Social Influences on Cigarette InitiationAmong College Students

Ruth R. Staten, PhD, ARNP-CS; Melody Noiand, PhD, CHESMary Kay Rayens, PhD; Ellen Hahn, DSN, RN; Mark Dignan, PhD, FAAHBS. Lee Ridner, PhD, ARNP-NP

Objectives: To examine the rela-tionship of demographic and socialinfluence with initiation of ciga-rette use among undergraduates.Methods: Students were mailedanonymous surveys including 437participants who indicated thatthey had not smoked cigarettesbefore age 18. Of those, 107 be-came late initiators (24%), and 330remained never smokers (76%).Results: Those who drank alcohol

in college and had at least 1 parentwith a college education were morelikely to initiate smoking than werethose who did not drink and nei-ther parent had attended college.Conclusions: Strategies that focuson reducing alcohol and tobaccouse need to be tested.

Key words: cigarette initiation,college students, social influ-ences, prevention

Am J Health Behav. 2007,31{'i):3S3-362

C igarette smoking is the leadingcause of preventable morbidity andmortality in the United States.' In

the United States, cigarette smoking hasdeclined to 21.6% of all adults. Lifetimecigarette use for 18- to 25-year-olds is65%, with 39.5% using cigarettes withinthe past 30 days.^ There was an increase

Ruth R. Staten, Associate Professor, Collegeof Nursing and University Health Service; MelodyNoiand, George and Betty Blanda Endowed Pro-fessor in Education, College of Education De-partment of Kinesiology and Health Promotion;Mary Kay Rayens, Associate Professor, Collegeof Nursing and College of Public Health; EllenHahn, Professor, College of Nursing and Collegeof Public Health; Mark Dignan, Professor, Collegeof Medicine Department of Internal Medicine, Pre-vention Research Center, University of Kentucky,Lexington, KY. S. Lee Ridner, Assistant Profes-sor, School of Nursing, University of Louisville,Louisville, KY.

Address correspondence to Dr Staten, Collegeof Nursing and University Health Service, Uni-versity of Kentucky, Lexington, KY. E-mail:rrstatOO@uky.edu

in smoking among 18- to 24-year-oldsfrom 1999 to 2002. However, smoking inthis age-group decreased from 28.5% in2002 to 23.9% in 2003.^ College students(30.5%) smoke less than their noncoUegepeers (44.5%).= Smoking among collegestudents increased from 22% in 1993 to28% in 1997"sto 32.9% in 1999.* In 2003,current cigarette use among college stu-dents declined to 22.5%.'' Of those whosmoked, more than half had attempted toquit within the last year, and 18% hadtried to quit more than 5 times within thelast year.5 Although those with highereducational levels are less likely to smokecigarettes,^"' many young adults becomeregular smokers after the age of 18 orafter entering college.^'°''' Although mostsmoking college students first smokedprior to college, more than one fourth ofthese smokers became regular smokersafter the age of 19 years.^

Little is known about prevention ofsmoking with college students, but fac-tors influencing initiation among middleand high school students are well docu-mented, and most smoking prevention

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programs have targeted these age-groups.'^ It has been widely assumed thatif these students could be prevented fromsmoking until they graduated from highschool, they would not start at all. How-ever, the data just presented do not sup-port this assumption. Therefore, it isimportant to examine what factors arerelated to the adoption of smoking amongcollege students. The literature suggeststhat evidenced-based prevention strate-gies that are tailored to college studentsare likely to be effective in reducing thistrend.'^ Understanding the social influ-ences on young people who begin smok-ing in college will assist in creating pre-vention strategies for at-risk groups.

Social influences on smoking initia-tion by adolescents and prevalence ofsmoking and factors associated with cur-rent smoking behaviors of college stu-dents are well documented. Yet little isknown about factors influencing smok-ing initiation after entering college. Thesocial influences associated with smok-ing initiation during middle and highschool and the continuation of smokingamong young adults include (1) alcoholuse;'"'^ (2) interpersonal factors such asparent, sibling, and peer smoking andattitudes toward smoking;'*"^' (3) involve-ment in student activities, such as socialclubs, athletics, work, church, and ser-vice; '*'"' and (4) images and risks associ-ated with cigarette use."'^^"^''

The purposes of this study were to (1)describe smoking initiation among un-dergraduate college students and (2) ex-amine the relationships of selected de-mographic characteristics and social in-fluences with initiation of cigarette useamong this population. The social influ-ences assessed in this study includedalcohol use, family and peer characteris-tics, views toward images and impacts ofsmoking, and involvement in school andcivic activities.

Social influence theory offers 1 view ofthe multifaceted and complex nature ofcigarette use initiation.^^ Social influencetheory, derived from social cognitivetheory, is defined as the impact of groupnorms and behaviors on individuals.^^'^*Generally, an individual is impacted bymultiple sources of influence. Althoughthe focus of this study is on selected socialinfluences, this does not imply that envi-ronmental, policy, and personal factorsare unimportant aspects of smoking ini-

tiation. Prevention efforts must be multi-faceted for maximum effectiveness.

METHODSMeasuresThe survey instrument was an 80-

item questionnaire adapted from the Cen-ters for Disease Control and PreventionNational College Health Risk BehaviorSurvey (NCHRBS)." This survey is usednationally to assess college students'health risk behaviors. Inclusion of spe-cific questions was based on previoussocial influence studies conducted withadolescents and focus groups with collegestudents who were late initiators andthose who had never smoked (Staten,unpublished data). Cigarette initiationwas measured using the question "Atwhat age did you first smoke a wholecigarette?" Alcohol use was measured byasking the following questions: (1) "Atwhat age did you have your first drink (1oz. of liquor, 4 oz. of wine, 12 oz. of beer)?"(2) "During the past 30 days, on how manydays did you (a) have at least 1 drink; (b)have 5 or more drinks within a couple ofhours; or (c) drink rapidly—shooting beers,funneiing or having 4 or more shots in anhour?"

Questions from the Youth Tobacco Pre-vention Project Survey^^ were used toassess parental, peer, school, and tobacco-production infiuences. Questions includedseparate questions about mother's andfather's education; use of tobacco prod-ucts including, "Do your mother, father,siblings, or 5 closest friends use any of thefollowing tobacco products: cigarettes, ci-gars, pipes, or smokeless tobacco?" Cur-rent living situation was measured in-cluding on- and off-campus residence andsmoking behavior of roommates. Ques-tions about tobacco involvement wereasked, including home state or countyknovwi for tobacco production, direct in-volvement in tobacco production, and re-ceipt of scholarship monies from the to-bacco industry.

Students were asked to indicate in-volvement in high school and college ac-tivities from a list including student gov-emment, performing arts, creative arts,junior varsity or varsity sports (intercolle-giate), service organizations, social orga-nizations, political groups, church or reli-gious activities, work for pay, and otherclubs.

Images and risks about smokers and

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smoking were adapted from items devel-oped by Hines.^^ Students were asked toindicate strong disagreement, disagree-ment, agreement, strong agreement, ordon't know to a list of images and risksassociated with cigarette use includingsophisticated, rebel, sexy, adventurous,masculine, feminine, daring, desirableas a date, attractive, outcast, mature,ruggedly individualistic, confident, de-pressed, cocky, social, healthy, likely todie an early death, likely to get heartdisease, likely to get cancer.

SampleThis cross-sectional survey collected

data from a random sample of 18- to 24-year-old full-time undergraduate studentswho were registered for classes duringthe spring semester of 2002 at a largesoutheastern public university in a ma-jor tobacco-growing state. The universityregistrar randomly selected the sample of1500 from the list of approximately 15,000enrolled undergraduates and suppliedmailing labels to the investigators. The1500 students chosen to participate weresent questionnaires via first class mail;of these, 98 questionnaires were returnedas undeliverable. Of the remaining 1402surveys, 842 complete questionnaireswere received, indicating a response rateof 60%. The original sample size waschosen because a margin of error of 3%was desired and the expectation was thatthe response rate would be at least 50%,Late initiators smoked their first ciga-rette at age 18 or older, and never smok-ers reported never having smoked a ciga-rette. Because the focus of this study wasthe differences between never smokersand late initiators, those who tried smok-ing prior to age 18 were not included inthe analyses.

The sample for the study presentedhere consists of 107 late initiators and330 never smokers. Of the 437 partici-pants in this study, over half (60%) werefemale, 88% were white, 96% had neverbeen married, 65% reported living with aroommate, and 63% lived off-campus. Themajority of the sample (63%) were juniorsor seniors, and more than two-thirds (69%)reported their GPA as 3.0 or above. Themajority of the students (63%) had jobs forpay, and the average number of hoursworked per week was 18.8 (SD=9.0; rangefrom 2 to 43). Seven percent of studentswere on intercollegiate athletic teams;

nearly one-fifth (19%) were members ofsocial fraternities or sororities; and 78%were in-state students. The average agewas 20.6 (SD=1.5), vidth a range from 18 to24 years.

ProcedureThe mailing procedure was based on

the Dillman^' guidelines. Subjects re-ceived a mailed questionnaire with acover letter explaining the purpose of thestudy and the importance of participat-ing. The subjects were encouraged torespond by returning the completed ques-tionnaire in the addressed and stampedenvelope enclosed in the survey packet.Two dollars were included in the mailingas an incentive for completing the ques-tionnaire. The study utilized a passiveconsent procedure that was approved bythe University of Kentucky InstitutionalReview Board prior to mailing the sur-veys.

Postcards with the subjects' names alsowere included with the questionnaire.Respondents were asked to complete boththe questionnaire and the postcard andreturn the postcard separately to indicatecompletion of the questionnaire. Thisprocedure preserved anonymity for theparticipants while allowing the research-ers to track who should receive a follow-up questionnaire. One week after thequestionnaires were mailed, a postcardwas sent to all subjects as a reminder ofthe importance of the study, with a re-quest to complete and return the ques-tionnaire. Approximately 3 weeks follow-ing the initial mailing, follow-up lettersand replacement questionnaires weremailed to all who had not returned asigned postcard. After the second ques-tionnaire mailing, those who did not re-turn questionnaires were considerednonrespondents. There was no furtherfollow-up.

Data AnalysisDescriptive analyses, including fre-

quency distributions or means Eind stan-dard deviations, as appropriate to the levelof measurement, were used to summa-rize the survey items. Bivariate tests,including the chi-square test of associa-tion and the 2-sample t-test, were used todetermine relationships among pairs ofvariables. To determine which social in-fluence variables may be protective orrisk factors for smoking initiation after

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Table 1Associations Between Cigarette

Demographic, Parental ]Initiation Status

[nfluence, and ActivityCharacteristics (N =

Characteristic

Live on campusYesNo

ClassFreshman/SophomoreJunior/Senior

Member ofa fraternity or sororityYesNo

Parents' college educationAt least 1 parent with college educationNeither parent with college education

College service organizationYesNo

College social organizationYesNo

NeverN

138189

146183

53277

26060

103227

63267

initiator%

42%58%

44%56%

16%84%

81%19%

31%69%

19%81%

= 4371Late initiator

n

2483

2483

2978

1007

2087

3770

%

22%78%

22%78%

27%73%

93%7%

19%81%

35%65%

and CategoricalParticipation

f} P-value

13,5 ,0002

16,3 <,0001

6,5 ,01

9,0 ,003

6,3 ,01

11,0 ,0009

coming to college, binary logistic regres-sion was used to assess the predictors ofnever versus late initiation of cigarettesmoking. The variance inflation factors(VIFs) for each regressor included in thelogistic models were examined to deter-mine whether multicollinearity affectedregression estimates for each model; lackof multicollinearity was assumed if allVIFs were at most 4. The Hosmer-Lemeshow test'" was used to determinethe goodness of fit of the logistic regres-sion model to the survey data. All analy-ses were conducted using SAS for Win-dows (version 8.02).^' To control the over-all Type I error rate, an alpha level of .01was used throughout,

RESULTSOf the 437 participants in this study,

107 (24%) had never smoked prior to age18 but became late initiators, smoking 1or more cigarettes after college age. Theremaining 330 respondents (76%) hadnever smoked any cigarettes.

Smoking Initiation and DemographicCharacteristicsThe participants who had never smoked

were more likely to live on campus com-pared with late initiators (Table 1). Thosewho had not started smoking were morelikely to be freshmen or sophomores. Con-sistent with this phenomenon, the neversmokers were somewhat younger (M =20.3) than late initiators (M = 20.9; t = 4.7,P<.0001). There also was an associationbetween being a member of a fraternity orsorority and initiation status, with lateinitiators more likely to be members ofthese groups, compared with never smok-ers. Smoking initiation status was unre-lated to gender, race, marital status, workstatus, whether the respondent lived witha roommate or not, being a collegiateathlete, and whether the respondent wasfrom within the state or not.

Smoking Initiation and Alcohol UseThere was not a difference between

these 2 groups in age of alcohol initiation:never smokers were just as likely as latecigarette initiators to have begun usingalcohol while in high school.

The majority of respondents (60%) hadhad at least 1 drink of alcohol in the past30 days. Also in the past month, 39% ofparticipants had drunk 5 or more drinks

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Staten et al

Images andVarious Items

Impacts (Table 2

of Smoking: Responses to theby the Combined Group of Late Initiators

and Never

Image/impact Agree/Strongly

Persons who smoke areSophisticatedRebelsSexyAdventurousMasculineFeminineDaringHealthyDesirable as a dateAttractiveOutcastRugged individualistMatureSelf-confidentDepressedCockySocialLikely to die earlyLikely to get cancerLikely to get heart diseaseLikely to be influenced by ads

n (%)

11(2)115(27)

8(2)25(6)16(4)3(1)

53(12)15(3)11(3)7(2)

73(17)33(8)19(4)27(6)

116(27)75(17)141(33)379 (89)400 (92)380(88)254 (59)

Smokers (N = 437)

agree Disagree/Strongly disagreen(%)

383 (89)279(65)410(95)374 (86)387 (90)404 (94)354 (82)409 (95)408 (94)407 (94)304(71)349(81)364(85)343 (80)225(52)276 (64)221(51)35(8)24(6)30(7)

119(27)

Don't known(%)

38(9)37(8)13(3)33(7)28(6)24(5)26(6)8(2)13(3)16(4)

53(12)50(11)46(11)60(14)89(21)80(19)68(16)14(3)10(2)24(5)60(14)

in a few hours 1 or more days, 34% hadenough drinks to get drunk at least once,and 19% had 1 or more occasions of drink-ing rapidly (eg, shooting beers or funnel-ing alcohol). There were significant asso-ciations between each of these drinking-behavior indicator variables and smok-ing initiation status (P<.0001 for eachtest of association). For each of the 4drinking measures, late initiators weremore likely to engage in the behavior,compared with never smokers.

Smoking Initiation and SocialInfluencesParental and sibling influence. Nearly

all students (90%) indicated that 1 or bothparents either "don't like" or "really don'tlike" cigarette use. There was no rela-tionship between the cigarette-initiationgrouping variable and parental opinion ofcigarette use. Similarly, actual use ofcigarettes by parents was not significantlyassociated with the cigarette initiation

pattern among responders; among all par-ticipants, 18% reported their fatherssmoked, and 15% indicated their moth-ers smoked cigarettes. Most of the re-spondents (84%) reported that at least 1 oftheir parents had attended college. Ini-tiation of cigarette use was significantlyassociated with parent education. Amongthe respondents who had 1 or both par-ents with at least some college education,only 72% had never initiated smoking,compared to 90% of respondents who indi-cated neither parent had attended college(Table 1), Among the study participants,13% indicated they had an older siblingwho smoked cigarettes. Having smokingolder siblings was not related to the re-spondents' age at cigarette initiation.

Influence of friends. Most participants(59%) had at least 1 high school friendwho smoked. There was no relationshipbetween cigarette initiation status (ie,late vs never initiators) and having atleast 1 smoking friend while in high

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Table 3Logistic Regression With Smoking Initiation

(Late versus Never) as

PredictorFemaleWhiteWork for payAgeLive on campusMember of fraternity or sororityParticipate in service organizationHad at least 1 drink in last 30 daysAt least 1 of 5 closest friends smokesAt least 1 parent attended college

Note.* Never smoker is used as the referencea P<.01b P<.001c P<.0001.

the Dependent Variable

Odds 95%Ratio

1.330.900.801.350.671.630.298.591.994.84

category

Category(n = 401)

confidence intervalfor odds ratio

0.77-2.280.38-2.140.43-1.481.09-1.660.33-1.330.86-3.080.15-0.554.00-18.461.07-3.70

1.95-12.07

Wald test

1.0<.l0.57.6"1.32.2

14.3"30.3'4.7

11.5"

school. More than half (61%) of the par-ticipants reported that at least 1 of their 5closest college friends smoked, and 11%indicated tha t their current friends "liked"or "really liked" cigarette smoking. Theassociation between cigarette initiationstatus and having at least 1 smokingcollege friend was significant (x^ = 16.0,P<.0001): of those who had never triedcigarettes, 56% had 1 or more close friendsin college who were smokers, whereas78% of late initiators had at least 1 cur-rent close friend who smoked cigarettes.

Images and impacts of smoking. Asshown in Table 2, participants gave opin-ions about various images of smokingand the impact of smoking. Respondentswere most likely to agree or strongly agreewith the impact items, including "Likelyto get cancer," "Likely to die early," and"Likely to get heart disease." More thanhalf (59%) agreed that smokers are likelyto be influenced by ads. Among the imageitems, the largest number of respondentsagreed that people who smoke are social(33%), depressed (27%), rebels (27%), cocky(17%), outcast (17%), and daring (12%).Fewer than one tenth of the participantsagreed or strongly agreed with any re-maining image items. Most participantsin this group of never smokers and late

initiators disagreed or strongly disagreedwith nearly all image items. The itemswith the largest percent of those in dis-agreement included sexy (95%), healthy(95%), desirable as a date (94%), attrac-tive (94%), feminine (94%), masculine(90%), sophisticated (89%), adventurous(86%), mature (85%), and daring (82%).The tests of association between smok-ing initiation status and endorsement ofthese image and impact items indicatedfew differences between never smokersand late initiators. The items that diddiffer significantly between the 2 smok-ing initiation groups included sexy (5% oflate initiators agreed or strongly agreed tothis, compared with 1% of never smokers;X = 6.1, P=.O1), outcast (9% of late initia-tors agreed, compared with 23% of neverinitiators; x = 8.8, P=.OO3), likely to getcancer (88% of late agreed versus 97% ofnever; x' = 12.1, P=.0005), likely to getheart disease (86% of late agreed versus95% of never; x = 8.5, P=.OO4), and influ-enced by ads (52% of late initiators agreed,compared with 73% of never smokers; x= 14.5, P=.OOO1).

Activities and OrganizationsRespondents were asked about their

participation in activities and organiza-

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Staten et al

tions while in high school, including stu-dent government, creative arts, perform-ing arts, athletics, service organizations,social organizations, political groups andchurch groups. The high school activitieswith the largest percentages of partici-pants were service organizations (66%),athletics (57%), church groups (51%), per-forming arts (37%), and student govern-ment (33%). None of the associationsbetween smoking initiation status andparticipation in each of these activitiesor organizations during high school weresignificant. The participants indicatedtheir involvement in various college ac-tivities and organizations including stu-dent government, creative arts, perform-ing arts, athletics, service organizations,social organizations, political groups andchurch groups. The organizations mostcommonly joined in college were churchgroups (32%), service organizations (28%),social organizations (23%), performing arts(9%), and creative arts (7%). Participationin service organizations and social orga-nizations was associated with smokinginitiation status (Table 1); participationin other types of activities was not signifi-cantly associated with smoking initia-tion. Compared with never initiators,those who started smoking after age 18were more likely to participate in collegesocial organizations and less likely toparticipate in college service organiza-tions.

Predictors of Smoking InitiationBinary logistic regression was used to

assess which factors were predictive ofthis 2-level smoking initiation variable;the reference group consisted of thosewho were never smokers. Potential pre-dictors included in the model were thosefactors that were significantly associatedvdth cigarette initiation status; controlvariables included in the model were gen-der, race, and having a paying job while incollege. Because age and class (upper-classman vs lowerclassman) are stronglyassociated, only the former was includedin the model. Due to the strong associa-tion between being a member of a frater-nity or sorority and participating in asocial organization at college, only theformer was included in the model. Simi-larly, because all 4 measures of drinkingbehavior were significantly related to eachother, only the indicator of 1 or morealcoholic drinks in the last month was

added to the model. Opinions of the im-ages and impact of smoking were notincluded in the model, not only becausethere were few differences between lateand never initiators, but also because ofthe nontrivial number of "Don't know"responses to these items, which wouldhave increased the number of respon-dents not included in the logistic model.High school experiences also were notincluded in the model because there wereno differences between the 2 cigaretteinitiation status groups on participationin high school activities or age of initia-tion of alcohol.

Significant predictors of cigarette ini-tiation status were age, participation in aservice organization, drinking 1 or morealcoholic drinks in the past 30 days, andhaving at least 1 parent who attendedcollege; the logistic model is shown inTable 3. For every additional year in-crease in age, the odds of being a lateinitiator increased by 35%. Participatingin a service organization was a protectivefactor: compared with those who did not dothis type of activity, those who partici-pated were only about one-fourth as likelyto initiate cigarette smoking while incollege. Those who had drunk 1 or morealcoholic drinks in the past 30 days hadmore than 8 times the odds of being a lateinitiator, compared with those who hadnot had alcohol. Participants with at least1 college-educated parent were at a higherrisk for late smoking initiation; com-pared with those whose parents did notattend college, those viath a college-edu-cated parent had nearly 5 times the oddsof beginning smoking once at college. Allof the VIFs for the potential predictorswere less than 2, indicatingmulticollinearity was unlikely to havecaused any distortion in the regressionestimates. The Hosmer-Lemeshow chi-square goodness-of-fit test was not sig-nificant (x = 5.4 with 8 df; P=.7), indicat-ing that the model fit the data well.

DISCUSSIONThe findings support previous studies

indicating that students initiate ciga-rette use after age 18.* Smoking preven-tion for new college students has beenvirtually ignored. Consistent with previ-ous studies,*"'^ this study indicates thata nontrivial percentage of college stu-dents (13%) started smoking after arrivalat college. Cigarette initiation is not lim-

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ited to the freshman class, as initiationcontinues throughout the sophomore andjunior years. Late initiation was similaracross ethnic groups, indicating the needfor smoking prevention that addressesthe diversity of college students. Genderwas not associated with late initiation ofsmoking.

The association between alcohol useand smoking initiation was supported inthis study. Late initiators were morelikely than the never smokers to be cur-rent drinkers and drink in high-risk ways,but smoking initiation was not related toage of first alcohol use. This is not sur-prising, as the link between alcohol andtobacco has been well established acrosspopulations. With increases in clean in-door air policies and rules, especially ascommunities move toward smoke-freebars and restaurants, it will be importantto measure the impact on smoking ini-tiation and continuation rates of collegestudents who are known for their alcoholuse.

Late initiators were more likely to bein social organizations, primarily frater-nities or sororities, than were neversmokers. Members of these organizationstend to be the heaviest drinkers on cam-pus. Research that continues to untanglethe dynamics of fraternity and sororitymembership and the influence of want-ing to be in the organization and theorganizational environmental and nor-mative behaviors is important to address-ing cigarette use initiation.'"

Initiation of cigarette use was associ-ated with parent education. Surprisingly,the late initiators were more likely tohave at least 1 parent who attended col-lege than were never smokers. This re-sult is not consistent with the literature;other studies have shown that educatedpeople (and their parents) are less likelyto smoke.'' Interestingly, the never smok-ers and the late initiators did not differ onparent cigarette use, and there were nodifferences between the 2 groups in pa-rental attitudes about smoking. The scopeof the study does not lead to an explana-tion of this phenomenon. We can specu-late that it may be tied to the socioeco-nomic level of the parents, with the moreaffiuent students likely to be involved inthe high drinking, high smoking socialenvironments. Previous studies have sup-ported the impact of price of cigarettes oninitiation. Thus students whose parents

have higher socioeconomic levels associ-ated with college education may be lessinfiuenced by the price of cigarettes thanare those who come from less affluentfamilies. Another explanation might bethat college experiences of the parentsget shared with their students in a waythat supports a "try it all" message, under-mining the "don't smoke" message. Be-cause some of these findings seem to beconfiicting, additional research is neededto explore the infiuence of parent's educa-tion on smoking initiation among collegestudents.

Late initiators and never smokers hadsimilar high school experiences includ-ing (1) few older siblings who smoke, (2)few high school friends who smoked, (3)few high school friends who really likedcigarette use and many friends who re-ally didn't like it, (4) participation in per-forming arts and church groups, and (5)having a paying job. These may havebeen factors in keeping these studentsfrom smoking in high school.

When they arrived at college, neversmokers were more likely to continueinvolvement with nonsmoking friends andto participate in church, service groups,and the performing arts. Opportunitiesand encouragement for students to con-tinue participation in activities that mayhave been protective factors in high schoolcould support continued not smoking incollege.

Data from this study provide some evi-dence that a prevention program for col-lege students should revolve around so-cial factors. Possible components of a pre-vention program would be teaching re-fusal and assertiveness skills, short-termand appearance effects, and correction ofmisperception of the norm (convincingstudents that they are in the majority ifthey do not smoke). The cross-sectionaldesign is 1 limitation of this study. Al-though the potential predictors chosen toinclude in the logistic model were limitedto those that occurred prior to or duringthe earliest smoking initiation ages (ie,during high school), future research withlongitudinal assessments wouldstrengthen the ability to demonstrate acausative link between social influencesand smoking initiation behavior. An ad-ditional limitation is the survey format ofthe study design, with a concern that theresults may not be fully representativedue to nonresponse. This potential limi-

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tation is somewhat alleviated by the rela-tively high response rate of 60%. Thesample for this study represents a subsetof all 18- to 24-year-olds who are in collegeand thus cannot be generalized to youngadults as a whole.

Although this study did not measureenvironmental influences such as mar-keting to college students by the tobaccocompanies, this is an important consid-eration. Since the Master SettlementAgreement with state attorneys general,tobacco companies agreed to stop adver-tising to children and adolescents.^^ As aresult, young adults became the youngestgroup to which the industry could overtly,legally market their products. Marketingpractices include brand advertisements,promotional items, contests, and free tri-als of cigarettes.33 In the current study,there was not a tremendous difference inthe endorsement of specific images andrisk of smoking between the late initia-tors and the never smokers. The lateinitiators were more likely to attributepositive images to smoking and less likelyto perceive risk than never smokers. Theincrease in college student smoking andadoption of more favorable images may bea reflection of the increased exposure toadvertising from tobacco companies.Rigotti and colleagues^"* found that collegestudents who attended social events thatwere sponsored by the tobacco industry atbars, nightclubs, and on campuses had ahigher smoking prevalence than did thosewho did not attend such events.

In conclusion, some factors appear todistinguish late initiators from neversmokers, including current alcohol use;parent education; and involvement infraternities and sororities, service andchurch participation, as well as closefriends who smoke. Community and uni-versity policies should be modified so thatsmoking initiation is not encouraged andsmoking behaviors are discouraged. Onlyrecently has tobacco prevention begun tobe addressed with this age-group. Theassumption had been that if young adultsarrived at college without starting smok-ing, they are no longer a risk for initia-tion. The current study found a sizeablepercentage of students who started smok-ing after age 18. Therefore, preventionefforts should be undertaken that specifi-cally focus on the social influences tosmoke among college students. Futurestudies are needed to understand the

relationship of parental education on thesmoking behaviors of college studentsand test strategies that reduce both alco-hol and tobacco use. Smoking initiationand continuation are multifaceted, com-plex behavior. Improved understanding ofsocial influences may lead to develop-ment of educational and environmentalstrategies that could reduce the numberof college students who initiate and con-tinue smoking. •

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2.Substance Abuse and Mental Health ServicesAdministration (2005). Results from 2004National Survey on Drug Use and Health:National Findings (Office of Applied Studies,NSDUH Series 14-28, DHHS PubUcation No.SMA 05-4062). Rockville, MD.

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