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Understanding and preventing college smoking

Institution: University of Southern California
Investigator(s): Donna Spruijt-Metz, Ph.D.
Award Cycle: 2000 (Cycle 9) Grant #: 9KT-0191 Award: $122,377
Subject Area: Epidemiology
Award Type: New Investigator Awards

Initial Award Abstract
Across the nation, the percentage of college students who smoke is on the rise. This increase has been found in both private and public institutions, in two year and four year colleges and universities, religious and secular institutions, small and large institutions, and urban and rural institutions. It is not limited to one gender or cultural group. College smoking is on the rise across the board. The increase in college smoking over the past 10 years is so substantial that this has been termed a 'cause for national concern'. Tobacco use now poses a major health risk to American college students. First-time college students are in a new environment, often away from their families for the first time. While there is more freedom, there are also many more demands made upon college students to make their own lifestyle decisions without parental supervision or input. There are many opportunities to experiment with risky behaviors such smoking. We know that the health behaviors of college students are important because it is a time when behaviors are changed, modified, or consolidated into lifetime patterns. We also know that college smokers often remain smokers throughout life. In order to prevent the uptake and consolidation of an addiction that carries over into adulthood, there is an urgent need to mount effective smoking prevention campaigns at the college level.

While there is a great need for good prevention programs on college campuses, there is little precedent for prevention of smoking on college campuses. There have not been many state-of-the-art prevention programs launched on college campuses, and those that have been undertaken have not been able to prevent smoking successfully. Perhaps this is due to the fact that so little is known about why college students are taking up smoking. Research has shown that anti-smoking campaigns are most effective when they are based on a solid knowledge of what motivates the population in question to smoke. This means that we need to develop a knowledge base on why college students are smoking before we can begin to intervene. One of the issues that must be taken into account in studying this population is the growing cultural diversity of our college campuses. Cultural as well as gender differences in smoking habits have been repeatedly found. This suggests that different groups of people might have different reasons for smoking. The research proposed here will study why different groups of college students smoke, in order to mount smoking prevention efforts on college campuses that will successfully prevent smoking in the future.

Moving from high school into college entails a whole constellation of potentially stressful experiences, including first-time independent personal care, increased academic pressures, and making new friends in a new environment. This transition often goes hand-in-hand with temporary dips in self-esteem. Both stress and lowered self-esteem are related to smoking. These factors may be especially prescient for cultural groups where the influence of the family and elders is strong and who had been protected by cultural and family influences before the move to college. We have also found that smoking might take on meanings or functions that motivate people to start or stay smoking. For instance, people tend to use smoking as a form of weight control, as a way to manage stress, or as a way to try to fit in with friends or groups of people who smoke. We think that stress, self-esteem issues, and these psychological functions that smoking fulfills combine to motivate people to smoke. We also expect that the way that perceived stress, self-esteem, and psychological functions of behavior influence smoking will differ between cultural groups and between women and men.

A private four-year university, a public four-year university, and a community college will participate in the proposed study. Interviews will be conducted with students from three cultural groups: Caucasian, Mexican (American), and Chinese students, reflecting three of the major cultural groups in California. The interviews will help us to understand smoking behavior in these groups. Three large-scale surveys will be undertaken on each campus in order to gather data to enable us to test our hypotheses.

The research proposed here is very timely. We are specifically interested in understanding and comparing the unique factors and forces that shape the cigarette consumption of Asian-American and Pacific Islanders and Mexican-Americans, as well as the role that acculturation and gender play in college smoking uptake in these groups. The research proposed here will contribute to our ability to provide much needed effective tobacco intervention programs to our culturally diverse college campuses.

Final Report
In 1981, it was estimated that only 8.2% of college students smoked. By 1998, approximately 28.5% of our college students were reporting regular tobacco use. Similar increases have been found in both private and public institutions, in two year and four year colleges and universities, religious and secular institutions, small and large institutions, in urban and rural institutions, and across gender and ethnicity. Although the precipitous rise in tobacco use has been documented by several independent agencies, prevention programs at the college level are few and far between. Furthermore, most college prevention programs that have been documented have not been able to show significant effects of their prevention and/or cessation efforts.

This project was designed to help researchers and health educators understand the processes and mechanisms driving this alarming rise in tobacco use on college campuses across the nation, in order to design evidence-based, relevant and effective prevention and cessation programs for college populations. We were especially interested in developing a knowledge base on why college students are taking up smoking, because research has shown that the best prevention programs are based on solid knowledge of what motivates the population in question to smoke. We thought that stress, low self-esteem, and functional meanings attached to smoking (for example: smoking as a means of weight control, smoking as a means of stress reduction, smoking to conform to norms of peer group) would be major influences on smoking behaviors in college populations. We also thought that there would be gender and ethnic differences in reasons why college students take up or avoid smoking. Our focus was on Mexican American, Chinese, and Caucasian college students. We proposed to examine motivating factors through interviews and questionnaires at three institutions, a private university, a state university, and a community college. Our final aim was to develop and test a model that would describe why college students start smoking and how these reasons for smoking differ between cultures and across genders. The model would serve as a basis for the design of evidence-based college level interventions in the future.

To date, the first year of the project has been completed. Interviews have been conducted with Chinese students in Mandarin by a trained research assistant, and are being transcribed. Interviews with Caucasian students and Mexican American students are near completion. A 21-page survey was mailed out to two of the three participating institutions (private university and community college). We are in the final stages of IRB approval at a state university, and questionnaires are ready to be mailed out. Data has been entered for the first two colleges, and preliminary analyses are very promising. In particular, meanings of smoking behavior (the theory and the scale were developed by the PI) seem to explain why college students smoke quite well. Different meanings are important for girls than for boys, and we are examining the data now for cultural differences. We have shown in previous research that prevention programs designed to change specific meanings of behavior can be very successful. We were also able to show in earlier research on nutrition that when meanings are changed through targeted prevention programs, behavior also changes.

Originally, this project was conceived of as a three-year project. Because of the nature of the funding (a New Investigator award), when the Principal Investigator received additional NIH funding, it was necessary to terminate the project after this first year. However, because of the importance of the emerging findings and the PI’s deep commitment to the research, new funding will be sought in the coming year in order to continue this important project. Using the knowledge gained from this research, we hope to be able to develop state-of-the-art evidence-based tobacco use prevention and cessation programs suited to California’s highly diverse college population.