Young adults between the ages of 20 to 24 are reported to have the highest smoking rates of any other age group. A questionnaire was used to assess the smoking practices and beliefs of 323 female university students. All participants were first year students entering university in a city where smoke-free

legislation had been enacted. Results indicated that smoking rates were lower then those found among other university samples. This suggests that no-smoking legislation may promote an atmosphere where pressures to smoke are minimized, thus assisting students in making positive choices concerning their health. These exploratory findings require replication in future research.

**********

Despite the documented adverse effects of smoking on health (1,2,3) and the devastating economic costs from a health care perspective (e.g., from lost productivity, fire damage) (4,5) society continues to use tobacco products. Health Canada (6) reports that 20 to 24 year olds have the highest smoking rates of any other age group. For example, numerous campus-based studies in North America have reported smoking rates between 10% to 19%; (7,8,9,10) however, if experimental smoking is considered, rates increase dramatically to 37% to 78%. (9,10) Although research reveals that smoking prevalence declines with higher educational attainment (American Lung Association, 2002; U.S. Department of Health and Human Services, 2001), (4,11) smoking still exists among the educated.

Over and above the effects smoking has on disease development, (2) smoking creates additional problems unique to women. For example, Stachenko et al. (3) found that female smokers who use oral contraceptives are 8 to 10 times more likely to suffer a cardiovascular incident then non-smoking oral contraceptive users, including the possibility of a subarachnoid hemorrhage, depressed HDL-cholesterol levels, and myocardial infarction. Additionally, women smokers are also more likely to face issues with infertility and problems while pregnant (e.g., higher rates of spontaneous abortion, stillbirth, low birth weight babies, premature deliveries). (2) Additionally Crocker et al. (12) revealed that smokers had lower levels of global self-esteem, body attractiveness and greater dietary restriction than non-smokers (see, also, George & Johnson (13)).

Purpose

This exploratory research highlights some of the findings obtained from the analysis of a questionnaire administered to university-aged women concerning their beliefs and smoking practices in a city with no-smoking legislation.

Methods

Three hundred and twenty three first year female students were recruited during weekly on-campus residence meetings from a university in Central Ontario. Individuals were residents of all-female on-campus dormitories and ranged in age from 17 to 22 years, with a mean of 19 years. A total of 254 participants classified themselves as non-smokers, 13 considered themselves smokers, 40 stated that they were social smokers and the remaining 16 former smokers. The response rate was approximately 95%. A 60-item questionnaire, developed by the research team, was distributed to participants.

Results

Most students were 19 and 20 years of age (94%) and from the Faculty of Arts (48%) in terms of academic discipline. Ninety three percent of the entire sample rated their overall health status as excellent or good. More non-smokers (94%), social smokers (90%) and former smokers (88%) rated their health as good or excellent, compared to current smokers (70%). The pill was used by 39% of non-smokers, 77% of smokers, 60% of social smokers and 56% of former smokers.

Prior to attending university, 75% of the sample classified themselves as nonsmokers; however, at the time of the study, 84% of participants indicated that they were either non-smokers or former smokers. All those classified as smokers at the time of the study claimed to have started smoking prior to attending university. Six percent of all non-smokers indicated that they had been a smoker sometime prior to entering university

When asked to respond to the statement, "Smokers pollute the air and endanger the health of others", 93% of the entire sample agreed. In addition, participants were asked about the benefits of smoking. Less then 1% of the non-smoking group reported any benefit to cigarette smoking, whereas smokers, former smokers and social smokers chose stress relief and the elimination of boredom as important benefits. Eighty five percent of smokers, 80% of social smokers and 56% of former smokers viewed stress relief as a benefit to smoking. In addition, 23% of smokers and 13% of both social and former smokers saw smoking as beneficial in weight control.

The most frequently reported reason for beginning cigarette use was curiosity (74%), followed by peer pressure and the need to be accepted (49%). Reasons for continuing to smoke after initial use included addiction (38%), peer pressure and the need to be accepted (20%), the desire to be rebellious (8%) and weight control (3%). Addiction was reported most often by current smokers (77%). When asked about smoking cessation, 78% of participants indicated health concerns as a reason for having quit or wanting to quit.

Almost half the participants (51%) were aware of the regional no-smoking by-law prior to entering their first year of university. While 85% of all participants were pleased about the by-law, 11% were unaffected and the rest (3%) were displeased. Ninety one percent of smokers, former smokers and social smokers reported adhering to the by-law. Approximately 57% of the sample stated that the by-law had no effect on their lifestyle, while 46% of the current smoking group and 28% of social smokers said they were less likely to smoke at restaurants and bars. In addition, 13% of the former smoking group indicated that their smoking cessation was a result of the by-law.

Discussion

Undoubtedly smoking threatens the health and well-being of smokers and second-hand smokers alike. Despite well-documented research confirming the detrimental effects caused by smoking, (l,2,3,4) individuals continue to endanger their health, and the health of those around them. Results from the present study confirm these findings. Four percent of the sample classified themselves as smokers which is substantially below other campus-based studies in North America (10% to 19%). (7,8,9,10) It is possible that the introduction of the no-smoking by-law influenced smokers' decisions to attend other universities, and thus the percentage of smokers is significantly below other universities within North America. Failure to classify oneself in the correct smoking category may also contribute to the lower percentages of smokers within this group.

One of the more disconcerting findings of this study was the percentage of cigarette users that were also oral contraceptive (OC) users. Past studies have confirmed the high percentage of OC users within university settings; (14) however, the greatest percentage of OC users in the present study (77% of smokers; 60% of social smokers; 56% of former smokers) are also smokers which seems particularly troublesome. Oral contraceptive users that smoke undeniably increase their risk of cardiac events. (3,15,16). Although OCs provide women with the ability to control their reproductive health (l4) and obtain various non-contraceptive benefits, (17,18,19,20) OC users within this study do not appear to be demonstrating the most efficacious behaviours surrounding OC use and smoking. Although health care professionals may be able to educate women about smoking practices and OC use, young women also need to assume more responsibility for their own health. (14)

Conclusions

Few research studies have been conducted concerning smoking legislation on university/college campuses (see, for example, Fiore et a (19)), particularly within Ontario Canada. Lachetti and Abernathy (21) report that no-smoking legislation has become increasingly more widespread and restrictive since the Ontario Tobacco Control Act in 1994. Although this exploratory study utilizing a convenience sample of young women attending university limits the generalizability of the findings, this study provides preliminary information about smoking practices and beliefs of university-aged women in a city with no-smoking legislation. Future research should focus on discerning whether no-smoking legislation, in conjunction with education efforts regarding the negative effects of smoking, influences smoking practices in regions with and without anti-smoking by-laws (e.g., has smoking rate decreased?; does no-smoking by-law foster healthier smoke-free environment which deters smoking initiation?). Leaving home to attend university/college provides women with the opportunity to make many of their own decisions, particularly with respect to their health behaviours. As such, providing sound educational information about the risks of smoking is imperative to students' present and future health.

References

American Cancer Society (2002). Smoking Legislation, www.cancer.org.

American Lung Association. (2002). Tobacco Control, Air Quality, Diseases www.lungusa.org/tobacco/.

Anderson, E.D and Cole, B.S. (1990). Smoking Attitudes and Behaviors of Adolescents and Young Adults. College Student Journal, 24(2), 120-127.

Burkman, R.T. (1995). Oral contraceptives: an update. Hospital Practice, 30(4), 85-96.

Canadian Cancer Society. (2002). Tobacco. What are the Health Issues for Women? www.cancer.ca.

Crocker, P., Kowalski, N., Chad, K., Humbert, L., Forrester, S. (2001). Smoking Behaviour and Dietary Restraint in Young Adolescent Women: The Role of Physical Self-Perceptions. Canadian Journal of Public Health, 92(6), 428-432.

Davis, M.C. (1999). Oral contraceptive use and hemodynamic, lipid, and fibrinogen responses to smoking and stress in women. Health psychology, 18(2), 122-130.

Fiore, M.C., Jorenby, D.E., Wetter, D.W., Kenford S.L., Smith S.S., Baker T.B. (1993). Prevalence of daily and experimental smoking among University of Wisconsin-Madison undergraduates, 1989-1993. Wisconsin Medical Journal, November, 605-608.

Fletcher, P.C., Bryden, PJ., Bonin, E. (2001). Preliminary examination of oral contraceptive use among university-aged females. Contraception, 63, 229-233.

George, V.A. and Johnson, P. (2001). Weight Loss Behaviors and Smoking in College Students of Diverse Ethnicity. American Journal of Health Behavior, 25(2), 115-125.

Health Canada. (2002). Canadian Tobacco Use Monitoring Survey (CTUMS). www.hcsc.gc.ca/hecs-secs/tobacco/research/ctums/20 01/table_02.html.

Kaiserman, M.J. (1997). The Cost of Smoking in Canada, 1991. Chronic Disease in Canada, 18(1), 13-19.

Lachetti, C. and Abernathy, T. (2001). Analysis of Factors Related to Development, Regulatory Level and Change in Municipal No-smoking By-laws in Ontario. Canadian Journal of Public Health, 92(6), 412-416.

Lewis, M.A., Heinemann, L.A., Spitzer, W.O., MacRae, K.D., Bruppacher, R. (1997). The use of oral contraceptives and the occurrence of acute myocardial infarction in young women. Contraception, 56, 129-140.

Makrides, L., Weinot, P., Richard, J., McKee, E., Gallivan, T. (1998). A Cardiovascular Health Needs Assessment of University Students Living in Residence. Canadian Journal of Public Health, 89(3), 171-175.

Moskal, P.D., Dziuban, C.D., West, G.B. (1999). Examining the Use of Tobacco on College Campuses. Journal of American College Health, 47, 260-265.

Narod, S.A., Risch, H., Moslehi R., Dorum, A., Neuhausen, S., Olsson, H., Provencher, D..

Radice, P., Evans, G., Brunet, J.S., Ponder, B.A. (1998). Oral contraceptives and the risk of hereditary ovarian cancer. The New England Journal of Medicine, 339(7), 424-428.

Stachenko, S.J., Reeder, B.A, Lindsay, E., Donovan, C., Lessard, R., Balram, C. (1992).

Smoking prevalence and associated risk factors in Canadian adults. Canadian Medical Association Journal, 146(11), 1989-1996.

Sulak, P.J. (1999). Oral Contraceptives: therapeutic uses and quality-of-life benefits--case presentations. Contraception, 59, 35S-38S.

Tyrer, L. (1999). Introduction of the Pill and its impact. Contraception, 50, 11S-16S. U.S. Department of Health and Human Services. (2001). HHS Topics: Smoking/Tobacco. www.hhs.gov/topics/smoking.html.

PAULA C. FLETCHER, PHD

AMY CAMBLIN, B.A.

Department of Kinesiology and Physical Education,

Wilfrid Laurier University, Waterloo, Ontario, Canada

Table 1:
Highlights of Socio-demographic and Health Information, by percent
and frequency

                          Non-Smoker    Smoker        Social
                                                      Smoker
                          (n=254)       (n=13)        (n=40)
Age
17-18                     6.3 (16)      7.7 (1)       2.5 (1)
19-20                     93.3 (237)    84.6 (11)     97.5 (39)
21-22                     0.4 (1)       7.7 (1)       0.0 (0)
Academic Program
Arts                      43.3 (110)    84.6 (11)     55.0 (22)
Science                   22.4 (57)     7.7 (1)       22.5 (9)
Business                  29.9 (76)     7.7 (1)       17.5 (7)
Music                     4.3 (11)      0.0 (0)       5.0 (2)
Overall Health Status
Excellent/Good            94.1 (239)    69.2 (9)      90.0 (36)
Fair/Poor                 5.5 (14)      30.8 (4)      10.0 (4)
Oral Contraceptive
Use
Yes                       38.9 (99)     76.9 (10)     60.0 (24)
No                        61.0 (155)    23.1 (3)      40.0 (16)

                          Former        Total
                          Smoker
                          (n=16)        (n=323)
Age
17-18                     0 (0)         5.6 (18)
19-20                     100.0 (16)    93.8 (303)
21-22                     0.0 (0)       0.6 (2)
Academic Program
Arts                      81.3 (13)     48.3 (156)
Science                   12.5 (2)      21.4 (69)
Business                  6.3 (1)       26.3 (85)
Music                     0.0 (0)       4.0 (13)
Overall Health Status
Excellent/Good            87.5 (14)     90.4 (292)
Fair/Poor                 12.5 (2)      7.4 (24)
Oral Contraceptive
Use
Yes                       56.3 (9)      43.9 (142)
No                        43.8 (7)      56.0 (181)

Table 2:
Individual Smoking Practice by percent and frequency

                    Non-Smoker       Smoker         Social
                                                    Smoker
                     (n=254)         (n=13)         (n=40)

Classification Prior to Attending University
Non-Smoker          93.7 (238)      0.0 (0)        7.5 (3)
Former Smoker        0.4 (1)        0.0 (0)        10.0 (4)
Social Smoker        5.5 (14)       23.1 (3)      62.5 (25)
Smoker               0.4 (1)       76.9 (10)       20.0 (2)
Smoking Trend Since Attending University
Quit Smoking         1.6 (4)           NA             NA
Started Smoking         NA           0 (0)         5.0 (2)
Reduced Smoking      4.3 (11)       46.2 (6)      42.5 (17)
Increased            0.8 (2)        38.5 (5)      25.0 (10)
Smoking
Smoking Same         0.4 (1)        15.4 (2)      27.5 (11)
Amount
Remained a          92.1 (234)         NA             NA
Non-Smoker

                      Former         Total
                      Smoker
                      (n=16)        (n=323)

Classification Prior to Attending University
Non-Smoker           6.3 (1)       74.9 (242)
Former Smoker        56.3 (9)       4.3 (14)
Social Smoker        25.0 (4)      14.2 (26)
Smoker               12.5 (2)       6.5 (21)
Smoking Trend Since Attending University
Quit Smoking         37.5 (6)       3.7 (10)
Started Smoking       0 (0)         0.6 (2)
Reduced Smoking      6.25 (1)      10.8 (35)
Increased            0.0 (0)        5.3 (17)
Smoking
Smoking Same         0.0 (0)        4.3 (14)
Amount
Remained a           56.3 (9)      90.0 (243)
Non-Smoker

Table 3:
Beliefs about Smoking, by percent and frequency

                              Non-                        Social
                              Smoker        Smoker        Smoker
                              (n=254)                     (n=40)
                                            (n=13)

Beliefs About Smoking and the Benefits of Smoking

Smokers Pollute Air and       93.3 (237)    100.0         95.0 (38)
Endanger Others Health                      (13)
Smoking is a Method of        0.0 (0)       84.6 (11)     80.0 (32)
Stress Relief
Smoking Benefits Weight       0.0 (0)       23.1 (3)      12.5 (5)
Control
Smoking Helps to Eliminate    0.4 (1)       76.9 (10)     62.5 (25)
Boredom

                              Former        Total
                              Smoker
                              (n=16)        (n=323)

Beliefs About Smoking and the Benefits of Smoking

Smokers Pollute Air and       75.0          92.9 (300)
Endanger Others Health        (12)
Smoking is a Method of        56.3 (9)      16.1 (52)
Stress Relief
Smoking Benefits Weight       12.5 (2)      3.1 (10)
Control
Smoking Helps to Eliminate    31.3 (5)      12.7 (41)
Boredom

Table 4:
Information about Motivation to Smoke, by percent and frequency

                          Smoker       Social
                                       Smoker
                          (n=13)       (n=40)

Reasons for Beginning to Smoke
Peer Pressure/ To be      30.8 (4)     60.0 (24)
Accepted
Method of Weight          15.4 (2)     5.0 (2)
Control
To be Rebellious          23.1 (3)     12.5 (5)
Curiosity                 92.3 (12)    67.5 (27)
Reasons for Continuing to Smoke
Peer Pressure/ To be      0.0 (0)      22.5 (9)
Accepted
Method of Weight          0.0 (0)      5.0 (2)
Control
To Be Rebellious          7.7 (1)      7.5 (30)
Addiction                 76.9 (10)    25.0 (10)
Reasons for Quitting or Wanting to Quit
Health Concerns           92.3 (12)    75.0 (30)
Cost                      84.6 (11)    55.0 (22)
Smell                     69.2 (9)     62.5 (25)

                          Former       Total of
                          Smoker       Smoking
                          (n=16)       Groups
                                       (n=69)

Reasons for Beginning to Smoke
Peer Pressure/ To be      37.5 (6)     49.3 (34)
Accepted
Method of Weight          0.0 (0)      5.8 (4)
Control
To be Rebellious          25.0 (4)     17.4 (12)
Curiosity                 75.0 (12)    73.9 (51)
Reasons for Continuing to Smoke
Peer Pressure/ To be      31.3 (5)     20.3 (14)
Accepted
Method of Weight          0.0 (0)      2.9 (2)
Control
To Be Rebellious          25.0 (4)     11.6 (8)
Addiction                 37.5 (6)     37.7 (26)
Reasons for Quitting or Wanting to Quit
Health Concerns           75.0 (12)    78.3 (54)
Cost                      37.5 (6)     56.5 (39)
Smell                     68.8 (11)    65.2 (45)

Table 5:
Information about Regional No-Smoking By-Law, by percent and frequency

                                Non-Smoker    Smoker        Social
                                (n=254)       (n=13)        Smoker
                                                            (n=40)
Awareness of Regional No-smoking By-law
Aware Prior to Beginning        50.0 (127)    38.5 (5)      55.0 (22)
University
Became Aware after Arriving     48.8 (124)    61.5 (8)      45.0 (18)
on Campus
Attitude Towards By-law
Pleased                         88.9 (226)    38.5 (5)      72.5 (29)
Not pleased                     0.4 (1)       46.2 (6)      7.5 (3)
Unaffected                      9.4 (24)      15.4 (24)     17.5 (7)
Adhere to By-law                n/a           92.3 (12)     92.5 (37)
Regulations
Lifestyle Changes Due to By-law
More Likely to Go to a Bar/     7.1 (18)      NA            NA
Restaurant
Less Likely to Smoke at Bars/   NA            46.2 (6)      27.5 (11)
Restaurants
Quit Smoking Due to By-law      0.0 (0)       0.0 (0)       0.0 (0)
Has had No Effect on            60.2 (153)    23.1 (3)      47.5 (19)
Lifestyle

                                Former        Total
                                Smoker        (n=323)
                                (n=16)
Awareness of Regional No-smoking By-law
Aware Prior to Beginning        62.5 (10)     50.8 (164)
University
Became Aware after Arriving     25.0 (4)      47.7 (154)
on Campus
Attitude Towards By-law
Pleased                         75.0 (12)     84.2 (272)
Not pleased                     0.0 (0)       3.1 (10)
Unaffected                      12.5 (2)      10.8 (35)
Adhere to By-law                87.5 (14)     91.3 (63)
Regulations
Lifestyle Changes Due to By-law
More Likely to Go to a Bar/     NA            7.1 (18)
Restaurant
Less Likely to Smoke at Bars/   NA            32.1 (17)
Restaurants
Quit Smoking Due to By-law      12.5 (2)      0.6 (2)
Has had No Effect on            56.3 (9)      56.9 (184)
Lifestyle