Environmental and Social Influences on Tobacco Use Among 18 to 24 Year-Olds in Idaho Dr. John Hetherington Clearwater Research, Inc. Influences on Young Adult Tobacco UsePage 1 Selina Carver Idaho Department of Health and Welfare

Background – Players and Roles n Idaho Tobacco Prevention and Control Program n Es/drake n Clearwater Research Policy R & E Media Influences on Young Adult Tobacco UsePage 2

Relevance of Young Adult Age Group n Key outcome point in evaluation of underage education efforts. n Since 1997, the age group had highest smoking rate nationwide 1. n 31.2% smoking rate in 2002 and 31.0% smoking rate in Influences on Young Adult Tobacco UsePage 3 1 Centers for Disease Control. (1999). Tobacco Use – United States, , MMWR, 48, Centers for Disease Control. (2002). BRFSS Prevalence Data (

Research on Year Olds n National research activity (NIH / CDC) n National College Health Risk Behavior Survey (1995) n Harvard School of Public Health’s College Alcohol Survey (1993 / 1997) n Monitoring the Future (University of Michigan) n Individual college surveillance n University of Minnesota, Texas Tech, Yale Influences on Young Adult Tobacco UsePage 4

2001 Smoking Rates in Idaho 38% 34% ~ 30% ~ 20% 17% ~ 25% ~ 20% ~ 15% 18 to 24 Age Group All Residents Influences on Young Adult Tobacco UsePage 5

2002 Study Design Overview n Data Collection n Telephone interview with Idaho young adults (18-24 years of age). n Sampling n Probability sample (list assisted RDD). n Stratified disproportionately by health district. n Analysis n Support answers to RQ about young adult population. Influences on Young Adult Tobacco UsePage 6

Research Questions n What are the general lifestyle characteristics of the target audience? n What are the characteristics and attitudes of the 18 to 24 year-old population that affect their choices on quitting or not starting the use of tobacco products? Influences on Young Adult Tobacco UsePage 7

Data Collection Methodology n Telephone interviews n CATI executed n 11.5 minute interviews n Screening questions n Determine eligibility of HH. n Enumerate number of young adults in HH. n Questions selected from BRFSS, ATS, and YTS. Influences on Young Adult Tobacco UsePage 8

Questionnaire Topics Smoker Non-Smoker Influences on Young Adult Tobacco UsePage 9

Sampling Strategy n Total of 1,387 interviews n List-assisted RDD n Health district stratification n ±2.6% C.I. at 95% C.L. Influences on Young Adult Tobacco UsePage 10

Data Collection n Fielding period: March 21 to May 23, 2002 n Response rate calculations n CASRO response rate: 50.1% n CASRO Upper Bound: 83.1% Influences on Young Adult Tobacco UsePage 11

Data Preparation n Case weights: Probability of selection (sample frame, young adults in HH, and phone lines) Poststratification (sex and age) Influences on Young Adult Tobacco UsePage 12

Findings: Current Smoking Status n Overall, 53% had smoked whole cigarette (Q025: n = 730). Influences on Young Adult Tobacco UsePage 13

Findings: Current Smoking Status n Of those who had smoked a whole cigarette, 68% had smoked 100 cigarettes in lifetime (Q030: n = 495). Influences on Young Adult Tobacco UsePage 14

Findings: Current Smoking Status n Three questions were used to categorize respondents: n Q025: Have you ever smoked a whole cigarette? n Q030: Have you ever smoked 100 cigarettes? n Q035: How many of the past 30 days have you smoked? Influences on Young Adult Tobacco UsePage 15

Findings: Current Smoking Status n Of the 52% overall who had smoked at least one cigarette: n 41% were Frequent smokers (n = 293) n 10% were Occasional smokers (n = 75) n 17% were Former smokers (n = 119) n 33% were Small amount smokers (n = 233) Influences on Young Adult Tobacco UsePage 16

Findings: Smoking Behavior n On average, smoked on 18 of past 30 days (n = 480). n On average, smoked 10 cigarettes a day (n = 359). n 33% smoked within 30 minutes of awakening (n = 119). Influences on Young Adult Tobacco UsePage 17

Findings: Cessation n 90% have considered reducing number of cigarettes smoked each day (n = 335). n 38% unsure about being able to refrain from smoking for at least a month (n = 141). n 70% tried to quit smoking > 1 day in past 12 months (n = 340). n 69% had tried cold turkey and 10% nicotine gum/patch (n = 243, n = 37). Influences on Young Adult Tobacco UsePage 18

Findings: Other Tobacco Use n Overall, 35% had smoked cigars at some time, and 6% in past 30 days (n = 482, n = 81). n Overall, 21% had used smokeless tobacco at some time, and 6% in past 30 days (n = 290, n = 82). Influences on Young Adult Tobacco UsePage 19

Findings: Frequent Smokers More Likely To... n Have a High School degree or less. n Earn $15-$30K / year. n Agree that They are addicted to cigarettes. n Agree that Light cigarettes are safer. n Have a parent or sibling who smokes. n Have more friends who smoke. n Allow smoking in their home or vehicle. Less Likely To... n Be female, a student, or exercise. n Have a college degree or attend college. n Agree that tobacco ads target youths. n Agree that second hand smoke harms others. n Have access to the Internet. n Participate in organized sports. n Read an alternative or campus newspaper. n Have a health club membership. n Read for inspiration or growth. Influences on Young Adult Tobacco UsePage 20

Findings: ETS Exposure n 84% overall responded “Smoking was not allowed anywhere inside your home” (n = 1157). n 63% overall indicated that “Smoking was not allowed anywhere inside your vehicle” (n = 849). n 57% overall indicated that “Smoking was not allowed in any work area” (n = 1157). Influences on Young Adult Tobacco UsePage 21

Findings: ETS Exposure n 65% overall did not have an adult smoking in HH (n = 903). n 61% overall did not have a sibling who smoked (n = 845). n 47% overall did not have any friends who smoked (n = 676). Influences on Young Adult Tobacco UsePage 22

Predictive Model n Predict smoking status categories: n Current Frequent Smoker n Current Occasional Smoker n Small Amount / Former Smoker n Structural Equations Modeling Approach n Unique / common variance components. n Personal, social, and environmental characteristics modeled simultaneously. Influences on Young Adult Tobacco UsePage 23

Influences on Young Adult Tobacco UsePage 24 Initial Model

Frequent Smokers n Frequent Smokers were more likely to: n Use other tobacco products. n Live with another smoking adult. n Have friends and siblings who smoke. Influences on Young Adult Tobacco UsePage 25 Model  2 (153) = CFI =.83

Frequent Smokers n Frequent Smokers were less likely to: Agree with general health / anti-tobacco statements. Report good or excellent general health. Be a student. Exercise, participate in organized sports, or have a membership in a health club. Have Internet access. Read campus or alternative newspapers. To not allow smoking in house or vehicle. Influences on Young Adult Tobacco UsePage 26 Model  2 (153) = CFI =.83

Occasional Smokers n Compared to FSA and Nonsmoking groups, Occasional Smokers were more likely to: n Use other tobacco products. n Live with another smoking adult. n Have friends and siblings who smoke. Influences on Young Adult Tobacco UsePage 27 Model  2 (25) = CFI =.79

Occasional Smokers n Compared to FSA and Nonsmoking groups, Occasional Smokers were less likely to: n To not allow smoking in their vehicle. Influences on Young Adult Tobacco UsePage 28 Model  2 (25) = CFI =.79

SA / Former Smokers n Compared to the Nonsmoking group, Former / Small Amount Smokers were more likely to: n Use other tobacco products. n Live with another smoking adult. n Have friends and siblings who smoke. n Be older (given the 18 to 24 age range). Influences on Young Adult Tobacco UsePage 29 Model  2 (58) = CFI =.72

SA / Former Smokers n Compared to the Nonsmoking group, Former / Small Amount Smokers were less likely to: n Agree with general health / anti- tobacco statements. n Be a student. n Live with their parents. n Have a child living in their household. Influences on Young Adult Tobacco UsePage 30 Model  2 (58) = CFI =.72

Thanks John Hetherington, Ph.D. Clearwater Research Study Director 1845 S. Federal Way Boise, ID (208) x Influences on Young Adult Tobacco UsePage 31