TABLE 2—

Synthesis of Key Findings on Smoking Cessation Among Young Adults Obtained From Review of Research Literature, Delphi Panel of Experts, and Young Canadian Focus Group Participants: 2006

	Literature	Experts	Young Adults
Research
Natural history
Prevalence	Young adults comprise largest proportion of smokers in Canada (27%)
Patterns	Smoking behavior is relatively persistent from adolescence to adulthood; young adults are more likely to engage in occasional smoking; young adults have a lower daily consumption than older adults; smoking rates vary according to employment status (student, employed, or unemployed	Most felt little is known about processes of smoking and quitting; research exploring factors that influence initiation and maintenance of smoking is needed	Most (74%) participants were medium to heavy smokers, 17% light smokers, 9% ex-smokers; average age at first cigarette was 13 (range = 6–20); mean no. cigarettes smoked per week was 90; almost half reported planning to quit smoking in next 6 months
Predictors of smoking cessation	Little is known about factors that affect smoking cessation among young adults; predictor variables with highest agreement among reviewed studies included extent of smoking among friends (8 studies), increased price of cigarettes (5 studies), and intent to quit (4 studies); inconsistent findings regarding education and employment	Need research to understand determinants of both contemplation of quitting and actual quitting and to understand meaning and functions of both smoking and quitting for young adults; need clearer understanding of needs of different subpopulations of young adults	A principal benefit of smoking is its significant social component; participants say they would have the most difficulty in resisting smoking when partying with friends or when stressed; all but 1 participant reported having friends who also smoke
Psychological characteristics	No differences found in smokers vs nonsmokers (but few studies exist)
Attitudes
Health beliefs, risk perceptions	These play an important role in smoking by young adults; smokers engage in risk minimization, believe they are at less risk than others, undervalue health consequences of smoking, and do not fully understand short-term effects of smoking; strategies for smoking cessation need to be tailored to fit young adults’ health beliefs	Important to increase awareness of the consequences of smoking and of quitting	Contrasting views on perceived health risks: some participants thought consequences are in the future and others were already seeing effects of smoking on their appearance and easily became tired or out of breath
Smoking cessation methods	Important factors in selecting a smoking cessation method include likelihood of its success; its cost, convenience, and flexibility; pain of quitting; low-demand interventions; social support; settings in naturally occurring social groups (such as community groups and fitness groups); participating in activities incompatible with smoking	Programs need to be easily accessible and comprehensive; important factors in selecting a smoking cessation method include acceptability of program, cost and convenience, and confidentiality	Participants held negative views toward traditional smoking cessation approaches; a prevailing theme was that individuals should quit smoking on their own; they had little interest in relatively new approaches, such as Web-based or cell phone text-messaging interventions; they had negative views on smoking cessation methods based in part on lack of knowledge and experience with smoking cessation interventions; important factors in selecting smoking cessation method include need of accurate information, cost, convenience, easy accessibility, location outside of hospitals or institutions, emphasis on benefits of quitting; they wanted interventions that were innovative and not conventional
Engagement and recruitment	Received little attention in literature; social marketing principles could be beneficial in designing and promoting smoking cessation programs	Young adults tend not to access available smoking cessation programs; little is known about how to engage young adults in smoking cessation; research into recruiting and retaining young adults in smoking cessation is needed; important to involve young adults in smoking cessation program and policy decisions	Participants believed accurate information on types of interventions and programs available would help recruitment; innovative interventions that recognize specific needs of young adults would encourage recruitment and engagement; wanted to be involved in designing and developing smoking cessation interventions
Interventions	Significant lack of intervention data on young adults in general, less for employed young adults, none for unemployed	Should be addressed in context of other issues of young adulthood (i.e., in larger context of their everyday lives); current interventions not always appropriate for all population groups; recruiting and engaging young adults for cessation programs requires creation of innovative interventions	Participants lacked experience with smoking cessation interventions; had minimal information regarding various types of interventions and were misinformed about most; although the preferred smoking cessation method is quitting on their own, were surprised at how difficult it was and were often unwilling to exert necessary effort; wanted to be involved in designing and developing smoking cessation interventions
Individual counseling (face to face, telephone quitlines)	No studies of face-to-face counseling; quitlines have shown some effectiveness with adults, but few studies with young adults	Little is known about effective approaches of individual counseling for young adults; research to determine which types of interventions most effective is needed	Had little experience with individual counseling; some had seen telephone number for a quitline but did not use it; had the perception that individual counseling involves professionals telling them what to do, and they would rather talk to friend about smoking concerns, although some see benefit (i.e., good to know that someone available if one wants to quit)
Group counseling	Few studies; groups led by peer leaders showed some value (1 study)	Little known about effective approaches of group counseling for young adults; research to determine which types of interventions are most effective is needed	Had no experience; saw numerous potential benefits such as opportunity to share ideas and experience andlearn from others; several would consider but prefer nontraditional methods (i.e., with focus on activities rather than just talking about quitting smoking)
Pharmacological aids (including nicotine replacement therapy)	Few studies; 2 on nicotine replacement therapy found neither nicotine lozenges nor nicotine gum were effective in reducing cravings among young adults (although they did reduce cravings among older adults)	May be effective as smoking intervention for young adults, but this topic had most conflicting views of panel members (i.e., some thought because of success with adults, should be encouraged for young adults, and others thought there is no evidence supporting use of pharmacotherapies with young adults and it needs more research); cost seen as barrier to use by young adults	23% had tried some form of pharmacological aid; some knew of others who had quit smoking using nicotine patch; had misperceptions regarding nicotine replacement therapy; some would consider using nicotine replacement therapy if it were free and others if they had more accurate information
Information and communication technology	Few studies; some effectiveness for Web-based smoking cessation found; some promise shown for cell phone text messaging	Important innovative channel for young adults; may be an effective way to engage them	Only 8% had checked Internet for smoking cessation Web site; general lack of enthusiasm for this approach; lack of access a major barrier (no longer living at home or in school); misperceptions about smoking cessation Web sites; thought too much effort involved; several would consider if they provided with individual feedback, knew it had high success rate, was not boring, and was targeted specifically to young adults
Self-help materials	No intervention studies		Very few with experience or interest; thought reading materials would be too time-consuming and boring; would consider if more relevant to young adults; they endorsed a 1-pager with simple bits of advice that could be carried in wallet or purse
Quit-and-win contests	No intervention studies		No experience; thought cessation would only be temporary with this approach
Exercise	Few studies on exercise-based interventions, none for young adults		Elicits most lively and enthusiastic discussion of any smoking cessation method (in all groups); several involved in some form of exercise; perceive many benefits (e.g., helps deal with stress, self-esteem, cravings, weight control, replaces time spent smoking with positive activities); several thought exercise and smoking not incompatible; most thought exercise would be a useful method to help smoking cessation
Providers	Few studies on effectiveness of type of provider; groups led by peer leaders showed some value (1 study)	Research needed to determine which types of providers are most effective with young adults	Strongly endorsed providers being ex-smokers, whether professional or peers
Settings	No studies on effectiveness of different types of settings	Research needed to determine which settings are most effective with young adults	Settings should not be hospitals or institutions; some endorse idea of separate smoking rehabilitation centers; main criteria: easy access, free, and no appointments required
Policya
Mass media	Purposeful messages that decrease social acceptability of smoking are most effective; type of campaign significantly related to age; TV is an effective medium for young adults; integrating promotions with young adult activities is a promising strategy to encourage cessation; “borrow” marketing strategies from tobacco industry	Mass media and social marketing campaigns encourage smoking cessation and reduce smoking prevalence; help to create or change social climate; to date, there is no mass media campaign on smoking cessation targeting young adults; this strategy needs to be implemented and adapted for young adults	Most believed media campaigns not effective in encouraging young adults to quit; had not seen young adults featured in any media campaigns; believed young adults need to appear in media campaigns if they are to be effective; ads should be straightforward and focus on short-term effects of smoking that are most relevant for young adults
Smoke-free indoor air restrictions	Lack of agreement on effectiveness of smoking restrictions for young adults; less impact on young adults than on older adults; agreement that smoking restrictions in workplace not very effective for smoking cessation among young adults but does tend to decrease consumption of cigarettes	Reinforces the social unacceptability of smoking; good evidence that these restrictions have a positive impact on both initiation and cessation, but better understanding of effect on young adults needed	Most did not believe smoke-free environments help smokers quit, but do feel that it helps cut down consumption
Increased prices (taxes)	Strongest impact on smoking cessation and level of consumption; increasing prices produce largest decline in young adults smoking		Most believed increasing cost would be a motivator to quit smoking
Sales and distribution		Differing opinions on impact of sales and distribution of cigarettes; most felt there is clear evidence of connection between availability and use of tobacco and that reducing access can be effective policy measure for young adults, although some thought these measures only marginally successful	Believed there should be less prominent placement of cigarettes in stores (e.g., under the counter); should have designated stores (such as Liquor Control Board of Ontario) for selling cigarettes to decrease current easy availability

^aIt is likely that a combination of policies, rather than any single policy, most significantly influences smoking behavior of young adults.