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Results of a National Survey

Nancy A. Rigotti, MD; Jae Eun Lee, DrPH; Henry Wechsler, PhD

JAMA. 2000;284:699-705.

Context  Adults aged 18 to 24 years, many of whom are in college, represent the youngest legal targets for tobacco industry marketing. Cigarette smoking has been described among college students, but little is known about noncigarette tobacco use by college students or cigar use by adults of any age.

Objectives  To assess the prevalence of all forms of tobacco use (cigarettes, cigars, pipes, and smokeless tobacco) among US college students and to identify student- and college-level factors associated with use of each product.

Design  The Harvard College Alcohol Survey, a self-administered survey conducted in 1999.

Setting  One hundred nineteen nationally representative US 4-year colleges.

Subjects  A total of 14,138 randomly selected students (60% response rate).

Main Outcome Measures  Self-report of current (in the past 30 days), past-year, and lifetime use of cigarettes, cigars, pipes, smokeless tobacco, and all tobacco products.

Results  Nearly half (45.7%) of respondents had used a tobacco product in the past year and one third (32.9%) currently used tobacco. Cigarettes accounted for most of the tobacco use (28.5% current prevalence), but cigar use was also substantial (37.1% lifetime prevalence, 23.0% past-year prevalence, and 8.5% current prevalence) and combinations of the 2 were common. Total tobacco use was higher in men than in women (37.9% vs 29.7%; P<.001), despite nearly identical current cigarette smoking rates between the sexes (28.5% for women vs 28.4% for men), because of greater use of cigars (current prevalence, 15.7% vs 3.9%; P<.001) and smokeless tobacco (current prevalence, 8.7% vs 0.4%; P<.001) by men. Tobacco use was significantly higher among white students (P<.001), users of other substances (alcohol and marijuana) (P<.001), and students whose priorities were social rather than educational or athletic (P<.05). Among students who had used both cigars and cigarettes, only 8.9% smoked cigars at an earlier age than they had smoked cigarettes.

Conclusion  Our study indicates that tobacco use is common among college students and is not limited to cigarettes. College appears to be a time when many students are trying a range of tobacco products and are in danger of developing lifelong nicotine dependence. National efforts to monitor and reduce tobacco use of all types should expand to focus on college students and other young adults.

Author Affiliations: Tobacco Research and Treatment Center, Division of General Medicine, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School (Dr Rigotti), and Department of Health and Social Behavior, Harvard School of Public Health (Drs Wechsler and Lee), Boston, Mass.

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