The College Freshman Nicotine Study Nicotine Study Study sponsored by the ASPH/Legacy STEPUP...

The College FreshmanThe College Freshman Nicotine StudyNicotine Study

Study sponsored by the ASPH/Legacy STEPUP Dissertation Scholarship

Johns Hopkins Bloomberg School of Public HealthJohns Hopkins Bloomberg School of Public Health

Stephanie Y. Smith, MPH, PhD Candidate

Frances A. Stillman, EdD, EdM

Outline of Remarks

Background

Design/Sample

Findings

Study Objective:To investigate reported use of “reduced risk” (e.g., purported low yield tobacco, medicinal nicotine, and novel nicotine) nicotine delivery products with awareness and risk perception of these products among full-time college freshmen attending the Johns Hopkins University in Baltimore, Maryland

Awareness

Risk Perception

Reported Use

Rationale for Study

Among 18-24 year olds in Baltimore City, MD -- Smoking initiation increased from 24.7% in 2000 to 39.8% in 2002 (MD Dept of Health and Mental Hygiene, 2002)

Prevalence of smoking among college students is higher than national prevalence -- 25.7% vs. 23.3% (Johnston, O’Malley, Bachman, 2002)

Why Harm Reduction and “Reduced Risk” Nicotine

Delivery Products?

We know that 50% of smokers will never quit; thus, focusing only on cessation ignores half the smokers (Hughes, JR. 1998)

Definition of Harm Reduction:

A product is harm-reducing if it lowers total tobacco-related mortality and morbidity even though use of that product may involve continued exposure to tobacco-related toxicants.

(IOM. Clearing the Smoke, 2001)

What ARE “Reduced Risk” Nicotine Delivery Products?

Medicinal Nicotine Purported Low Yield Tobacco

Novel Nicotine Products

Potential Unintended Consequences

Low-tar/low-nicotine cigarettes or cigarette-like products might be less-aversive starter products (Hughes, JR. 1998)

Historical Examples of “Reduced Risk” or “Harm Reducing” Products and

Unintended Consequences

1950’s “Filtered” Cigarettes

1970’s “Light” Cigarettes

1970s-1980s Smokeless Tobacco

Specific Aims

1. To explore awareness and beliefs about nicotine and “reduced risk” nicotine delivery products among full-time college freshmen attending the Johns Hopkins University in Baltimore, Maryland

2. To test hypotheses comparing the reported use of “reduced risk”nicotine delivery products with psychosocial vulnerabilities (e.g., gender, smoking status) of full-time college freshmen attending the Johns Hopkins University in Baltimore, Maryland

Design

Phase I: QualitativePhase I: Qualitative

Focus GroupsFocus Groups

Phase II: Quantitative

Risk Perception Survey

1-Year, Two-Phase, Mixed-Method Study

Phase I Goal:

To assess the knowledge, attitudes, and beliefs that college freshmen have pertaining to nicotine, products that contain nicotine, and nicotine addiction.

Data gathered from Phase I will be used to tailor a risk perception survey to be administered in Phase II

Phase I Sample

Categorization of Focus Groups

Committed Nonsmokers and Susceptible Nonsmokers*

Experimenters and Smokers*

FemaleN=16

Mean Age = 18

Focus Group #1

N=10

Mean Age = 18

Experimenters > 30 days

Focus Group #2

N=6

Mean Age = 18

Experimenters < 30 days

MaleN=19

Mean Age = 18

Focus Group #3

N=8

Mean Age = 18

Committed Nonsmokers

Focus Group #4

N=11

Mean Age = 18

Experimenters <30 days and Smokers

Full-Time College Freshmen Attending the Johns Hopkins University

*Smoking Status based on work by Pierce, Choi, and Gilpin (1998)

Focus Group Questions

1. Tell me what you know about nicotine.

2. Tell me about the types of products that contain nicotine.

3. Why would your peers want to use these products?

4. Tell me what you know about nicotine addiction.

Phase I: Preliminary Findings1. Tell me what you know about nicotine.

Positive Negative

Relieves stress

Relaxes you

Stimulant

Helps control weight

Controls appetite

Laxative

Available in many forms

Increases metabolism (FG#4)

Helps keep you awake (FG#4)

Increases short term memory (FG#4)

Addictive

Crave it (FG#4)

Expensive

Harmful during pregnancy

Raises blood pressure

Causes veins and arteries to constrict

Causes heart attacks

Causes cancer

Phase I: Preliminary Findings2. Tell me about the types of products that contain nicotine.

Cigarettes

Cigars

Bidis

Chaw/Chew/Dip/Snuff

Pipe

Gum

Patch

Inhaler

Water

Wafers (FG#4)

Cloves/Kreteks (FG#4)

Lollipops (FG#4)

Hookah (FG#123) / Shisha (FG#4)

Phase I: Preliminary Findings3. Why would your peers want to use these products?

Recreation

Stress relief

Entertainment

Meditation

Socially

Want a buzz

Cessation

Addicted but in denial

Weight loss

Look cool

Look hot (guys only)

Look rugged, dangerous, and gorgeous

Status (cigar only)

Celebration (cigar only)

Victory (cigar only)

Leisure

Image/Glamour

To fit in

Make a name for yourself

Just to experiment

Make smoke rings (they’re cool)

Conventional Tobacco Products

(Tobacco Industry Products)

Purported Low Yield Products (Tobacco Industry Products)

Novel Nicotine Products Medicinal Nicotine Products (Pharmaceutical Industry Products)

FG#1, FExp>30days Regular unfiltered cigs

Regular filtered cigs

Hookah

Regular cigar

Light cigs

Ultra Light cigs

Omni/Omni Free®

Advance®

Quest 123®

Accord®

Lozenge Ariva®

Nicotine Water

Nicotine Lollipop

Bidis

Kreteks

Lozenge Commit®

Nicotine Inhaler

Nicotine Patch

Nicotine Gum

FG#2, FExp<30days Regular unfiltered cigs

Regular filtered cigs

Hookah

Regular cigar

Chew

Snuff/Dip

Traditional pipe tobacco

Light cigs

Ultra Light cigs

Lozenge Ariva®

Nicotine Water

Nicotine Lollipop

Bidis

Kreteks

Lozenge Commit®

Nicotine Inhaler

Nicotine Patch

Nicotine Gum

FG#3, MCNS Regular unfiltered cigs

Regular filtered cigs

Hookah

Regular cigar

Chew

Snuff/Dip

Traditional pipe tobacco

Light cigs

Ultra Light cigs

Bidis

FG#4, MExp<30days and Smokers

Regular unfiltered cigs

Regular filtered cigs

Hookah

Regular cigar

Chew

Snuff/Dip

Traditional pipe tobacco

Light cigs

Ultra Light cigs

Omni/Omni Free®

SCOR®

Advance®

Quest 123®

Eclipse®

Accord®

Stonewall®

Lozenge Ariva®

Spitless tobacco sachet, Revel®, Exalt®

Nicotine Lollipop

Bidis

Kreteks

Nicotine Wafer

Lozenge Commit®

Nicotine Inhaler

Nicotine Patch

Nicotine Gum

Nicotine Nasal Spray

Nicotine Vaccine

Phase I: Preliminary Findings3. Why would your peers want to use these products?

“It’s all about image – whatever product I use, it’s all about how it makes me look”

“Shisha is hot -- it’s not addictive -- it’s social -- it’s meditative -- it smells good -- it tastes good -- it looks cool -- it’s inexpensive cuz you split the cost with friends -- don’t even have to smoke it, just smell it -- the smoke isn’t bad for you”

“NRT is for the weak” – All groups associated it with dependency and therefore those who use it are weak, “It’s weak nicotine”

“Whatever product you develop to get people off the cigarette…it’s gotta be prevalent, like everywhere and hot beautiful people gotta be using it…ideally it’d mimic the cigarette”

Phase I: Preliminary Findings4. Tell me what you know about nicotine addiction.

“Cigs are the most addictive, then dip, don’t hear much about the other products and serious addiction problems.”

“Most people view smoking as unhealthy, so if Big Tobacco (BT) markets NRT then it could be viewed as healthy…with BT’s tarnished image, they could profit from making NRT, they could make a bundle…”

“You don’t care who makes it or if it’s regulated or not, you care about which one is cheaper, and which one tastes better”

“Put all cigarette taxes into prevention and cessation for <18 year olds…[treatment centers in schools, support groups in schools, in addition to prevention in health classes]”

Phase I: In Summary

Awareness

High

Knowledge

High

Beliefs

Use a product socially = no addiction

Use a product by yourself = addiction

Study Limitations

Limited generalizability

Phase I qualitative phase lacks ‘saturation’

Misclassification of smoking status – no biochemical verification

Self-report and social desirability

Convenience sample

Study Strengths

Combination of qualitative and quantitative methods

Literature review addresses critical gap

Unites multidisciplinary literature

First look at risk perception of “reduced risk” nicotine delivery products in college freshmen

Importance of topic

Policy application

Educational and prevention strategies

Contact Information:

Stephanie Smith

stsmith@jhsph.edu

JHUFreshmanNicotineStudy@yahoo.com

References1. Johnston, L.D., O’Malley, P.M., Bachman, J.G. 2002. Monitoring the Future

National Survey Results on Drug Use, 1975-2001. Volume II: College Students and Adults Ages 19-40. (NIH Publication No. 02-5107). Bethesda, MD National Institute on Drug Abuse

2. Johnston, L.D., O’Malley, P.M., Bachman, J.G. 2002. Monitoring the Future National Survey Results on Drug Use, 1975-2001. Volume I: College Secondary School Students. (NIH Publication No. 02-5106). Bethesda, MD National Institute on Drug Abuse

3. First Annual Tobacco Study, Sept. 2002, MD Department of Health and Mental Hygiene

4. Hughes, J.R. 1998. “Harm Reduction Approaches to Smoking: The Need for Data.” American Journal of Preventive Medicine 15(1):78-79

5. IOM (Institute of Medicine). 2001. Clearing the Smoke. K. Stratton, P. Shetty, R. Wallace, and S. Bondurant, eds. Washington, D.C.: National Academy Press

6. Pierce, J.P., Choi, W.S., and Gilpin, E.A. 1998. “Tobacco Industry Promotion of Cigarettes and Adolescent Smoking.” Journal of the American Medical Association 279:511-515

Phase I ProceduresQualitative Focus Groups

RecruitmentFlyersConsentTimeframeCompensation

4 Focus GroupsGenderSmoking Status