Smoking, but not smokers: identity among college students who smoke cigarettes.

Cigarette smoking in college is often described as social smoking, but the term lacks definition and implicitly discounts dependence. We report on college students' use of the terms social smoker and smoker. Students who currently smoked cigarettes were asked whether they considered themselves smokers, and whether they smoked because they were social smokers. The survey was conducted during 1999-2004 at eight colleges; analysis was limited to 1,401 students aged 18-24 years. More than half of students (56.3%) denied being smokers ("deniers") despite current smoking behavior. Half of deniers, and fewer than half of admitters, called themselves social smokers. Deniers were highly likely to smoke infrequently, to say they were not addicted to cigarettes, to have mostly nonsmokers as close friends, to prefer dating nonsmokers, and to smoke for reasons other than stress relief. In contrast, social-smoker identity was associated only weakly with any attitude, behavior, or belief. Smoker and social-smoker identities were not significantly correlated with each other. Regardless of identity, more than half of the respondents wanted to quit smoking by graduation. Results suggest that denying being a smoker may be a widespread dissonance among college students who smoke. The possibility should be evaluated using population-level research, because it has potentially undermining implications for smoking cessation campaigns. Campus health centers should avoid using "smoker" self-assessment items on pre-exam questionnaires. Further research is needed to explore the psychosocial mechanisms involved with denier identity, to clarify the implications for public health communications, and to develop appropriate intervention strategies.     

Brief report: pain and readiness to quit smoking cigarettes.

This study explored the relationship between smoking and significant pain. It was hypothesized that readiness to quit smoking would be negatively affected by pain issues. A cross-sectional design was used in this phone-based survey with randomly selected adult smokers. A total of 307 adult participants in the control group from a larger Quit and Win Study participated in the interview. Participants were contacted at home and completed a 20-min phone survey including measures of pain, stress, depressive symptoms, social support, tobacco use status, and readiness to quit smoking. A total of 28% reported significant pain in the past week. Participants who experienced significant pain smoked more cigarettes per day than those who did not report significant pain. However, pain was not associated with readiness to quit. More than half (58%) of those with significant pain were in the contemplation stage of change or higher. The fact that smokers with pain were just as likely as those without significant pain to be ready to quit demands that each individual patient with pain be assessed for readiness to quit so that a tailored approach can be adopted either to motivate the patient to quit or to assist the patient with evidence-based tobacco dependence treatment strategies if he or she wants such treatment. Placing formal tobacco dependence treatment programs within pain clinics and addressing pain in smoking cessation programs is recommended.     

Cigarette acquisition and proof of age among US high school students who smoke

OBJECTIVE: To determine how US high school students who are under 18 years of age and who smoke obtain their cigarettes and whether they are asked for proof of age. DESIGN AND SETTING: Data from the Centers for Disease Control and Prevention's 1995, 1997, and 1999 national Youth Risk Behavior Surveys which employed national probability samples of students in grades 9-12 (ages 14-18 years). MAIN OUTCOME MEASURES: Associations of usual source of cigarettes and request for proof of age with variables such as sex, race/ethnicity, grade, and frequency of smoking. RESULTS: In 1999, among current smokers under age 18 years, 23.5% (95% confidence interval (CI), -4.5% to +4.5%) usually purchased their cigarettes in a store; among these students, 69.6% (95% CI -5.7% to +5.7%) were not asked to show proof of age. As days of past month smoking increased, reliance on buying cigarettes in a store (p < 0.001) and giving someone else money to buy cigarettes (p < 0.001) increased, and usually borrowing cigarettes decreased (p < 0.001). From 1995 to 1999, relying on store purchases significantly decreased (from 38.7% (95% CI -4.6% to + 4.6%) to 23.5% (95% CI -4.5% to +4.5%)); usually giving someone else money to buy cigarettes significantly increased (from 15.8% (95% CI -3.6% to +3.6%) to 29.9% (95% CI -4.5% to + 4.5%)). CONCLUSIONS: Stricter enforcement of tobacco access laws is needed to support other community and school efforts to reduce tobacco use among youth. Furthermore, effective interventions to reduce non-commercial sources of tobacco, including social, need to be developed and implemented.     

The dog as a passive smoker: effects of exposure to environmental cigarette smoke on domestic dogs.

Of the few studies available regarding the effects of smoking on animals, most of them involve animals actively smoking through the use of a mask or tracheostomy. The present study investigated the effects of passive smoke exposure on domestic dogs. The sample comprised 30 Yorkshire terriers (18 males) ranging in age from 27 to 106 months (M = 38.6+/-15.8) and weighing 1.9-4.0 kg (M = 3.04+/-0.48). Half of the dogs came from homes where residents smoked at least 20 cigarettes/day for a minimum of 24 months, and the other half were from homes without smokers. All animals were subjected to bronchoalveolar lavage to determine cell populations and the presence of anthracosis in macrophage cytoplasm; in addition, a carinal biopsy was obtained. To characterize environmental cigarette smoke exposure, urinary cotinine was determined by an immunochromatographic assay. Cotinine was not detected in the urine of dogs not exposed to cigarette smoke, whereas exposed dogs tested positive. In dogs exposed to cigarette smoke, macrophage and lymphocyte populations were significantly increased (p<.05) and anthracosis was present in the cytoplasm of macrophages. The measurement of urinary cotinine by an immunochromatographic assay is an effective method that can be used to confirm environmental tobacco exposure. Cytological analysis of bronchoalveolar lavage fluid demonstrated airway alterations triggered by passive exposure to tobacco smoke in domestic animals.     

Longitudinal study of household smoking ban adoption among households with at least one smoker: associated factors, barriers, and smoker support.

We conducted a longitudinal study among Oregon households with at least one smoker to assess smoking-related associations with ban adoption, to examine smoker support for bans, and to examine barriers to ban establishment. We followed a cohort of 1,604 baseline survey respondents for a median time of 21 months and re-interviewed 825 respondents (51.4% response rate). Of these, 512 did not have a full household ban in place at baseline. Thirty-two percent of the respondents without a ban at baseline adopted a full ban. Baseline smoking-related factors associated with ban adoption were: longer time until first cigarette, stage of change, and attitudes towards respondent's smoking. Associated follow-up factors included cessation and reduced consumption. Ninety-one percent of respondents reported smoker support of a ban. Future work should focus on ban establishment in households with more highly addicted smokers.     

Reconsidering stress and smoking: a qualitative study among college students

Background

Although it is widely acknowledged among adult smokers that increases in smoking are often precipitated by stressful events, far less attention has been given to smoking during times of stress among youth.

Aims

To address this gap by drawing attention to the social utility of smoking in contexts associated with stress among college students.

Design

Face‐to‐face semistructured interviews with college freshmen at a large midwestern university in the US.

Participants

Male and female low‐level smokers (n = 24), defined as those who reported regular weekday smoking (typically 3–4 cigarettes a day) and smoking at parties on weekends, were interviewed once in person. In addition, 40 brief interviews with smokers were conducted during final examination.

Measurements

Interviews focused on a range of issues including current smoking behaviour and reasons for smoking. As part of the interview, students were given a deck of cards that listed a range of reasons for smoking. Participants were asked to select cards that described their smoking experience in the past 2 weeks. Those who selected cards that indicated smoking when stressed were asked to explain the reasons why they did so.

Results

A review of qualitative responses reveals that smoking served multiple functions during times of stress for college students. Cigarettes are a consumption event that facilitates a brief social interaction during study times when students feel isolated from their friends. Cigarettes also serve as an idiom of distress, signalling non‐verbally to others that they were stressed. Students described smoking to manage their own stress and also to help manage “second‐hand stress” from their friends and classmates.

Conclusions

Moving away from an individual‐focused analysis of stress to a broader assessment of the social contexts of smoking provides a more nuanced account of the multifunctionalilty of cigarettes in students'' lives. Qualitative research draws attention to issues including the need for smoking and socialising during examination time, smoking as a way to take a break and refocus, notions of second‐hand stress and smoking to manage social relationships.In the past decade, several US‐based studies have reported significant levels of smoking among college students, with approximately 30% of college students reporting having smoked in the past 30 days, and 40% reporting having smoked in the past year.^1,2 Studies have found that a majority of college students who smoke are social smokers, meaning that they smoke more often with others than when alone, particularly when drinking, and that they smoke at low levels.^3,4 To understand better the patterns of low‐level tobacco use, qualitative research was conducted to examine closely the contexts in which students smoked. It has been suggested that a better understanding of the social context of smoking may help enhance tobacco control research and practice.⁵ Two broad contexts that begged consideration were positive social contexts in which tobacco use occurred (such as parties where alcohol was consumed), and contexts associated with stress, be this stressful life events (such as the taking of exams) or stressful events related to the management of social relationships and shifts in identity at this time of transition in life.This article highlights major findings of qualitative research on smoking in contexts associated with stress among college students. It is well established in the general population that increases in smoking are often precipitated by stressful events.^6,7 We draw attention to the social utility of smoking in contexts associated with stress, acknowledging that tobacco use also has psychological and physiological effects when used as a form of stress management and self‐medication.Three major issues guided the research: (1) to explore the extent to which students use smoking as a multifunctional tool for stress management; (2) to determine whether students use smoking as an idiom of distress and a means of showing empathy when a friend is under stress; and (3) to provide details on the complex of motivations that lead students to smoke during examination time.     

Perception of foreign cigarettes and their advertising in China: a study of college students from 12 universities

OBJECTIVE—To examine how deeply foreign cigarette advertising had penetrated the Chinese market when a new ban on cigarette advertising was enacted in February 1995.DESIGN—A survey using self-completion questionnaires administered in college classrooms from November 1994 to March 1995.SETTINGS—Eight universities and four medical schools in three Chinese cities: Beijing, Wenzhou, and Hangzhou.SUBJECTS—1896 college students who agreed to complete a written questionnaire. The mean age was 21.2 years; 39.5% of respondents were female.RESULTS—Four of the top eight cigarette brands most familiar to the respondents were foreign: Marlboro, 555, Kent, and Hilton. Advertisements for the foreign brands were much more likely to be seen than those for the domestic brands; those for Marlboro were reported most often (29.7%), followed by 555 (21.8%) and Kent (18.1%). Among smokers, Marlboro was the most preferred foreign brand, by 44.2%. The preference for Marlboro was also correlated with smokers having seen its advertisements. Most respondents, 71.8%, believed that cigarette advertising should be banned.CONCLUSIONS—The previous restrictions on cigarette advertising in China failed to prevent a large portion of the population from seeing and understanding the advertisements. Before the 1995 advertising ban took effect, strict limitations on imports of foreign cigarettes notwithstanding, certain highly advertised brands such as Marlboro achieved wide recognition and even consumer preference. Stricter restrictions are suggested as previous ones have failed to achieve their intended effects.     

The influence of personality and affect on nicotine dependence among male college students.

Many clinicians and researchers hypothesize that tobacco use disorders, regardless of the route of administration, are maintained by the ability of nicotine to regulate positive and negative mood states. The present study (N=137) examined whether certain mood states predicted dependence on either cigarettes or smokeless tobacco and whether specific personality characteristics (e.g., extraversion, neuroticism, and psychoticism) mediated these relationships among young male college students. Results indicated that positive and negative moods predicted cigarette dependence (p values=.01) and that neuroticism partially mediated the relationship between positive affect and cigarette dependence. Exploratory analyses revealed that positive affect also interacted with neuroticism to predict smokeless tobacco dependence (p=.04). Simple effects analyses revealed that this relationship was maintained only among individuals high in neuroticism. Results suggested that dependence on cigarettes and smokeless tobacco among male college students may have different affective correlates and that certain personality characteristics may enhance and explain the effects of mood on tobacco dependence.     

Predictors of the development of elementary-school children's intentions to smoke cigarettes: hostility, prototypes, and subjective norms.

Children's intentions to smoke are reliable predictors of subsequent smoking and precede smoking initiation; thus identifying predictors of intentions is important for preventing or delaying smoking initiation. Children's hostility and sociability, mediated by the development of prototypes (i.e., social images of children who smoke cigarettes) and subjective norms regarding smoking among peers, were expected to predict the development of their intentions to smoke cigarettes in the future. Children in 2nd through 5th grades (N = 809) from a western Oregon community participated in a longitudinal study. Hostility and sociability were assessed by teachers' ratings, and prototypes, subjective norms, and intentions were assessed by self-report at each of the first four annual assessments. Children's intentions to smoke predicted whether they had tried cigarettes by the fifth assessment. For both genders, latent growth modeling demonstrated that hostility, but not sociability, predicted the development of smoking intentions. Children who were more hostile were more likely to have higher initial levels of intentions to smoke, and for boys this effect was mediated by their higher initial levels of subjective norms about smoking. Sociability was not related to the development of smoking cognitions for boys or girls. These results are discussed in terms of opportunities to intervene in early influences on smoking intentions.     

Characteristics associated with rapid transition to tobacco dependence in youth.

Epidemiologic data suggests the smoking trajectory for some adolescents escalates rapidly and that tobacco dependence can develop quickly after initiation. In this study, we examine variation in cigarette consumption and individual characteristics associated with the rapid development of tobacco dependence, focusing particularly on the 24-month interval after tobacco initiation. The analysis is based on public use data files of the National Household Survey on Drug Abuse conducted in 1994-1996. Representative samples of adolescents aged 12-17 years old, totaling 13,831, completed a standardized interview assessing demographic characteristics, tobacco involvement and past year dependence, and psychological functioning over the preceding 6-month period as assessed by the Youth Self-Report. Analyses were restricted to the 1,734 youth who had started smoking within 0-24 months prior to being assessed, of which the onset for 70% of them was between 11-24 months. Logistic regression models took into account sample weights and used a variance estimation procedure appropriate for the complex multistage sampling design. Overall, 210 recent initiators met dependence criteria (13.5%, 95% CI = 12.0-15.2). Dependent smokers had greater cigarette involvement than youth who had not transitioned to being tobacco dependent by the time of assessment. Variation in mental health and sociodemographic characteristics were also detected. Disruptive behavior (p = .05) and being female (p = .02) were associated with being tobacco dependent. The rapid transition to dependence in youth depends not only on cigarette consumption features, but may also be associated with individual characteristics.     

Activation of platelets exposed to shear stress in the presence of smoke extracts of low-nicotine and zero-nicotine cigarettes: the protective effect of nicotine.

Mainstream and sidestream smoke extracts of both high-tar and low-tar cigarettes have been shown to increase platelet activation directly and to sensitize them to further activation by exposure to mechanical stimuli such as shear stress. However, nicotine has an inhibitory effect on platelet activation, opposite to that of whole cigarette smoke extracts. To distinguish between the nicotine-dependent and non-nicotine-dependent effects of smoke, platelets were exposed to mainstream and sidestream smoke extracts of low-nicotine and zero-nicotine cigarettes in vitro under flow conditions comparable with the normal circulation, and their activation state was measured using a modified prothrombinase-based assay. Both low-nicotine and zero-nicotine extracts caused increased platelet activation upon exposure to shear stress, and they caused significantly greater activation than extracts from ordinary high-tar, high-nicotine cigarettes. That nicotine was crucial was confirmed by adding 50 nM nicotine (comparable with the nicotine level in smokers' plasma) to zero-nicotine smoke extracts and demonstrating a reduction in the shear-dependent rate of platelet activation of more than 75%.     

Estimate of dietary exposure to sulphites using Brazilian students as a sample population.

In Brazil, there is neither a register of the use of sulphites by the food industry nor is research being undertaken on their dietary exposure to the population. The objective of the work reported here was to estimate the dietary exposure to sulphites in two different groups of high school students, a fee-paying school group and a state school group. The data were collected through a 24-hour dietary recall, which provided estimates of sulphited foods and beverages in the diet. The Maximum Permitted Level (MPL), established by the Brazilian legislation for each of the sulphited food and beverages, was used to measure the dietary exposure to this additive. On this basis none of the students could have exceeded the Acceptable Daily Intake (ADI) of 0.70 mg SO2/kg bw/day, with a average dietary exposure of 0.07 mg SO2/kg bw/day (p<0.001), with no significant statistical difference (p=0.643) between fee-paying and state school students. Highly exposed consumers (dietary exposure to more than 50% of the ADI, or either, 0.35 mg SO2/kg bw/day, to the maximum of 0.52 mg SO2/kg bw/dia) represented 4.5% of the researched samples and reached these levels of intake due to a consumption beyond 500 ml/day of industrialized packaged fruit juices, and, in the fee-paying school, for associating its consumption with alcoholic beverages like beer and wine.     

Incremental validity of anxiety sensitivity in terms of motivation to quit, reasons for quitting, and barriers to quitting among community-recruited daily smokers.

The present investigation examined the relationships between anxiety sensitivity and motivation to quit smoking, barriers to smoking cessation, and reasons for quitting smoking among 329 adult daily smokers (160 females; M (age) = 26.08 years, SD = 10.92). As expected, after covarying for the theoretically relevant variables of negative affectivity, gender, Axis I psychopathology, nonclinical panic attack history, number of cigarettes smoked per day, and current levels of alcohol consumption, we found that anxiety sensitivity was significantly incrementally related to level of motivation to quit smoking as well as current barriers to quitting smoking. Partially consistent with the hypotheses, after accounting for the variance explained by other theoretically relevant variables, we found that anxiety sensitivity was significantly associated with self-control reasons for quitting smoking (intrinsic factors) as well as immediate reinforcement and social influence reasons for quitting (extrinsic factors). Results are discussed in relation to better understanding the role of anxiety sensitivity in psychological processes associated with smoking cessation.     

Smoking practices, risk perception of smoking, and environmental tobacco smoke exposure among 6th-grade students in Ciudad Juárez, Mexico.

This study assessed the smoking practices, risk perception of smoking, and environmental tobacco smoke (ETS) exposure among adolescents in Ciudad Juárez, Mexico. We used a cross-sectional method to examine the smoking practices, risk perception of smoking, and ETS exposure of 6th-grade students (N=506), aged 11-13 years, attending six randomly selected middle schools. Schools were classified by school setting (i.e., public vs. private) and socioeconomic status (SES; i.e., low, middle, or high). The results indicated that 6th-grade students attending a public, low-SES school setting in Ciudad Juárez not only exhibited significantly higher rates of ETS exposure at home and in public places (p<.01) but also were more likely to have tried smoking (p<.01) and to be current smokers (p<.01), and were less likely to support a ban on smoking in public places (p<.01), compared with students who attended a private school or a public, middle- or high-SES school setting. These results provide further evidence that public health interventions to prevent initiation of smoking and to assist in smoking cessation among adolescents and to reduce their ETS exposure at home and in public need to target all school-aged students, especially those attending school in a low-SES settings.     

Factor structure and validity of the Medication Adherence Questionnaire (MAQ) with cigarette smokers trying to quit.

The Medication Adherence Questionnaire (MAQ) is a scale used to evaluate adherence to medications. The present study assessed the factor structure and validity of the MAQ with cigarette smokers. A principal components analysis was conducted on MAQ scores from a sample of smokers presenting for treatment in a clinical trial of naltrexone and nicotine patch for smoking cessation (N = 385). Indices of convergent and predictive validity were tested using electronic medication caps for naltrexone, nicotine patch counts, plasma drug levels of naltrexone, and treatment outcomes. The principal components analysis revealed two factors. Factor 1, labeled "unintentional nonadherence," measured the extent to which individuals were nonadherent because they were careless or forgot to take their medications. Factor 2, labeled "purposeful nonadherence," assessed nonadherence related to purposefully stopping medication use after feeling better or worse. Only the second factor was shown to have good convergent and predictive validity. Specifically, this factor was related to pill-taking behavior measured with electronic medication caps and drug plasma levels and nicotine patch use based on nicotine patch count data, and it was associated with smoking cessation outcome. Thus the purposeful nonadherence factor of the MAQ may be used as a brief screening tool for medication adherence with cigarette smokers seeking treatment. Information obtained with this questionnaire could be used to counsel patients regarding the importance of medication adherence.     

励精图治辛勤耕耘--安徽古井双喜葡萄酒有限公司总经理王福涛访谈录

“五一”放长假不如去农村，去农村最好去葡萄酒庄，在这里可以呼吸田野的空气，沐浴早春的阳光，欣赏葡萄园景，而且还可以尽情品尝佳酿。今年“五一”节前，我去了位于黄河故道的安徽省萧县，参观了古井双喜葡萄酒公司的葡萄园和酒厂。萧县在黄河故道的东部，经济欠发达，然而，在40多年前的大跃进时代，它曾是中国葡萄酒运动的热点，万亩葡萄园，万吨酒厂当时全国闻名。今天萧县葡萄酒厂已归属安徽古井集团，经过3年的奋斗，已创出辉煌的业绩，在葡萄酒行业中大有后来居上之势。为此，我到古井双喜葡萄酒公司拜访了王福涛总经理，探其究…