Abigail C. Halperin

Cigarette smoking and associated health risks among students at five universities

INTRODUCTION While most college students and other young adults who smoke fall into the light and intermittent smoking (LITS) category, they remain at risk for tobacco dependence and other adverse health effects from their smoking. This study examines smoking patterns, tobacco dependence, and other health variables among students at five universities to better understand how to identify and address tobacco use and related risks in a college health clinic setting. METHODS A health screening survey was completed by 2,091 college and graduate student volunteers seeking routine care at their university health centers or participating in a health class. Independent health variables were analyzed descriptively and in regression analyses with three levels of smoking (none, non-daily, and daily) and tobacco dependence to determine predictors and associated risks. RESULTS Nearly a quarter of students reported any current smoking, 41% of whom reported smoking less than 1 cigarette/day (cpd). Of the daily smokers, 80% smoked less than 10 cpd but 45% met criteria for tobacco dependence. Any smoking was associated with high-risk alcohol use, risky driving, relational abuse, depression, less exercise, and utilization of emergency and mental health services. In regression analyses, students who experienced depression had more than double the odds of being dependent smokers (odds ratio [OR] = 2.32), as did those who reported abuse (OR = 2.07) or sought mental health counseling (OR = 2.09). DISCUSSION Student health providers should be alerted to the multiple risks and comorbidities that occur among all smokers, including LITS, and intervene concurrently to help prevent or mitigate adverse outcomes that result from these conditions and behaviors.

Prevalence and Characteristics of Smokers at 30 Pacific Northwest Colleges and Universities

College is an important transition period during which young adults explore tobacco use. Few large-scale studies have been conducted among college students regarding tobacco use. We initiated a study examining tobacco use in 30 colleges and universities in the Pacific Northwest. We conducted a baseline survey among students. Sample size varied by the school size; for the 14 largest schools, we drew a random sample of all students, oversampling freshmen (n approximately 750) so that we could recruit and follow a cohort to assess smoking onset during the college years. Of the remaining students, we sampled equivalent numbers of sophomores, juniors, and seniors (n = 200 each). For the 16 schools with fewer than 1,350 students, we surveyed all students. We found overall smoking rates of 17.2%. Males (18.6%) were more likely to smoke than females (16.6%; p = .03), and public college students were more likely to smoke (20.5%) than those who attended private independent schools (18.9%; p = .61), whose rates were higher than those of private religious schools (11.6%; p = .001). Overall, college students are light smokers who do not smoke every day of the month. Further, they tend not to be highly dependent on tobacco, do not consider themselves regular smokers, and plan to quit before they graduate (56.8%). School type should be considered when estimating smoking rates among 4-year college students. Data indicate that college smokers wish and plan to quit before graduation, suggesting that efforts to assist smokers in quitting during the college years may be fruitful.

IMPACT OF SYMPTOMS EXPERIENCED BY VARENICLINE USERS ON TOBACCO TREATMENT IN A REAL WORLD SETTING

This article examines reported symptoms, nonsmoking rates, and medication use among 1,018 smokers using varenicline in a randomized trial comparing three forms of behavioral support for smoking cessation (phone, Web, or phone + Web). One month after beginning varenicline, 168 people (17%) had discontinued the medication. Most (53%) quit due to side effects and other symptoms. The most common side effect among all users was nausea (reported by 57% of users). At 1 month post medication initiation, those not taking varenicline were more likely to report smoking than those who continued the medication (57% vs. 16%, p < .001). Women reported more symptoms but did not discontinue medication at higher rates. Participants who received any telephone counseling (n = 681) were less likely to discontinue their medication than those with Web support only (15% vs. 21%, p < .01). Counseling may improve tolerance of this medication and reduce the rate of discontinuation due to side effects.

Association of Maternal Smoking during Pregnancy with Infant Hospitalization and Mortality Due to Infectious Diseases

Background: Maternal smoking is associated with infant respiratory infections and with increased risk of low birth weight infants and preterm birth. This study assesses the association of maternal smoking during pregnancy with both respiratory and nonrespiratory infectious disease (ID) morbidity and mortality in infants. Methods: We conducted 2 retrospective case-control analyses of infants born in Washington State from 1987 to 2004 using linked birth certificate, death certificate and hospital discharge records. One assessed morbidity—infants hospitalized due to IDs within 1 year of birth (47,404 cases/48,233 controls). The second assessed mortality—infants who died within 1 year due to IDs (627 cases/2730 controls). Results: Maternal smoking was associated with both hospitalization (adjusted odds ratio [AOR] = 1.52; 95% confidence interval [CI]: 1.46, 1.58) and mortality (AOR = 1.51; 95% CI: 1.17, 1.96) due to any ID. In subgroup analyses, maternal smoking was associated with hospitalization due to a broad range of IDs including both respiratory (AOR = 1.69; 95% CI: 1.63, 1.76) and nonrespiratory IDs (AOR = 1.27; 95% CI: 1.20, 1.34). Further stratification by birth weight and gestational age did not appreciably change these estimates. In contrast, there was no association of maternal smoking with ID infant mortality when only low birth weight infants were considered. Conclusions: Maternal smoking was associated with a broad range of both respiratory and nonrespiratory ID outcomes. Despite attenuation of the mortality association among low birth weight infants, ID hospitalization was found to be independent of both birth weight and gestational age. These findings suggest that full-term infants of normal weight whose mothers smoked may suffer an increased risk of serious ID morbidity and mortality.

A Qualitative Study of Attitudes, Beliefs, and Practices among 40 Undergraduate Smokers.

Objective: Because little is known about college-age smokers, the authors conducted a qualitative study to better understand this population. Participants: Forty college student smokers from 12 Pacific Northwest colleges participated in the study. Methods: The authors identified themes and built models to ascertain important factors related to smoking and smoking cessation. Four models emerged: smoking facilitators, smoking barriers, cessation facilitators, and cessation barriers. Results: The authors observed physical, psychological, and social influences across models, and social influences were strongly associated with both smoking and cessation. Many smokers were unlikely to define themselves as regular smokers. Most smokers had made prior quit attempts. Conclusions: College students are a unique category of smoker and colleges can play a role in helping them achieve cessation.

Comparison of 4 recruiting strategies in a smoking cessation trial.

OBJECTIVES To compare 4 online and off-line recruiting methods. METHODS Young adult smokers (n=3353) were recruited to a trial comparing smoking cessation services with an online health risk assessment (HRA), online ads, offline materials, and quit-line screening. RESULTS Online ads (n=1426;

Cigarette Smoking and Outcomes after Allogeneic Hematopoietic Stem Cell Transplantation

41.35) and off-line materials recruited the most smokers (n=1341;

A case-based clinician training program for treating tobacco use in college students.

56.23) for the lowest cost. Quitline screening was more expensive (n=189;

Tobacco Use Treatment in Primary Care Patients with Psychiatric Illness

132.22), but enrollees used cessation services the most (34%-82%). Online HRA was least successful and most costly (n=397;

Effect of nicotine replacement therapy on quitting by young adults in a trial comparing cessation services.

630.85) but had the highest follow-up (45%-55%). CONCLUSIONS Online ads and off-line materials were most effective and cost-effective methods.