Tobacco Use and Norms Among Young Adults Attending Bars and Clubs

Theoretical Background and research questions/hypothesis: For decades, the tobacco industry conducted research on young adult (age 18-26) smoking behaviors and aggressively promoted attractive smoker identities within specific social environments, particularly bars and nightclubs. This high risk population also warrants attention for tobacco control interventions.  We aimed to describe tobacco use patterns and social norms among young adults frequenting bars and nightclubs in four U.S. communities.  Two of the communities were in States with long-standing clean indoor air laws that included bars and clubs (CA and ME), one had recently implemented smokefree bars (NM), and one did not have smokefree bars (OK).

Methods: Quasi-experimental study with cross sectional surveys in San Diego, CA (N=1198); Albuquerque, NM (N=1261); Tulsa and Oklahoma City, OK (N=452); and Portland, ME (N=1043) using a randomized venue-based sampling method at bars and clubs frequented by young adults.  Surveys measured demographics, social affiliation, concern with social success, tobacco use, and tobacco social norms.  Hookah and snus use was assessed in Oklahoma sites only.

Results: Self reported past 30-day smoking prevalence in all bar and club samples was significantly higher than State BRFSS data for young adult smoking rates: 56% in San Diego CA, 47% in Albuquerque NM, 50% in Portland ME, and 59% in Tulsa/Oklahoma City OK. BRFSS data reports 18% young adult smoking prevalence in CA, 25% in NM, 25% in ME, and 27% in OK. The majority of smokers were non-daily smokers: 60% of smokers in San Diego, 72% in Portland, 66% in Albuquerque and 51% in Oklahoma. In all sites, perceived smoking prevalence among "the most social and well-known people," was higher than other young adults. In Oklahoma, current smokers and chew users were significantly more likely to report having experimented with both hookah and Snus.

Conclusions: In all four sites, young adults attending bars and nightclubs had smoking rate about twice as much as the general young adult population smoking prevalence (BRFSS), and in Oklahoma young adult smokers were also most likely to use other tobacco products.  Many of these young adults are not yet daily smokers and thus provide an opportunity for early intervention.  Smoking social norms were higher among perceived social leaders, suggesting tobacco use may be associated with social success for smokers.  We found very high smoking rates for young adults in bars in every community, regardless of smokefree bar policies.

Implications for research and/or practice: Bars and nightclubs are important settings for prevention that provide efficient access to large numbers of young adult smokers. As message framing must be consistent and relevant to the high-risk population's beliefs, attitudes, and values, practitioners must better tailor interventions to the mindset and priorities of bar and club-goers, including needs for social success. Despite the powerful effect of clean indoor air laws on the general population, young adult bar and club-goers have persistently high smoking rates and interventions are needed to augment the effects of smokefree policies in these venues.