5.17 Factors influencing uptake of smoking later in life

Last updated April 2012 

Although most smoking behaviour is 'seeded' during the early teenage years, some individuals begin smoking after this period.

The later teenage years are associated with major life changes such as finishing school, leaving home, gaining greater mobility and independence through learning to drive, travelling, changing peer groups, entering the workforce, and starting higher education. For some young adults, significant changes such as these also signify a period of vulnerability, where feelings of stress, insecurity and uncertainty may surface, along with new social pressures. These transitions mark a period of major influence on smoking behaviour.1,2 The susceptible teenage non-smoker may start to experiment with cigarettes; occasional smokers may become established smokers; and established smokers may increase their daily consumption levels.3

Australian research from the early 1990s found that just over one-third of smokers began regular smoking at school (35%), followed by in their first job (27%), and between leaving school and starting work or going to post-secondary education (14%).4 Research has variously estimated that around 10%5 to 20%6 of US college students who smoke commence smoking at college, while results of Canadian research suggest that between 27% and 30% of smokers in post-secondary education programs begin smoking at around the time they enter university or college.7

Research drawing on data from the Australian Longitudinal Study of Women's Health has examined changes in smoking behaviour among a large sample of young women over 10 years, from an initial age of 18–23 years in 1996.1,8 Analyses over four time points found uptake of smoking to be associated with leaving home,1 binge drinking and use of illicit drugs.1,8 Marriage or being in a committed relationship was associated with a lower likelihood of taking up smoking or continuing to smoke and a greater chance of quitting and of remaining an ex-smoker.1,8

Other risk factors identified for uptake of smoking in young adults include going to bars and clubs where smoking is permitted, not living in a smokefree home,9 and being at the younger end of the cohort age group.9,10 Recent research has found varying levels of alcohol consumption to be associated with smoking uptake among college students in Japan 11 and in the US,12 and among young Australian women.1,8 Exposure to trauma (such as interpersonal violence or unwanted sexual contact) in early adulthood is also associated with the uptake of smoking.13

Smoking initiation after leaving secondary school is also more likely to occur among students who have prior smoking experience, who have expressed an intention to smoke, and who have performed less well at school.10 In the tertiary education setting, smokers are more likely to rate social activities over academic or sporting achievement and to have achieved lower academic grades, and are less likely to follow religious beliefs.14,15 Taking up employment in an area with a strong culture of smoking, such as the military, is also associated with smoking uptake.16,17

There is some evidence that moderate to high physical activity is a protective factor against the adoption of smoking among young adults such as never smoking Japanese college students11 and against relapse among young Australian female ex-smokers (for those aged in their late 20s to early 30s).8

Studies of smoking patterns have generally shown that young adults have the highest rates of smoking in Australia (see Chapter 1, Section 1.4). The 2010 National Drug Strategy Household Survey shows that those aged 18–19 years are much more likely than other teenagers (aged 12–17 years) to smoke daily (13.0% vs. 2.5%), while in the next oldest cohort, aged 20–29 years, almost 1 in 5 people (18%) smoke daily.18 In the same survey, almost 6% of men and women aged 20–29 years were occasional smokers (using tobacco weekly, or less often than weekly), a higher rate than in any other age group.18 This suggests a likely connection between smoking behaviour and specific social settings, and also signals a pool of the population more susceptible to smoking.

The strategic importance of this target group to the tobacco industry makes it a logical and critical focus of attention; internal industry documents highlight the industry need for young smokers to renew the market for tobacco and the crucial role of young smokers' brand loyalty compared with older smokers.19 As teenagers regard young adults as role models, it is likely that advertising to young adults helps to maintain adolescent interest in smoking.9 In Australia, there has been increased channelling of tobacco promotions into nightclubs, events and media significant to young adults.20 The tobacco industry's focus on targeting young adults has been extensively examined in research undertaken in the US.21–23 For further discussion, refer to Section 5.15.2, and Chapter 11, Sections 11.1.2 and 11.6.

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References

1. McDermott L, Dobson A and Russell A. Changes in smoking behaviour among young women over life stage transitions. Australian and New Zealand Journal of Public Health 2004;28:330-5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15704696

2. Jamner L, Whalen C, Loughlin S, Mermelstein R, Audrain-McGovern J, Krishnan-Sarin S, et al. Tobacco use across the formative years: a road map to developmental vulnerabilities. Nicotine & Tobacco Research 2003;5(suppl.1):S71-87. Available from: http://ntr.oxfordjournals.org/content/5/Suppl_1

3. Schofield P, Borland R, Hill D, Pattison P and Hibbert M. Instability in smoking patterns among school leavers in Victoria, Australia. Tobacco Control 1998;7:149-55. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9789933

4. Hill D and Borland R. Adults' accounts of onset of regular smoking: influences of school, work and other settings. Public Health Reports 1991;106(2):181–5. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1580225&blobtype=pdf

5. Wechsler H, Rigotti NA, Gledhill-Hoyt J and Lee H. Increased levels of cigarette use among college students: a cause for national concern. Journal of the American Medical Association 1998;280:1673-8. Available from: http://jama.ama-assn.org/cgi/content/abstract/280/19/1673

6. Everett S, Husten C, Kann L, Warren C, Sharp D and Crossett L. Smoking initiation and smoking patterns among US college students. Journal of American College Health 1999;48:55-60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10500367

7. Cairney J and KA L. Smoking on campus. An examination of smoking behaviours among post-secondary students in Canada. Canadian Journal of Public Health 2002;93:313-16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12154537

8. McDermott L, Dobson A and Owen N. Determinants of continuity and change over 10 years in young women's smoking. Addiction 2009;104(3):478-87. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2008.02452.x/full

9. Gilpin E, White V and Pierce J. What fraction of young adults are at risk for future smoking, and who are they? Nicotine & Tobacco Research 2005;7:747-59. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16191746

10. Ellickson P, McGuigan K and Klein D. Predictors of late-onset smoking and cessation over 10 years. Journal of Adolescent Health 2001;29:101-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11472868

11. Kiyohara K, Kawamura T, Kitamura T and Takahashi Y. The start of smoking and prior lifestyles among Japanese college students: a retrospective cohort study. Nicotine & Tobacco Research 2010;12(10):1043-9. Available from: http://ntr.oxfordjournals.org/content/early/2010/08/28/ntr.ntq141.full

12. Reed M, McCabe C, Lange J, Clapp J and Shillington A. The relationship between alcohol consumption and past-year smoking initiation in a sample of undergraduates. American Journal of Drug and Alcohol Abuse 2010;36(4):202–7. Available from: http://informahealthcare.com/doi/full/10.3109/00952990.2010.493591

13. Roberts M, Fuemmeler B, McClernon F and Beckham J. Association between trauma exposure and smoking in a population-based sample of young adults. Journal of Adolescent Health 2008;42(3):266–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18295135

14. Rigotti NA, Lee JE and Wechsler H. US college students' use of tobacco products: results of a national survey. Journal of the American Medical Association 2000;284:699-705. Available from: http://jama.ama-assn.org/cgi/content/abstract/284/6/699

15. Lantz P. Smoking on the rise among young adults: implications for research and policy. Tobacco Control 2003;12(suppl.1):i60–70. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1766087&blobtype=pdf

16. Conway TL. Tobacco use and the United States military: a longstanding problem [Editorial]. Tobacco Control 1998;7:219-21. Available from: http://tc.bmjjournals.com

17. Chisick MC, Poindexter FR and York AK. Comparing tobacco use among incoming recruits and military personnel on active duty in the United States. Tobacco Control 1998;7:236-40. Available from: http://tc.bmjjournals.com/cgi/content/abstract/7/3/236

18. Australian Institute of Health and Welfare. 2010 National Drug Strategy Household Survey: survey report. Drug statistics series no. 25, AIHW cat. no. PHE 145. Canberra: AIHW, 2011. Available from: http://www.aihw.gov.au/publication-detail/?id=32212254712&libID=32212254712&tab=2

19. Mangini. Younger adult smokers: strategies and opportunities. San Francisco: Legacy Tobacco Documents Library, University of California, 2002. Available from: http://legacy.library.ucsf.edu/tid/krx52d00

20. Harper T and Martin J. Under the radar - how the tobacco industry targets youth in Australia. Drug and Alcohol Review 2002;21:387-92. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12537709

21. Sepe E and Glantz SA. Bar and club tobacco promotions in the alternative press: targeting young adults. American Journal of Public Health 2002;92(1):75–8. Available from: http://www.ajph.org/cgi/content/full/92/1/75/T1

22. Ling PM and Glantz SA. Why and how the tobacco industry sells cigarettes to young adults: evidence from industry documents. American Journal of Public Health 2002;92(6):908–16. Available from: http://www.ajph.org/cgi/content/full/92/6/908

23. Song A, Ling P, Neilands T and Glantz S. Smoking in movies and increased smoking among young adults. American Journal of Preventive Medicine 2007;33:396-403. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17950405

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