Vast majority of college smokers don't quit

Almost 90 percent of college students who were daily smokers and 50 percent of occasional smokers were still smoking four years later, according to a study conducted at the University of Wisconsin-Madison and just published in the current issue of Health Psychology.

The high rates of smoking identify college students as an important group to target for smoking cessation interventions. The results also dispel the mistaken belief that most college students who smoke easily give up tobacco use within a few years.

"We also found that some college smokers did move between categories -14 percent of occasional smokers became daily smokers, and 11 percent of nonsmokers took up smoking," says Michael Fiore, director of the University of Wisconsin Center for Tobacco Research and Intervention. Progression from occasional smoking to daily smoking seemed to be gender-related, with more males than females making the progression.

Some college students who were smoking quit during the four-year study. Slightly more than 50 percent of occasional smokers and 13 percent of daily smokers stopped smoking before the end of the study.

Other findings indicate potential areas for intervention to promote cessation. The strongest predictor for continued smoking among occasional smokers related to expectations about smoking. More likely to continue smoking were those students with the strongest beliefs that smoking provides positive emotional experiences, lessens negative ones and helps control weight. Nonsmokers were more likely to believe other activities would produce these results.

"Helping students to develop realistic expectations about smoking and to find other ways to cope with negative feelings may be helpful in reducing dependence upon smoking," Fiore says. "This is critical since we know that half of those who become daily lifetime smokers will be killed prematurely by a disease directly caused by their smoking."

The study was conducted with 647 freshmen and sophomores enrolled in the introductory psychology class at the University of Wisconsin-Madison. Smokers were typed as daily (smoked every day), occasional (smoked every few days, weeks or months) and non-smokers (never smoked). Factors such as alcohol use, family smoking, peer smoking, smoking expectations, and emotions and stress were measured at the baseline of the study.

Four years later, 85 percent of the students (548) participated in a follow-up study, which included using the same mutually exclusive smoking status categories. Follow-up with daily smokers showed that only 13 percent had quit, 28 percent had become occasional smokers and 59 percent were still daily smokers. Among occasional smokers, 51 percent had stopped smoking, 35 percent were still occasional smokers and 14 percent had become daily smokers. Of non-smokers, 89 percent were still non-smokers, 11 percent had become occasional smokers and none were daily smokers.

The persistence of daily smoking suggests a significant degree of tobacco dependence among the college-aged population. These smokers may then require high levels of intervention, including medication (nicotine replacement therapy or bupropion) and smoking cessation counseling.

"Because their smoking status seems more changeable than adults, college students may be more receptive to smoking cessation," Fiore says. "Plus, the relatively confined nature of the college environment might be an excellent setting for implementing both policy and individual interventions."