults.13 Because public health research on young adult smoking is relatively new, little is known about what strategies will successfully counter tobacco-industry marketing campaigns aimed at young adults.

One promising strategy is the “tobacco industry denormalization”21,22 approach, pioneered by the CA Department of Health Services,23 which educates the public about the deceptive practices of the tobacco industry in order to motivate action against smoking and to increase the relevance of tobacco issues. Industry denormalization, the core strategy of the truth® campaign in Florida,24,25 and nationally,2629 is associated with reduced adolescent smoking. Attitudes associated with exposure to tobacco-industry denormalization media campaigns were negatively associated with smoking behavior among young adults, and they were positively associated with intentions to quit smoking among young adult smokers in CA.30 The generalizability of this result remains open to question because CA had a media campaign in place for over a decade (one that included tobacco-industry denormalization messages) at the time of the current study, so one could question whether these results would generalize to the young adult population in the U.S. as a whole. The current study uses a national sample to examine whether the CA results generalize. These results are that attitudes associated with tobacco-industry denormalization are negatively associated with smoking and positively associated with intentions to quit among young adult smokers.

Methods

A cross-sectional survey of 1528 young adults (aged 18–25 years) was conducted using a web-enabled panel maintained by the research group Knowledge Networks. The web-enabled panel members were recruited from a random digit–dialing sample of the U.S. population and provided with free Internet access in exchange for completing surveys. The panel closely tracks U.S. population demographics, attitudes, and behaviors, and it is comparable to random digit dialing surveys.31 Because of the recruitment and “payment” procedures, the panel includes people without ready access to the Internet and is more likely to represent the population than voluntary Internet samples.31 The smoking rate in the panel in 2002 was 24.7%, comparable to the 23.2% adult smoking prevalence in the 2002 National Health Interview Survey. Panel members aged 18–25 years were recruited for the current study; of 1669 requests, 1325 completed surveys (79.3% response rate). In addition, 203 former Knowledge Networks panel members aged 18–25 years were recruited to achieve the desired sample size of 1500. All surveys were completed via the Internet between September and November 2005; analyses were completed in 2007.

Measures

Smoking behavior

Because young adults are at the transition point between adolescence and adulthood, two measures of current smoking were used: the adult definition of current smokers (have smoked ≥ 100 cigarettes in their lifetime and now smoke cigarettes either every day or on some days) and the youth definition (have smoked ≥ 1 cigarette in the past 30 days). Among current smokers by the adult definition, intention to quit smoking was defined as responding that they intended to quit smoking within the next 6 months. Having made a serious quit attempt was defined as having quit for ≥ 1 month during the past year.

Independent variables

Four items measuring attitudes associated with exposure to tobacco-industry denormalization campaigns were adapted from the Legacy Media Tracking Survey.26 Questions were adapted from marketing research conducted by the tobacco industry,1,2,30,32 including 11 questions from an R.J. Reynolds segmentation study measuring attitudes about smoking and secondhand smoke,33 and 37 measures from a Philip Morris young adult segmentation study.34 Six items from the Impulsive Sensation Seeking Scale from the Zukerman–Kuhlman Personality Questionnaire were integrated with the personality questions from the tobacco-industry survey.35 Questions on exposure to smokers, exposure to tobacco advertising, depression, and advertising receptivity were included, as described previously.30 Binge drinking was measured by asking how often respondents had ≥5 alcoholic drinks on one occasion. Perceived prevalence of smoking was measured by respondents’ estimates of how many people their age smoke. See Appendix A (available online at www.ajpm-online.net) for more information on these measures.

Statistical Analysis

Exploratory factor analysis and scoring

Because of the large number of independent variables, preliminary factor analyses were performed on attitudes about smoking, future goals, personality characteristics, exposure to smokers, and depression, in order to reduce the data. Factors with eigenvalues >1 were selected, and within each factor, items with factor loadings >0.70 were selected for scoring. For each factor, the average score on the 5-point Likert scale for all included items was calculated to create scores to maximize generalizability and consistency.36 Logit plots were created to examine whether a linear relationship between each score and the logit of smoking in the past 30 days was present. If the relationship was linear, the variable was treated as a continuous predictor in subsequent analyses. If the relationship was not linear, scores were recoded into categoric or binary variables based on the distribution of the data and the logit plot.

Factor analysis yielded one factor that contained three items that matched the measure of “supporting action against the tobacco industry” in the current CA study.30 The fourth item in the CA study: NOT smoking is a way to express independence, had a factor loading of only 0.412, so this item was not included in the score in the present study. The score was recoded as a binary item with an average score of ≥4 on the Likert scale coded as 1 and average scores <4 coded as zero. The same process was used to determine factors and scores for the other sets of questions related to smoking attitudes, personality, and future priorities (see Appendix A, available online at www.ajpm-online.net).

Regressions

Bivariate logistic regression was used to determine the relationships between the variables in Appendix A and demographic variables in order to predict current smoking (using both adult and teen definitions, n=1528). The current smokers (by adult definition, n=455) were analyzed to determine factors associated with intention to quit and having made a serious quit attempt.

Predictors with a bivariate association with smoking outcomes with p<0.25 were entered into multivariate logistic regression models.37 In multivariate analyses, predictors with p>0.05 were eliminated using backward stepwise logistic regression, except for the demographic factors that were forced into all models (age, gender, race/ethnicity, education, marital status, income). All data were weighted with post-stratification weights so that estimates would be generalizable to the national population of young adults. All analyses were performed using SPSS version 14.0.

Results

In all, 28.9% of young adults surveyed were current smokers by the adult definition, and 30.8% were current smokers by the teen definition. The sample was 50% male, 62% non-Hispanic white, 18% Hispanic, 14% non-Hispanic African American, and 7% non-Hispanic other race/ethnicity or two or more races/ethnicities. High school or less was the education level for 51.5% of respondents. Most (80%) had never married. Of the 455 current smokers, 40% (181) reported that they intended to quit smoking in the next 6 months, and 29% (132) had made a serious quit attempt in the past year.

Logistic Regressions

Table 1 summarizes the relationships between predictor variables and both adult and teen definitions of smoking (data not shown for individual demographic variables). Supporting action against the tobacco industry was strongly negatively associated with current smoking as established by the adult definition (AOR=0.38 [95% CI=0.24, 0.60]) and the teen definition (AOR=0.31 [95% CI=0.20, 0.47]). Among demographics, being older was associated with current smoking, whereas having a bachelor’s degree or more or being of African-American or Hispanic race/ethnicity were negatively associated with current smoking. Perceived smoking usefulness, exposure to smokers, increased perceived prevalence of smoking, receptivity to tobacco advertising, binge drinking, and exposure to tobacco advertising in bars were associated with current smoking.

Table 1
Associations with current smoking behavior, all respondents N=1528

Factors associated with lack of an intention to quit or not having made a serious quit attempt in the past year among the current smokers are summarized in Table 2. Supporting action against the tobacco industry was strongly associated with intentions to quit smoking (AOR= 4.43 [95% CI=2.18, 8.60]; reverse outcome reported in Table 2) but not with having made a serious quit attempt in the past year. Among demographics, being male or in one of the higher income categories was associated with greater intention to quit but not with actual quitting behavior. Both having higher income and being of Hispanic ethnicity were associated with having made a quit attempt. Being of African-American race was associated with greater intent to quit but not with quitting behavior in multivariate analyses. Advertising receptivity, exposure to smokers, and —being hip were all associated with a lack of intent to quit smoking. Exposure to smokers, materialism, assertiveness, and exposure to tobacco advertising in bars were negatively associated with serious quit attempts.

Table 2
Quitting behavior among current smokers (by adult definition), N=451

Discussion

This study is limited by the fact that it used a panel sample of young adults in the U.S., which may differ from a random national sample of young adults in unmeasured ways. However, random digit–dialing methods are increasingly less effective at reaching young adults for many reasons. For example, in 2008, the Harris Poll found that over one third of young adults aged 18–29 years reported using only a cell phone or the Internet for all phone calls (http://www.harrisinteractive.com/harris_poll/index.asp?PID=890). The smaller size of the current smoking subgroup may have limited the ability to detect significant associations with quitting behavior. Interactions were not included in the current analysis because none were hypothesized in the literature; future studies should consider theory-driven interactions. The study is limited by its cross-sectional design; the observed associations do not prove causality between the measured attitudes and smoking behavior.

This study provides confirmation in a national sample of CA results30 that supporting action against the tobacco industry, as reflected by agreement with the statements: Taking a stand against smoking is important to me; I would like to see cigarette companies go out of business; and I want to be involved with efforts to get rid of cigarette smoking is negatively associated with current smoking and positively associated with intentions to quit smoking. Tobacco-industry denormalization campaigns have been shown to decrease youth smoking in several studies.21,24,3840 The current results suggest that denormalization media campaigns, such as the national truth campaign,2629 may also be associated with young adult smoking behavior. An association between these attitudes and having made a serious past quit attempt was not observed. Whether intentions to quit smoking in the future result in actual cessation should be investigated prospectively.

Several other factors associated with young adult smoking behavior were identified. Consistent with other studies,4144 exposure to smokers (family members, friends, coworkers, and social contacts) was strongly associated with current smoking and negatively associated with quitting intention and attempts among young adults. Tobacco-industry marketing strategies that attempt to create smoker-friendly social environments, through activities such as bar promotions,1,36,18,20,30,45 exploit this vulnerability. Young adult homes, workplaces, and social environments are also important venues for public health interventions to decrease smoking uptake and to promote cessation. Countermarketing campaigns that decrease the social acceptability of smoking may directly address the effects of smoker-friendly social environments created by tobacco marketing.

Our data support the conclusion that young adults continue to be vulnerable to the effects of tobacco advertising.20 Receptivity to tobacco advertising was associated with current smoking and negatively associated with intent to quit smoking. Exposure to tobacco advertising in bars was associated with current smoking and having not made a serious quit attempt, independent of alcohol use. Advertising restrictions, such as those in the 1998 Master Settlement Agreement,46 contain loopholes that allow advertising in “adult-only” venues, exempting most tobacco-industry bar promotions, which expanded rapidly in the 1990s.5,47 Attendance at “adults only” promotional events is associated with young adult smoking behavior.4 The current results highlight the importance of bars and clubs as venues for recruitment of new smokers and promotion of regular smoking.

Attitudes attesting to the usefulness of smoking either as a social lubricant or as a means to reduce stress were strongly associated with current smoking but not with quitting. It may be that believing smoking is useful is more important in promoting smoking uptake than in deterring quitting. In contrast, some factors associated with personality types and general attitudes were significantly associated with quitting intentions and quitting behavior, but not with current smoking, and should be explored further.

Conclusion

This study demonstrates a strong association between attitudes reflecting tobacco-industry denormalization and smoking behavior among young adults. In addition, exposure to smokers and advertising is associated with young adult smoking and quitting behavior. Strong anti-tobacco media campaigns that denormalize tobacco may be useful interventions to decrease young adult smoking. Tobacco policies such as advertising restrictions should take into account not only the protection of youth but also the recruitment of new smokers through advertising to young adults. Social environments such as bars and clubs are important venues for public health efforts to address young adult smoking.

Supplementary Material

Acknowledgments

This work was supported by the Flight Attendant Medical Research Institute and National Cancer Institute Grant CA-87472. The sponsors played no role in the conduct of the research or preparation of the manuscript.

Footnotes

No financial disclosures were reported by the authors of this paper.

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

References

1. Ling PM, Glantz SA. Why and how the tobacco industry sells cigarettes to young adults: evidence from industry documents. Am J Public Health. 2002;92(6):908–16. [PubMed]
2. Ling PM, Glantz SA. Using tobacco industry marketing research to design more effective tobacco control campaigns. JAMA. 2002;287:2983–9. [PubMed]
3. Biener L, Albers AB. Young adults: vulnerable new targets of tobacco marketing. Am J Public Health. 2004;94(2):326–30. [PubMed]
4. Rigotti NA, Moran SE, Wechsler H. U.S. college students’ exposure to tobacco promotions: prevalence and association with tobacco use. Am J Public Health. 2005;95(1):138–44. [PubMed]
5. Sepe E, Ling PM, Glantz SA. Smooth moves: bar and nightclub tobacco promotions that target young adults. Am J Public Health. 2002;92(3):414–9. [PubMed]
6. Katz SK, Lavack AM. Tobacco related bar promotions: insights from tobacco industry documents. Tob Control. 2002;11(1):S:I92–101. [PMC free article] [PubMed]
7. Everett SA, Husten CG, Kann L, Warren CW, Sharp D, Crossett L. Smoking initiation and smoking patterns among U.S. college students. J Am Coll Health. 1999;48(2):55–60. [PubMed]
8. Chassin L, Presson CC, Rose JS, Sherman SJ. The natural history of cigarette smoking from adolescence to adulthood: demographic predictors of continuity and change. Health Psychol. 1996;15(6):478–84. [PubMed]
9. Pierce JP, Naquin M, Gilpin E, Giovino G, Mills S, Marcus S. Smoking initiation in the United States: a role for worksite and college smoking bans. J Natl Cancer Inst. 1991;83(14):1009–13. [PubMed]
10. Gilpin EA, Emery SL, Farkas AJ, Distefan JM, White MM, Pierce JP. The California Tobacco Control Program: a decade of progress, 1989–1999. La Jolla CA: University of California San Diego; 2001.
11. Wechsler H, Rigotti NA, Gledhill-Hoyt J, Lee H. Increased levels of cigarette use among college students: a cause for national concern [published erratum appears in JAMA 1999;281(2):136] JAMA. 1998;280(19):1673–8. [PubMed]
12. Rigotti NA, Lee JE, Wechsler H. U.S. college students’ use of tobacco products: results of a national survey. JAMA. 2000;284(6):699–705. [PubMed]
13. Lantz PM. Smoking on the rise among young adults: implications for research and policy. Tob Control. 2003;12(1):S:i60–70. [PMC free article] [PubMed]
14. Wortley PM, Husten CG, Trosclair A, Chrismon J, Pederson LL. Nondaily smokers: a descriptive analysis. Nicotine Tob Res. 2003;5(5):755–9. [PubMed]
15. Harris JB, Schwartz SM, Thompson B. Characteristics associated with self-identification as a regular smoker and desire to quit among college students who smoke cigarettes. Nicotine Tob Res. 2008;10(1):69–76. [PubMed]
16. Levinson AH, Campo S, Gascoigne J, Jolly O, Zakharyan A, Tran ZV. Smoking, but not smokers: identity among college students who smoke cigarettes. Nicotine Tob Res. 2007;9(8):845–52. [PubMed]
17. Moran S, Wechsler H, Rigotti NA. Social smoking among U.S. college students. Pediatrics. 2004;114(4):1028–34. [PubMed]
18. Gilpin EA, White VM, Pierce JP. How effective are tobacco industry bar and club marketing efforts in reaching young adults? Tob Control. 2005;14(3):186–92. [PMC free article] [PubMed]
19. Gilpin EA, White VM, Pierce JP. What fraction of young adults are at risk for future smoking, and who are they? Nicotine Tob Res. 2005;7(5):747–59. [PubMed]
20. Gilpin EA, White MM, Messer K, Pierce JP. Receptivity to tobacco advertising and promotions among young adolescents as a predictor of established smoking in young adulthood. Am J Public Health. 2007;97(8):1489–95. [PubMed]
21. Goldman L, Glantz S. Evaluation of antismoking advertising campaigns. JAMA. 1998;279(10):772–7. [PubMed]
22. Hersey JC, Niederdeppe J, Evans WD, et al. The theory of “truth”: how counterindustry campaigns affect smoking behavior among teens. Health Psychol. 2005;24(1):22–31. [PubMed]
23. Stevens C. Designing an effective counteradvertising campaign California. Cancer. 1998;83(12 Suppl Robert):2736–41. [PubMed]
24. Zucker D, Hopkins RS, Sly DF, Urich J, Kershaw JM, Solari S. Florida’s “truth” campaign: a counter-marketing, anti-tobacco media campaign. J Public Health Manag Pract. 2000;6(3):1–6. [PubMed]
25. Niederdeppe J, Farrelly MC, Haviland ML. Confirming “truth”: more evidence of a successful tobacco countermarketing campaign in Florida. Am J Public Health. 2004;94(2):255–7. [PubMed]
26. Farrelly MC, Healton CG, Davis KC, Messeri P, Hersey JC, Haviland ML. Getting to the truth: evaluating national tobacco countermarketing campaigns. Am J Public Health. 2002;92(6):901–7. [PubMed]
27. Farrelly MC, Davis KC, Haviland ML, Messeri P, Healton CG. Evidence of a dose-response relationship between “truth” antismoking ads and youth smoking prevalence. Am J Public Health. 2005;95(3):425–31. [PubMed]
28. Thrasher JF, Niederdeppe JD, Jackson C, Farrelly MC. Using anti-tobacco industry messages to prevent smoking among high-risk adolescents. Health Educ Res. 2006;21(3):325–37. [PubMed]
29. Farrelly MC, Davis KC, Duke J, Messeri P. Sustaining ‘truth’: changes in youth tobacco attitudes and smoking intentions after 3 years of a national antismoking campaign. Health Educ Res. 2009;24(1):42–8. [PubMed]
30. Ling PM, Neilands TB, Glantz SA. The effect of support for action against the tobacco industry on smoking among young adults. Am J Public Health. 2007;97(8):1449–56. [PubMed]
31. Krosnick JA, Chang LC. A comparison of the random digit dialing telephone survey methodology with internet survey methodology as implemented by Knowledge Networks and Harris interactive. Presented at the Conference of the American Association for Public Opinion Research; 2001.
32. Ling PM, Glantz SA. Tobacco industry research on smoking cessation. Recapturing young adults and other recent quitters. J Gen Intern Med. 2004;19(5 Pt 1):419–26. [PMC free article] [PubMed]
33. Reynolds RJ. RJR Segmentation Study. Cigarette Issues Cluster Banner. Cigarette Attribute Cluster Banner. 1997. 372-60. http://legacy.library.ucsf.edu/tid/oxk97c00.
34. Marketing Information Systems Intl. YAM YAF Study (Screener) 1997. http://legacy.library.ucsf.edu/tid/hqm37c00.
35. Zukerman M. Zukerman-Kuhlman Personality Questionnaire (ZKPQ): an alternative five-factorial model. In: DeRaad B, Perugini M, editors. Big five assessment. Hogrefe & Huber; 2002. pp. 377–96.
36. Grice JW. Computing and evaluating factor scores. Psychol Methods. 2001;6(4):430–50. [PubMed]
37. Hosmer DW, Lemeshow S. Applied logistic regression. New York: John Wiley and Sons; 1989.
38. Balbach ED, Glantz SA. Tobacco control advocates must demand high-quality media campaigns: the California experience. Tob Control. 1998;7(4):397–408. [PMC free article] [PubMed]
39. Sly DF, Hopkins RS, Trapido E, Ray S. Influence of a counteradvertising media campaign on initiation of smoking: the Florida “truth” campaign. Am J Public Health. 2001;91(2):233–8. [PubMed]
40. Wakefield M, Chaloupka F. Effectiveness of comprehensive tobacco control programmes in reducing teenage smoking in the USA. Tob Control. 2000;9(2):177–86. [PMC free article] [PubMed]
41. Daly KA, Lund EM, Harty KC, Ersted SA. Factors associated with late smoking initiation in Minnesota women. Am J Public Health. 1993;83(9):1333–5. [PubMed]
42. Backinger CL, Fagan P, Matthews E, Grana R. Adolescent and young adult tobacco prevention and cessation: current status and future directions. Tob Control. 2003;12(4):IV46–53. [PMC free article] [PubMed]
43. Nelson DE, Mowery P, Asman K, et al. Long-term trends in adolescent and young adult smoking in the United States: metapatterns and implications. Am J Public Health. 2008;98(5):905–15. [PubMed]
44. Solberg LI, Boyle RG, McCarty M, Asche SE, Thoele MJ. Young adult smokers: are they different? Am J Manag Care. 2007;13(11):626–32. [PubMed]
45. Ling PM, Glantz SA. Nicotine addiction, young adults, and smoke-free bars. Drug Alcohol Rev. 2002;21(2):101–4. [PubMed]
46. King C, 3rd, Siegel M. The Master Settlement Agreement with the tobacco industry and cigarette advertising in magazines. N Engl J Med. 2001;345(7):504–11. [PubMed]
47. Sepe E, Glantz SA. Bar and club tobacco promotions in the alternative press: targeting young adults. Am J Public Health. 2002;92(1):75–8. [PubMed]