This chapter presents information on the prevalence and patterns of use of cigarettes, cigars, smokeless tobacco, and pipes for three particular subpopulations: college students, high school dropouts, and pregnant women.
The smoking behavior of college students is an important measure of tobacco use among young adults. Over one third of persons aged 18 to 24 attend college, and one quarter attend a 4-year college (Rigotti, Lee, & Wechsler, 2000; U.S. Bureau of the Census, 1997). Tobacco use is common among college students nationwide and is not limited to cigarettes. One study found that the four most common reasons that college students gave for their smoking were stress, less supervision, having more free time, and the number of their friends who smoke (Hochberg & Siber, 1999). Unfortunately, many students do not realize how addictive nicotine is.
Table 6.1 in Appendix F presents, by college enrollment status and gender, 1999 NHSDA data on lifetime, past year, and past month (i.e., "current") use of cigarettes, cigars, smokeless tobacco, and pipes among young people aged 18 to 24. Table 6.2 focuses on 1999 cigarette use data, specifically, no use, former use, daily use, and current use (excluding daily use), by college enrollment status and gender. For cigars, smokeless tobacco, and pipes, Table 6.3 provides information, by college enrollment status and gender, about 18 to 24 year olds who never used or discontinued using tobacco products (discontinued use is defined as lifetime use, but not current use). Comparisons of current tobacco use among full- and part-time college students and those not enrolled in school are presented graphically in Figure 6.1.Figure 6.1 Percentages of Persons Aged 18 to 24 Reporting Past Month Use of Tobacco, by College Enrollment Status: 1999
Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999.
As stated previously, cigar smoking was primarily a behavior of older men until the early 1990s in the United States. Few young adults and few women smoked cigars prior to this period (U.S. Department of Health and Human Services [DHHS], 1998b). However, after major industry promotions in the 1990s, cigar use became more prevalent among younger people, including college students.
Unlike the relationship seen for college enrollment and cigarette use, Table 6.1 shows that both college students and 18 to 24 year olds who were not enrolled in any school were equally likely to be current cigar users in 1999. Current use was reported by 11.1 percent of those enrolled full time in college, 11.4 percent of those enrolled part time, and 11.9 percent of those not enrolled in any school. Cigar use was a predominantly male behavior. Current use was reported by 18.3 percent of males and 5.5 percent of females aged 18 to 24. Among males, 17.9 percent enrolled full time in college, 19.2 percent enrolled part time, and 17.8 percent not enrolled in any school reported current cigar use. Male full-time college students were also significantly more likely than their peers not enrolled in any school to report past year use of cigars (40.3 vs. 34.8 percent, respectively).
Almost half of full-time college students had smoked a cigar at least once in their lifetime (47.1 percent), including almost two thirds of the men (61.7 percent) and about one third of the women (34.0 percent). More than one in four full-time college students smoked a cigar in the past year (27.5 percent), and 11.1 percent smoked a cigar in the past month. As discussed in Section 4.5.2, most cigar use was occasional (1 to 2 days a month).
As seen in Table 6.1, the prevalence of smokeless tobacco use was similar for 18 to 24 year olds enrolled or not enrolled in college. Smokeless tobacco use, mainly a male behavior, was engaged in by 11.1 percent of males and 0.6 percent of females aged 18 to 24 in the past month. Almost 90 percent of women enrolled full time in college, part time in college, or not enrolled in any college had never used smokeless tobacco in their lives. Among male 18 to 24 year olds, about 60 percent of those enrolled full time in college, part time in college, and not enrolled in any school had not tried smokeless tobacco even once during their lifetime.
Most smokeless tobacco users discontinued use, especially among females (see Tables 6.1 and 6.2). For full-time college students who were 18 to 24 years of age at the time of the survey, 24.7 had tried smokeless tobacco at least once and 5.1 percent were current users. For male full-time college students, 40.2 percent had tried smokeless tobacco in their lives and 10.4 percent were current users. Of the 10.9 percent of female full-time college students who had tried smokeless tobacco, only 0.4 percent were current smokeless tobacco users. Among 18 to 24 year olds not enrolled in any school, 26.7 percent had tried smokeless tobacco at least once in their lives and 6.1 percent were current users. Almost 44 percent of males not enrolled in any school had used smokeless tobacco at least once in their lives, and 11.6 percent were current users in 1999. A little more than 10 percent of females not enrolled in any school had tried smokeless tobacco at least once, but only 0.7 percent were current users. Overall, less than 1 percent of college-enrolled and unenrolled females were current users of smokeless tobacco.
Rates of current pipe use were relatively low among young people aged 18 to 24: 1.3 percent overall, 2.1 percent among males, and 0.6 percent among females (Table 6.1). Current pipe use was similar among those in college full or part time or not enrolled in school (about 1 percent). An estimated 11 percent of full-time college students, 7.5 percent of part-time college students, and 10 percent of those not enrolled in school had ever tried pipe smoking. Males were more than 3 times more likely than females to be current smokers and almost 4 times as likely to have smoked pipes in their lifetime; these gender differences were found for each of the college enrollment groups.
About 90 percent or more of each of the college enrollment groups had never smoked a pipe, and 6 to 10 percent of each group had at one time smoked a pipe but discontinued use (Table 6.3).Rates of discontinuing use were highest among full-time college students and several times higher among males than females, perhaps reflecting their higher rates of ever smoking pipes.
Over the past 10 years in the United States, approximately 5 out of every 100 students dropped out of high school prior to completion (National Center for Education Statistics, 1998). Young people who drop out of school prior to high school graduation are at high risk for many negative social and economic consequences. A number of studies have looked at the relationship between dropping out of school and problem behaviors. Some of these studies have reported higher rates of substance use among dropouts than among adolescents who remain in school (Bruno & Doscher, 1979; Elliot, Huizinga, & Ageton, 1985; Fagan & Pabon, 1990; Guagliardo, Huang, Hicks, & D'Angelo, 1998). Early onset of substance use, such as tobacco, is considered a risk factor for progressing to more serious forms of substance abuse, which in turn may be linked to negative social and economic consequences. A dropout in the NHSDA was defined as someone aged 16 to 25 who was not currently enrolled in school and had not completed high school or taken an equivalency exam.
Cigarette use is closely tied to dropping out of school. Among 16 and 17 year olds, and 18 to 25 year olds, as shown in Table 6.4, dropouts were more likely than those who had not dropped out of school to have smoked cigarettes in the lifetime, past year, and past month. For those aged 16 and 17, current cigarette use was more than double among dropouts (56.4 percent) compared with nondropouts (24.7 percent) and about 1½ times higher among dropouts aged 18 to 25 (50.8 percent) compared with nondropouts in that age group (38.4 percent).
Daily cigarette use, past month (or current) use, and past year use were substantially higher among dropouts than nondropouts for males and females as well as whites and blacks, as shown in Table 6.5. However, rates were more similar among Hispanic dropouts and nondropouts. More than half of white dropouts (55.7 percent) were daily cigarette smokers, while more than half of male dropouts (56.3 percent) and almost three fourths of white dropouts (71.1 percent) were current cigarette smokers. Daily cigarette use and past month cigarette use were markedly lower among Hispanics than other race/ethnic groups.
Cigarette smoking use during pregnancy has long been known to cause a variety of adverse outcomes. The negative infant outcomes studied most often have been low birth weight (LBW) andinfant mortality. (Infant LBW is defined as fewer than 2,500 grams for whites and fewer than 2,350 grams for blacks.) In the 1970s, the Surgeon General's reports (U.S. Department of Health, Education, and Welfare [DHEW], 1971, 1973, 1979) concluded that smoking during pregnancy retards fetal growth and may cause fetal death late in pregnancy. Lubs (1973) demonstrated a strong dose relationship between the number of cigarettes smoked during pregnancy and infant LBW. Sudden infant death syndrome (SIDS) is the most common cause of death among infants older than 1 month (CDC, 2001; DHHS, 1998a). This important component of infant mortality has been studied in relation to cigarette smoking. Multiple studies have found increased risk of SIDS among infants exposed to maternal smoking (Li & Daling, 1991; Schoendorf & Kiely, 1992; DHHS, 1998a). The inverse relationship between LBW and the child's blood pressure is widely acknowledged (Law & Shiell, 1996; Blake et al., 2000). Cigarette smoking during pregnancy is also related to multiple problems for the pregnant women. The 1977-78 Surgeon General's report (DHEW, 1979; DHHS, 1994) also found that cigarette use during pregnancy has dose-response relationships with placenta previa, bleeding during pregnancy, and premature and prolonged rupture of placental membranes (also see CDC, 2001). Other health problems for pregnant women who smoke include ectopic pregnancy and abruptio placentae (DHEW, 1979, DHHS, 1980; Rosenberg, 1987). Moreover, impaired fertility has been linked to cigarette smoking in several Surgeon General's reports (CDC, 2001; DHHS, 1980).
At the time of their participation in the 1999 NHSDA, 1,137 women reported being pregnant. Pregnant women were generally less likely than nonpregnant women to use tobacco products. Pregnant women aged 15 to 44 were about half as likely as women of that age group who were not pregnant to be past month users of any tobacco product or cigarettes, as shown in Table 6.6. About 17 percent of pregnant women were current cigarette users compared with 30.5 percent of women who were not pregnant. Rates of use of smokeless tobacco, cigars, or pipes were less than 1 percent among pregnant women and slightly higher among women who were not pregnant compared with women who were pregnant.
The lower rates of current cigarette use among pregnant women compared with nonpregnant women overall were found for older age groups, but among women aged 15 to 17, pregnant women were more likely than nonpregnant women to be current smokers (24.8 vs. 23.0 percent; Table 6.7). Among whites and blacks, rates of current cigarette smoking were about half among pregnant women compared with nonpregnant women.
