摘要：Objectives. We sought to fill gaps in knowledge of smoking behaviors among college-educated and non–college-educated young adults. Methods. We used data from the 2003 Tobacco Use Supplement of the Current Population Survey to analyze smoking behaviors among young adults aged 18–24 years and older young adults aged 25–34 years by college status (enrolled, or with a degree, but not enrolled) and other measures of socioeconomic position. Results. Current smoking prevalence among US young adults aged 18–24 years who are not enrolled in college or who do not have a college degree was 30%. This was more than twice the current smoking prevalence among college-educated young adults (14%). Non–college-educated young adults were more likely than were college-educated young adults to start smoking at a younger age and were less likely to have made a quit attempt, although no differences were found in their intentions to quit. Higher rates of smoking in the non–college-educated population were also evident in the slightly older age group. Conclusions. Non–college-educated young adults smoke at more than twice the rate of their college-educated counterparts. Targeted prevention and cessation efforts are needed for non–college-educated young adults to prevent excess morbidity and mortality in later years. Despite documented evidence dating back to the 1980s of tobacco industry marketing toward young adults (aged 18–35 years), 1 – 7 the public health literature on smoking among this demographic in the United States, particularly among non–college-educated young adults, remains relatively sparse. What little attention has been given to smoking among young adults has been devoted largely to college students. 8 – 13 However, young adults who are not currently enrolled in college or do not hold a college degree represent the majority of the young adult population, 14 – 15 and thus their behaviors may contribute disproportionately to the high rates of smoking for this age group. 16 – 17 The smoking behavior of young adults is important for several reasons. First, young adults are at risk for established smoking (i.e., having smoked more than 100 cigarettes in a lifetime and on at least 20 of the last 30 days). Up to 80% of smokers begin smoking before age 18, 18 – 21 yet the number of individuals aged 18 to 19 years in the early stages of smoking initiation is more than double that of established smokers aged 18 years. 3 , 20 Recent data suggest that even among smokers who first try smoking in their youth, regular or daily smoking may develop between ages 20 and 21, 16 and the cumulative risk of smoking initiation does not begin to plateau until age 22 years. 22 – 23 Average consumption per smoker also increases in the decade following adolescence. 24 – 25 Second, young adulthood is a pivotal period for smoking behavior. Patterns of smoking among young adults are influenced by the significant life transitions that occur during this time. Dramatic changes in social networks, living arrangements, and school or work settings increase susceptibility to smoking. 24 As young adults transition to marriage, parenthood, and occupational roles, tobacco use may either be rejected or become an established addiction. 20 Nonsmokers may start to smoke, smokers may shift from experimentation to regular smoking, and non-addicted smokers may become addicted smokers. 22 Finally, smoking behavior among young adults is predictive of smoking in later years. A longitudinal study examining the natural history of smoking from adolescence to adulthood found that among those who smoked as young adults, 72% were adult smokers. 26 Among those who did not smoke as young adults, only 7% were adult smokers. 26 Although few studies have focused on smoking among the non–college-educated young adult population, research suggests that smoking behavior among young adults is a much stronger predictor of smoking in later life for those with less formal education as compared with those with more formal education. 26 Since the early 1980s, rates of current, daily, and heavy smoking have been found to be significantly greater among young adults who are not in college than among young adults in college. 15 – 16 Given the presumed high smoking rates among non–college-educated young adults and the dearth of related research, we sought to fill the gaps in knowledge of smoking behaviors in this population. We used data from a nationally representative sample of US adults to analyze current smoking among young adults aged 18 to 24 years. We also examined smoking behaviors among young adults aged 25 to 34 years to examine how smoking behaviors may change as young adults enter into a generally more stable phase of life. Our main objective was to characterize patterns in smoking rates and behaviors by college status (in college, with a college degree, or not college educated), and to understand the role of education in smoking behaviors of young adults and older young adults. Although empirical evidence suggests education may be associated with smoking 26 – 27 and predictive of good health, 28 – 29 other aspects of socioeconomic position, such as income and occupation, have also been linked to smoking. 30 Therefore, we assessed the independent and combined effects of education, income, and occupation among young adults.
