摘要：Objectives. We sought to study gender differences in young adult smoking declines and enrollment in populationwide cessation services. Methods. The New York City (NYC) Department of Health and Mental Hygiene implemented populationwide cessation programs to distribute free nicotine replacement therapy (NRT); demographic data were collected from enrollees. Smoking prevalence was assessed using data from the Community Health Survey, an annual population-based survey. Results. Between 2002 and 2005, smoking among young adults in NYC declined from 23.8% to 18.8%, which was explained entirely by a 41.8% decline among young adult women (23.2% to 13.5); prevalence remained at 24% among young adult men. More young adult women enrolled in cessation services than did men, although once enrolled, the likelihood of using NRT was high among both groups. Conclusions. Among young adults, women have been responsive to comprehensive tobacco control, but men require more-intensive strategies. Population-wide NRT distribution can be effective with young adults overall; however, additional resources need to be devoted to identifying successful outreach strategies for young adult men. The young adult population is of particular interest to the tobacco industry for several reasons, many of which have been noted in recent analyses of tobacco industry documents. First, because young adults function as role models for adolescents, marketing to young adults may indirectly promote smoking to adolescents. 1 Second, the transitional nature of young adulthood provides opportunities for experimentation and the establishment of addiction. 2 Finally, although most smokers try their first cigarette before age 18 years, 3 , 4 the transition from experimental or occasional smoking to daily smoking often occurs in young adulthood. 5 Evidence shows that marketing efforts to this group may successfully encourage a shift from occasional smoking to regular smoking. 6 Thus, as smoking among youth (younger than 18 years) and young adults (aged 18 to 24 years) continues to decline, 7 the young adult population will likely continue to be targets of already aggressive tobacco marketing. 1 , 6 Although national increases in smoking by young adults during the 1990s were cause for concern, 8 , 9 , 10 since 2002 young adult smoking appears to have declined. 11 , 12 A better understanding of cessation strategies that are effective for this population is needed to accentuate successes and may counteract any increase in marketing to this population by the tobacco industry. Research shows that smoking cessation at earlier ages is associated with reduced risk of premature death. 13 , 14 Studies also show that the period of young adulthood is associated with increased likelihood of quit attempts and success in quitting. 15 It is, therefore, prudent for tobacco control programs to broaden their understanding of successful cessation strategies for young adults overall and for subgroups in need of targeted intervention. The New York City Department of Health and Mental Hygiene (DOHMH) implemented a comprehensive, 5-point tobacco control program in 2002. This program, which includes taxation, legislation, education, cessation services, and evaluation efforts, resulted in a 1-year decline in smoking prevalence among New York City adults from 21.6% in 2002 to 19.2% in 2003, which was maintained in 2005 (18.9%). 16 , 17 The cessation services component of the New York City program included physician outreach and education, support of quit smoking clinics, and 3 populationwide giveaways of nicotine replacement therapy (NRT) patches in 2003, 2005, and 2006. In response to evidence that smokers who use NRT are more likely to quit than those who don’t, 18 , 19 NRT distribution has been a primary focus of New York City’s cessation services. An evaluation of the 2003 DOHMH patch giveaway showed that smokers who received patches through the program were significantly more likely to be smoke-free at 6 months than were smokers who did not receive patches. 20 We examined declines in smoking prevalence among young adults and participation in the citywide NRT distribution program (including patterns of enrollment and use of patches) by gender. We also make recommendations for targeting populationwide NRT distribution to address these disparities.
