Low-Rate Smokers

doi:10.1006/pmed.1995.1011

Preventive Medicine

Volume 24, Issue 1, January 1995, Pages 80-84

https://doi.org/10.1006/pmed.1995.1011 Get rights and content

Abstract

Background. Some smokers maintain a low daily smoking rate and do not appear to be addicted to nicotine (tobacco "chippers"). In a context of increasing social and environmental constraints on cigarette smoking, it is of interest to determine the population prevalence and the characteristics of low-rate smoking behavior. Methods. A representative population survey was used to determine the prevalence and the correlates of low-rate smoking (five or less cigarettes a day). A range of sociodemographic, contextual, cognitive, and smoking-behavior variables was examined. Results. Of 697 smokers age 20 years and over who had smoked for more than 2 years, 8.2% smoked five or less cigarettes a day; their average age was 39 years, and half were under 35 years of age; 88% had been smoking for 6 or more years; 86% were in the contemplation or preparation stages of readiness to quit. The significant independent predictors of being a low-rate smoker, compared to smoking at a higher daily rate, were perceiving quitting as not very difficult, smoking the first cigarette of the day more than 30 min after waking, buying packets of 30 or less cigarettes, and having not been advised by a doctor to quit. Conclusions. There were few differences between low-rate and other smokers on the range of variables that we were able to assess in a population survey. Since there is no safe level of cigarette smoking, medical advice to quit and public-education campaigns could target low-rate smokers specifically. Such initiatives could make significant contributions to reducing overall smoking prevalence.

References (0)

Cited by (78)

Light cigarette smoking and all-cause mortality in Spain. A national population-based cohort study
2023, Annals of Epidemiology
Citation Excerpt :
Finally, model 4 tried to assess whether the group of smokers trying to quit smoking may impact the association of interest. These individuals are likely to have decreased consumption which would place them in the light smoking categories [15]. Our results show that this group mainly impacts the mortality risk of smokers of 1–2 cigarettes/day with an HR going from 2.23 to 1.48, a risk magnitude very likely to approach that of lifetime low cigarette smoking.
Regular light cigarette consumption (light smoking) is increasing in many countries; however, few studies have assessed its impact on mortality. The main aim of this study is to estimate the association between the number of cigarettes consumed and all-cause mortality in Spain while focusing on light smoking.
Longitudinal study based on data from 42,902 individuals aged ≥15 years included in the 2011–2012 (Spanish) National Health Survey or the 2014 European Health Survey for Spain. Data were linked with the mortality registry up to December 2020. Multivariate Cox regression models were used to estimate hazard ratios (HR) adjusted for sociodemographic variables, lifestyle factors, and health status indicators.
Compared to never smokers, the mortality HR for nondaily smokers was 1.30 (95% CI: 0.81–2.09), increasing to 2.23 (95% CI: 1.25–3.96) among those smoking 1–2 cigarettes/d, and to 1.54 (95%CI: 1.14–2.07) for consumers of 3–5 cigarettes/day. When individuals who reported trying to quit during the previous year were excluded, resulting HRs were 1.31 (95% CI: 0.81–2.10), 1.48 (95% CI: 0.69–3.19) and 1.64 (95% CI: 1.16–2.34), respectively.
Compared to never smokers, consumers of small quantities of tobacco, that is, light smoking, had an increased mortality risk. In view of these results, we suggest the need for awareness-raising campaigns regarding how smoking even a small number of cigarettes a day causes serious harm to one´s health.
Disparities in knowledge and use of tobacco treatment among smokers in California following healthcare reform
2019, Preventive Medicine Reports
The Affordable Care Act (ACA) promised to narrow smoking disparities by expanding access to healthcare and mandating comprehensive coverage for tobacco treatment starting in 2014. We examined whether two years after ACA implementation disparities in receiving clinician advice to quit and smokers' knowledge and use of treatment resources remained.
We conducted telephone interviews in 2016 with a stratified random sample of self-reported smokers newly enrolled in the Kaiser Permanente Northern California's (KPNC) integrated healthcare delivery system in 2014 (N = 491; 50% female; 53% non-white; 6% Spanish language). We used Poisson regression with robust standard errors to test whether sociodemographics, insurance type, comorbidities, smoking status in 2016 (former, light/nondaily [<5 cigarettes per day], daily), and preferred language (English or Spanish) were associated with receiving clinician advice to quit and knowledge and use of tobacco treatment. We included an interaction between smoking status and language to test whether the relation between smoking status and key outcomes varied with preferred language.
Overall, 80% of respondents received clinician advice to quit, 84% knew that KPNC offers cessation counseling, 54% knew that cessation pharmacotherapy is free, 54% used pharmacotherapy, and 6% used counseling. In multivariate models, Spanish-speaking light/nondaily smokers had significantly lower rates of all outcomes, while there was no association with other demographic and clinical characteristics.
Following ACA implementation, most smokers newly enrolled in KPNC received clinician advice to quit and over half used pharmacotherapy, yet counseling utilization was low. Spanish-language outreach efforts and treatment services are recommended, particularly for adults who are light/nondaily smokers.
Individual differences in responding to bupropion or varenicline in a preclinical model of nicotine self-administration vary according to individual demand for nicotine
2019, Neuropharmacology
Citation Excerpt :
Like heavy smokers, light smokers have difficulties to quit smoking and have worse health outcomes than non-smokers (DHHS, 1998). As much as 50% of all smokers can be categorized as light smokers (Kandel and Chen, 2000; Owen et al., 1995; Russell, 1990). Light smokers are often excluded from cessation intervention studies due to perceived low health risk associated with light smoking and methodological strategies to focus only on heavy smokers.
Bupropion and varenicline are the top two smoking cessation interventions that are marginally successful in increasing abstinence rates when compared to placebo. Although smokers vary in their history and pattern of tobacco use, there is a significant gap in addressing this individual variability with individually targeted treatments. The present study takes the initial step towards a better understanding of individual differences in treatment outcomes by assessing the effect of bupropion or varenicline on nicotine self-administration in rats. Rats were first assessed for their individual economic demand for sucrose and then for self-administered nicotine (0.03 mg/kg/inf; 2 h sessions). We then examined the effect of bupropion (0, 10, 30, 60 mg/kg) or varenicline (0, 0.1, 1.0, 3.0 mg/kg) pretreatment on individual rates of nicotine self-administration using progressive ratio schedule of reinforcement. Thereafter, rats were subjected to four rounds of extinction and reinstatement tests. We found that individual demand for sucrose did not predict individual demand for nicotine. Acute pretreatments with bupropion or varenicline were most effective at decreasing nicotine self-administration in rats that had a higher demand for nicotine. Rats with higher demand for nicotine also showed higher magnitude of responding in extinction and during nicotine-triggered reinstatement tests. Although the acute treatment protocol employed in this study is an important initial step towards a better understanding of individual treatment effects, future research modeling chronic treatment approaches will be needed to further extend our findings.
Assessing 30-day quantity-frequency of U.S. adolescent cigarette smoking as a predictor of adult smoking 14 years later
2016, Drug and Alcohol Dependence
Citation Excerpt :
Although there are likely health risks associated with lower levels of smoking, the greatest increases in mortality are observed among daily cigarette smokers and among those smoking more than one pack per day (Bjartveit and Tverdal, 2005; Teo et al., 2006). Smokers consuming low numbers of cigarettes are not well defined; they have been referred to as “chippers”, “low-rate”, “occasional”, “intermittent”, “light”, and “non-daily smokers” (Hennrikus et al., 1996; Husten et al., 1998; Owen et al., 1995; Shiffman, 1989; Wortley et al., 2003). National surveys define “non-daily” smoking in a variety of ways; smoking weekly or less than weekly [but not daily], having smoked at least 100 cigarettes and currently smoking on some days (CCD, 1994, 2011).
To improve measures of monthly tobacco cigarette smoking among non-daily smokers, predictive of future non-daily monthly and daily smoking.
Data from United States National Longitudinal Study of Adolescent to Adult Health, tracking adolescents, ages 12–21, over 14 years were analyzed. At baseline, 6501 adolescents were assessed; 5114 individuals provided data at waves 1 and 4. Baseline past 30-day non-daily smokers were classified using quantity-frequency measures: cigarettes smoked/day by number of days smoked in the past 30 days.
Three categories of past 30-day non-daily smokers emerged using cigarettes/month (low:1–5, moderate: 6–60, high: 61+) and predicted past 30-day smoking at follow-up (low: 44.5%, moderate: 60.0%, high: 77.0%, versus 74.2% daily smokers; r_τ= −0.2319, p < 0.001). Two categories of non-smokers plus low, moderate and high categories of non-daily smokers made up a five-category non-daily smoking index (NDSI). High NDSI (61+ cigs/mo.) and daily smokers were equally likely to be smoking 14 years later (High NDSI OR = 0.97, 95% CI = 0.53–1.80 [daily as reference]). Low (1–5 cigs/mo.) and moderate (6–60 cigs/mo.) NDSI were distinctly different from high NDSI, but similar to one another (OR = 0.21, 95% CI = 0.15–0.29 and OR = 0.22, 95% CI = 0.14–0.34, respectively) when estimating future monthly smoking. Among those smoking at both waves, wave 1 non-daily smokers, overall, were less likely than wave 1 daily smokers to be smoking daily 14 years later.
Non-daily smokers smoking over three packs/month were as likely as daily smokers to be smoking 14-years later. Lower levels of non-daily smoking (at ages 12–21) predicted lower likelihood of future monthly smoking. In terms of surveillance and cessation interventions, high NDSI smokers might be treated similar to daily smokers.
Cigarettes and alcohol: The influence of nicotine on operant alcohol self-administration and the mesolimbic dopamine system
2015, Biochemical Pharmacology
Studies in human populations consistently demonstrate an interaction between nicotine and ethanol use, each drug influencing the use of the other. Here we present data and review evidence from animal studies that nicotine influences operant self-administration of ethanol. The operant reinforcement paradigm has proven to be a behaviorally relevant and quantitative model for studying ethanol-seeking behavior. Exposure to nicotine can modify the reinforcing properties of ethanol during different phases of ethanol self-administration, including acquisition, maintenance, and reinstatement. Our data suggest that non-daily intermittent nicotine exposure can trigger a long-lasting increase in ethanol self-administration. The biological basis for interactions between nicotine and ethanol is not well understood but may involve the stress hormone systems and adaptations in the mesolimbic dopamine system. Future studies that combine operant self-administration with techniques for monitoring or manipulating in vivo neurophysiology may provide new insights into the neuronal mechanisms that link nicotine and alcohol use.
Risk perception and intention to quit among a tri-ethnic sample of nondaily, light daily, and moderate/heavy daily smokers
2014, Addictive Behaviors
Although the relationship between risk perceptions and quit intentions has been established, few studies explore the potential impact of smoking level on these associations, and none have done so among diversely-aged samples of multiple ethnicities.
Participants, ranging in age from 25 to 81, were 1133 nondaily smokers (smoked ≥ 1 cigarette on 4 to 24 days in the past 30 days), 556 light daily smokers (≤ 10 cigarettes per day), and 585 moderate to heavy daily smokers (> 10 cigarettes per day). Each smoking level comprised approximately equal numbers of African Americans, Latinos, and Whites. A logistic regression analysis, adjusted for sociodemographics, self-rated health, time to the first cigarette of the day and smoking level, was used to examine the association between risk perception (perceived risk of acquiring lung cancer, lung disease, and heart disease) and intention to quit (≤ 6 months versus > 6 months/never). A second adjusted model tested moderation by smoking level with an interaction term.
Greater risk perception was associated with a higher odds of planning to quit within 6 months (AOR = 1.34, CI_.95 = 1.24, 1.45). Smoking level did not moderate this association (p = .85).
Results suggest that educating all smokers, irrespective of their smoking level, about increased risk of developing smoking-related diseases might be a helpful strategy to enhance their intention to make a smoking quit attempt.

View all citing articles on Scopus

View full text

Regular ArticleLow-Rate Smokers

Abstract

Regular Article
Low-Rate Smokers