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A Cause for National Concern

Henry Wechsler, PhD; Nancy A. Rigotti, MD; Jeana Gledhill-Hoyt, MPH; Hang Lee, PhD

JAMA. 1998;280:1673-1678.

Context.— Adolescent smoking prevalence is tracked annually and has increased since 1991. In contrast, little is known about trends in smoking among college students, a group that has previously been more resistant to tobacco use than other young adults.

Objective.— To examine changes in cigarette smoking among college students between 1993 and 1997 and among different types of students and colleges.

Design.— Self-administered survey (Harvard School of Public Health College Alcohol Study).

Setting.— One hundred sixteen nationally representative 4-year colleges.

Subjects.— A total of 15,103 randomly selected students in 1993 (70% response rate) and 14,251 students in 1997 (60% response rate).

Main Outcome Measures.— Self-reports of cigarette smoking in the past 30 days and in the past year, age at smoking first cigarette, and number of attempts to quit.

Results.— Over 4 years, the prevalence of current (30-day) cigarette smoking rose by 27.8%, from 22.3% to 28.5% (P<.001). The increase was observed in 99 of 116 colleges and was statistically significant (P<.05) in 27 (23%) of them. Current smoking increased across all student subgroups (defined by sex, race/ethnicity, and year in school) and in all types of colleges. Smoking is rising faster in public schools (from 22.0% to 29.3%) than in private schools (from 22.9% to 26.8%). Eleven percent of college smokers had their first cigarette and 28% began to smoke regularly at or after age 19 years, by which time most were already in college. Half of current smokers tried to quit in the previous year; 18% had made 5 or more attempts to quit.

Conclusions.— Cigarette use is increasing on campuses nationwide in all subgroups and types of colleges. Substantial numbers of college students are both starting to smoke regularly and trying to stop. National efforts to reduce smoking should be extended to college students.

From the Department of Health and Social Behavior, Harvard School of Public Health (Dr Wechsler and Ms Gledhill-Hoyt), and the Tobacco Research and Treatment Center, Division of General Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School (Dr Rigotti), Boston; and the Center for Vaccine Research, University of California, Los Angeles (Dr Lee).

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