Studies review smoking among college freshmen and tobacco use by adolescents with ADHD

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"The findings in this supplemental issue are of interest to smokers, researchers and policy makers because they focus on practical issues and represent the work of noted scientists from a variety of disciplines," according to Robin Mermelstein, Ph.D., of the University of Illinois at Chicago. Mermelstein wrote the introductory paper in the supplement.

Smoking Habits of College Freshmen

Studies show that smoking initiation typically occurs at age 15 or 16 and over a two- or three-year period gradually increases to daily smoking. Daily smokers continue to escalate their use of cigarettes over the next several years as they develop into chronic, heavily dependent smokers.

This study looked at the daily smoking habits of 912 college students at Purdue University during their freshman year to understand some of the factors that influence trajectories of smoking behavior and tobacco dependence. Students were assessed weekly over the course of the academic year using a web-based survey and provided monthly saliva samples for cotinine analysis. Rates of alcohol and marijuana use were also examined.

Results revealed several patterns of substance use. Heightened use of cigarettes, alcohol, and marijuana were observed during the earliest weeks of school, followed by steady rates of decline over the next several weeks, suggesting that many college freshmen initially experiment with substance use upon arriving on campus, but do not continue to use. Results also found a weekly pattern of smoking, with most cigarettes smoked on Fridays and Saturdays. This pattern was relative consistent across the academic year, with the exception of specific holidays when rates of use increased (i.e., Halloween and New Years Eve), and specific weeks when rates of use decreased (i.e., finals week, winter and spring break). Patterns of smoking and alcohol use were similar, especially for students with higher levels of use.

Among freshmen who had smoked very little prior to beginning college, findings revealed that their initial early-use episodes of smoking during college occurred within a social/party setting and that over 90% occurred when the person was with other people who were smoking. In addition, the majority (65%) of the first recorded early use of cigarettes occurred while the participant was drinking alcohol.

Title of Paper: "Smoking in College Freshmen: University Project of the Tobacco Etiology Research Network (UpTERN)." Lead author: Stephen T. Tiffany, University of Utah.

Attention Deficit Hyperactivity Disorder, Depression and Anxiety

Some studies suggest that individuals with attentional and emotional problems continue to smoke at high rates and are less successful with smoking cessation. With the majority of smokers beginning to smoke by age 18, adolescents with attentional and emotional dysfunctions also have a higher risk for smoking compared to those without such problems. Smoking behavior may reflect adolescents' use of nicotine for self-medicating purposes: to reduce symptoms associated with attention-deficit/ hyperactivity disorder, and to regulate emotions among those who struggle with depression or anxiety.

This paper proposes that adolescents with attentional and emotional disorders may be especially vulnerable to start smoking as a result of their brain functioning. Nicotine may "normalize" certain parts of the brain, thereby increasing the risk of nicotine dependence and increasing difficulty in quitting. Treatment of these attentional and emotional dysfunctions through behavioral and pharmacological interventions that "normalize" the affected parts of the brain may reduce the reinforcing effects of smoking and, thus, may represent tailored smoking cessation strategies. Such tailored smoking cessation strategies may also be useful in prevention programs for at-risk youths.

Title of Paper: "Smoking to self-medicate attentional and emotional dysfunctions." Lead author: Jean-G. Gehricke, Ph.D., Department of Psychiatry and Human Behavior, University of California, Irvine.

Nicotine Dependence/First Cigarette of the Day

Whether or not smokers can quit cigarettes and remain tobacco free is related to their dependence on nicotine. There are many ways to measure nicotine dependence, including number of cigarettes smoked in a day, the withdrawal experienced by smokers, and attitudes toward smoking and quitting. One paper that examined various measures of nicotine dependence, found that the amount of time before lighting the first cigarette of the day was most predictive of a smoker's ability to quit smoking.

The paper finds that the time to the first cigarette in the morning reflected a need for "heavy, uninterrupted and automatic smoking," and it was a valid predictor of a smoker's ability to quit cigarettes and remain tobacco free. The earlier a person smoked the first cigarette, the more difficult it would be for that smoker to quit cigarettes.

Title of Paper: "Time to first cigarette in the morning as an index of ability to quit smoking: Implications for nicotine dependence." Lead author: Timothy B. Baker, Ph.D., University of Wisconsin School of Medicine & Public Health, Center for Tobacco Research and Intervention.

Reduced-Exposure Tobacco Products

The use of tobacco products that have the potential to reduce exposure to tobacco toxicants is a controversial issue among scientists, policy makers, advocacy groups and health professionals. This controversy reflects, in part, the experience of low-tar, low-nicotine tobacco products introduced in the 1970s, which initially seemed to hold promise for reducing tobacco harm but instead were based on misleading claims that may have led to a negative public health impact.

After dramatic decreases in the prevalence of tobacco use that were observed over the past decades, the rate of quitting smoking has slowed, leading scientists to debate whether the remaining smokers tend to be hardened or hard-core smokers. Of the 22 million smokers who tried to quit, approximately 3-5% are successful for at least one year and at any one time, only 4-20% are seriously thinking of quitting smoking within the next month.

Not starting to smoke and quitting smoking are still the best ways to avoid the harm from tobacco. But for current smokers, this paper also suggests that the tobacco industry must be regulated: a) to avoid misleading consumers about the safety of products ( e.g., by labeling them as "light" or "ultra-light" or "reduced exposure to carcinogens") , b) to prevent the initiation of tobacco use among children and adolescents (e.g., by adding flavors to cigarettes that encourage experimentation ) ; c) to be sure that smokers who would otherwise have quit do not maintain tobacco use (e.g., through the marketing of smokeless tobacco as a substitute to cigarettes in smoke-free locations); and d) to stop the continued manufacturing of extremely toxic products when the technology to manufacture less toxic products is available.

Title of Paper: "Developing the Science Base for Reducing Tobacco Harm." Lead author: Dorothy K. Hatsukami, Ph.D., University of Minnesota, Transdisciplinary Tobacco Use Research Center.

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