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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
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
