The reported study investigates college students' perceptions of light compared to regular and ultra-light compared to light cigarettes, and whether perceptions vary by smoking status (nonsmoker, former smoker, social smoker, or regular smoker) and gender. A survey of 172 college students found
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In August 2006, a federal court judge ruled that tobacco companies can no longer refer to cigarettes as light or ultra-light. If the ruling stands, it is one of the harshest blows ever against the tobacco industry because it not only bans use of descriptors such as "low tar," "light," "ultra-light" and "mild." but also requires tobacco companies to run corrective advertising (CNN Money, 2006). However, Philip Morris USA, a tobacco company, states that use of the descriptors light and ultra-light is to describe the strength of taste and flavor, rather than safety (Philip Morris USA, 2007).
Approximately 45 million Americans currently smoke cigarettes (National Youth Risk Behavior Survey, 2006). One of the national health objectives for 2010 is to reduce cigarette smoking among high school students to 16% or less, among adults to 12% or less, and among college students to 10.5% or less (Healthy People 2010, 2000; Healthy Campus 2010, 2002). In 2005, 23% of high school students, 21% of adults, and 24% of college students smoked at least once during the past 30 days. Non-college adults, ages 19-28, are even further away from the 12% goal with smoking rates at 29% (Johnston, O'Malley, & Bachman, 2006).
Numerous studies examined the perceptions of college students toward smoking, but not their perceptions about light and ultra-light cigarettes in particular (Morrell, Cohen, Bacchi, & West, 2005; DeBarnardo & Aldinger, 1999; Everett & Husten, 1999; Wechsler, Rigotti, Gledhill-Hoyt, & Lee, 1998). Several studies examined the perceptions of adult smokers toward light and ultra-light cigarettes (Kozlowski and Pillitteri, 2001; Shiffman, Pillitteri, Barton, Rohay, & Gitchell, 2001), but only one study looked at adolescents' perceptions of lights (Kropp & Halpern-Felsher, 2004), and one study looked at college and non-college students' perceptions of lights (Richter, Pederson, & O'Hegarty, 2006). No studies have examined college students' perceptions of ultra-light cigarettes. Studies in the health literature have concluded that many smokers perceive light and ultra-light cigarettes to be safer than regular cigarettes and infer that these misperceptions are partly responsible for smoking rates remaining high despite the known risks of smoking (Etter, Kozlowski, & Perneger, 2003; Gilpin, Emery, White, & Pierce, 2002; Kozlowski et al., 1998).
College students are important to study due to their size, education, and the large number of students who smoke occasionally, a group referred to as social smokers. Although social smokers are a large segment among college students, only a few studies have compared the perceptions of regular and social smokers (Moran, Wechsler, & Rigotti, 2004). Therefore, the purpose of this exploratory study is to examine the perceptions of college students toward light cigarettes compared to regular cigarettes and ultra-light cigarettes compared to light cigarettes to assess whether students perceive these cigarettes as safer and whether their perceptions differ based on their smoking status (nonsmoker, former smoker, social smoker, or regular smoker). Also, gender differences will be examined.
Light and Ultra-light Cigarettes
Based on the Federal Trade Commission method of machine-yield measurements, light cigarettes are designed to deliver approximately 7-15 mg of tar and ultra-lights to deliver 6 mg of tar or less. In a study by Cummings and Giovino (2004), 58.5% of adult smokers and 52.8% of adolescent smokers reported using light cigarettes. Females are more likely than males to smoke lights and ultra-lights (Shiffman et al., 2001). According to Etter, Kozlowski and Perneger, (2003), ultralight smokers tend to be older, have smoked longer, are less nicotine dependent, and smoke fewer cigarettes per day than regular or light smokers.
Approximately 70% of ultra-light cigarette smokers and 80% of light cigarette smokers reported they smoked lights or ultra-lights because they preferred the taste compared to regular cigarettes (Kozlowski & Pillitteri, 2001). Respondents also reported other reasons for smoking lights or ultra-lights, including lower tar and nicotine, reduced risk of smoking without having to quit, and as a step toward quitting. However, research has failed to show a significant reduction in smoking-related health risks, such as cardiovascular disease or lung cancer, or an increase in the rates of smoking cessation associated with light/ultra-light cigarette use compared with regular cigarette use (Kropp & Halpern-Felsher, 2004; Thun & Burns, 2001).
Many studies have examined adult smokers' and former smokers' knowledge of the tar and nicotine yields in light and ultra-lights (Shiffman, et al., 2001; Etter et al., 2003; Gilpin et al., 2002; Kozlowski et al., 1998; Borland et al., 2004). Conclusions from these studies are consistent and suggest that many smokers choose lights and ultra-lights because they think such cigarettes are safer, less addictive, and less harsh than regular cigarettes. Further, these researchers infer that smokers are typically unaware that one light cigarette can deliver the same amount of tar and nicotine as one regular cigarette especially if the smoker compensates by (1) smoking more cigarettes, (2) taking deeper or more frequent puffs on the cigarette, or (3) covering the ventilation holes in the cigarettes using their fingers or lips (Kozlowski & Pillitteri, 2001; Etter et al., 2003; Kozlowski et al., 1998; Goldberg & Kozlowski, 1997).
However, examination of specific measures used in some studies indicates that the perception that lights and ultra-lights are safer or healthier may not be as widespread as first thought. For example, Borland et al. (2004) measured perceived safety as agreement with at least one of three statements: "lights make quitting easier," "lights are less harmful," or "lights give less tar." In that study, about half of the participants agreed with at least one of the statements. Forty-three percent of respondents agreed that lights provide less tar than regular cigarettes and twenty-eight percent agreed that lights were less harmful. Furthermore, more than seventy-five percent of participants agreed that the way a smoker puffs on a cigarette can affect the amount of tar and nicotine a smoker takes in, indicating that many smokers are aware of compensation.
An investigation of adolescents' attitudes, knowledge, and perceptions of the risks associated with smoking light cigarettes (Kropp & Halpern-Felsher, 2004) found that adolescents hold misperceptions relative to risks and addictive properties of light cigarettes compared to regular cigarettes. Subjects reported that they would be significantly less likely to suffer from health problems associated with smoking (e.g., lung cancer, heart disease, and emphysema) and less likely to die from these smoking related diseases if they smoked lights. Only one study looked at college students' perceptions of light cigarettes. In focus groups of college and non-college adults, ages 18-22, participants consistently rated light cigarettes as safer than regular cigarettes and regular cigarettes as more harmful than light cigarettes (Richter, Pederson, & O'Hegarty, 2006).
College Students and Smoking
As of 2005, there were approximately 17.3 million students enrolled in degree-granting institutions in the U.S., and enrollments are expected to increase to almost 20 million by 2014 (Digest of Education Statistics, 2004). In one study of college student smoking behavior, over 60% of college students reported trying cigarettes in their lifetimes and over 30% reported being current smokers (Morrell et al., 2005). According to Wechsler et al., (1998), 11% of college smokers had their first cigarette after the age of 19 and 28% began to smoke regularly after that age. Research indicates that although 98% of college students were aware of the consequences of smoking, only 39% of smokers desired to quit smoking, while 11% of nonsmokers actually indicated that they wanted to start smoking (DeBarnardo & Aldinger, 1999).
College students who smoked were half as likely as nonsmokers to believe there are health risks from smoking only on weekends, which is when most social smoking occurs (Murphy-Hoefer, Alder, & Higbee, 2004). In the same study, smokers and nonsmokers differed in their perceptions about health risks, with smokers not fully understanding the risks associated with smoking. However, Biasco and Hartnett (2002) found that college students who smoke view smoking as a bad habit but believe that others are not harmed by their second-hand smoke. According to Moran et al., (2004), a smoker's decision to smoke may occur with full knowledge of health risks.
Several studies found that social, or occasional smoking, is common among college students, many of whom do not think of themselves as smokers. Social smoking among college students may be associated with a lower frequency of tobacco use and less nicotine dependence (Moran et al., 2004) and is heavily affected by situational factors, such as smoking and drinking, smoking as an ice-breaker, and smoking to get more breaks at work or to reduce stress during final exams (Smith, Zank, & Stutts 2006).
Although several differences have been found between types of smoker, fewer differences have been noted between males and females (Wechsler et al., 1998; Rigotti, Lee, & Wechsler, 2000; Emmons, Wechsler, Dowdall, & Abraham, 1998). For example, total tobacco use is higher among male college students primarily due to the fact that males are more likely to smoke cigars and/or use smokeless tobacco products in addition to cigarettes. Also, among college students who have ever tried smoking, females were as likely as men to report being current smokers (Everett & Husten, 1999).
Methodology
Participants
A convenience sample of 172 college students at a large state university located in the southwest United States participated in the study. The students received extra credit for participation in the survey. Participation was voluntary and the study was approved by the University's Institutional Review Board.
The sample composition consisted of 57% males and 43% females, and almost 95% juniors and seniors. The majority of participants were traditional college students, with only 15% over age 25. About 54% of respondents identified themselves currently as nonsmokers, 27% were social smokers, 12% were regular smokers and 6% were former smokers. Of those that smoked, 9% indicated that they smoked regular cigarettes, 75% smoked light cigarettes, 1% smoked ultra-light cigarettes, 5% "other" and 10% said "it depends upon the situation." Forty-five percent were business majors, with the remainder from other majors, such as education, mass communication, political science, and exercise sport science.
Measures
The survey consisted of fixed-response items adapted from prior research (Shiftman et al.; Borland et al., 2004). Thirteen scale items, using a seven-point scale with one being strongly disagree, to seven being strongly agree, were developed to assess perceptions of light cigarettes compared to regular cigarettes and perceptions of lights compared to ultra-light cigarettes. Six items measured health-related perceptions: safer, less harmful, healthier, safer with second-hand smoke, healthier with second-hand smoke, and reduce risk of lung cancer. Two items measured perceptions of tar and nicotine levels. Five items measured non-health-related perceptions: milder, less harsh, easier on the throat, less irritating, and lighter taste.
To assess smoking status, participants were asked to classify themselves as nonsmokers, social smokers, regular smokers, or former smokers. Compensation was measured by two items: "If you switched from a regular cigarette to a light or ultralight, (1) do you smoke more than before switching, the same as before switching, or less than before switching and (2) do you inhale more deeply than before switching, the same as before switching, or less deeply than before switching. Regular, social, and former smokers were also asked if they ever tried to determine how much tar and nicotine they got in their brand of cigarettes and if they knew that light and ultra-light cigarettes were just as harmful as regular cigarettes would they switch back to regular cigarettes, stay with light cigarettes, or quit smoking.
Results
Type of Cigarette
Perceptions. Table 1 reports the means and standard deviations for the thirteen scale items measuring perceptions of light compared to regular cigarettes and ultralights compared to light cigarettes. For participants overall, means for the six health-related items were significantly below the median value (4) of the scale, indicating that college students did not agree that lights are safer or healthier than regular cigarettes. The same was true when comparing ultra-light to light cigarettes. In addition to evaluating means, the percent of respondents indicating agreement with each of the six scale items confirmed that most respondents did not believe light (ultra-light) cigarettes to be safer or healthier than regular (light) cigarettes. Furthermore, the means for the tar and nicotine items indicated that students disagreed that lights and ultra-lights have less tar and nicotine.
In contrast, means were significantly above the median of 4 for some of the non-health-related items, indicating agreement with those items. Participants agreed that lights are milder than regular cigarettes and that lights have a lighter taste than regular cigarettes, and that ultra-lights are milder than regular cigarettes. However, the participants disagreed that ultra-lights were less irritating than light cigarettes. Although not statistically significant, lights were also believed to be less harsh and easier on the throat than regular cigarettes, whereas ultra-lights were not perceived to be easier on the throat than light cigarettes.
Compensation. As shown in Table 2, 32% of those who switched from regular to light or ultra-light cigarettes compensated by inhaling more deeply and smoking more cigarettes. It is important to note that since these are self-reported measures, it is likely that the measures may under-represent the number compensating by either smoking more or inhaling more deeply.
It is possible that people smoke lights for many reasons other than health. Only 9% indicated that they would switch back to regular cigarettes if they knew that light cigarettes were just as harmful as regular cigarettes (see Table 3). And only 10% of the respondents indicated that they would quit smoking given this situation.
Smoking Status
One-way ANOVAs were used to test for differences in perceptions between smoking categories. Least Significant Difference was used as a post-hoc test to determine which between-group differences were significant. Means by smoking category and the significant differences between means are shown in Table 1.
When examining the six health-related scale items comparing light (ultra-light) cigarettes and regular (light) cigarettes, there were no significant differences between groups; all groups disagreed that lights/ultra-lights are safer or healthier. Similarly, there were no significant differences for the tar and nicotine items; again all groups disagreed that lights/ultralights have less tar and nicotine. In contrast to the health-related and tar and nicotine items, there were significant differences among groups with respect to the nonhealth-related items. In most cases, nonsmokers disagreed, while regular, social, and former smokers agreed with the items. For example, only non-smokers disagreed that lights were easier on the throat. Similar patterns were observed for both lights and ultra-lights.
Gender
A Chi-square test was used to determine if there was an association between gender and type of cigarette smoked. Responses for type of cigarette smoked included regular, light, ultra-light, other, and it depends upon the situation. There was no significant association between gender and type of cigarette smoked ([chi square] = 3.128).
Independent t-tests indicated very few statistical differences between men and women. Women more strongly agreed than men with the statement that light cigarettes are milder than regular cigarettes. In addition, women more strongly disagreed than men with the statement that smoking light cigarettes reduces one's risk of getting lung cancer. This same relationship held for the statement that smoking ultra-lights reduces one's risk of getting lung cancer. Although there were significant differences in the strength of agreement or disagreement with three items (lights are milder, lights reduce cancer risk, and ultra-lights reduce cancer risk), responses to the items were consistent in direction (agreement or disagreement). No other differences were found between genders.
Discussion
It is often suggested that people need to be educated about the harm of smoking in order to decrease smoking rates. Prior research on lights and ultra-lights suggests that people smoke light or ultra-light cigarettes because they believe that they are less harmful or healthier than smoking regular cigarettes. However, the findings of this study suggest that, at least for college students, this is not the case. Overall, there were three main findings.
First, all types of smokers disagreed with all six health-related statements. It did not matter whether a student was a regular smoker, former smoker, social smoker, or nonsmoker, they all disagreed with the scale items that suggested smoking light or ultra-light cigarettes is healthier, safer, or less harmful than smoking regular or light cigarettes. Although there were no significant differences between smoking categories in terms of their mean responses to these scale items, it is important to note that social and regular smokers more strongly disagreed with the statements that light or ultra-light cigarettes were healthier than regular or light cigarettes. Thus, college students seem to understand that smoking light or ultra-light cigarettes offers no health benefits over smoking regular cigarettes. This contradicts findings by Richter et al., (2006) in which focus groups of college students and non-college students reported that they believed that light cigarettes were safer and regular cigarettes were more harmful.
Second, an interesting finding was that most college students disagreed with the statement that lights and ultra-lights have less tar and nicotine than regular cigarettes. Perhaps, many of the students are aware that compensation can increase the amount of tar and nicotine inhaled into the lungs. The fact that almost one third of respondents who smoked light or ultra-light cigarettes indicated that they inhaled more deeply and/or smoked more cigarettes lends credibility to the premise that they know they compensate. Another explanation may be that college students do not know how much tar and nicotine are in cigarettes, and since they assume lights and ultra-lights are as unsafe as regulars, they may infer the same tar and nicotine amounts.
Third, nonsmokers disagreed, but smokers (former, social, and regular) agreed with all five non-health-related items (milder, less harsh, easier on the throat, less irritating, and lighter taste). This is consistent with Borland, et al., (2004) and Shiffman, et al., (2001) where smokers agreed that lights and ultra-lights provide some non-health related advantages over regular cigarettes. It also suggests that students may associate light and ultra-light cigarettes with non-health-related attributes only after becoming smokers. Also, there were differences between social and regular smokers for the non-health-related items. In most cases, social smokers agreed with the non-health related items, but not as strongly as regular smokers. This held for both lights compared to regular cigarettes and ultralights compared to light cigarettes. Possibly, social smokers may not have experienced the non-health-related benefits to the extent of regular smokers. Alternatively, the regular smoker of light and ultra-light cigarettes may subconsciously look for ways to feel better about their decision to smoke. Given that so many college students smoke light cigarettes (75% in this study), an important reason that lights are chosen over regular cigarettes might be because that is what they started smoking initially.
Findings in the present study suggest that there may be factors, other than health, influencing why smokers choose light or ultra-light cigarettes over regular cigarettes. This is supported by the fact that the majority of smokers indicated that they would stay with light or ultra-light cigarettes even if they knew they were just harmful as regular cigarettes. As the discussion above suggests, this number is high probably because college students already know that smoking light or ultra-light cigarettes is just as harmful as regular cigarettes so there is no reason to switch. It is also possible that social smokers perceive that smoking only on weekends, often in conjunction with alcohol consumption, does little or no harm to them.
This study is important because it suggests that, contrary to much of the previous research on light and ultra-light cigarettes, a significant segment of college students know that these cigarettes are as unhealthy as regular cigarettes. The results highlight the fact that other forces are influencing college smoking rates, rather than ignorance of the dangers of lights and ultra-lights. There are also implications for consumer advocacy groups, health professionals, and campus intervention programs attempting to reduce unhealthy consumption behaviors. For example, campus intervention programs may want to combine efforts to reduce alcohol and cigarette consumption, since alcohol consumption often leads to increased smoking, especially by social smokers. In addition, these programs may want to focus on factors other than health education (e.g., expense associated with tobacco use) since college students are already aware of the health risks.
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GAIL M. ZANK
Associate Professor
KAREN H. SMITH
Associate Professor
MARY ANN STUTTS, Professor
McCoy College of Business Administration
Texas State University-San Marcos
Table 1
Means and Standard Deviations by Type of Smoker
Lights
N F S
Health-related items:
Safer 2.57 2.50 2.44
(1.97) (2.12) (1.84)
Less harmful 2.70 2.40 2.47
(2.06) (2.17) (1.85)
Healthier 2.50 2.40 2.16
(1.98) (2.17) (1.80)
Safer for people
exposed to second-hand 2.23 2.50 2.18
smoke (1.72) (1.58) (1.71)
Healthier for people
exposed to second-hand 2.14 2.60 2.23
smoke (1.64) (1.58) (1.43)
Reduce the risk of 2.00 1.60 1.96
getting lung cancer (1.58) (1.26) (1.40)
Non-health-related items:
Milder 4.41 (abc) 5.50 5.09
(2.13) (1.72) (1.81)
Less harsh 3.70 (bc) 4.30 4.78
(2.08) (2.45) (1.99)
Easier on the throat 3.63 (bc) 4.70 4.96
(2.13) (1.89) (1.94)
Less irritating 3.30 (abc) 4.80 4.29
(2.13) (2.10) (2.05)
Have a lighter taste 3.76 (abc) 4.60 5.16
(1.94) (1.17) (1.87)
Tar/nicotine items:
Have less tar 3.55 4.00 3.82
(2.05) (1.76) (2.06)
Have less nicotine 3.38 4.20 3.14
(2.04) (1.81) (2.06)
Number of participants 88 10 45
Lights
R Overall
Health-related items:
Safer 1.85 2.51 (d)
(1.23) (1.90)
Less harmful 2.00 2.60 (d)
(1.38) (1.96)
Healthier 2.20 2.41 (d)
(1.61) (1.90)
Safer for people
exposed to second-hand 1.85 2.23 (d)
smoke (1.14) (1.67)
Healthier for people
exposed to second-hand 2.10 2.24 (d)
smoke (1.59) (1.60)
Reduce the risk of 1.55 1.94 (d)
getting lung cancer (0.89) (1.44)
Non-health-related items:
Milder 5.85 4.86 (e)
(1.42) (1.97)
Less harsh 5.10 4.23
(1.71) (2.07)
Easier on the throat 5.55 4.31
(1.23) (2.07)
Less irritating 4.90 3.92
(1.80) (2.13)
Have a lighter taste 4.79 4.41 (e)
(2.04) (1.97)
Tar/nicotine items:
Have less tar 3.40 3.69 (d)
(2.06) (2.00)
Have less nicotine 3.63 3.47 (d)
(2.22) (2.04)
Number of participants 20 172
Ultra-Lights
N F S
Health-related items:
Safer 2.63 2.70 2.73
(1.84) (2.45) (1.80)
Less harmful 2.63 2.40 2.53
(1.91) (2.01) (1.80)
Healthier 2.61 2.40 2.38
(1.98) (2.17) (1.71)
Safer for people
exposed to second-hand 2.36 2.30 2.20
smoke (1.78) (1.34) (1.50)
Healthier for people
exposed to second-hand 2.20 1.90 2.07
smoke 1.67 (1.20) (1.40)
Reduce the risk of 1.97 1.80 1.80
getting lung cancer (1.52) (1.32) (1.24)
Non-health-related items:
Milder 3.93 (ac) 5.40 4.48
(2.00) (1.43) (1.96)
Less harsh 3.57 (bc) 4.40 4.42
(2.01) (2.01) (2.02)
Easier on the throat 3.48 (c) 4.40 3.93
(2.00) (2.01) (1.91)
Less irritating 3.12 (bc) 4.20 3.93
(1.96) (2.04) (1.75)
Have a lighter taste 3.56 (ab) 5.20 4.37
(1.84) (1.32) (1.88)
Tar/nicotine items:
Have less tar 3.48 3.80 3.36
(2.01) (1.32) (1.99)
Have less nicotine 3.42 3.20 2.84
(1.96) (1.69) (1.93)
Number of participants 88 10 45
Ultra-Lights
R Overall
Health-related items:
Safer 2.15 2.64 (d)
(1.63) (1.84)
Less harmful 2.10 2.58 (d)
(1.65) (1.88)
Healthier 2.30 2.55 (d)
(1.92) (1.91)
Safer for people
exposed to second-hand 2.15 2.35
smoke (1.60) (1.67)
Healthier for people
exposed to second-hand 2.20 2.21 (d)
smoke (1.58) (1.59)
Reduce the risk of 1.45 1.92 (d)
getting lung cancer (0.69) (1.44)
Non-health-related items:
Milder 5.00 4.32 (e)
(2.03) (1.98)
Less harsh 5.05 4.04
(1.93) (2.04)
Easier on the throat 4.95 3.87
(1.96) (2.00)
Less irritating 4.70 3.62 (d)
(2.13) (1.98)
Have a lighter taste 4.10 3.96
(2.20) (1.90)
Tar/nicotine items:
Have less tar 3.45 3.49 (d)
(2.11) (1.95)
Have less nicotine 3.40 3.28 (d)
(2.16) (1.95)
Number of participants 20 172
Note: 9 participants failed to indicate type of smoker, N =
nonsmoker, F = former smoker, S = social smoker, R = regular
smoker, (a) indicates significant difference between nonsmoker
and former smoker at the .05 level; (b) indicates significant
difference between nonsmoker and social smoker cat the .05
level; (c) indicates significant difference between nonsmoker and
regular smoker at the .05 level; (d) indicates that the overall
mean was significantly below the scale median of 4.0 (disagreement
with scale item) at the .05 level; (e) indicates that the overall
mean was significantly above the scale median of 4.0 (agreement
with scale item) at the .01 or better level.
Table 2
Compensation Behavior of Participants Switching from
Regular Cigarettes to Lights
Total participants who switched 28
to lights
After switching:
Smoke more cigarettes 32%
Smoke the same number 60%
Smoke fewer cigarettes 8%
After switching: %
Inhale more deeply 32%
Inhale the same 64%
Inhale less deeply 4%
Table 3
If you knew that light cigarettes are just as harmful as
recular, would you?
Switch back to regular cigarettes 9%
Stay with light cigarettes 69%
Quit smoking 10%
Other 12%
Total 100%