Established Smokers Research Articles

Abstract P137: Smoking Susceptibility and its Predictors among Nepalese Adolescents: Evidence from the Jhaukhel- Duwakot Health Demographic Surveillance Site, Bhaktapur District, Nepal

Introduction: Cognitive susceptibility to smoking is defined as absence of firm commitment not to smoke in the future or if offered a cigarette by best friends. It begins in adolescence and is the first step in the transition to current smoking. Psychosocial risk factors play a crucial role to discourage susceptible adolescents from becoming established smokers. Most studies were conducted in the USA and evidence from low-income countries is limited. Despite the established Tobacco Product Control and Regulatory Bill 2011S in Nepal, cigarette smoking is widely prevalent among adolescents and the absolute number of smokers continues to rise. Hypothesis: We tested the hypothesis that socio-demographic and environmental risk factors associated with susceptibility to smoking among adolescents living in a peri-urban area of Nepal. Methods: We conducted a community cross-sectional study during October-November 2011 in the Jhaukhel - Duwakot Health Demographic Surveillance Site, a peri-urban area in Bhakapur district, 13 km east of the capital Kathmandu in Nepal, where tobacco products are easily available to adolescents. Trained local enumerators conducted face-to-face interviews with 352 randomly selected 14-16 year old non-smoking adolescents. The Nepal Health Research Council and Ethical Committee of Kathmandu Medical College approved this study. Results: The percentage of smoking susceptibility was 49.70% (95% CI: 44.49%-54.93%). In univariate analysis, sex, family members/relatives smoke, teacher smokes, friend smokes, exposure to secondhand smoke, participation in picnic/concerts, exposure to tobacco advertisements, and having seen actors smoke were associated with susceptibility to smoking. While in multiple regression analysis, smoking behavior of family members/relatives, teacher smoking, exposure to pro-tobacco advertisements and involvement in picnic/concerts were associated with susceptibility to smoking. Conclusion: Our results reveal that non-smoking adolescents, depending on their socio-demographic and environmental backgrounds, consider smoking initiation risk factors differently. We therefore suggest that future smoking intervention programs should also take socio-environmental influences into account for efficiently preventing non-smoking adolescents becoming susceptible to smoking.

Are Tobacco Control Policies Effective in Reducing Young Adult Smoking?

We examined the influence of tobacco control program funding, smoke-free air laws, and cigarette prices on young adult smoking outcomes. We use a natural experimental design approach that uses the variation in tobacco control policies across states and over time to understand their influence on tobacco outcomes. We combine individual outcome data with annual state-level policy data to conduct multivariable logistic regression models, controlling for an extensive set of sociodemographic factors. The participants are 18- to 25-year-olds from the 2002-2009 National Surveys on Drug Use and Health. The three main outcomes are past-year smoking initiation, and current and established smoking. A current smoker was one who had smoked on at least 1 day in the past 30 days. An established smoker was one who had smoked 1 or more cigarettes in the past 30 days and smoked at least 100 cigarettes in his or her lifetime. Higher levels of tobacco control program funding and greater smoke-free-air law coverage were both associated with declines in current and established smoking (p < .01). Greater coverage of smoke-free air laws was associated with lower past year initiation with marginal significance (p = .058). Higher cigarette prices were not associated with smoking outcomes. Had smoke-free-air law coverage and cumulative tobacco control funding remained at 2002 levels, current and established smoking would have been 5%-7% higher in 2009. Smoke-free air laws and state tobacco control programs are effective strategies for curbing young adult smoking.

Clinical Features of Precocious Acute Coronary Syndrome

BackgroundAcute coronary syndrome due to acute plaque rupture has been well described and is associated with established risk factors, including hypertension, diabetes mellitus, hyperlipidemia, and smoking. The prevalence of these risk factors in very young patients (aged ≤35 years) is not well known, and they may have other nontraditional risk factors. We hypothesized that acute coronary syndrome in very young patients may represent a thrombotic event independent of underlying atherosclerotic disease. MethodsWe performed a dual-institution, retrospective study of consecutive patients aged ≤35 years who presented with acute coronary syndrome and underwent coronary angiography from January 2000 to December 2011. Standard demographics, risk factors, and detailed angiographic information were obtained. ResultsA total of 124 patients met inclusion criteria. The mean age was 31 ± 4 years for both sexes. Approximately half (49%) of the patients were obese (body mass index ≥30 kg/m2); 90% of patients had at least 1 traditional risk factor, most commonly hyperlipidemia (63%) and smoking (60%); 52% of patients underwent re-vascularization, of which 94% were by percutaneous coronary intervention, and 42.9% of patients had intracoronary thrombus, of whom approximately one third had no detectable underlying coronary disease. ConclusionsVery young patients with acute coronary syndrome tend to be obese, with a high prevalence of smoking and hyperlipidemia. The presence of thrombus in the absence of underlying coronary disease suggests a thromboembolic event or de novo thrombotic occlusion, which may reflect primary hemostatic dysfunction in a considerable number of these patients.

Electronic cigarette use by college students

BackgroundElectronic cigarettes, or e-cigarettes, are battery operated devices that deliver nicotine via inhaled vapor. There is considerable controversy about the disease risk and toxicity of e-cigarettes and empirical evidence on short- and long-term health effects is minimal. Limited data on e-cigarette use and correlates exist, and to our knowledge, no prevalence rates among U.S. college students have been reported. This study aimed to estimate the prevalence of e-cigarette use and identify correlates of use among a large, multi-institution, random sample of college students. Methods4444 students from 8 colleges in North Carolina completed a Web-based survey in fall 2009. ResultsEver use of e-cigarettes was reported by 4.9% of students, with 1.5% reporting past month use. Correlates of ever use included male gender, Hispanic or “Other race” (compared to non-Hispanic Whites), Greek affiliation, conventional cigarette smoking and e-cigarette harm perceptions. Although e-cigarette use was more common among conventional cigarette smokers, 12% of ever e-cigarette users had never smoked a conventional cigarette. Among current cigarette smokers, e-cigarette use was negatively associated with lack of knowledge about e-cigarette harm, but was not associated with intentions to quit. ConclusionsAlthough e-cigarette use was more common among conventional cigarette smokers, it was not exclusive to them. E-cigarette use was not associated with intentions to quit smoking among a sub-sample of conventional cigarette smokers. Unlike older, more established cigarette smokers, e-cigarette use by college students does not appear to be motivated by the desire to quit cigarette smoking.

Using student and school factors to differentiate adolescent current smokers from experimental smokers in Canada: A multilevel analysis

ObjectiveIn order to understand the factors that differentiate adolescents who have tried smoking from those who have become established smokers, this study examined which student- and school-level factors differentiated current smokers from experimental smokers among a nationally representative sample of Canadian secondary school students. MethodStudent-level secondary data from the 2008–2009 Canadian Youth Smoking Survey was linked with school-level data from the 2006 Census and one built environment characteristic, and examined using multilevel logistic regression analyses. ResultsThe current smoking rates varied (P<0.001) across schools. The number of tobacco retailers surrounding the schools was associated with current smoking when adjusting for student characteristics. Additionally, students were more likely to be current smokers if they were: male, in higher grades, believed that smoking can help when they are bored, reported low school connectedness, used marijuana, had a sibling or close friend who smoked, and had no smoking bans at home. ConclusionsThese study findings suggest that school anti-smoking strategies need to target males, increase students' attachment to their school, address tobacco-related beliefs, and include interventions targeting smoking siblings and friends. The government should consider zoning restrictions to limit sales of tobacco products near schools.

Risk Factors for Esophageal Adenocarcinoma After Antireflux Surgery

Gastroesophageal reflux is the main risk factor for esophageal adenocarcinoma, but there is no strong support for any cancer-protective effect after antireflux surgery. We hypothesized that recurrent reflux or high exposure to other established risk factors, that is, obesity and tobacco smoking, are overrepresented among patients who despite antireflux surgery develop esophageal adenocarcinoma. A population-based case-control study was nested within an antireflux surgery cohort from the Swedish Patient Register between 1965 and 2006. Cases were patients who developed esophageal adenocarcinoma more than 5 years after antireflux surgery, whereas randomly selected controls were matched to the cases regarding age, sex, and calendar year of the antireflux surgery. Study exposures among cases and controls were collected through review of medical records. Data on cancer were assessed through the Swedish Cancer Register. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using multivariable conditional logistic regression, adjusted for recurrent reflux, body mass index (BMI), tobacco smoking, and type of antireflux surgery. From 14,102 patients in the total antireflux surgery cohort, 55 cases and 240 controls were included. Patients who developed esophageal adenocarcinoma were 3 times more likely to have recurrent reflux after their antireflux surgery, compared with those who had not (OR: 3.1, 95% CI: 1.5-6.3). There were no statistically significant differences in risk when comparing BMI of 30 kg/m or more with BMI of less than 25 kg/m (OR: 1.6, CI: 0.8-3.5), ever smokers with never smokers (OR: 1.4, 95% CI: 0.7-2.8), or total fundoplication with partial fundoplication (OR: 0.6, 95% CI: 0.3-1.3). Recurrence of reflux might explain the lack of protective effect of antireflux surgery regarding risk of developing esophageal adenocarcinoma.

TNIP1/ANXA6 and CSMD1 variants interacting with cigarette smoking, alcohol intake affect risk of psoriasis

BackgroundPsoriasis is a common multi-factorial skin disease, in which gene–gene and gene–environment interactions may affect the onset, manifestation and clinical course. ObjectiveTo investigate the underlying gene-environment interaction among several established susceptibility genes, cigarette smoking and alcohol intake. MethodsUsing a two-stage case–control design, we searched for pairwise interactions between cigarette smoking and alcohol intake respectively with 9 single nucleotide polymorphisms (SNPs) at ERAP1, PTTG1, CSMD1, GJB2, SERPINB8, ZNF816A and TNIP1/ANXA6 that have been associated with risk for psoriasis in 7,223 subjects. Multiple logistic regression analysis was used for data analysis. ResultsSignificant interactions were found for alcohol intake with rs3762999 (p=0.0257) and rs999556 (p=0.0071) at TNIP/ANXA6; and for cigarette smoking with rs7007032 (p=0.0023) and rs10088247 (p=0.0023) at CSMD1. ConclusionThis study provides empirical evidence for the gene–environment interactions between TNIP1/ANXA6 and alcohol use, CSMD1 and cigarette smoking, highlighting the importance of gene–environment interactions in the pathogenesis of psoriasis.

Older smokers could be the strongest supporters for U.S. government regulation of tobacco: a focus group study.

BackgroundTargeting of marginalized groups with aggressive tobacco marketing has been identified as exacerbating health disparities. However, interpretation of such targeting by groups varies, from surprise and outrage to regarding such marketing as evidence of social legitimacy. We sought to learn how an often-overlooked marginalized group, older adults, would respond to industry documents offering evidence of tobacco company target marketing.MethodsWe conducted 10 focus groups in California cities with older (≥50 years) smokers and former smokers. A set of previously-undisclosed tobacco industry documents related to target marketing was shown to the group in sequence. Audiotaped discussions were transcribed and data analyzed using qualitative approaches.ResultsResponses to evidence of tobacco industry targeting varied, with some regarding it as exploitive and others as normal business practice. However, in most groups, discussions turned to government’s failure to protect the public—even though government action /inaction was not prompted nor addressed in the discussion documents.ConclusionGiven the Food and Drug Administration’s new authority to regulate tobacco products, these findings suggest that some of the tobacco industry’s “best customers” (older, established smokers and ex-smokers) may be strong supporters of government regulation of tobacco.

Initiation with menthol cigarettes and youth smoking uptake

We aimed to assess whether young people who first tried menthol cigarettes were at greater risk of becoming established smokers and dependent on nicotine than young people who started smoking non-menthol cigarettes. Cohort study using data from the American Legacy Longitudinal Tobacco Use Reduction Study (ALLTURS), a three-wave longitudinal school-based survey of middle school and high school students. Regression methods were used to assess the association between initiation with menthol cigarettes on risk of transitioning to established smoking or quitting from a non-smoking state at baseline and on nicotine dependence score at wave 3. The study was conducted in 83 schools in seven communities and five states in the United States. Analyses were restricted to youth who participated in all three waves of ALLTURS, were younger than age 17 at baseline, and had initiated smoking during waves 1 or 2 of the study. Outcomes were indicators of a transition to established smoking or non-smoking from non-established smoking and a nicotine dependence score. The key explanatory variables were an indicator of initiation with menthol cigarettes and indicators for pattern of menthol use over time. Initiating smoking with menthol cigarettes was associated with progression to established smoking [odds ratio (OR) = 1.80, confidence interval (CI): 1.02-3.16] and higher levels of nicotine dependence (β = 1.25, CI: 0.1-2.4). Young people in the United States who start smoking menthol cigarettes are at greater risk of progression to regular smoking and nicotine dependence than are young people who start smoking non-menthol cigarettes.

Robust Escalation of Nicotine Intake with Extended Access to Nicotine Self-Administration and Intermittent Periods of Abstinence

Although established smokers have a very regular pattern of smoking behavior, converging lines of evidence suggest that the escalation of smoking behavior is a critical factor in the development of dependence. However, the neurobiological mechanisms that underlie the escalation of smoking are unknown, because there is no animal model of the escalation of nicotine intake. On the basis of the pattern of smoking behavior in humans and presence of monoamine oxidase inhibitors in tobacco smoke, we hypothesized that the escalation of nicotine intake may only occur when animals are given extended-access (21 h per day) self-administration sessions after repeated periods of abstinence (24-48 h), and after chronic inhibition of monoamine oxidase using phenelzine sulfate. Intermittent access (every 24-48 h) to extended nicotine self-administration produced a robust escalation of nicotine intake, associated with increased responding under fixed- and progressive-ratio schedules of reinforcement, and increased somatic signs of withdrawal. The escalation of nicotine intake was not observed in rats with intermittent access to limited (1 h per day) nicotine self-administration or daily access to extended (21 h per day) nicotine self-administration. Moreover, inhibition of monoamine oxidase with daily administration of phenelzine increased nicotine intake by ≈ 50%. These results demonstrate that the escalation of nicotine intake only occurs in animals given intermittent periods of abstinence with extended access to nicotine, and that inhibition of monoamine oxidase may contribute to the escalation of smoking, thus validating both an animal model of the escalation of smoking behavior and the contribution of monoamine oxidase inhibition to compulsive nicotine-seeking.

Smoking Behavior and Exposure to Tobacco Toxicants during 6 Months of Smoking Progressively Reduced Nicotine Content Cigarettes

Recent federal legislation gives the U.S. Food and Drug Administration authority to regulate the nicotine content of cigarettes. A nationwide strategy for progressive reduction of the nicotine content of cigarettes is a potential way to reduce the addictiveness of cigarettes, to prevent new smokers from becoming addicted, and to facilitate quitting in established smokers. We conducted a trial of progressive nicotine content tapering over 6 months to determine the effects on smoking behaviors and biomarkers of tobacco smoke exposure and cardiovascular effects. One hundred and thirty-five healthy smokers were randomly assigned to one of two groups. A research group smoked their usual brand of cigarettes followed by five types of research cigarettes with progressively lower nicotine content, each smoked for one month. A control group smoked their own brand of cigarettes for the same period of time. Nicotine intake, as indicated by plasma cotinine concentration, declined progressively as the nicotine content of cigarettes was reduced. Cigarette consumption and markers of exposure to carbon monoxide and polycyclic aromatic hydrocarbons, as well as cardiovascular biomarkers remained stable, whereas urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) excretion decreased. No significant changes in biomarkers of exposure or cardiovascular effects were observed in controls. Our data support the proposition that the intake of nicotine from cigarettes of smokers can be substantially lowered without increasing exposure to other tobacco smoke toxins. These findings support the feasibility and safety of gradual reduction of the nicotine content in cigarettes.

Abstract 2621: Relative excess risk due to interactions between GWAS-identified susceptibility loci and other breast cancer risk factors

Abstract Background: The characterization of the joint effects of multiple susceptibility loci identified in genome wide association studies (GWAS) and known breast cancer risk factors has the potential to inform functional mechanisms of carcinogenesis, public health guidelines and disease risk prediction. Additive interactions- departures from additivity on the absolute risk scale- can have public health and etiologic implications, but are infrequently reported. Methods: We assessed additive interactions among 11,043 non Hispanic White breast cancer cases and 11,665 similar controls within the National Cancer Institute's Breast and Prostate Cancer Cohort Consortium (BPC3). Logistic regression models were used to calculate estimates and confidence intervals for risk excess due to interactions (RERI) between 34 GWAS identified breast cancer susceptibility SNPs and 10 established breast cancer risk factors (age at menarche, parity, age at first full term pregnancy, age at menopause, family history, Gail score, height, body mass index (BMI), alcohol consumption and smoking status). All analyses were adjusted for age (5 year intervals) and cohort. Results and conclusions: After correction for multiple comparisons, we identified a statistically significant RERI (estimate = 0.48, CI=0.24,0.72, uncorrected p-value = 0.0000877) between a SNP in RAD51L1 gene, rs10483813, and BMI (&amp;lt;30 vs. &amp;gt;=30 kg/ m2). Among non-carriers of the risk allele, high BMI was found to significantly protect against breast cancer, but no difference in risks was observed due to BMI among carriers of at least one risk allele. This intriguing result requires replication. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2621. doi:1538-7445.AM2012-2621

Association of Established Smoking Among Adolescents With Timing of Exposure to Smoking Depicted in Movies

It is not known whether exposure to smoking depicted in movies carries greater influence during early or late adolescence. We aimed to quantify the independent relative contribution to established smoking of exposure to smoking depicted in movies during both early and late adolescence. We prospectively assessed 2049 nonsmoking students recruited from 14 randomly selected public schools in New Hampshire and Vermont. At baseline enrollment, students aged 10-14 years completed a written survey to determine personal, family, and sociodemographic characteristics and exposure to depictions of smoking in the movies (early exposure). Seven years later, we conducted follow-up telephone interviews to ascertain follow-up exposure to movie smoking (late exposure) and smoking behavior. We used multiple regression models to assess associations between early and late exposure and development of established smoking. One-sixth (17.3%) of the sample progressed to established smoking. In analyses that controlled for covariates and included early and late exposure in the same model, we found that students in the highest quartile for early exposure had 73% greater risk of established smoking than those in the lowest quartile for early exposure (27.8% vs 8.6%; relative risk for Q4 vs Q1 = 1.73, 95% confidence interval = 1.14 to 2.62). However, late exposure to depictions of smoking in movies was not statistically significantly associated with established smoking (22.1% vs 14.0%; relative risk for Q4 vs Q1 = 1.13, 95% confidence interval = 0.89 to 1.44). Whereas 31.6% of established smoking was attributable to early exposure, only an additional 5.3% was attributable to late exposure. Early exposure to smoking depicted in movies is associated with established smoking among adolescents. Educational and policy-related interventions should focus on minimizing early exposure to smoking depicted in movies.

2. Established Smoking Among Adolescents and its Association With Early and Late Exposure to Smoking Depicted in Movies

While smoking is associated with multiple sociodemographic, personal and environmental factors, evidence indicates that exposure to smoking depicted in movies is a strong risk factor for smoking outcomes among adolescents. However, it is not known whether exposure to smoking depicted in movies carries greater influence during early or late adolescence. We aimed to quantify the independent relative contribution to established smoking of exposure to smoking depicted in movies during both early and late adolescence.

Smoking Initiation Among Young Adults in the United States and Canada, 1998-2010: A Systematic Review

Young adults have the highest smoking rate of any age group in the United States and Canada, and recent data indicate that they often initiate smoking as young adults. The objective of this study was to systematically review peer-reviewed articles on cigarette smoking initiation and effective prevention efforts among young adults. We searched 5 databases for research articles published in English between 1998 and 2010 on smoking initiation among young adults (aged 18-25) living in the United States or Canada. We extracted the following data from each study selected: the measure of initiation used, age range of initiation, age range of study population, data source, target population, sampling method, and sample size. We summarized the primary findings of each study according to 3 research questions and categories of data (eg, sociodemographic) that emerged during the data extraction process. Of 1,072 identified studies, we found 27 articles that met our search criteria, but several included a larger age range of initiation (eg, 18-30, 18-36) than we initially intended to include. Disparities in young adult smoking initiation existed according to sex, race, and educational attainment. The use of alcohol and illegal drugs was associated with smoking initiation. The risk of smoking initiation among young adults increased under the following circumstances: exposure to smoking, boredom or stress while serving in the military, attending tobacco-sponsored social events while in college, and exposure to social norms and perceptions that encourage smoking. Effective prevention efforts include exposure to counter-marketing, denormalization campaigns, taxation, and the presence of smoke-free policies. Much remains to be learned about young adult smoking initiation, particularly among young adults in the straight-to-work population. Dissimilar measures of smoking initiation limit our knowledge about smoking initiation among young adults. We recommend developing a standardized measure of initiation that indicates progression to regular established smoking.

Cross-sectional association between smoking depictions in films and adolescent tobacco use nested in a British cohort study

ObjectiveTo assess associations between exposure to smoking depictions in films and adolescent tobacco use in a British population cohort.MethodsData on exposure to smoking in films and smoking behaviour were collected...

MIXTURES OF PLASTIC ASSOCIATED CHEMICALS, HIGHLY CHLORINATED PCBs, CADMIUM AND MERCURY ARE RELATED TO ATHEROSCLEROSIS

Background and Aims: We have previously shown that several environmental contaminants are related to atherosclerosis. In real life however, we are exposed to a mixture of contaminants. Therefore, the present study aims to investigate whether mixtures of environmental contaminants are related to atherosclerosis in the elderly. Methods: We used the grey scale of the intima-media complex, which is a measure of the lipid infiltration in the vascular wall, as the outcome variable in a sample of 1016 subjects aged 70 years. Predictions were generated from a linear model with 15 contaminants (4 PCBs, 4 plastic associated chemicals and 8 metals), their pair-wise interactions and the established risk factors cholesterol, BMI, blood pressure, smoking, sex and diabetes using the elastic net. These predictions were used as the outcome in a model which was simplified using a backwards step-down procedure until 95% of the variance in the predictions was accounted for. Each variable’s partial R2 statistic was used as a measure of that variable’s relative importance in the final model. PCBs 170 and 209 were used as markers for high-chlorinated PCBs. Results: The interaction between Mono-methyl phthalate (MMP) and Cadmium was the most important (rank 5, partial R2= 3.8%) followed by the interactions between high-chlorinated PCBs and Cadmium (rank 7, partial R2= 2.2%) and high-chlorinated PCBs and MMP (rank 10, partial R2= 1.2%). An interaction of lesser importance between MMP and Mercury could also be seen (rank 14, partial R2= 0.5%). All interaction effects affected the grayness of the intima-media complex and had p-values &lt; 0.001. Conclusions: The present study is amongst the first to investigate effects of mixtures of environmental contaminants on human health. The main finding is that MMP and Cadmium, highly chlorinated PCBs and MMP and Cadmium as well as MMP and Mercury may act in synergy to influence atherosclerosis development.

Rauchen in Filmen und Etablierung des Rauchens im Jugendalter

The aim of this study was to examine whether smoking in movies can predict established smoking in adolescence. A longitudinal study was conducted over a period of 13 months with 4112 German students. Adolescents' exposure to smoking in movies was assessed by asking each student to indicate which film he or she had seen from a unique list of 50 movies, which was randomly selected for each individual survey from a sample of 398 popular contemporary movies. We calculated exposure to movie smoking for each respondent by summing the number of smoking occurrences for each movie that the respondent reported seeing. At follow-up, a total of 272 young people had smoked more than 100 cigarettes during their lifetime. While 2.1% of the young people with the lowest exposure to movie smoking initiated established smoking, 13.4% of the group with the highest exposure to movie smoking initiated established smoking. The adjusted relative risk of initiation of established smoking was 2.05 times higher in the group with the highest movie smoking exposure compared to the group with the lowest exposure (95% confidence interval: 1.25-3.35). Our data indicate that smoking in movies can be regarded as an independent risk factor for the initiation of established smoking in adolescence.

The reciprocal relationships between changes in adolescent perceived prevalence of smoking in movies and progression of smoking status

BackgroundSmoking in movies is associated with adolescent smoking worldwide. To date, studies of the association mostly are restricted to the exposure to smoking images viewed by 9–15-year-olds. The association among...

Social Smoking Among Young Adults: Investigation of Intentions and Attempts to Quit

We compared the association between 3 different definitions of social smoking-a common pattern of smoking among young adults-and cessation indicators. We used a Web-enabled, cross-sectional national survey of 1528 young adults (aged 18-25 years) from a panel (recruited by random-digit dialing) maintained by the research group Knowledge Networks. Among 455 smokers, 62% self-identified or behaved as social smokers. Compared with established smokers, self-identified social smokers were less likely to have cessation intentions (odds ratio [OR] = 0.83; 95% confidence interval [CI] = 0.70, 0.98) and cessation attempts lasting 1 month or longer (OR = 0.54; 95% CI = 0.45, 0.66). Behavioral social smokers (mainly or only smoking with others) were more likely than were self-identified social smokers (those who did not report these behavior patterns) to have cessation intentions (mainly OR(mainly) = 1.66; 95% CI = 1.05, 2.63; and OR(only) = 2.02; 95% CI = 1.02, 3.97) and cessation attempts (OR(mainly) = 4.33; 95% CI = 2.68, 7.00; and OR(only) = 6.82; 95% CI = 3.29, 14.15). Self-identified social smokers may be considered a high-risk group with particular challenges for cessation. Behavioral social smokers may represent a group primed for cessation. Public health efforts should address these differences when developing smoking cessation strategies.