8/3/2019 A Closer Look at Smoking Among Young Adults Where
Tobacco Control Should Focus Its Attention
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R E S E A R C H A N D P R A C T I C E
C l o s e r L o o k a t S m o k i n g A m o n g Y o u n g A d u
l t s :h e r e T o b a c c o C o n t r o l S h o u l d F o c u s I
t s A t t e n t i o nP Green, MPH, Kristen L. McCausland, MSW, MPH,
Haijun Xiao, M S , Jennifer C. Duke, P h D , Donna M. Vaiione, P h
D , MPH,
in the U nited States, partic-ly spa rse. W hat little
ents.*"'^ How ever, young adults w ho
tant for several reasons. First, young adults
on at least 20 of the last 3 0 days). Up toof smokers begin
smoking before age
yet the number of individuals aged 189 years in the early stages
of smoking initia-
18 years.^' Recent data suggestamong smokers w ho first try
smoking
2 1 , ' " and thetion doe s not
and occupational roles, tobaccod or become an es-
Objectives. We sought to f il l gaps in knowledge of smoking
behaviors am ongcollege-educated and non -col lege-educated young
adults.Methods. We used data from the 2003 Tobacco Use Supp lemen t
of the CurrentPopulation S urve^ to analyze smoking behaviors amon
g young adults aged 18-24years and older young adults aged 25-34
years by college status (enrolled, orwith a degree, but not
enrolled) and other measures of socioeconomic position.Results.
Current smoking prevalence amon g US youn g adults aged 18-24
yearswho are not enrol led in col lege or who do not have a college
degree was 30%.This was more than twice the current smoking
prevalence among col lege-educated young adults (14%). Non-col
lege-educated young adults were morel ikely than were col
lege-educated young adults to start smoking at a youngerage and
were less likely to have made a quit attem pt, although no
differences werefound in their intentions to quit. Higher rates of
smoking in the non-col lege-educated population were also evident
in the slightly older age group.Conclusions. Non-college-educated
young adults smoke at more than twice therate of their
college-educated counterparts. Targeted pre vention and cessation
ef-forts are needed for n on-college-educated yo ung a dults to
prevent excess m orbidityand mo rtality in later years. {Am J P
ublic Health. 2007;97:1427-U 33. doi:10.2105/AJPH.2006.103945)
to smoke, smokers may shift from experi-mentation to regular
smoking, and non-addicted smokers may become addicted
Finally, smoking behavior among youngadults is predictive of
smoking in later years.A longitudinal study examining the
naturalhistory of smoking from adolescence to adult-hood found that
among those who smokedas young adults, 72% were adult
smokers.^''Among those who did not smoke as youngadults, only 7%
were adult smokers.^"
Although few studies have focused onsmoking among the
non-college-educatedyoung adult population, research suggeststhat
smoking behavior among young adultsis a much stronger predictor of
smoking inlater life for those with less formal educationas
compared with those with more formeil ed-ucation.^" Since the early
1980s, rates ofcurrent, daily, and heavy smoking have beenfound to
be significantly gi'eater amongyoung adults who are not in college
thanamong young adults in college."""'
Given the presumed high smoking ratesamong non-college-educated
young adultsand the dearth of related research, we soughtto fill
the gaps in knowledge of smoking be-haviors in this population. We
used data froma nationally representative sample of USadults to
analyze current smoking amongyoung adults aged 18 to 24 years. We
alsoexamined smoking behaviors among youngadults aged 25 to 34
years to examine howsmoking behaviors may change as youngadults
enter into a generally more stablephase of life. Our main objective
was to char-acterize patterns in smoking rates and behav-iors by
college status (in college, with a col-lege degree, or not college
educated), and tounderstand the role of education in
smokingbehaviors of young adults and older youngadults. Although
empirical ev idence suggestseducation may be associated vnth
smok-ing^""^' and predictive of good health,^""^"other aspects of
socioeconomic position, suchas income and occupation, have also
beenlinked to smoking.""' Therefore, we assessed
8/3/2019 A Closer Look at Smoking Among Young Adults Where
Tobacco Control Should Focus Its Attention
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R E S E A R C H A N D P R A C T I C E
the independent and combined effects of edu-cation, income, and
occupation among youngadults.METHODSSample population
Data for this analysis were drawn from the2003 Tobacco Use
Supplement (TUS) of theCurrent Population Survey (CPS).^' The
CPS,conducted by the US Census Bureau on amonthly basis, is a
nadoncd househ old,interviewer-directed, complex survey
adminis-tered to the noninstitutionalized, civilian pop-ulation
aged 15 years or older in the UnitedStates. The TTJS, sponsored by
the NationalCancer Institute and the Centers for DiseaseControl and
Prevention in 2 0 0 3 , has beenadded to the CPS every 3 years
since 1992to mea sure various smoking-related topics.
The 2003 TUS-CPS includes responsesfrom approximately 2 4 9 6 2
0 individuals, aresponse rate of 8 3 % . Proxy responses, or
in-formation collected from a household respon-dent for another
member of the household,are permitted but not preferred in the
TUS-CPS. Nonetheless, 24 % of responses in the2003 TUS-CPS were
proxy responses. Proxyresponses were excluded from the
presentanalyses so we could compare results to othernational
studies for this age group in whichwritten questionnaires were
completed by therespondents themselves. The final sampleconsisted
of 47987 respondents aged 18-34years.Measures
Smoking behaviors. Smoking status waspartially assessed by the
survey item, "Does[respondent] now smoke cigarettes every day,some
days, or not at all?" In addition, respon-dents were asked whether
or not they hadsmoked at least 100 cigarettes in their entirelife.
Current smokers consisted of both dailyand occasional smokers. Age
of initiation forcurrent smokers and daily smokers was de-termined
by asking respondents how oldthey were when they first started
smokingcigarettes regularly or every day. Respondentswere further
probed to determine their num-ber of quit attempts in the past 12
months.Intention to quit was defined as planning tostop smoking
within the next 30 days.
College status. A dichotomous variable wascreated for college
status. Among those aged18 to 24 years, college educated was
definedas being currently enrolled in a 2- or 4-yearcollege or
university or having at least a col-lege degree but no longer
enrolled in schoolIn the TUS-CPS, school enrollment questionsdid
not distinguish between 2- and 4-yearcolleges and universities.
Because school en-rollment status was not asked of respondentsaged
25 years and older, the college-educated among this age group was
com-prised of those respondents having at least adegree from a 2-
or 4-year college or univer-sity. To be assigned to the non-college
-edu-cated group, respondents aged 18 to 24 musthave reported that
they were currently notenrolled in a college or university and
thattheir educational attainment was less than adegree from a 2- or
4-year college or univer-sity. For respondents older than 24
years,non-college-educated was defined as havingless than a degree
from a 2- o r 4-yecir collegeor university.
Occupation. Occupational data were ob-tained from respondents
and recode d to followthe US Standard Occupational
Classificationsystem.''^ Categories were white collar worker(as
defined by CPS; includes following cate-gories: management,
business, and financial;professional and related; sales and
related; andoffice and administrative support), servicesworker,
farm worker, and blue collar worker(as defined by CPS; includes the
following cat-egories: construction and extraction; installa-tion,
maintenance, and repair; production; andtransportation and material
moving).''''
Employment status. Persons were classifiedas being in the labor
force (if they were em-ployed), unemployed (defined as person s
whowere not employed during the referenceweek but were available
for work and hadmad e specific efforts to find employment dur-ing
the past month), or in the Armed Forcesduring the survey week. We
used 3 mainlevels to denote the major labor force cate-gories
available in the TUS-CPS: employed,unemployed, and not in the labor
force (de-fined as persons who had not looked forwork during the
past month).
Annual household income. Data on annualhousehold income were
based on respon-dents' total combined household income from
the previous 12 months. Combined incoincluded money from jobs;
net income business, a farm, or rent; dividends; intesocial
security payments; and other incoreceived by family members who
were 15 years or older."" As per the procedurused by Barbeau et
al.,^" income data wcollapsed into 4 categories of annual eaings:
less than $1999 9 , $2 00 00 -4 99 9$50000 and more, and
unknown.
Race/ethnidty an d gender. Data on rethnidty were categorized in
accordancea directive from the Office of ManagemeBudget, which
stipulated that the 20 03 Cchange its race/etfinicity questions.^"*
Cagories were no longer mutually exclusiveCPS respondents could
select more thanrace when answering the survey. We usefollowing
categories: non-Hispanic WhiteHispanic Black, Hispanic, Asian,
Other, aMultiple Race. Although the change in wdoes not affect
smoking estimates and trefor the nation, it potentially affects
smokestimates and trends by race/ethnicity.
CPS respondents were asked to indicatheir gender as male or
female.Data AnalysisPopulation estimates were generated scribe the
demographic characteristics ocollege-educated and
non-college-educapopulations among 2 age groups: those 18-24 years
and those aged 25-34 yeaAdditional descriptive statistics were
callated to illustrate the preva lence of smokrelated behaviors.
Along with smoking plence, age of smoking initiation, intent toand
attempts to quit were computed for rent smokers. To determine the
odds of a current smoker in relation to educatioage, gender, annual
household income, opation, and employment status, a multiplgistic
regression was performed. All dataanalyzed using Stata version 9
.2. (Stata CCollege Station, Tex). Survey weights weused to adjust
for nonresponse and to cofor age, gender, race, and Hispanic
ethniRESULTS
Table 1 presents the distribution of thstudy population by
college status and agroup in relation to gender, race/ethnici
