Occasional smoking is increasing and shouldn’t get a pass

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Smoking-cessation programs typically target frequent smokers with fairly hefty habits. But it may be time to also put some focus on occasional and social smokers, according to a commentary released today in the Archives of Internal Medicine.

This group of intermittent smokers may not be studied as much as more prolific puffers, but the fact that they do smoke should be cause for concern, the authors say. They note that while daily tobacco smoking has decreased, nondaily smoking increased between 1996 and 2001 in most states, according to the Centers for Disease Control and Prevention. Younger smokers ages 18 to 29 were particularly at risk. They add that a 2009 study in the journal Nicotine & Tobacco Research showed that smoking bans in workplaces and other areas may be associated with a rise in light smoking.

The fact that many occasional and social smokers consider themselves nonsmokers and, therefore, not at risk for health problems makes it difficult for healthcare providers to treat them. Some studies have linked nondaily smoking to health problems such as cardiovascular disease and osteoporosis.

This intermittent smoking group differs from daily smokers in that they tend to be younger, better educated, better off financially, from minority backgrounds and are more often female. Intermittent smoking is also associated with drinking, particularly binge drinking, on college campuses.

A story we did in August 2008 focused on people who exercise regularly and also smoke. Some defined themselves as social smokers, saying that smoking usually took place when they were out with friends from whom they could bum cigarettes and that they rarely bought cigarettes themselves. Although all were aware that smoking carried health risks, not all were consumed with quitting.

The authors point out that there isn’t much research on nicotine addiction among occasional smokers, and no studies they know of have examined results for stop-smoking programs targeted to intermittent smokers. In the commentary, they wrote: ‘Clinical education and training programs need to improve their screening and identification of nondaily and social smokers. Once identified, clinicians must recognize that nondaily smokers, especially social smokers, may be more motivated to quit by messages stressing the harm of secondhand smoke and by encouragement to break associations between social activities and tobacco use rather than by an emphasis on personal health risks.’

-- Jeannine Stein