Knowledge of student smoking behaviors and attitudes was sought to inform a proposal to implement a smoke-free university campus. This study assessed prevalence of student smoking and quitting behaviors and associated demographic, contextual and attitudinal factors. A cross-sectional design using a convenience sample on a single university site was utilized. Data were collected by anonymous self-administered questionnaires and analyzed using bivariate and multivariable logistic models comparing smokers and non-smokers (Model 1) and daily with occasional smokers Model 2. Of 739 respondents, 19% of students smoked; 12% occasional (non-daily) and 7% daily smokers. Smokers were more likely to be ≥22 years and to allow smoking inside their accommodation (Model 1). They were less likely to agree that tobacco was addictive and to consider those who smoked at parties and weekends to be regular smokers. In Model 2, daily smokers were older and nine times more likely to report increased difficulty in handling stress if they quit smoking. Forty-four percent of all smokers had attempted to quit in the past year, 35% of smokers intended to quit in the next 30 days and 53% in the next six months. Forty percent did not use quitting supports. Occasional rather than daily smoking was more prevalent in university students. Smokers differed from non-smokers in their perception of smoking-related health risks. Increasing age was the best predictor of regular and occasional smoking. Intentions to quit smoking and quit attempts were high among all smokers although use of on-site cessation supports was less than the optimal. These combined factors indicate a need for better targeting of our prevention strategies and the need to promote greater awareness of cessation supports for successful implementation of a smoke-free campus.
University is a time of transition for many aspects of life in young adults, including health smoking behaviors [
A prior online survey of staff and student attitudes towards implementation of a tobacco free campus showed that the majority of the university community was in favor of the campus becoming tobacco-free (50% of undergraduates, 58% of postgraduates and 66% of staff) [https://www.tcd.ie/collegehealth/assets/documents/TFT%20April%202013%20Survey.pdf].
Smoking in young adults varies widely (8% - 34%) and the proportion of university students that smoke tend to be less than in their peers [
Attitudes and beliefs about smoking risk differ according to smoking status [
Overall approximately 50% of student smokers reported attempting to quit at some time or in the previous year [
Previous experience with smoking bans has shown greater success in reducing second-hand smoking and its health effects than in reducing smoking itself [
The aim of this study was to assess prevalence of student smoking and quitting behaviors, and to identify the demographic, contextual and attitudinal factors associated with these behaviors as part of a move towards establishing a tobacco free university campus.
The study was a one site cross-sectional, descriptive study.
A previously developed questionnaire meeting the aims of this study was not identified from review of the literature, therefore the study team developed a questionnaire utilizing, where possible, definitions and questions used in other studies. A pilot questionnaire was circulated for content validity for review by academic colleagues. The reviewers were asked to rate the questions for clarity and relevance on a four-part Likert scale, from very clear to not clear and from very relevant to not relevant. Seven questions were classified as “only somewhat clear” or “not clear” and seven were classified as “only somewhat relevant” or “not relevant”. The research team then altered or deleted questions as appropriate based on these ratings and additional comments made by the reviewers. The final anonymous questionnaire included socio-demographic characteristics, exposure to second- hand smoke and accommodation smoking rules, participants’ beliefs about smoking and risk perceptions. Participants were asked to define their smoking status as non-smoker, daily smoker or non-daily/occasional smoker. Smokers were asked type of cigarettes usually smoked, number of cigarettes smoked and their smoking patterns on campus. Questions relating to quitting behaviors asked “During the past 12 months have you stopped smoking for 24 hours or longer because you were trying to quit smoking”, supports used for quitting, and intention to quit in the next 30 days and next 6 months. The final question explored smokers’ views on perceived benefits of giving up smoking.
Based on a population of approximately 7300 undergraduate students it was estimated that a sample of 290 was required to determine smoking prevalence [
Access to the students was arranged through the relevant School coordinators. Data collection occurred in the classroom. Module lecturers facilitated access to students during 15 minutes of class time; questionnaires were distributed and collected by members of the research team or administration personnel. To encourage participation, all students who submitted a questionnaire were invited to submit a detachable separate slip with email address for entry into a draw for a tablet computer. Questionnaires were administered to six classes; over a two-week period in October 2013.
Data were analyzed using SPSS version 22. Descriptive statistics were used to describe the population. Bivariate analyses were conducted using Chi squared tests or Fisher’s exact test as appropriate to examine associations between non-smokers and smokers and occasional and daily smokers’ profiles, perceptions, beliefs and behaviors. Significant variables in bivariate analyses were then examined using two logistic regression models (backward, stepwise): Model 1 comparing smokers and non-smokers, Model 2 comparing daily and occasional smokers. Significance level for entry into the model was 0.1. The significance level for variable retention in the models and for bivariate analyses was set at 0.05.
The estimated population was 1000; as there were 750 respondents this represents an estimated response rate of 75%. However, class attendance was not recorded; as a consequence, the exact response rate to the survey could not be calculated. Eleven respondents did not complete the question on smoking habits and were excluded from the analysis. Of the remaining 739 respondents, the majority were biochemistry students (55%), first year students (70%), and aged less than 22 (84%). Most were non-smokers (81%). Smoking was significantly more common among nursing and psychology students, in those aged 22 years or more, and in those living in their own home (
There were significant differences in the behaviors and in the beliefs held by smokers and non-smokers. In bivariate analysis, non-smokers were more likely to report never being exposed to second-hand smoke indoors (81% vs. 57%) but less likely to report never being affected by smoking outside buildings on campus (40% vs. 56%). Non-smokers were more likely to say that smoking was not allowed anywhere inside their accommodation (88% vs. 67%). Smokers were significantly less likely than non-smokers to agree that people risk harming themselves by smoking only at weekends or on a few days per week (67% vs. 80%), to consider those who smoke at parties and weekends to be regular smokers (21% vs. 48%) or to agree that tobacco is addictive (54% vs. 74%). Compared to non-smokers, smokers were more likely to report that they regarded the university’s supports for quitting as being just right (26% versus 18%). However, over 60% of both groups said they were unsure if the supports were too little or just right (
Model 1 examined the factors and beliefs which best predicted the odds of being a smoker or non-smoker. The final model, which contained four variables (age, accommodation rules, perception of smoking being addictive, perception
Variable (n) | Total N = 739 (100%) | Non-smokers N = 597 (80.8%) | Smokers N = 142 (19.2%) | χ2 (df) p | |
---|---|---|---|---|---|
n (%) | n (%) | n (%) | |||
School (738) | Biochemistry | 408 (55.3) | 344 (84.3) | 64 (15.7) | 7.45 (2) 0.03* |
Nursing and Midwifery | 260 (35.2) | 199 (76.5) | 61 (23.5) | ||
Psychology | 70 (9.5) | 53 (75.7) | 17 (24.3) | ||
Age (739) | <22 | 622 (84.2) | 518 (83.3) | 104 (16.7) | 14.76 (1) <0.01* |
≥22 | 117 (15.8) | 79 (67.5) | 38 (32.5) | ||
Gender (446) | Male | 153 (34.3) | 121 (79.1) | 32 (20.9) | 1.32 (1) 0.25 |
Female | 293 (65.7) | 246 (84.0) | 47 (16.0) | ||
Current year (738) | First year | 514 (69.6) | 417 (81.1) | 97 (18.9) | 0.08 (1) 0.78 |
Third Year | 224 (30.4) | 179 (79.9) | 45 (20.1) | ||
Main living accommodation (739) | Living with parents | 394 (53.3) | 329 (83.5) | 65 (16.5) | 9.52 (3) 0.03* |
Living in own home | 57 (7.7) | 38 (66.7) | 19 (33.3) | ||
Living in college | 121 (16.4) | 98 (81) | 23 (19) | ||
Other e.g. rented rooms or flats | 167 (22.6) | 132 (79) | 35 (21) |
*p < 0.05.
Variable (n) | Non-smokers N = 597 (80.8%) | Smokers N = 142 (19.2%) | χ2 (df) p | |
---|---|---|---|---|
n (%) | n (%) | |||
Exposed to tobacco smoke indoors from others smoking (739) | Never | 484 (81.1) | 81 (57) | 43.86 (2) <0.01* |
<1 hour day | 88 (14.7) | 38 (26.8) | ||
≥1 hour day | 25 (4.2) | 23 (16.2) | ||
Are you affected by smoking outside the buildings on campus that you use (548) | Never | 182 (40.1) | 53 (56.4) | 9.83 (2) <0.01* |
Occasionally | 223 (49.1) | 37 (39.4) | ||
Often | 49 (10.8) | 4 (4.3) | ||
Rules about smoking inside your accommodation (701) | Not anywhere inside | 496 (88.3) | 93 (66.9) | 37.87 (2) <0.01* |
Some places/at some times | 48 (8.5) | 34 (24.5) | ||
Everywhere inside | 18 (3.2) | 12 (8.6) | ||
People risk harming themselves if they smoke 1 - 5 cigarettes a day (736) | Agree | 568 (95.5) | 129 (91.5) | 2.84 (1) 0.09 |
Disagree/Unsure | 27 (4.5) | 12 (8.5) | ||
People risk harming themselves if they only smoke on a weekend/a few days per week (732) | Agree | 475 (80.1) | 93 (66.9) | 10.53 (1) <0.01* |
Disagree/unsure | 118 (19.9) | 46 (33.1) | ||
Do you consider people who smoke at weekends or parties to be regular smokers (728) | Agree | 283 (48) | 29 (20.9) | 45.98 (2) <0.01* |
Disagree | 219 (37.2) | 95 (68.3) | ||
Unsure | 87 (14.8) | 15 (10.8) | ||
People get addicted to using tobacco like they get addicted to using cocaine/heroin (727) | Agree | 435 (73.6) | 74 (54.4) | 18.49 (1) <0.01* |
Disagree/unsure | 156 (26.4) | 62 (45.6) | ||
In relation to college supports for people to stop smoking are they (723) | Too little | 82 (14.1) | 13 (9.3) | 6.48 (2) 0.04* |
*p < 0.05.
of party/weekend smokers as smokers) (N = 592), was significant (χ2 = 97.76, df = 5, p < 0.01) and correctly classified 81.8% of cases. Compared to non-smokers, smokers were significantly less likely to be under 22 years (OR = 0.24, p < 0.01), more likely to allow smoking inside their accommodation (p < 0.01), less likely to agree that tobacco is addictive (OR = 0.42, p < 0.01) and much less likely to consider those who smoke at parties and weekends to be regular smokers (OR = 0.22, p < 0.01) (
Twelve percent of respondents (88) defined themselves as occasional smokers and 7% (54) as daily smokers, representing a total of 19% (142) of the total population. Bivariate analysis indicated that there were significantly higher proportions of daily smokers than occasional smokers studying nursing or psychology than biochemistry, among students aged 22 years or more and those living in their own home (
Forty-four percent of all smokers (56/126) reported making a quit attempt (purposefully stopped smoking for 24 hours or longer) in the 12 months prior to the study (42% of occasional and 48% of daily smokers). A total of 53% (62/116) of smokers said they intended to quit in the next six months (52% occasional, 56% daily) and 35% (41/116) said they intended to quit in the next 30 days (43% of occasional and 26% of daily smokers). The quitting behavior and intentions of daily and occasional smokers were not significantly different. Just under 60% of smokers reported using any help during their last quit attempt (84/142), but only a few (<2%) reported using nicotine replacement therapy, varenicline or bupropion, or quit apps. Daily smokers were more likely than occasional smokers (70% vs. 18%) to report more difficulty in handling stress in their lives if they gave up smoking (p < 0.01) (
Model 2, which examined the factors and beliefs which best predicted the odds of being an occasional or daily smoker was also significant (χ2 (N = 88), 36.3, df = 2, p < 0.01) (
Variable | Odds ratio | 95% Confidence intervals | p value | ||
---|---|---|---|---|---|
Non-smokers vs. smokers | Lower | Upper | |||
Age group (years) | ≥22 (reference) <22 | 1.00 0.24 | 0.14 | 0.43 | <0.01* |
Rules about smoking inside accommodation | Smoking not allowed inside (reference) | 1.00 | |||
Smoking allowed some places/times | 2.98 | 1.62 | 5.51 | <0.01* | |
Smoking allowed everywhere inside | 4.23 | 1.76 | 10.15 | <0.01* | |
People get addicted to using tobacco like they get addicted to using cocaine/heroin | Disagree/unsure (reference) Agree | 1.00 0.42 | 0.26 | 0.67 | <0.01* |
Consider people who smoke at weekends or parties to be regular smokers | No (reference) Yes | 1.00 0.22 | 0.13 | 0.45 | <0.01* |
*p < 0.05.
Variable (n) | All smokers N = 142 (100%) | Occasional smokers N = 88 (62.0%) | Daily smokers N = 54 (38%) | χ2 (df) p | |
---|---|---|---|---|---|
n (%) | n (%) | n (%) | |||
School (142) | Biochemistry | 64 (45.1) | 47 (73.4) | 17 (26.6) | 6.86 (2) 0.03* |
Nursing and Midwifery | 61 (43.0) | 31 (50.8) | 30 (49.2) | ||
Psychology | 17 (12.0) | 10 (58.8) | 7 (41.2) | ||
Age (142) | <22 | 104 (73.2) | 77 (74.0) | 27 (26.0) | 22.14 (1) <0.01* |
≥22 | 38 (36.8) | 11 (28.9) | 27 (71.1) | ||
Gender (79) | Male | 32 (40.5) | 19 (59.4) | 13 (40.6) | 0.31 (1) 0.58 |
Female | 47 (59.5) | 32 (68.1) | 15 (31.9) | ||
Current year (142) | First year | 97 (68.3) | 60 (61.9) | 37 (38.1) | 0.00 (1) 1.00 |
Third Year | 45 (31.7) | 28 (62.2) | 17 (37.8) | ||
Main living accommodation (142) | Living with parents | 65 (45.8) | 43 (66.2) | 22 (33.8) | 12.3 (3) <0.01* |
Living in own home | 19 (13.4) | 5 (26.3) | 14 (73.7) | ||
Living in college | 23 (16.2) | 17 (73.9) | 6 (26.1) | ||
Other e.g. rented rooms or flats | 35 (24.6) | 23 (65.7) | 12 (34.3) |
*p < 0.5.
Variable | Occasional smokers N = 88 | Daily smokers N = 54 | χ2 (df) p | |
---|---|---|---|---|
n (%) | n (%) | |||
Exposed to tobacco smoke indoors from others smoking (142) | Never | 51 (58) | 30 (55.6) | 0.01 (1) 0.92 |
Any | 37 (42) | 24 (44.4) | ||
Are you affected by smoking outside the buildings on campus that you use (94) | Never | 33 (50) | 20 (71.4) | 2.85 (1) 0.09 |
Occasionally/often | 33 (50) | 8 (28.6) | ||
Rules about smoking inside your accommodation (139) | Not anywhere inside | 62 (72.1) | 31 (58.5) | 2.77 (2) 0.25 |
Some places/at some times | 18 (20.9) | 16 (30.2) | ||
Everywhere inside | 6 (7) | 6 (11.3) | ||
People risk harming themselves if they smoke 1 - 5 cigarettes a day (141) | Agree | 84 (96.6) | 45 (83.3) | 0.01*# |
Disagree/Unsure | 3 (3.4) | 9 (16.7) | ||
People risk harming themselves if they only smoke on a weekend/a few days per week (139) | Agree | 57 (67.1) | 36 (66.7) | 0.00 (1) 1.0 |
Disagree/unsure | 28 (32.9) | 18 (33.3) | ||
Do you consider people who smoke at weekends or parties to be regular smokers (139) | Agree | 12 (14.1) | 17 (31.5) | 5.02 (1) 0.03* |
Disagree/unsure | 73 (85.9) | 37 (68.5) | ||
People get addicted to using tobacco like they get addicted to using cocaine/heroin (136) | Agree | 45 (54.2) | 29 (54.7) | 0.00 (1) 1.0 |
Disagree/unsure | 38 (45.8) | 24 (45.3) | ||
Usual type of cigarettes smoked (142) | Manufactured cigarettes | 54 (61.4) | 34 (63) | 0.00 (1) 1.0 |
Other | 34 (38.6) | 20 (37) | ||
Over the past 30 days have you smoked on campus: | ||||
At short breaks between classes (142) | Yes | 9 (10.2) | 39 (72.2) | 54.48 (1) <0.01* |
No | 79 (89.8) | 15 (27.8) | ||
At meals (142) | Yes | 9 (10.2) | 37 (68.5) | 49.29 (1) <0.01* |
No | 79 (89.8) | 17 (31.5) | ||
While drinking alcohol (142) | Yes | 23 (26.1) | 31 (57.4) | 12.59 (1) <0.01* |
No | 65 (73.9) | 23 (42.6) | ||
At parties (142) | Yes | 31 (35.2) | 28 (51.9) | 3.16 (1) 0.08 |
No | 57 64.8 | 26 48.1 |
During the past 12 months have you stopped smoking for 24 hours or longer because you were trying to quit smoking (126) | Yes | 31 (41.9) | 25 (48.1) | 0.26 (1) 0.61 |
---|---|---|---|---|
No | 43 (58.1) | 27 (51.9) | ||
Do you intend to quit smoking in next 6 months (116) | Yes | 33 (51.6) | 29 (55.8) | 0.07 (1) 0.79 |
No | 31 (48.4) | 23 (44.2) | ||
Do you plan to quit in next 30 days (116) | Yes | 27 (42.9) | 14 (26.4) | 2.72 (1) |
No | 36 (57.1) | 39 (73.6) | ||
During your last attempt to give up, did you use any help? (142) | Yes | 56 (63.6) | 28 (51.9) | 1.47 (1) 0.23 |
No | 32 (36.4) | 26 (48.1) | ||
College supports for people to stop smoking are: (140) | Too little | 8 (9.2) | 5 (9.4) | 2.62 (2) 0.27 |
Just right | 19 (21.8) | 18 (34) | ||
Unsure | 60 (69) | 30 (56.6) | ||
In your opinion if you gave up smoking: | ||||
Your health would improve in the short term (105) | Yes | 44 (73.3) | 39 (86.7) | 2.01 (1) 0.16 |
No/unsure | 16 (26.7) | 6 (13.3) | ||
Your health would benefit in the long term (112) | Yes | 59 (93.7) | 48 (98) | 0.38# |
No/unsure | 4 (6.3) | 1 (2) | ||
You would put on weight (99) | Yes | 14 (26.4) | 21 (45.7) | 3.19 (1) 0.07 |
No/unsure | 39 (73.6) | 25 (54.3) | ||
It would be harder to handle stress in your life (88) | Yes | 8 (17.8) | 30 (69.8) | 22.15 (1) <0.01* |
No/unsure | 37 (82.2) | 13 (30.2) | ||
You would feel you had done something worthwhile (91) | Yes | 39 (79.6) | 38 (90.5) | 1.31 (1) 0.25 |
No/unsure | 10 (20.4) | 4 (9.5) | ||
You would save money (107) | Yes | 48 (87.3) | 49 (94.2) | 0.32# |
No/unsure | 7 (12.7) | 3 (5.8) |
#Fisher’s exact test; *p < 0.05.
This study provides a comprehensive analysis of student smoking and quitting behaviors, their attitudes and perceptions of smoking, comparing not only smokers and non-smokers, but also comparing daily with occasional smokers. The The proportion of students in this study who were smokers was 19%, 12% were occasional smokers. A substantial proportion of both occasional (42%) and daily
Variable | Odds ratio | 95% Confidence intervals | p value | ||
---|---|---|---|---|---|
Daily vs. occasional smokers | Lower Upper | ||||
Age group (years) | ≥22 (reference) <22 | 1.00 0.2 | 0.06 | 0.64 | <0.01* |
People risk harming themselves if they smoke 1 - 5 cigarettes a day | Disagree/unsure (reference) Agree | 1.00 0.11 | 0.01 | 1.15 | 0.07 |
If you gave up smoking it would be harder to handle stress in your life | No (reference) Yes | 1.00 8.76 | 2.99 | 25.69 | <0.01* |
*p < 0.05.
smokers (48%) had attempted unsuccessfully to quit in the last year and a high percentage of both occasional (36%) and daily (48%) smokers reported their most recent quit attempt being made without assistance. Increasing age was the single most important factor predicting smoking. Within the relatively narrow age range of this sample, daily smokers were more likely to be older than occasional smokers and of the opinion that giving up smoking would make it harder to handle stress in their lives.
The prevalence of smoking (19%), is at the lower end of the range previously reported in university students and is in keeping with studies on young populations as a whole in Ireland (8% - 44%) [
In line with previous student studies a high proportion of smokers in this study (58% occasional, 52% daily) had attempted to quit smoking in the previous year [
This study identified several misconceptions and behaviors that could be addressed to help narrow this gap. As in previous research, the negative effects of smoking were recognized by all students. However, this alone was not enough to stimulate successful quitting [
The less than optimal utilization of supports may in part be due to the high proportion of smokers who were unsure if the university had enough supports for students to quit smoking or the nature of those supports. This suggests that better advertising is required to highlight campus cessation supports available. Students’ fears concerning difficulties in handling stress if they quit smoking indicates the need for supplementary interventions to help students cope with stress. It also indicates that the timing of smoking cessation media strategies not to coincide with exam periods may make them more likely to succeed.
Student exposure to second-hand smoke at home and in public places varies widely depending on country [
Continued sustained media campaigns have been shown to be effective in increasing quitting rates in occasional and daily smokers in the 20 - 30 age groups [
A strength of the study was the high response rate. Collecting data separately from the lecturer may have facilitated participants in being honest in their replies. There were however a number of limitations. Content validation was not carried out in the target population. Class attendance was not recorded; as a consequence, the response rate to the survey could only be estimated. The responses of those who did not attend the class may potentially differ from attendees. Not all variables known to affect smoking in this cohort were recorded. Gender was not recorded in the nursing group. Smoking rate was self-reported, hence prevalence of smoking may be under-reported but the use of anonymous questionnaires will have mitigated this.
Nineteen percent of students smoked. Increasing age was the best predictor of regular and occasional smoking. Smokers differed from non-smokers in their perception of smoking-related health risks. Intention to quit smoking and quitting attempts were high among daily and occasional smokers. Current use of on- site cessation supports was less than the optimal. These combined factors indicate a need for greater targeting of our prevention strategies e.g. as part of the induction process for new students, and the need to promote greater awareness of the cessation supports available for students. It is expected that these targeted measures will result in greater usage of smoking cessation services, translating into higher quit rates and reversing the transition from occasional to regular smoking. Our findings will thus aid the implementation of a smoke-free campus.
McKee, G., Barry, J., Mullin, M., Allwright, S. and Hayes, C. (2017) Predictors of Daily and Occasional Smoking and Quitting in Irish University Students. Health, 9, 435-450. https://doi.org/10.4236/health.2017.93031