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.21,24,38 –40
The current results suggest that denormalization media campaigns, such as the national truth campaign,26–29
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,41–44
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,1,3–6,18,20,30,45
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.