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E. A. Pinsker, C. J. Berg, E. J. Nehl, A. V. Prokhorov, T. S. Buchanan, J. S. Ahluwalia, Intent to quit among daily and non-daily college student smokers, Health Education Research, Volume 28, Issue 2, April 2013, Pages 313–325, https://doi.org/10.1093/her/cys116
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Abstract
Given the high prevalence of young adult smoking, we examined (i) psychosocial factors and substance use among college students representing five smoking patterns and histories [non-smokers, quitters, native non-daily smokers (i.e. never daily smokers), converted non-daily smokers (i.e. former daily smokers) and daily smokers] and (ii) smoking category as it relates to readiness to quit among current smokers. Of the 4438 students at six Southeast colleges who completed an online survey, 69.7% (n = 3094) were non-smokers, 6.6% (n = 293) were quitters, 7.1% (n = 317) were native non-daily smokers, 6.4% (n = 283) were converted non-daily smokers and 10.2% (n = 451) were daily smokers. There were differences in sociodemographics, substance use (alcohol, marijuana, other tobacco products) in the past 30 days and psychosocial factors among these subgroups of students (P < 0.001). Among current smokers, there were differences in cigarettes smoked per day, recent quit attempts, self-identification as a smoker, self-efficacy and motivation to quit (P < 0.001). After controlling for important factors, converted non-daily smokers were more likely to be ready to quit in the next month versus native non-daily smokers (OR = 2.15, CI 1.32–3.49, P = 0.002). Understanding differences among young adults with different smoking patterns and histories is critical in developing interventions targeting psychosocial factors impacting cessation among this population.
Introduction
Tobacco use is the number 1 preventable cause of death in the United States. Despite preventive efforts, ∼46 million people or 20.6% of the US population smokes cigarettes [1]. Among American smokers, up to 33% smoke non-daily [2] or smoke between 1 and 29 days out of every 30 [3]. Non-daily smoking represents a common smoking pattern among young adults, with 19.9% reporting smoking <30 days per month [4].
Non-daily smokers suffer from significant smoking-related morbidity and mortality compared with individuals who have never smoked [5–7]. A recent systematic review of published research on the health outcomes of light and non-daily smoking [8] documented that light and intermittent smoking carry nearly the same risk for cardiovascular disease as daily smoking [9, 10] and that the dose–response relationship between tobacco exposure and cardiovascular mortality is highly non-linear [10]. Given the health consequences of non-daily smoking, promoting smoking cessation among young adult smokers is especially important because individuals who quit before the age of 30 will reduce their chances of dying prematurely from smoking-related diseases by >90% [7].
Non-daily versus daily smokers have been shown to be more likely to be ready to quit in the next month and confident that they can quit, but are less likely to consider themselves to be addicted [11]. However, non-daily smokers have difficulty quitting smoking [2]. Research suggests that even low-level smokers experience loss of autonomy over smoking and addiction [12–14]. Others contend that difficulty quitting among non-daily smokers may be due to the importance of external stimuli in maintaining smoking [2]. Unfortunately, traditional models of addiction developed for daily smokers do not explain why non-daily smokers have difficulty quitting.
Previous research has found differences between non-daily smokers who are former daily smokers (termed ‘converted non-daily smokers’) and non-daily smokers who have never been daily smokers (termed ‘native non-daily smokers’) [2]. Native non-daily smokers smoke less days per month and smoke fewer cigarettes than converted non-daily smokers [11]. In a recent study of adults conducted by Tindle and Shiffman [2], converted non-daily smokers, native non-daily smokers and daily smokers were compared in relation to having attempted to quit smoking. They found that converted non-daily smokers were more likely to quit smoking when compared with native non-daily and daily smokers, although only 18% of native non-daily smokers and 27% of converted non-daily smokers were able to remain abstinent for at least 90 days. This research suggests that converted non-daily smokers may transition from daily smoking to non-daily smoking then to cessation. However, this study did not specifically examine young adults representing these smoker categories.
Two theoretical approaches are particularly relevant for understanding factors that contribute to smoking and to promoting smoking cessation. The first, Problem Behavior Theory [15], suggests that multiple factors contribute to problem behaviors, including (i) the perceived-environment system, involving social controls, models and support; (ii) the personality system including values, expectations, beliefs, attitudes and orientations toward self and society and (iii) the behavior system, encompassing both problem and conventional behaviors. This framework has been supported for substance use; substance use has been empirically associated with social influences [16, 17], depressive symptoms [18, 19] and attitudes toward substance use and perceived harm of substance use [20–23]. Second, according to the Transtheoretical Model (TTM) [24–26], changes in smoking behaviors occur when individuals have strong positive intentions and motivation to change [27]. Previous research has consistently documented that readiness to quit predicts subsequent quit attempts and cessation [28–30]. The TTM incorporates a series of intervening or outcome variables, including self-efficacy (i.e. confidence in the ability to change across problem situations [31]) [32–34] and situational temptations to engage in the problem behavior (e.g. social situations).
Guided by these theoretical frameworks, the aims of this study were to (i) examine psychosocial factors and other substance use among subgroups of college students representing five smoking patterns and histories (non-smokers, quitters, native non-daily smokers, converted non-daily smokers and daily smokers) and (ii) examine smoking category as it relates to readiness to quit smoking among current smoker categories, controlling for other important sociodemographic and smoking-related factors. Understanding the psychosocial profiles of these subcategories of college student smokers and how these factors relate to readiness to quit smoking are critical for developing appropriate interventions for cessation effectively targeting these important factors.
Methods
Procedure
In October 2010, students at six colleges in the Southeast were recruited to complete an online survey [35]. Random samples of 5000 students at each school were invited to complete the survey. Two of the six schools had enrollment of <5000 students; thus, all students at these two schools were invited to participate (total invited N = 24 055). Students received an e-mail containing a link to the consent form with the alternative of opting out. Students who consented to participate were directed to the online survey. To encourage participation, students received up to three e-mail invitations to participate. As an incentive for participation, all students who completed the survey received entry into a drawing for cash prizes of $1,000 (one prize), $500 (two prizes) and $250 (four prizes) at each participating school. Of students who received the invitation to participate, 4849 (20.1%) returned a completed survey. The current analyses focused on the 4438 participants who had complete data on their smoking behaviors. The Emory University Institutional Review Board approved this study, IRB# 00030631.
Measures
Demographic characteristics
We assessed students’ age, gender, ethnicity, highest parental educational attainment and type of school attended (two-year versus four-year). We conducted preliminary analyses to examine clustering of smoking status by school, and the significant differences were between the two-year and four-year campuses. Thus, we included that variable in our analyses rather than each individual school for ease of interpretation.
Smoking behaviors
We asked, ‘In the past 30 days, on how many days did you smoke a cigarette (even a puff)?’ [36, 37]. Using the American College Health Association and the Substance Abuse and Mental Health Association [3, 38] definitions, we categorized students who reported smoking on all 30 days of the past month as daily smokers and those who smoked from 1 to 29 days of the past 30 days as non-daily smokers. They were also asked, ‘Have you ever smoked cigarettes daily, that is, at least one cigarette every day for 30 days?’ Using these two questions, we created five subgroups: (i) non-smokers who had never been daily smokers (i.e. non-smokers); (ii) non-smokers who were former daily smokers (i.e. quitters); (iii) non-daily smokers who had never been daily smokers (i.e. native non-daily smokers); (iv) non-daily smokers who were former daily smokers (i.e. converted non-daily smokers) and (v) daily smokers.
They were also asked, ‘On the days that you smoke, how many cigarettes do you smoke on average?’ Nicotine dependence was assessed using a single question regarding time to first cigarette (i.e. within 30 min of waking versus after) from the Fagerström Test for Nicotine Dependence [39].
Other substance use
To assess other substance use, students were asked, ‘In the past 30 days, on how many days did you: Drink alcohol? Drink five or more alcoholic drinks on one occasion? Use chewing tobacco, snuff, or dip, such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, or Copenhagen? Smoke cigars (Please do not include little cigars or cigarillos, such as Black and Milds, when answering this question)? Smoke little cigars (such as Black and Milds)? Smoke cigarillos (such as Swisher Sweets cigarillos)? Smoke tobacco from a water pipe (hookah)? Use marijuana (pot, weed, hashish, hash oil)?’ The reliability and validity of these assessments have been documented by previous research [36, 37]. These variables were dichotomized as have used versus had not used these substances in the past month. In addition, an aggregate variable for other tobacco use was created.
Smoking attitudes
The Smoking Attitudes Scale [40] is a 17-item questionnaire assessing attitudes toward smoking. The Smoking Attitudes Scale asked participants to rate on a 7-point scale how strongly they agree (1 = strongly disagree, 7 = strongly agree) with 17 smoking-related statements across four dimensions—interpersonal relationships with smokers, laws and societal restrictions on smoking in public places, health concerns and the marketing and sale of cigarettes [40]. For example, items included ‘second-hand smoke is a legitimate health risk’ and ‘non-smokers should be more tolerant of smokers’. Higher scores indicate more negative attitudes regarding smoking. The scale has good validity and internal consistency reliability with subscale Cronbach’s αs ranging from 0.69 to 0.88 [40]. Cronbach’s α in the current study was 0.88.
Perceived harm
Participants were asked, ‘Do you believe there is any harm in having an occasional cigarette?’ with response options of ‘yes’ or ‘no’ [41].
Depressive symptoms
Participants were asked to complete the Patient Health Questionnaire2 [42], which is a two-item depression screening tool, based on DSM-4 diagnostic criteria, assessing frequency of depressed mood and anhedonia over the past 2 weeks. Responses were rated on a 4-point Likert scale and range from ‘not at all’ (0) to ‘nearly every day’ (3). A total score ≥3 has been used to reflect clinical depression [42].
Social aspects of smoking
Participants were asked, ‘Did either of your parents smoke when you lived with them?’ [43] and ‘Out of your five closest friends, how many of them smoke cigarettes?’ [44] to determine the extent to which their social network includes smokers.
Previous quit attempts
Participants were also asked, ‘During the past 12 months, how many times have you stopped smoking for one day or longer because you were trying to quit smoking?’ [45]. This variable was dichotomized as having made at least one quit attempt in the past year versus not having made an attempt to quit.
Readiness to quit smoking
Readiness to quit was assessed by asking ‘What best describes your intentions regarding quitting smoking?’ Response options were ‘never expect to quit’, ‘may quit in the future’, ‘but not in the next 6 months’, ‘will quit in the next 6 months’ and ‘will quit in the next month’ [46]. For the present study, this variable was dichotomized as intending to quit in the next 30 days versus all other responses.
Social smoking
To assess social smoking, participants were also asked, ‘In the past 30 days, did you smoke: mainly when you were with other people; mainly when you were alone, as often by yourself as with others, or not at all’ [47]. This variable was dichotomized as ‘social smoking’ (i.e. smoking mainly when with others) versus other responses.
Identification of a smoker
Participants were asked, ‘Do you consider yourself a smoker?’ [48]
Treatment self-regulation questionnaire
Motivation to quit was measured using the 15-item Treatment Self-Regulation Questionnaire (TSRQ) [49]. The TSRQ contains items that measure autonomous motivation (six items), controlled motivation (six items) and amotivation (three items). Participants were asked to indicate the extent to which several motivators for change were relevant to them. Examples of items include the following: ‘Because I personally believe it is the best thing for my health’ (autonomous motivation), ‘Because I would feel guilty or ashamed of myself if I smoked’ (controlled motivation) and ‘I really don’t think about stopping smoking’ (amotivation). Responses ranged from ‘not at all true’ to ‘very true’ and were on a 7-point scale. Scores ranged from 15 to 105, with higher scores indicating greater motivation. Construct validity was established for the scale [49]. In the present study, Cronbach’s αs for the Autonomous motivation, Controlled motivation and Amotivation subscales were 0.88, 0.86 and 0.50, respectively.
Self-efficacy questionnaire
Self-efficacy was measured using the Smoking Self-Efficacy Questionnaire (SEQ-12) [50]. The SEQ-12 is a 12-item scale that measures confidence in one’s ability to refrain from smoking in certain situations. The scale is two-dimensional with six items that measure abstinence self-efficacy for internal stimuli (e.g. ‘When I feel nervous’) and six items that measure abstinence self-efficacy for external stimuli (e.g. ‘When having a drink with friends’). Responses ranged from ‘not at all sure’ to ‘absolutely sure’ and were on a 5-point Likert scale. SEQ-12 scores ranged from 12 to 60 with higher scores indicating greater self-efficacy. Reliability in test–retest procedures was established for the scale along with content validity, construct validity and predictive validity [50]. In the present study, Cronbach’s αs for the Intrinsic and Extrinsic subscales were 0.93 and 0.82, respectively.
Data analysis
Participant characteristics were summarized using descriptive statistics. Bivariate analyses were conducted to examine differences among groups in terms of sociodemographic, other substance use, psychosocial and smoking-related factors, using χ2 tests for categorical variables and analysis of variance for continuous variables. We conducted post hoc analyses to determine which comparisons were statistically different. We then examined smoking status (native non-daily smoker versus converted non-daily smoker versus daily smoker) in relation to readiness to quit in the next month using sequential binary logistic regression. We used blocked entry to create three models. Model A only included smoker category, Model B included smoker category plus sociodemographic variables and Model C included smoker category and sociodemographic variables forced into the model, with psychosocial variables and smoking-related characteristics associated with readiness to quit at the P < 0.10 being entered using backward stepwise entry. Issues of multicollinearity were examined in the process of building the regression models. PASW 18.0 was used for all data analyses. Statistical significance was set at α = 0.05 for all tests.
Results
Overall, 69.7% (n = 3094) were non-smokers, 6.6% (n = 293) were quitters, 7.1% (n = 317) were native non-daily smokers, 6.4% (n = 283) were converted non-daily smokers and 10.2% (n = 451) were daily smokers (Table I). There were significant differences in sociodemographics such as age, gender, ethnicity, parental education and type of school among the subgroups of college students by smoking status (P < 0.001). There were also significant differences in other substance use (alcohol, binge drinking, marijuana and other tobacco products) in the past 30 days (P < 0.001). Finally, there were significant differences in psychosocial factors such as attitudes toward smoking, perceived harm of an occasional cigarette, depressive symptoms and the number of parents and friends who smoke among the subgroups of college students by smoking status (P < 0.001). Post hoc comparisons indicated significant differences (P < 0.05) among the groups in regard to most factors (see footnote in Table I).
. | All participants (N = 4,438) . | Non-smokers (N = 3094) . | Quitters (N = 293) . | Native non-daily smokers (N = 317) . | Converted non-daily smokers (N = 283) . | Daily smokers (N = 451) . | . |
---|---|---|---|---|---|---|---|
Variable . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | P . |
Sociodemographics | |||||||
Age (SD) | 23.54 (6.18) | 22.59 (6.18) | 29.69 (11.00) | 21.63 (4.63) | 24.21 (5.95) | 26.97 (8.92) | <0.001 |
Gender (%) | <0.001 | ||||||
Male | 1276 (28.8) | 783 (25.3) | 104 (35.5) | 117 (36.9) | 110 (38.9) | 162 (35.9) | |
Female | 3162 (71.2) | 2311 (74.7) | 189 (64.5) | 200 (63.1) | 173 (61.1) | 289 (64.1) | |
Ethnicity (%) | <0.001 | ||||||
White | 2024 (45.6) | 1100 (35.6) | 206 (70.3) | 173 (54.6) | 200 (70.7) | 345 (76.5) | |
Black | 1730 (39.0) | 1486 (48.0) | 46 (15.7) | 83 (26.2) | 52 (18.4) | 63 (14.0) | |
Other | 684 (15.4) | 508 (16.4) | 41 (14.0) | 61 (19.2) | 31 (11.0) | 43 (9.5) | |
Parental education (%) | <0.001 | ||||||
<Bachelors | 2756 (62.1) | 1944 (62.8) | 183 (62.5) | 181 (57.1) | 141 (49.8) | 307 (68.1) | |
≥Bachelors | 1682 (37.9) | 1150 (37.2) | 110 (37.5) | 136 (42.9) | 142 (50.2) | 144 (31.9) | |
Type of school (%) | <0.001 | ||||||
Four-year | 2754 (62.1) | 2156 (69.7) | 111 (37.9) | 211 (66.6) | 149 (52.7) | 127 (28.2) | |
Two-year | 1684 (37.9) | 938 (30.3) | 182 (62.1) | 106 (33.4) | 134 (47.3) | 324 (71.8) | |
Psychosocial factors | |||||||
Attitudes toward smoking, Total (SD) | 88.06 (18.06) | 93.61 (14.89) | 86.29 (19.08) | 81.78 (13.67) | 73.23 (14.93) | 64.82 (16.09) | <0.001 |
Interpersonal | 21.98 (8.14) | 24.75 (6.64) | 21.01 (7.97) | 18.61 (6.03) | 14.51 (6.38) | 10.65 (5.72) | <0.001 |
Laws/restrictions | 35.68 (7.70) | 36.95 (6.86) | 35.56 (7.89) | 35.11 (6.91) | 32.46 (8.12) | 29.53 (9.46) | <0.001 |
Health concerns | 17.83 (4.18) | 18.45 (3.92) | 17.61 (4.38) | 16.94 (4.27) | 16.13 (4.08) | 15.36 (4.40) | <0.001 |
Marketing | 12.57 (5.00) | 13.47 (4.81) | 12.11 (5.37) | 11.12 (4.18) | 10.13 (4.53) | 9.27 (4.71) | <0.001 |
Harm of occasional cigarette (%) | <0.001 | ||||||
No | 1034 (23.3) | 532 (17.2) | 70 (23.9) | 129 (40.7) | 129 (45.6) | 174 (38.6) | |
Yes | 3404 (76.7) | 2562 (82.8) | 223 (76.1) | 188 (59.3) | 154 (54.4) | 277 (61.4) | |
Depressive symptoms (SD) | 1.24 (1.31) | 1.16 (1.27) | 1.19 (1.34) | 1.44 (1.36) | 1.45 (1.38) | 1.50 (1.47) | <0.001 |
Parents smoked (%) | <0.001 | ||||||
No | 2654 (59.8) | 2037 (65.8) | 129 (44.0) | 203 (64.0) | 136 (48.1) | 149 (33.0) | |
Yes | 1784 (40.2) | 1057 (34.2) | 164 (56.0) | 114 (36.0) | 147 (51.9) | 302 (67.0) | |
Number of friends that smoke (SD) | 1.47 (1.57) | 0.98 (1.28) | 1.82 (1.53) | 1.94 (1.43) | 2.69 (1.46) | 3.52 (1.36) | <0.001 |
Other substance use, past 30 days | |||||||
Any alcohol use (%) | <0.001 | ||||||
No | 1925 (43.4) | 1591 (51.4) | 110 (37.5) | 56 (17.7) | 35 (12.4) | 133 (29.5) | |
Yes | 2513 (56.6) | 1503 (48.6) | 183 (62.5) | 261 (82.3) | 248 (87.6) | 318 (70.5) | |
Any binge drinking (%) | <0.001 | ||||||
No | 3441 (77.5) | 2642 (85.4) | 213 (72.7) | 161 (50.8) | 141 (49.8) | 284 (63.0) | |
Yes | 997 (22.5) | 452 (14.6) | 80 (27.3) | 156 (49.2) | 142 (50.2) | 167 (37.0) | |
Marijuana (%) | <0.001 | ||||||
No | 3795 (86.2) | 2805 (91.5) | 253 (86.6) | 212 (67.5) | 196 (70.0) | 329 (73.3) | |
Yes | 606 (13.8) | 261 (8.5) | 39 (13.4) | 102 (32.5) | 84 (30.0) | 120 (26.7) | |
Other tobacco products (%) | <0.001 | ||||||
No | 3567 (82.0) | 2747 (90.4) | 237 (83.5) | 117 (38.4) | 161 (58.1) | 305 (68.7) | |
Yes | 782 (18.0) | 292 (9.6) | 47 (16.5) | 188 (61.6) | 116 (41.9) | 139 (31.3) |
. | All participants (N = 4,438) . | Non-smokers (N = 3094) . | Quitters (N = 293) . | Native non-daily smokers (N = 317) . | Converted non-daily smokers (N = 283) . | Daily smokers (N = 451) . | . |
---|---|---|---|---|---|---|---|
Variable . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | P . |
Sociodemographics | |||||||
Age (SD) | 23.54 (6.18) | 22.59 (6.18) | 29.69 (11.00) | 21.63 (4.63) | 24.21 (5.95) | 26.97 (8.92) | <0.001 |
Gender (%) | <0.001 | ||||||
Male | 1276 (28.8) | 783 (25.3) | 104 (35.5) | 117 (36.9) | 110 (38.9) | 162 (35.9) | |
Female | 3162 (71.2) | 2311 (74.7) | 189 (64.5) | 200 (63.1) | 173 (61.1) | 289 (64.1) | |
Ethnicity (%) | <0.001 | ||||||
White | 2024 (45.6) | 1100 (35.6) | 206 (70.3) | 173 (54.6) | 200 (70.7) | 345 (76.5) | |
Black | 1730 (39.0) | 1486 (48.0) | 46 (15.7) | 83 (26.2) | 52 (18.4) | 63 (14.0) | |
Other | 684 (15.4) | 508 (16.4) | 41 (14.0) | 61 (19.2) | 31 (11.0) | 43 (9.5) | |
Parental education (%) | <0.001 | ||||||
<Bachelors | 2756 (62.1) | 1944 (62.8) | 183 (62.5) | 181 (57.1) | 141 (49.8) | 307 (68.1) | |
≥Bachelors | 1682 (37.9) | 1150 (37.2) | 110 (37.5) | 136 (42.9) | 142 (50.2) | 144 (31.9) | |
Type of school (%) | <0.001 | ||||||
Four-year | 2754 (62.1) | 2156 (69.7) | 111 (37.9) | 211 (66.6) | 149 (52.7) | 127 (28.2) | |
Two-year | 1684 (37.9) | 938 (30.3) | 182 (62.1) | 106 (33.4) | 134 (47.3) | 324 (71.8) | |
Psychosocial factors | |||||||
Attitudes toward smoking, Total (SD) | 88.06 (18.06) | 93.61 (14.89) | 86.29 (19.08) | 81.78 (13.67) | 73.23 (14.93) | 64.82 (16.09) | <0.001 |
Interpersonal | 21.98 (8.14) | 24.75 (6.64) | 21.01 (7.97) | 18.61 (6.03) | 14.51 (6.38) | 10.65 (5.72) | <0.001 |
Laws/restrictions | 35.68 (7.70) | 36.95 (6.86) | 35.56 (7.89) | 35.11 (6.91) | 32.46 (8.12) | 29.53 (9.46) | <0.001 |
Health concerns | 17.83 (4.18) | 18.45 (3.92) | 17.61 (4.38) | 16.94 (4.27) | 16.13 (4.08) | 15.36 (4.40) | <0.001 |
Marketing | 12.57 (5.00) | 13.47 (4.81) | 12.11 (5.37) | 11.12 (4.18) | 10.13 (4.53) | 9.27 (4.71) | <0.001 |
Harm of occasional cigarette (%) | <0.001 | ||||||
No | 1034 (23.3) | 532 (17.2) | 70 (23.9) | 129 (40.7) | 129 (45.6) | 174 (38.6) | |
Yes | 3404 (76.7) | 2562 (82.8) | 223 (76.1) | 188 (59.3) | 154 (54.4) | 277 (61.4) | |
Depressive symptoms (SD) | 1.24 (1.31) | 1.16 (1.27) | 1.19 (1.34) | 1.44 (1.36) | 1.45 (1.38) | 1.50 (1.47) | <0.001 |
Parents smoked (%) | <0.001 | ||||||
No | 2654 (59.8) | 2037 (65.8) | 129 (44.0) | 203 (64.0) | 136 (48.1) | 149 (33.0) | |
Yes | 1784 (40.2) | 1057 (34.2) | 164 (56.0) | 114 (36.0) | 147 (51.9) | 302 (67.0) | |
Number of friends that smoke (SD) | 1.47 (1.57) | 0.98 (1.28) | 1.82 (1.53) | 1.94 (1.43) | 2.69 (1.46) | 3.52 (1.36) | <0.001 |
Other substance use, past 30 days | |||||||
Any alcohol use (%) | <0.001 | ||||||
No | 1925 (43.4) | 1591 (51.4) | 110 (37.5) | 56 (17.7) | 35 (12.4) | 133 (29.5) | |
Yes | 2513 (56.6) | 1503 (48.6) | 183 (62.5) | 261 (82.3) | 248 (87.6) | 318 (70.5) | |
Any binge drinking (%) | <0.001 | ||||||
No | 3441 (77.5) | 2642 (85.4) | 213 (72.7) | 161 (50.8) | 141 (49.8) | 284 (63.0) | |
Yes | 997 (22.5) | 452 (14.6) | 80 (27.3) | 156 (49.2) | 142 (50.2) | 167 (37.0) | |
Marijuana (%) | <0.001 | ||||||
No | 3795 (86.2) | 2805 (91.5) | 253 (86.6) | 212 (67.5) | 196 (70.0) | 329 (73.3) | |
Yes | 606 (13.8) | 261 (8.5) | 39 (13.4) | 102 (32.5) | 84 (30.0) | 120 (26.7) | |
Other tobacco products (%) | <0.001 | ||||||
No | 3567 (82.0) | 2747 (90.4) | 237 (83.5) | 117 (38.4) | 161 (58.1) | 305 (68.7) | |
Yes | 782 (18.0) | 292 (9.6) | 47 (16.5) | 188 (61.6) | 116 (41.9) | 139 (31.3) |
Bonferroni post hoc comparisons indicated significant differences in all comparisons except the following: age—no difference between non-smokers and native non-daily smokers; ATS—laws/restrictions—no differences between quitters and native non-daily smokers; ATS—health concerns—no differences between quitters and native non-daily smokers, native non-daily smokers and converted non-daily smokers, and converted non-daily smokers and daily smokers; ATS—marketing—no differences between quitters and native non-daily smokers, native non-daily smokers and converted non-daily smokers, and converted non-daily smokers and daily smokers; Patient Health Questionnaire-2 scores—no differences between Non-smokers and quitters, quitters and native non-daily smokers, quitters and converted non-daily smokers, native and converted non-daily smokers, native non-daily and daily smokers, converted non-daily and daily smokers; and number of friends who smoke—no differences between quitters and native non-daily smokers.
. | All participants (N = 4,438) . | Non-smokers (N = 3094) . | Quitters (N = 293) . | Native non-daily smokers (N = 317) . | Converted non-daily smokers (N = 283) . | Daily smokers (N = 451) . | . |
---|---|---|---|---|---|---|---|
Variable . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | P . |
Sociodemographics | |||||||
Age (SD) | 23.54 (6.18) | 22.59 (6.18) | 29.69 (11.00) | 21.63 (4.63) | 24.21 (5.95) | 26.97 (8.92) | <0.001 |
Gender (%) | <0.001 | ||||||
Male | 1276 (28.8) | 783 (25.3) | 104 (35.5) | 117 (36.9) | 110 (38.9) | 162 (35.9) | |
Female | 3162 (71.2) | 2311 (74.7) | 189 (64.5) | 200 (63.1) | 173 (61.1) | 289 (64.1) | |
Ethnicity (%) | <0.001 | ||||||
White | 2024 (45.6) | 1100 (35.6) | 206 (70.3) | 173 (54.6) | 200 (70.7) | 345 (76.5) | |
Black | 1730 (39.0) | 1486 (48.0) | 46 (15.7) | 83 (26.2) | 52 (18.4) | 63 (14.0) | |
Other | 684 (15.4) | 508 (16.4) | 41 (14.0) | 61 (19.2) | 31 (11.0) | 43 (9.5) | |
Parental education (%) | <0.001 | ||||||
<Bachelors | 2756 (62.1) | 1944 (62.8) | 183 (62.5) | 181 (57.1) | 141 (49.8) | 307 (68.1) | |
≥Bachelors | 1682 (37.9) | 1150 (37.2) | 110 (37.5) | 136 (42.9) | 142 (50.2) | 144 (31.9) | |
Type of school (%) | <0.001 | ||||||
Four-year | 2754 (62.1) | 2156 (69.7) | 111 (37.9) | 211 (66.6) | 149 (52.7) | 127 (28.2) | |
Two-year | 1684 (37.9) | 938 (30.3) | 182 (62.1) | 106 (33.4) | 134 (47.3) | 324 (71.8) | |
Psychosocial factors | |||||||
Attitudes toward smoking, Total (SD) | 88.06 (18.06) | 93.61 (14.89) | 86.29 (19.08) | 81.78 (13.67) | 73.23 (14.93) | 64.82 (16.09) | <0.001 |
Interpersonal | 21.98 (8.14) | 24.75 (6.64) | 21.01 (7.97) | 18.61 (6.03) | 14.51 (6.38) | 10.65 (5.72) | <0.001 |
Laws/restrictions | 35.68 (7.70) | 36.95 (6.86) | 35.56 (7.89) | 35.11 (6.91) | 32.46 (8.12) | 29.53 (9.46) | <0.001 |
Health concerns | 17.83 (4.18) | 18.45 (3.92) | 17.61 (4.38) | 16.94 (4.27) | 16.13 (4.08) | 15.36 (4.40) | <0.001 |
Marketing | 12.57 (5.00) | 13.47 (4.81) | 12.11 (5.37) | 11.12 (4.18) | 10.13 (4.53) | 9.27 (4.71) | <0.001 |
Harm of occasional cigarette (%) | <0.001 | ||||||
No | 1034 (23.3) | 532 (17.2) | 70 (23.9) | 129 (40.7) | 129 (45.6) | 174 (38.6) | |
Yes | 3404 (76.7) | 2562 (82.8) | 223 (76.1) | 188 (59.3) | 154 (54.4) | 277 (61.4) | |
Depressive symptoms (SD) | 1.24 (1.31) | 1.16 (1.27) | 1.19 (1.34) | 1.44 (1.36) | 1.45 (1.38) | 1.50 (1.47) | <0.001 |
Parents smoked (%) | <0.001 | ||||||
No | 2654 (59.8) | 2037 (65.8) | 129 (44.0) | 203 (64.0) | 136 (48.1) | 149 (33.0) | |
Yes | 1784 (40.2) | 1057 (34.2) | 164 (56.0) | 114 (36.0) | 147 (51.9) | 302 (67.0) | |
Number of friends that smoke (SD) | 1.47 (1.57) | 0.98 (1.28) | 1.82 (1.53) | 1.94 (1.43) | 2.69 (1.46) | 3.52 (1.36) | <0.001 |
Other substance use, past 30 days | |||||||
Any alcohol use (%) | <0.001 | ||||||
No | 1925 (43.4) | 1591 (51.4) | 110 (37.5) | 56 (17.7) | 35 (12.4) | 133 (29.5) | |
Yes | 2513 (56.6) | 1503 (48.6) | 183 (62.5) | 261 (82.3) | 248 (87.6) | 318 (70.5) | |
Any binge drinking (%) | <0.001 | ||||||
No | 3441 (77.5) | 2642 (85.4) | 213 (72.7) | 161 (50.8) | 141 (49.8) | 284 (63.0) | |
Yes | 997 (22.5) | 452 (14.6) | 80 (27.3) | 156 (49.2) | 142 (50.2) | 167 (37.0) | |
Marijuana (%) | <0.001 | ||||||
No | 3795 (86.2) | 2805 (91.5) | 253 (86.6) | 212 (67.5) | 196 (70.0) | 329 (73.3) | |
Yes | 606 (13.8) | 261 (8.5) | 39 (13.4) | 102 (32.5) | 84 (30.0) | 120 (26.7) | |
Other tobacco products (%) | <0.001 | ||||||
No | 3567 (82.0) | 2747 (90.4) | 237 (83.5) | 117 (38.4) | 161 (58.1) | 305 (68.7) | |
Yes | 782 (18.0) | 292 (9.6) | 47 (16.5) | 188 (61.6) | 116 (41.9) | 139 (31.3) |
. | All participants (N = 4,438) . | Non-smokers (N = 3094) . | Quitters (N = 293) . | Native non-daily smokers (N = 317) . | Converted non-daily smokers (N = 283) . | Daily smokers (N = 451) . | . |
---|---|---|---|---|---|---|---|
Variable . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | P . |
Sociodemographics | |||||||
Age (SD) | 23.54 (6.18) | 22.59 (6.18) | 29.69 (11.00) | 21.63 (4.63) | 24.21 (5.95) | 26.97 (8.92) | <0.001 |
Gender (%) | <0.001 | ||||||
Male | 1276 (28.8) | 783 (25.3) | 104 (35.5) | 117 (36.9) | 110 (38.9) | 162 (35.9) | |
Female | 3162 (71.2) | 2311 (74.7) | 189 (64.5) | 200 (63.1) | 173 (61.1) | 289 (64.1) | |
Ethnicity (%) | <0.001 | ||||||
White | 2024 (45.6) | 1100 (35.6) | 206 (70.3) | 173 (54.6) | 200 (70.7) | 345 (76.5) | |
Black | 1730 (39.0) | 1486 (48.0) | 46 (15.7) | 83 (26.2) | 52 (18.4) | 63 (14.0) | |
Other | 684 (15.4) | 508 (16.4) | 41 (14.0) | 61 (19.2) | 31 (11.0) | 43 (9.5) | |
Parental education (%) | <0.001 | ||||||
<Bachelors | 2756 (62.1) | 1944 (62.8) | 183 (62.5) | 181 (57.1) | 141 (49.8) | 307 (68.1) | |
≥Bachelors | 1682 (37.9) | 1150 (37.2) | 110 (37.5) | 136 (42.9) | 142 (50.2) | 144 (31.9) | |
Type of school (%) | <0.001 | ||||||
Four-year | 2754 (62.1) | 2156 (69.7) | 111 (37.9) | 211 (66.6) | 149 (52.7) | 127 (28.2) | |
Two-year | 1684 (37.9) | 938 (30.3) | 182 (62.1) | 106 (33.4) | 134 (47.3) | 324 (71.8) | |
Psychosocial factors | |||||||
Attitudes toward smoking, Total (SD) | 88.06 (18.06) | 93.61 (14.89) | 86.29 (19.08) | 81.78 (13.67) | 73.23 (14.93) | 64.82 (16.09) | <0.001 |
Interpersonal | 21.98 (8.14) | 24.75 (6.64) | 21.01 (7.97) | 18.61 (6.03) | 14.51 (6.38) | 10.65 (5.72) | <0.001 |
Laws/restrictions | 35.68 (7.70) | 36.95 (6.86) | 35.56 (7.89) | 35.11 (6.91) | 32.46 (8.12) | 29.53 (9.46) | <0.001 |
Health concerns | 17.83 (4.18) | 18.45 (3.92) | 17.61 (4.38) | 16.94 (4.27) | 16.13 (4.08) | 15.36 (4.40) | <0.001 |
Marketing | 12.57 (5.00) | 13.47 (4.81) | 12.11 (5.37) | 11.12 (4.18) | 10.13 (4.53) | 9.27 (4.71) | <0.001 |
Harm of occasional cigarette (%) | <0.001 | ||||||
No | 1034 (23.3) | 532 (17.2) | 70 (23.9) | 129 (40.7) | 129 (45.6) | 174 (38.6) | |
Yes | 3404 (76.7) | 2562 (82.8) | 223 (76.1) | 188 (59.3) | 154 (54.4) | 277 (61.4) | |
Depressive symptoms (SD) | 1.24 (1.31) | 1.16 (1.27) | 1.19 (1.34) | 1.44 (1.36) | 1.45 (1.38) | 1.50 (1.47) | <0.001 |
Parents smoked (%) | <0.001 | ||||||
No | 2654 (59.8) | 2037 (65.8) | 129 (44.0) | 203 (64.0) | 136 (48.1) | 149 (33.0) | |
Yes | 1784 (40.2) | 1057 (34.2) | 164 (56.0) | 114 (36.0) | 147 (51.9) | 302 (67.0) | |
Number of friends that smoke (SD) | 1.47 (1.57) | 0.98 (1.28) | 1.82 (1.53) | 1.94 (1.43) | 2.69 (1.46) | 3.52 (1.36) | <0.001 |
Other substance use, past 30 days | |||||||
Any alcohol use (%) | <0.001 | ||||||
No | 1925 (43.4) | 1591 (51.4) | 110 (37.5) | 56 (17.7) | 35 (12.4) | 133 (29.5) | |
Yes | 2513 (56.6) | 1503 (48.6) | 183 (62.5) | 261 (82.3) | 248 (87.6) | 318 (70.5) | |
Any binge drinking (%) | <0.001 | ||||||
No | 3441 (77.5) | 2642 (85.4) | 213 (72.7) | 161 (50.8) | 141 (49.8) | 284 (63.0) | |
Yes | 997 (22.5) | 452 (14.6) | 80 (27.3) | 156 (49.2) | 142 (50.2) | 167 (37.0) | |
Marijuana (%) | <0.001 | ||||||
No | 3795 (86.2) | 2805 (91.5) | 253 (86.6) | 212 (67.5) | 196 (70.0) | 329 (73.3) | |
Yes | 606 (13.8) | 261 (8.5) | 39 (13.4) | 102 (32.5) | 84 (30.0) | 120 (26.7) | |
Other tobacco products (%) | <0.001 | ||||||
No | 3567 (82.0) | 2747 (90.4) | 237 (83.5) | 117 (38.4) | 161 (58.1) | 305 (68.7) | |
Yes | 782 (18.0) | 292 (9.6) | 47 (16.5) | 188 (61.6) | 116 (41.9) | 139 (31.3) |
Bonferroni post hoc comparisons indicated significant differences in all comparisons except the following: age—no difference between non-smokers and native non-daily smokers; ATS—laws/restrictions—no differences between quitters and native non-daily smokers; ATS—health concerns—no differences between quitters and native non-daily smokers, native non-daily smokers and converted non-daily smokers, and converted non-daily smokers and daily smokers; ATS—marketing—no differences between quitters and native non-daily smokers, native non-daily smokers and converted non-daily smokers, and converted non-daily smokers and daily smokers; Patient Health Questionnaire-2 scores—no differences between Non-smokers and quitters, quitters and native non-daily smokers, quitters and converted non-daily smokers, native and converted non-daily smokers, native non-daily and daily smokers, converted non-daily and daily smokers; and number of friends who smoke—no differences between quitters and native non-daily smokers.
Table II presents the bivariate analyses examining smoking-related factors among current (past 30 day) smokers. There were significant differences in the average number of cigarettes smoked per day, the number of smokers who smoke a cigarette within 30 min of waking, made quit attempts in the past 12 months, are ready to quit in the next month, are social smokers and consider themselves to be a smoker among current smokers (P < 0.001). In addition, there were significant differences in intrinsic and extrinsic self-efficacy (P < 0.001), controlled motivation (P < 0.001), autonomous motivation (P = 0.03) and amotivation (P = 0.002) among current smokers. Finally, there was a significant difference in the number of smokers who smoked mentholated cigarettes among current smokers (P = 0.04). Post hoc comparisons indicated significant differences (P < 0.05) among the groups in regard to most factors (see footnote in Table II).
. | Native non-daily smokers (N = 317) . | Converted non-daily smokers (N = 283) . | Daily smokers (N = 451) . | . |
---|---|---|---|---|
Variable . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | P . |
Number of days smoked, past 30 (SD) | 5.43 (6.21) | 14.44 (9.99) | 30.00 (0.00) | <0.001 |
Average CPD (SD) | 2.31 (4.67) | 4.65 (5.36) | 11.77 (7.14) | <0.001 |
Menthol (%) | 0.04 | |||
No | 150 (57.7) | 147 (58.8) | 206 (49.8) | |
Yes | 110 (42.3) | 103 (41.2) | 208 (50.2) | |
First cigarette, 30 min of waking (%) | <0.001 | |||
No | 251 (96.5) | 223 (89.2) | 190 (45.9) | |
Yes | 9 (3.5) | 27 (10.8) | 224 (54.1) | |
Quit attempts, past 12 months (%) | <0.001 | |||
No | 40 (15.4) | 10 (4.0) | 4 (1.0) | |
Yes | 220 (84.6) | 240 (96.0) | 410 (99.0) | |
Ready to quit in next month (%) | <0.001 | |||
No | 143 (55.0) | 153 (61.2) | 376 (90.8) | |
Yes | 117 (45.0) | 97 (38.8) | 38 (9.2) | |
Social smoker (%) | <0.001 | |||
No | 53 (20.4) | 122 (48.8) | 354 (85.5) | |
Yes | 207 (79.6) | 128 (51.2) | 60 (14.5) | |
Consider yourself a smoker (%) | <0.001 | |||
No | 273 (86.1) | 124 (43.8) | 6 (1.3) | |
Yes | 44 (13.9) | 159 (56.2) | 445 (98.7) | |
Self-efficacy—intrinsic (SD) | 22.52 (7.38) | 19.92 (6.55) | 16.99 (8.31) | <0.001 |
Self-efficacy—extrinsic (SD) | 21.78 (7.02) | 19.61 (5.74) | 17.17 (7.74) | <0.001 |
TSRQ—controlled motivation (SD) | 27.05 (12.68) | 24.18 (11.39) | 21.11 (10.91) | <0.001 |
TSRQ—autonomous motivation (SD) | 32.65 (8.95) | 32.49 (9.07) | 30.94 (9.96) | 0.03 |
TSRQ—amotivation (SD) | 6.75 (3.64) | 5.76 (3.45) | 5.86 (3.65) | 0.002 |
. | Native non-daily smokers (N = 317) . | Converted non-daily smokers (N = 283) . | Daily smokers (N = 451) . | . |
---|---|---|---|---|
Variable . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | P . |
Number of days smoked, past 30 (SD) | 5.43 (6.21) | 14.44 (9.99) | 30.00 (0.00) | <0.001 |
Average CPD (SD) | 2.31 (4.67) | 4.65 (5.36) | 11.77 (7.14) | <0.001 |
Menthol (%) | 0.04 | |||
No | 150 (57.7) | 147 (58.8) | 206 (49.8) | |
Yes | 110 (42.3) | 103 (41.2) | 208 (50.2) | |
First cigarette, 30 min of waking (%) | <0.001 | |||
No | 251 (96.5) | 223 (89.2) | 190 (45.9) | |
Yes | 9 (3.5) | 27 (10.8) | 224 (54.1) | |
Quit attempts, past 12 months (%) | <0.001 | |||
No | 40 (15.4) | 10 (4.0) | 4 (1.0) | |
Yes | 220 (84.6) | 240 (96.0) | 410 (99.0) | |
Ready to quit in next month (%) | <0.001 | |||
No | 143 (55.0) | 153 (61.2) | 376 (90.8) | |
Yes | 117 (45.0) | 97 (38.8) | 38 (9.2) | |
Social smoker (%) | <0.001 | |||
No | 53 (20.4) | 122 (48.8) | 354 (85.5) | |
Yes | 207 (79.6) | 128 (51.2) | 60 (14.5) | |
Consider yourself a smoker (%) | <0.001 | |||
No | 273 (86.1) | 124 (43.8) | 6 (1.3) | |
Yes | 44 (13.9) | 159 (56.2) | 445 (98.7) | |
Self-efficacy—intrinsic (SD) | 22.52 (7.38) | 19.92 (6.55) | 16.99 (8.31) | <0.001 |
Self-efficacy—extrinsic (SD) | 21.78 (7.02) | 19.61 (5.74) | 17.17 (7.74) | <0.001 |
TSRQ—controlled motivation (SD) | 27.05 (12.68) | 24.18 (11.39) | 21.11 (10.91) | <0.001 |
TSRQ—autonomous motivation (SD) | 32.65 (8.95) | 32.49 (9.07) | 30.94 (9.96) | 0.03 |
TSRQ—amotivation (SD) | 6.75 (3.64) | 5.76 (3.45) | 5.86 (3.65) | 0.002 |
Bonferroni post hoc comparisons indicated significant differences in all comparisons except the following: TSRQ autonomous motivation—no differences among the groups; and TSRQ amotivation—no differences between converted non-daily smokers and daily smokers.
. | Native non-daily smokers (N = 317) . | Converted non-daily smokers (N = 283) . | Daily smokers (N = 451) . | . |
---|---|---|---|---|
Variable . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | P . |
Number of days smoked, past 30 (SD) | 5.43 (6.21) | 14.44 (9.99) | 30.00 (0.00) | <0.001 |
Average CPD (SD) | 2.31 (4.67) | 4.65 (5.36) | 11.77 (7.14) | <0.001 |
Menthol (%) | 0.04 | |||
No | 150 (57.7) | 147 (58.8) | 206 (49.8) | |
Yes | 110 (42.3) | 103 (41.2) | 208 (50.2) | |
First cigarette, 30 min of waking (%) | <0.001 | |||
No | 251 (96.5) | 223 (89.2) | 190 (45.9) | |
Yes | 9 (3.5) | 27 (10.8) | 224 (54.1) | |
Quit attempts, past 12 months (%) | <0.001 | |||
No | 40 (15.4) | 10 (4.0) | 4 (1.0) | |
Yes | 220 (84.6) | 240 (96.0) | 410 (99.0) | |
Ready to quit in next month (%) | <0.001 | |||
No | 143 (55.0) | 153 (61.2) | 376 (90.8) | |
Yes | 117 (45.0) | 97 (38.8) | 38 (9.2) | |
Social smoker (%) | <0.001 | |||
No | 53 (20.4) | 122 (48.8) | 354 (85.5) | |
Yes | 207 (79.6) | 128 (51.2) | 60 (14.5) | |
Consider yourself a smoker (%) | <0.001 | |||
No | 273 (86.1) | 124 (43.8) | 6 (1.3) | |
Yes | 44 (13.9) | 159 (56.2) | 445 (98.7) | |
Self-efficacy—intrinsic (SD) | 22.52 (7.38) | 19.92 (6.55) | 16.99 (8.31) | <0.001 |
Self-efficacy—extrinsic (SD) | 21.78 (7.02) | 19.61 (5.74) | 17.17 (7.74) | <0.001 |
TSRQ—controlled motivation (SD) | 27.05 (12.68) | 24.18 (11.39) | 21.11 (10.91) | <0.001 |
TSRQ—autonomous motivation (SD) | 32.65 (8.95) | 32.49 (9.07) | 30.94 (9.96) | 0.03 |
TSRQ—amotivation (SD) | 6.75 (3.64) | 5.76 (3.45) | 5.86 (3.65) | 0.002 |
. | Native non-daily smokers (N = 317) . | Converted non-daily smokers (N = 283) . | Daily smokers (N = 451) . | . |
---|---|---|---|---|
Variable . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | Mean (SD) or N (%) . | P . |
Number of days smoked, past 30 (SD) | 5.43 (6.21) | 14.44 (9.99) | 30.00 (0.00) | <0.001 |
Average CPD (SD) | 2.31 (4.67) | 4.65 (5.36) | 11.77 (7.14) | <0.001 |
Menthol (%) | 0.04 | |||
No | 150 (57.7) | 147 (58.8) | 206 (49.8) | |
Yes | 110 (42.3) | 103 (41.2) | 208 (50.2) | |
First cigarette, 30 min of waking (%) | <0.001 | |||
No | 251 (96.5) | 223 (89.2) | 190 (45.9) | |
Yes | 9 (3.5) | 27 (10.8) | 224 (54.1) | |
Quit attempts, past 12 months (%) | <0.001 | |||
No | 40 (15.4) | 10 (4.0) | 4 (1.0) | |
Yes | 220 (84.6) | 240 (96.0) | 410 (99.0) | |
Ready to quit in next month (%) | <0.001 | |||
No | 143 (55.0) | 153 (61.2) | 376 (90.8) | |
Yes | 117 (45.0) | 97 (38.8) | 38 (9.2) | |
Social smoker (%) | <0.001 | |||
No | 53 (20.4) | 122 (48.8) | 354 (85.5) | |
Yes | 207 (79.6) | 128 (51.2) | 60 (14.5) | |
Consider yourself a smoker (%) | <0.001 | |||
No | 273 (86.1) | 124 (43.8) | 6 (1.3) | |
Yes | 44 (13.9) | 159 (56.2) | 445 (98.7) | |
Self-efficacy—intrinsic (SD) | 22.52 (7.38) | 19.92 (6.55) | 16.99 (8.31) | <0.001 |
Self-efficacy—extrinsic (SD) | 21.78 (7.02) | 19.61 (5.74) | 17.17 (7.74) | <0.001 |
TSRQ—controlled motivation (SD) | 27.05 (12.68) | 24.18 (11.39) | 21.11 (10.91) | <0.001 |
TSRQ—autonomous motivation (SD) | 32.65 (8.95) | 32.49 (9.07) | 30.94 (9.96) | 0.03 |
TSRQ—amotivation (SD) | 6.75 (3.64) | 5.76 (3.45) | 5.86 (3.65) | 0.002 |
Bonferroni post hoc comparisons indicated significant differences in all comparisons except the following: TSRQ autonomous motivation—no differences among the groups; and TSRQ amotivation—no differences between converted non-daily smokers and daily smokers.
Before building the regression model indicating significant predictors of readiness to quit, we conducted bivariate tests to identify candidate predictors related to readiness to quit (significant at the P < 0.10 level). Potential predictor variables included the following: attitudes toward smoking, depressive symptoms, number of friends that smoke, average number of cigarettes smoked per day, number of days smoked in the past 30 days, intrinsic and extrinsic self-efficacy, controlled motivation, autonomous motivation, amotivation, perceived harm of an occasional cigarette, parents smoked, first cigarette within 30 min of waking, smoking mentholated cigarettes, quit attempts in the past 12 months, social smoking and considering oneself a smoker.
Table III presents the sequential binary logistic regression models identifying factors significantly associated with readiness to quit. Model A indicated that daily smokers were less likely to be ready to quit when compared with native non-daily smokers (OR = 0.12, CI 0.08–0.19, P < 0.001). Model B indicated that daily smokers were less likely to be ready to quit when compared with native non-daily smokers (OR = 0.12, CI 0.08–0.20, P < 0.001) and that females were more likely to be ready to quit (OR = 1.56, CI 1.12–2.18, P = 0.009). Model C indicated that after controlling for sociodemographics and other psychosocial and smoking-related factors, converted non-daily smokers were more likely to be ready to quit in the next month when compared with native non-daily smokers (OR = 2.15, CI 1.32–3.49, P = 0.002). Other factors associated with readiness to quit smoking in the next month included more negative attitudes toward smoking (OR = 1.03, CI 1.02–1.04, P < 0.001), fewer days smoked in the past 30 days (OR = 0.94, CI 0.92–0.97, P < 0.001), smoking the first cigarette within 30 min of waking (OR = 2.11, CI 1.23–3.62, P = 0.006), not considering oneself to be a smoker (OR = 0.55, CI 0.32–0.95, P = 0.03) and greater autonomous motivation (OR = 1.04, CI 1.01–1.06, P = 0.001). No other significant associations were found.
. | Model A . | Model B . | Model C . | ||||||
---|---|---|---|---|---|---|---|---|---|
Variable . | OR . | CI . | P . | OR . | CI . | P . | OR . | CI . | P . |
Smoking status | |||||||||
Native non-daily smoker | Ref | — | — | Ref | — | — | Ref | — | |
Converted non-daily smoker | 0.78 | 0.55, 1.10 | 0.16 | 0.80 | 0.55, 1.15 | 0.23 | 2.15 | 1.32, 3.49 | 0.002 |
Daily smoker | 0.12 | 0.08, 0.19 | <0.001 | 0.12 | 0.08, 0.20 | <0.001 | 0.97 | 0.42, 2.28 | 0.95 |
Age | 0.99 | 0.96, 0.20 | 0.49 | 0.98 | 0.95, 1.01 | 0.23 | |||
Gender | 0.19 | ||||||||
Male | Ref | — | — | Ref | — | ||||
Female | 1.56 | 1.12, 2.18 | 0.009 | 1.28 | 0.89, 1.85 | ||||
Ethnicity | |||||||||
White | Ref | — | — | Ref | — | ||||
Black | 0.94 | 0.61, 1.44 | 0.76 | 1.15 | 0.72, 1.81 | 0.55 | |||
Other | 0.94 | 0.59, 1.53 | 0.83 | 1.09 | 0.65, 1.84 | 0.75 | |||
Parental education | |||||||||
< Bachelors | Ref | — | — | Ref | — | ||||
≥ Bachelors | 0.87 | 0.62, 1.22 | 0.43 | 0.83 | 0.58, 1.20 | 0.33 | |||
Type of school | |||||||||
Four-year | Ref | — | — | Ref | — | ||||
Two-year | 0.99 | 0.69, 1.42 | 0.96 | 1.15 | 0.78, 1.72 | 0.48 | |||
Attitudes toward smoking | 1.03 | 1.02, 1.04 | <.001 | ||||||
Number of days smoked, past 30 | 0.94 | 0.92, 0.97 | <.001 | ||||||
First cigarette, 30 min of waking | |||||||||
No | Ref | — | |||||||
Yes | 2.11 | 1.23, 3.62 | 0.006 | ||||||
Consider yourself a smoker | |||||||||
No | Ref | — | |||||||
Yes | 0.55 | 0.32, 0.95 | 0.03 | ||||||
Self-efficacy—extrinsic | 1.02 | 1.00, 1.05 | 0.07 | ||||||
TSRQ—autonomous motivation | 1.04 | 1.01, 1.06 | 0.001 |
. | Model A . | Model B . | Model C . | ||||||
---|---|---|---|---|---|---|---|---|---|
Variable . | OR . | CI . | P . | OR . | CI . | P . | OR . | CI . | P . |
Smoking status | |||||||||
Native non-daily smoker | Ref | — | — | Ref | — | — | Ref | — | |
Converted non-daily smoker | 0.78 | 0.55, 1.10 | 0.16 | 0.80 | 0.55, 1.15 | 0.23 | 2.15 | 1.32, 3.49 | 0.002 |
Daily smoker | 0.12 | 0.08, 0.19 | <0.001 | 0.12 | 0.08, 0.20 | <0.001 | 0.97 | 0.42, 2.28 | 0.95 |
Age | 0.99 | 0.96, 0.20 | 0.49 | 0.98 | 0.95, 1.01 | 0.23 | |||
Gender | 0.19 | ||||||||
Male | Ref | — | — | Ref | — | ||||
Female | 1.56 | 1.12, 2.18 | 0.009 | 1.28 | 0.89, 1.85 | ||||
Ethnicity | |||||||||
White | Ref | — | — | Ref | — | ||||
Black | 0.94 | 0.61, 1.44 | 0.76 | 1.15 | 0.72, 1.81 | 0.55 | |||
Other | 0.94 | 0.59, 1.53 | 0.83 | 1.09 | 0.65, 1.84 | 0.75 | |||
Parental education | |||||||||
< Bachelors | Ref | — | — | Ref | — | ||||
≥ Bachelors | 0.87 | 0.62, 1.22 | 0.43 | 0.83 | 0.58, 1.20 | 0.33 | |||
Type of school | |||||||||
Four-year | Ref | — | — | Ref | — | ||||
Two-year | 0.99 | 0.69, 1.42 | 0.96 | 1.15 | 0.78, 1.72 | 0.48 | |||
Attitudes toward smoking | 1.03 | 1.02, 1.04 | <.001 | ||||||
Number of days smoked, past 30 | 0.94 | 0.92, 0.97 | <.001 | ||||||
First cigarette, 30 min of waking | |||||||||
No | Ref | — | |||||||
Yes | 2.11 | 1.23, 3.62 | 0.006 | ||||||
Consider yourself a smoker | |||||||||
No | Ref | — | |||||||
Yes | 0.55 | 0.32, 0.95 | 0.03 | ||||||
Self-efficacy—extrinsic | 1.02 | 1.00, 1.05 | 0.07 | ||||||
TSRQ—autonomous motivation | 1.04 | 1.01, 1.06 | 0.001 |
Model A: Nagelkerke R2 = 0.200; Model B: Nagelkerke R2 = 0.212; Model C: Nagelkerke R2 = 0.345.
. | Model A . | Model B . | Model C . | ||||||
---|---|---|---|---|---|---|---|---|---|
Variable . | OR . | CI . | P . | OR . | CI . | P . | OR . | CI . | P . |
Smoking status | |||||||||
Native non-daily smoker | Ref | — | — | Ref | — | — | Ref | — | |
Converted non-daily smoker | 0.78 | 0.55, 1.10 | 0.16 | 0.80 | 0.55, 1.15 | 0.23 | 2.15 | 1.32, 3.49 | 0.002 |
Daily smoker | 0.12 | 0.08, 0.19 | <0.001 | 0.12 | 0.08, 0.20 | <0.001 | 0.97 | 0.42, 2.28 | 0.95 |
Age | 0.99 | 0.96, 0.20 | 0.49 | 0.98 | 0.95, 1.01 | 0.23 | |||
Gender | 0.19 | ||||||||
Male | Ref | — | — | Ref | — | ||||
Female | 1.56 | 1.12, 2.18 | 0.009 | 1.28 | 0.89, 1.85 | ||||
Ethnicity | |||||||||
White | Ref | — | — | Ref | — | ||||
Black | 0.94 | 0.61, 1.44 | 0.76 | 1.15 | 0.72, 1.81 | 0.55 | |||
Other | 0.94 | 0.59, 1.53 | 0.83 | 1.09 | 0.65, 1.84 | 0.75 | |||
Parental education | |||||||||
< Bachelors | Ref | — | — | Ref | — | ||||
≥ Bachelors | 0.87 | 0.62, 1.22 | 0.43 | 0.83 | 0.58, 1.20 | 0.33 | |||
Type of school | |||||||||
Four-year | Ref | — | — | Ref | — | ||||
Two-year | 0.99 | 0.69, 1.42 | 0.96 | 1.15 | 0.78, 1.72 | 0.48 | |||
Attitudes toward smoking | 1.03 | 1.02, 1.04 | <.001 | ||||||
Number of days smoked, past 30 | 0.94 | 0.92, 0.97 | <.001 | ||||||
First cigarette, 30 min of waking | |||||||||
No | Ref | — | |||||||
Yes | 2.11 | 1.23, 3.62 | 0.006 | ||||||
Consider yourself a smoker | |||||||||
No | Ref | — | |||||||
Yes | 0.55 | 0.32, 0.95 | 0.03 | ||||||
Self-efficacy—extrinsic | 1.02 | 1.00, 1.05 | 0.07 | ||||||
TSRQ—autonomous motivation | 1.04 | 1.01, 1.06 | 0.001 |
. | Model A . | Model B . | Model C . | ||||||
---|---|---|---|---|---|---|---|---|---|
Variable . | OR . | CI . | P . | OR . | CI . | P . | OR . | CI . | P . |
Smoking status | |||||||||
Native non-daily smoker | Ref | — | — | Ref | — | — | Ref | — | |
Converted non-daily smoker | 0.78 | 0.55, 1.10 | 0.16 | 0.80 | 0.55, 1.15 | 0.23 | 2.15 | 1.32, 3.49 | 0.002 |
Daily smoker | 0.12 | 0.08, 0.19 | <0.001 | 0.12 | 0.08, 0.20 | <0.001 | 0.97 | 0.42, 2.28 | 0.95 |
Age | 0.99 | 0.96, 0.20 | 0.49 | 0.98 | 0.95, 1.01 | 0.23 | |||
Gender | 0.19 | ||||||||
Male | Ref | — | — | Ref | — | ||||
Female | 1.56 | 1.12, 2.18 | 0.009 | 1.28 | 0.89, 1.85 | ||||
Ethnicity | |||||||||
White | Ref | — | — | Ref | — | ||||
Black | 0.94 | 0.61, 1.44 | 0.76 | 1.15 | 0.72, 1.81 | 0.55 | |||
Other | 0.94 | 0.59, 1.53 | 0.83 | 1.09 | 0.65, 1.84 | 0.75 | |||
Parental education | |||||||||
< Bachelors | Ref | — | — | Ref | — | ||||
≥ Bachelors | 0.87 | 0.62, 1.22 | 0.43 | 0.83 | 0.58, 1.20 | 0.33 | |||
Type of school | |||||||||
Four-year | Ref | — | — | Ref | — | ||||
Two-year | 0.99 | 0.69, 1.42 | 0.96 | 1.15 | 0.78, 1.72 | 0.48 | |||
Attitudes toward smoking | 1.03 | 1.02, 1.04 | <.001 | ||||||
Number of days smoked, past 30 | 0.94 | 0.92, 0.97 | <.001 | ||||||
First cigarette, 30 min of waking | |||||||||
No | Ref | — | |||||||
Yes | 2.11 | 1.23, 3.62 | 0.006 | ||||||
Consider yourself a smoker | |||||||||
No | Ref | — | |||||||
Yes | 0.55 | 0.32, 0.95 | 0.03 | ||||||
Self-efficacy—extrinsic | 1.02 | 1.00, 1.05 | 0.07 | ||||||
TSRQ—autonomous motivation | 1.04 | 1.01, 1.06 | 0.001 |
Model A: Nagelkerke R2 = 0.200; Model B: Nagelkerke R2 = 0.212; Model C: Nagelkerke R2 = 0.345.
Discussion
The current research examined sociodemographic and psychosocial factors among college students with differing smoking patterns and histories. Controlling for sociodemographics, daily smokers were less ready to quit smoking than non-daily smokers, but no significant differences between converted non-daily smokers and native non-daily smokers in relation to their readiness to quit smoking. However, we found that after controlling for sociodemographic, smoking-related and other psychosocial characteristics, converted non-daily smokers were more likely to be ready to quit smoking than native non-daily smokers, whereas native non-daily smokers and daily smokers were not statistically different in their intentions to quit. This suggests that garnering greater information about the psychosocial factors associated with smoking, such as attitudes toward smoking, whether one considers oneself to be a smoker, self-efficacy and motivation to quit, is critical in fully understanding how young adult current smokers think about their smoking and likelihood of cessation.
Guided by the TTM [24–26], we examined the associations between intention to quit and smoking status, controlling for mediating variables. Differences between the bivariate findings and Models B and C of the multivariate results suggest that psychosocial factors and smoking-related characteristics must be important in understanding how these groups of non-daily smokers view their smoking and the need to quit. For example, smokers who smoked their first cigarette within 30 min of waking (i.e. more nicotine dependent) were more likely to be ready to quit in the next month, suggesting that individuals who are physiologically addicted to smoking may feel a stronger need to quit. In contrast, however, those who smoked fewer days per month were more likely to be ready to quit. Importantly, current smokers who did not consider themselves to be smokers, those who had more negative attitudes toward smoking and those who had greater autonomous motivation to quit were more likely to be ready to quit in the next month. Thus, social stigma may influence readiness to quit smoking in this college student population.
Among native non-daily, converted non-daily and daily smokers, significant differences were found in smoking-related characteristics such that native non-daily smokers seemed to represent the group with lowest exposure and risk in terms of their smoking levels and attitudes, whereas daily smokers represented the highest risk group. Consistent with previous research, native non-daily smokers smoked the fewest days per month [11], smoked the least amount of cigarettes per day [2, 11] and were the least likely to smoke within the first 30 min of waking [2], whereas daily smokers smoked the most [2] and were the most likely to smoke after waking [2]. Furthermore, native non-daily smokers were the least likely to consider themselves a smoker [48] and were most likely to smoke socially, whereas daily smokers were the most likely to consider themselves a smoker and were least likely to be social smokers [48]. Native non-daily smokers reported the highest controlled motivation, whereas daily smokers reported the lowest controlled motivation. Interestingly, however, native non-daily smokers also reported the greatest amotivation, which may reflect their tendency to not consider themselves a smoker. Native non-daily smokers had the highest self-efficacy to refrain from smoking, while daily smokers had the lowest [51]. However, in this sample, daily smokers were the most likely to have made a recent quit attempt, with the native non-daily smokers being the least likely. This last finding is in contrast with the previous research [2] in which daily smokers were the least likely to have made a quit attempt and converted non-daily smokers were the most likely to have attempted to quit. However, these findings were documented among adult smokers comprising mostly adults over the age of 30.
Another noteworthy finding was that while converted non-daily smokers were the least likely to smoke mentholated cigarettes, current daily smokers were the most likely to smoke mentholated cigarettes. Previous research has suggested that menthol may increase nicotine absorption [52, 53], indicating that menthol may make cigarettes more addictive, promote the maintenance of smoking and making it more difficult to quit smoking menthol cigarettes than plain cigarettes [54]. However, previous research has been equivocal with some studies showing no relationship between menthol and successful cessation [55, 56] and other indicating an association between menthol and lower cessation rates or greater difficulty quitting [57-59]. The current findings highlight the need to examine this in the young adult years.
Among all five groups, we found that, consistent with previous findings, non-smokers included the greatest proportion of females [60], 2005), blacks [51, 60] and four-year college students [43, 61]. Consistent with Problem Behavior Theory [15], non-smokers were less likely to use alcohol, binge drink, smoke marijuana or use other tobacco products than former or current smokers, which is consistent with previous research [51]. Furthermore, non-smokers had the most negative attitudes toward smoking [40], were the most likely to view smoking as harmful to your health, the least likely to have parents that smoked [62] and had the fewest amount of friends who smoked [60]. Thus, non-smokers experienced several factors, both interpersonally and intrapersonally, that are associated with reduced risk of smoking initiation. On the opposite end of the spectrum, daily smokers included the largest proportion of white smokers, which aligns with previous research [51, 63]. Also previously documented, they had less educated parents and were more likely to attend a two-year school [43, 61], had the least negative attitudes toward smoking, were most likely to have parents who smoked and had the greatest amount of friends who smoked [60]. These findings highlight that non-smokers who have never smoked daily and current daily smokers in the young adult population might exemplify extreme opposite ends of a spectrum in terms of risk factors associated with smoking initiation and progression, which is line with Problem Behavior Theory. In addition, quitters were the oldest subgroup, which may be reflective of the natural progression of smoking to cessation among some individuals [2].
In terms of other substance use, native non-daily smokers were the most likely to smoke marijuana and use other tobacco products. Converted non-daily smokers were the most likely to use alcohol and binge drink. Previous research has documented the greatest proportion of substance use (e.g. alcohol and marijuana) and other tobacco use among non-daily smokers [64], yet research has not documented differences in native versus converted non-daily smokers.
Interestingly, converted non-daily smokers were the least likely of the five groups to view smoking as harmful to one’s health but had the greatest intention to quit smoking. This may seem counterintuitive given that higher perceived harm tends to be associated with greater intent to quit smoking [23]. However, these findings might be reflective of their ability to reduce to a non-daily smoking pattern after regular daily use, and thus an impression that quitting smoking or reducing smoking is not as challenging as the other groups might perceive. Their lower levels of concern about the harm of smoking may result from their lower level current use of cigarettes relative to the risks of daily smoking.
Limitations
Limitations to this study include limited generalizability due to recruitment at six colleges in the Southeast. However, our respondents were representative of the college student populations among these colleges, except that there was a greater representation of females who responded. An additional limitation is the relatively low response rate (20.1%), which may suggest response bias. However, previous research has found that the average e-mail survey response rate is 24%, which is only slightly higher than the response rate for this survey [65]. In addition, it is possible that some recruited students did not open the e-mail or had inactive accounts, which would influence the response rate. Furthermore, previous research has indicated that, despite lower response rates, Internet surveys yield similar data regarding health behaviors compared with mail and phone surveys [66]. We also had roughly 9% missing data, which limits the generalizability of our findings. In addition, it is difficult to determine the clinical significance of some of our statistically significant findings. Finally, terminology used for characterizing and identifying non-daily smoking patterns should be further explored and agreed upon by the research community.
Conclusions
Our analyses indicated that comprehensively examining the smoking-related and psychosocial factors associated with smoking among young adult smokers was critical in understanding their attitudes toward cessation. Differing cigarette use and psychosocial factors are inherent among native non-daily, converted non-daily and daily smokers, and these differences have implications for readiness to quit smoking. Thus, intervention efforts targeting young adult smokers must identify specific intervention targets within the subgroups of smokers in this population.
Funding
This research was supported by the National Cancer Institute (1K07CA139114-01A1; PI: Berg) and the Georgia Cancer Coalition (PI: Berg). J.S.A. is supported in part by 1P60MD003422 from the National Institute for Minority Health Disparities.
Conflict of interest statement
None declared.
Acknowledgement
We would like to thank our collaborators across the state of Georgia in developing and administering this survey.