Interventions against alcohol consumption targeting college-age students have tended to focus solely on drinking without including any discussion of tobacco.
This is concerning to University of Arizona anthropologists Mimi Nichter and Mark Nichter, whose research indicates that, among other key findings, college students in social settings often smoke and drink in tandem.
As a consequence of years of research, the two conclude that preventative interventions should be structured in a way that drinking and smoking are addressed simultaneously.
"We need to recognize how smoking is being used in social performances and the meaning it has in different interactional places," said Mark Nichter, a UA Regents' Professor in the School of Anthropology.
"Tobacco cessation needs to be promoted on a space-by-space basis," Nichter said. "What's been missing is an understanding of the meaning of smoking in changing smoking environments where smoking is increasingly regulated."
The Nichters point to reports showing marked increases over the last 15 years in the rate at which young adults, particularly those ages 18 to 24, begin smoking.
Their recent research highlights the commonality of smoking cigarettes as a behavior that goes along with drinking. In fact, UA students describe drinking and smoking as "going together like peanut butter and jelly" or "like milk and cookies," said Mimi Nichter, an associate professor in the School of Anthropology.
Their most recent article, "Smoking and Drinking Among College Students: ‘It's a Packaged Deal,'" was published in the January issue of Drug and Alcohol Dependence. Other authors on the paper are Asli Carkoglu, a faculty member in the psychology department at Dogus University in Turkey, and Elizabeth Lloyd-Richardson, a faculty member in the psychology department at the University of Massachusetts, Dartmouth.
The authors note that while being seen as a smoker on campus is often stigmatized, drinking alcohol and smoking at parties is typically viewed as normative and socially acceptable.
The article draws on a series of studies conducted on college campuses by members of the Robert Wood Johnson Foundation's Tobacco Etiology Research Network, or TERN.
The transdisciplinary research group, composed of scientists and researchers from around the country, met for seven years to investigate tobacco use and dependency among youth and young adults.
One major study the group led included more than 900 college freshmen, who were followed through the academic year to provide detailed assessments of their smoking and drinking habits.
"There is a window of initiation to smoking that takes place in the early months of the freshman year," Mimi Nichter said.
"We were able to interview college students within one or two weeks of the actual occurrence to better understand their behaviors," she added. "Most studies rely on retrospective accounts which can be inaccurate and cloudy."
Nichter said the close-in-time intensive methodology provided valuable insights into why students initiate smoking and what perceptions they have about risks.
The average number of cigarettes smoked on the weekend nights was five nightly for both males and females, Nichter said.
Interestingly, the majority of student respondents who smoked at parties did not think of themselves as "real smokers," instead, that smoking was simply something to do. Having a cigarette with friends helped social interaction at parties, helping to bypass "awkward" moments of silence and disconnect.
And those who rarely smoked reported that having a cigarette while drinking lessened the negative side effects that people often complain of – like the taste of tobacco – or the harshness in the throat, the Nichters noted.
"Many young people are not concerned about smoking because they are just doing it on the weekends, or only when they're drinking," Mark Nichter said. "But recent research shows that there are many forms and expressions of tobacco dependency."
Mark Nichter noted that some people become dependent even at low levels of smoking while others can maintain long-term intermittent cigarette smoking without becoming dependent.
While many young people who "are just party smokers" believe they are not "real" smokers and not at risk to becoming one, abundant research exists to shows that they are at substantial risk to addiction, he added.
"In fact, about one-third to one-half of those who try cigarettes eventually become regular or dependent smokers," Mark Nichter said. "And even low level smoking has been proven to be harmful to health."
Another factor often associated with smoking in college populations is stress.
In an earlier published study on stress and smoking among the same group of college students, the Nichters and Carkoglu questioned the meaning of surveys that associated increased smoking during exam times to "stress."
They found that students who smoked more regularly often did so during testing times, but reasons why varied.
Some smoked to take a short break or to celebrate having finished a task or test. Others smoked to help manage not only their personal stress, but the stress of friends, experiencing what some termed as "second-hand stress."
The Nichters also found that students engaged in "empathetic smoking," such as when their friends were upset or especially stressed. For instance, young men mentioned using cigarettes to share feelings instead of talking.
Given the research findings, the Nichters said interventions must also be targeted during specific times.
"We need to make student cessation services more readily available to support students who realize that they are becoming dependent," Mimi Nichter said.
"For many college students, smoking will not fit into the world they imagine for themselves after graduation," she said. "Many students agree that it is not okay to smoke in the real world – once they graduate and get a job – so they need help in quitting."
By La Monica Everett-Haynes, University Communications February 8, 2010