Nicotine & Tobacco Research, 2015, 546–551 doi:10.1093/ntr/ntu169 Original investigation Advance Access publication September 1, 2014
Original investigation
Comparison of Native Light Daily Smokers and Light Daily Smokers Who Were Former Heavy Smokers Laura J. Fish PhD1, Kathryn I. Pollak PhD1, Taneisha S. Scheuermann PhD2, Lisa Sanderson Cox PhD2, Charu Mathur PhD3, Jasjit S. Ahluwalia MD, MPH, MS4 Cancer Control and Population Sciences and Community and Family Medicine, Duke University, Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC; 2Department of Preventive Medicine and Public Health, School of Medicine, University of Kansas, Kansas City, KS; 3Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; 4Center for Health Equity and Department of Medicine, University of Minnesota, Minneapolis, MN 1
Corresponding Author: Laura J. Fish, PhD, Cancer Control and Population Sciences and Community and Family Medicine, Duke University, Cancer Control and Population Sciences, Duke Cancer Institute, Box 2715, Durham, NC 27710, USA. Telephone: 919-681-3820; Fax: 919-681-4785; E-mail: [email protected]
Abstract Introduction: An increasing proportion of daily smokers are light smokers (≤10 cigarettes per day). Some light smokers have never smoked more than 10 cigarettes per day (native light smokers) and others smoked at higher levels but have cut down (converted light smokers). It is important that we expand our understanding of these distinct subgroups of light smokers in order to develop effective interventions. Methods: Data for this report come from a larger sample of smokers who completed a cross-sectional survey administered through an online panel survey service. The sample of 522 light smokers included 256 native light smokers and 266 as converted light smokers. The goal of the analysis was to examine demographic, smoking, and psychosocial factors that differentiate between native and converted light smokers. Results: Multivariable logistic regression results showed 4 variables that differentiated between native and converted light smokers. Native light smokers were more likely to be Black than White, smoke fewer cigarettes per day, smoked fewer total years, and had higher perceived risk of heart disease than converted light smokers. Conclusions: Native and converted light smokers are similar in many ways and also differ on some important characteristics. Further exploration of group difference is needed and could help to inform for cessation strategies for daily light smokers.
Introduction
groups such as Latino and Black smokers.2 Light smokers, like heavy
Although the number of smokers in the United States continues to decline, the proportion of light smokers, those who smoke 10 or fewer cigarettes per day (CPD), is increasing.1 Approximately 22% of daily smokers are light smokers, with prevalence higher than 50% among some minority
smokers, benefit from quitting smoking as even light smoking increases risk of cardiovascular and lung disease and many forms of cancer.3–6 Compared to heavy smokers, light smokers tend to be younger, racial and ethnic minority members, female, better educated,
© The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: [email protected].
546
Nicotine & Tobacco Research, 2015, Vol. 17, No. 5 and have higher incomes.7 Light smokers also report less physical withdrawal symptoms than moderate and heavy smokers.8 There are differences in smoking history among light smokers, as some are former heavy smokers who have reduced to low level smoking (“converted light smokers”), whereas others have always smoked at low levels (“native light smokers”). Similar terminology has been used to describe subgroups of intermittent or nondaily smokers.9 For the purposes of this article, we use the term “light smoker” to refer to daily smokers who smoke 10 or fewer CPD.10 Few studies have examined light smokers as a group. Further, little is known about whether light smokers who used to be heavier smokers differ substantially from smokers who have always been light smokers. It is possible that these two groups differ in their smoking behavior and smoking-related beliefs, such as risk perceptions and smoker identity, all of which would affect designing effective cessation interventions. Among moderate and heavy smokers, high perceived risk is associated with increased motivation to quit11–13 and most smokers underestimate their risk of smoking-related diseases.14 Light smokers may be defensively biased to not believe smoking risk information (e.g., “I don’t smoke that much so it’s not that bad”).11 This bias may be stronger among converted light smokers because they have already reduced their smoking behavior.15 Smoker identity may also be an important construct to address in developing cessation strategies for light smokers. Intermittent or occasional smokers frequently do not self-identify as smokers because they smoke so few cigarettes and have low nicotine dependence.16 This may also be true among light smokers; however, limited research has examined smoker identity among light smokers. The few studies to examine treatment interventions specifically for light smokers had mixed findings.10,17–19 Results from these initial trials suggest that nicotine lozenges and directive counseling may be effective interventions for achieving long-term quit rates among light smokers.10,19 Only one trial examined differences between native and converted light smokers and found lower cessation rates among converted light smokers.18 For future interventions to help light smokers quit permanently, we need a better understanding of what characterizes native versus converted light smokers. The purpose of this article is to examine differences between native and converted light smokers regarding tobaccorelated and psychosocial variables with the aim of informing more effective and potentially tailored cessation interventions for light smokers.
Methods Participants Data for this report come from a larger sample of smokers who completed a cross-sectional survey administered through an online panel survey service (Survey Sampling International [SSI] Inc.). Data were collected between July 5, 2012, and August 15, 2012. Briefly, quotas were used to recruit approximately 1,200 daily smokers (further stratified to light and moderate/heavy) and approximately 1,200 nondaily smokers with equal numbers of Black, Latino, and White smokers in each group. A total of 42,715 participants were screened for the larger study; 35,666 were ineligible, 4,581 provided incomplete data (90% prior to starting the survey), and 60 participants’ responses were removed from the data due to possible duplicate surveys. This resulted in 2,408 participants completing the
547 survey—1,201 nondaily smokers and 1,207 daily smokers, of whom 604 were light daily smokers. Eligible participants self-identified as Black, White, or Latino (of any race) and were English speaking. They were at least 25 years old to exclude individuals initiating smoking, especially among Blacks who tend to start smoking later.20 In addition, participants were current smokers who smoked for at least 1 year, smoked at their current rate for at least 6 months, and had not participated in any smoking cessation treatment in the past 30 days. Women who were currently pregnant or breast feeding were excluded from the study. Data for this report on light smokers come from participants who reported daily smoking, defined as 25–30 days in the past 30 days, and reported currently smoking ≤10 CPD.10,21,22 Light smokers were categorized as native light smokers (now smoking ≤10 CPD and always smoked ≤10 CPD) and converted light smokers (smoking more than 10 CPD “during the time in their life when they smoked the most” and now smoking ≤10 CPD). Twenty-six light smokers responded inconsistently on the previous level of smoking questions and were excluded from the analysis. This resulted in a final study sample size of 522 light daily smokers, with 256 as native light daily smokers and 266 as converted light daily smokers.
Procedures All procedures were approved by the University of Minnesota Institutional Review Board. SSI used preliminary questions (e.g., smoking frequency) and existing participant information (e.g., race/ ethnicity and age) to direct smokers to this study. Potential participants gave consent and were screened; if the quota for one of the nine subgroups (three race/ethnicity groups and three smoking levels) was filled, participants with those characteristics were no longer recruited. Participants who completed the survey received SSI’s standard incentives, entry into a quarterly drawing for $12,500 available to the entire panel of 1.5 million points that could be redeemed for cash.
Measures Demographic Variables Demographic questions included participants’ age, race and ethnicity, gender, highest level of education, relationship status, employment status, and monthly household income. Monthly household income was assessed with an item containing income brackets and we dichotomized to 30 min); smoking within 30 min of waking denotes greater nicotine dependence.26 Using an item from the Cigarette Dependence Scale, participants were asked to report their level of perceived addiction to cigarettes on a scale of 0 (I am not addicted to cigarettes at all)
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Smoking-Related Beliefs Perceived vulnerability to smoking-related illness was assessed using participant’s responses to three questions, “If you continue to smoke, how likely do you think it is that you will develop…”: (1) “lung cancer,” (2) “other lung diseases,” and (3) “heart disease.”11 Response options ranged from 1 (no chance) to 7 (certain to happen). Items were summed to calculate an overall measure of perceived vulnerability. Identity as a smoker was assessed using a two-item measure: “I consider myself a smoker” and “If someone casually asked if I was a smoker, I would say yes”.9 Response options for these items ranged from 1 (strongly disagree) to 10 (strongly agree). The items were summed to calculate a smoker identity score.
(p = .02), and were employed full time (p = .01) compared to converted light smokers. There were no differences between native light smokers and converted light smokers regarding education or income. On average, native light smokers smoke fewer CPD (p < .0001), were less likely to report smoking their first cigarette within 30 min of waking (p = .02), and reported smoking fewer total years (p < .0001) compared to converted light smokers. Converted light smokers were also more likely than native light smokers to report trying to cut down the number of cigarettes they smoke (p = .003). There were no differences between native and converted light smokers in overall perceived vulnerability to smoking-related illnesses. Native light smokers had a significantly lower score on the smoker identity measure compared to converted light smokers (p = .006). We conducted multivariable logistic regression with factors with significant bivariate associations. Multivariable analysis identified four variables that differentiated between native and converted light smokers (Table 2). Native light smokers were more likely to be Black than White (odds ratio [OR] = 2.16; CI = 1.31–3.56; p = .003), smoke fewer CPD (OR = 0.73; CI = 0.67–0.80; p < .0001), and smoked fewer total years than converted light smokers (OR = 0.97; CI = 0.95–0.99; p = .03). Native light smokers were less likely than converted light smokers to report trying to cut down on number of cigarettes smoked per day (OR = 0.46; CI = 0.29–0.72; p = .0006). There was a trend for native light smokers to report higher perceived vulnerability to smoking-related illnesses than converted light smokers (OR = 1.05; CI = 1.0–1.11; p = .06). We examined each of the three perceived vulnerability items separately in the model and found that higher perceived vulnerability to lung cancer (OR = 1.08; CI = 1.00–1.39; p = .04) and heart disease (OR = 1.19; CI = 1.01– 1.39; p = .04) were predictive of native light smoking (data not shown).
Statistical Analyses
Discussion
to 100 (I am extremely addicted to cigarettes).9,25 To assess changes in smoking level, participants were asked “Are you currently trying to cut down on the number of cigarettes you smoke?” (yes/no). Participants were asked about use of other tobacco products in the past 30 days including cigars, cigarillos, little cigars, pipes, smokeless tobacco, hand-rolled cigarettes, and water pipes (yes/no). Data on use of other tobacco products were summed to calculate the total number of other tobacco products used in the past 30 days. In relation to quitting, participants were asked the number of times they had made a 24-hr quit attempt in the previous year. The data were dichotomized to no quit attempt versus made a quit attempt. Intention to quit was assessed using a single-item measure that asked participants, “What describes your intention to stop smoking completely, not even a puff? Would you say you…” Four response options included “Never expect to quit,” “may quit in the future, but not in the next 6 months,” “will quit in the next 6 months,” “will quit in the next 30 days.”
The goal of the analysis was to examine demographic, smoking, and psychosocial factors that differentiate between native and converted light smokers. First, we examined bivariate associations and used Fisher’s exact tests for categorical variables and Student’s t test for continuous variables. Variables with bivariate associations with a p value of .10 or lower were included in a multivariable model using logistic regression to identify variables that were associated with native light smoking (referent group). Analysis was conducted using SAS 9.2 (SAS).
Results Due to the sampling strategy, the sample of light smokers had equal numbers of Whites, Blacks, and Latinos. The mean age was 43.8 years, 64% were female, 71% had some college or more, 59% reported a monthly income greater than or equal to $1,800/month, and 58% reported working full time. The mean number of years smoked was 19.5 (SD = 13.6), and the mean number of CPD was 7.5 (SD = 2.7). Most (63%) respondents reported smoking their first cigarette within 30 min of waking. Many (41%) reported making a quit attempt in the previous year. The sample included 49% native light smokers and 51% converted light smokers (Table 1). There were several bivariate significant differences between native and converted light smokers (Table 1). Native light smokers were younger than converted light smokers (p < .0001). A greater proportion of native light smokers were Black (p = .0009), male
This is one of the first reports to examine similarities and differences between native and converted light smokers. Our findings suggest that there are many similarities and also some differences in demographics, number of years smoking, and smoking-related beliefs between subgroups of light smokers. The differences we found have implications for possible cessation strategies for light smokers. First, we found that Blacks are more likely to be native rather than converted light smokers. Light smoking among Blacks has been well documented.2,27 Potential reasons for maintaining low levels of cigarette consumption among Blacks are slower nicotine metabolism and deeper inhalation.28 Previous cessation interventions designed specifically for light Black smokers have considered variation in daily smoking patterns but have not differentiated between native and converted light smokers.10,17 Thus, it may be important to distinguish between native and converted light smokers, especially among Blacks. Our findings suggest that smoking history is an important factor when developing cessation strategies for light smokers. On one hand, native light smokers in our sample reported smoking fewer CPD and for fewer years compared to converted light smokers. Both characteristics may be related to greater success with quitting. In an intervention trial for light smokers, Gariti et al.18 found that those with a history of heavier smoking were less likely to quit. Thus, converted light smokers may have more difficulty quitting. On the other hand, native light smokers were less likely to report trying to cut down than converted light smokers. One possible explanation for
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Table 1. Characteristics of a Sample of Native and Converted Light Smokers (N = 522) Total Characteristic Demographics Age (mean) Race/ethnicity Black Latino White Female Education: some college or more Income ≥$1,800 a month Employed full time Smoking and quitting history CPD (1–10) TTFC
Original investigation
Comparison of Native Light Daily Smokers and Light Daily Smokers Who Were Former Heavy Smokers Laura J. Fish PhD1, Kathryn I. Pollak PhD1, Taneisha S. Scheuermann PhD2, Lisa Sanderson Cox PhD2, Charu Mathur PhD3, Jasjit S. Ahluwalia MD, MPH, MS4 Cancer Control and Population Sciences and Community and Family Medicine, Duke University, Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC; 2Department of Preventive Medicine and Public Health, School of Medicine, University of Kansas, Kansas City, KS; 3Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; 4Center for Health Equity and Department of Medicine, University of Minnesota, Minneapolis, MN 1
Corresponding Author: Laura J. Fish, PhD, Cancer Control and Population Sciences and Community and Family Medicine, Duke University, Cancer Control and Population Sciences, Duke Cancer Institute, Box 2715, Durham, NC 27710, USA. Telephone: 919-681-3820; Fax: 919-681-4785; E-mail: [email protected]
Abstract Introduction: An increasing proportion of daily smokers are light smokers (≤10 cigarettes per day). Some light smokers have never smoked more than 10 cigarettes per day (native light smokers) and others smoked at higher levels but have cut down (converted light smokers). It is important that we expand our understanding of these distinct subgroups of light smokers in order to develop effective interventions. Methods: Data for this report come from a larger sample of smokers who completed a cross-sectional survey administered through an online panel survey service. The sample of 522 light smokers included 256 native light smokers and 266 as converted light smokers. The goal of the analysis was to examine demographic, smoking, and psychosocial factors that differentiate between native and converted light smokers. Results: Multivariable logistic regression results showed 4 variables that differentiated between native and converted light smokers. Native light smokers were more likely to be Black than White, smoke fewer cigarettes per day, smoked fewer total years, and had higher perceived risk of heart disease than converted light smokers. Conclusions: Native and converted light smokers are similar in many ways and also differ on some important characteristics. Further exploration of group difference is needed and could help to inform for cessation strategies for daily light smokers.
Introduction
groups such as Latino and Black smokers.2 Light smokers, like heavy
Although the number of smokers in the United States continues to decline, the proportion of light smokers, those who smoke 10 or fewer cigarettes per day (CPD), is increasing.1 Approximately 22% of daily smokers are light smokers, with prevalence higher than 50% among some minority
smokers, benefit from quitting smoking as even light smoking increases risk of cardiovascular and lung disease and many forms of cancer.3–6 Compared to heavy smokers, light smokers tend to be younger, racial and ethnic minority members, female, better educated,
© The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: [email protected].
546
Nicotine & Tobacco Research, 2015, Vol. 17, No. 5 and have higher incomes.7 Light smokers also report less physical withdrawal symptoms than moderate and heavy smokers.8 There are differences in smoking history among light smokers, as some are former heavy smokers who have reduced to low level smoking (“converted light smokers”), whereas others have always smoked at low levels (“native light smokers”). Similar terminology has been used to describe subgroups of intermittent or nondaily smokers.9 For the purposes of this article, we use the term “light smoker” to refer to daily smokers who smoke 10 or fewer CPD.10 Few studies have examined light smokers as a group. Further, little is known about whether light smokers who used to be heavier smokers differ substantially from smokers who have always been light smokers. It is possible that these two groups differ in their smoking behavior and smoking-related beliefs, such as risk perceptions and smoker identity, all of which would affect designing effective cessation interventions. Among moderate and heavy smokers, high perceived risk is associated with increased motivation to quit11–13 and most smokers underestimate their risk of smoking-related diseases.14 Light smokers may be defensively biased to not believe smoking risk information (e.g., “I don’t smoke that much so it’s not that bad”).11 This bias may be stronger among converted light smokers because they have already reduced their smoking behavior.15 Smoker identity may also be an important construct to address in developing cessation strategies for light smokers. Intermittent or occasional smokers frequently do not self-identify as smokers because they smoke so few cigarettes and have low nicotine dependence.16 This may also be true among light smokers; however, limited research has examined smoker identity among light smokers. The few studies to examine treatment interventions specifically for light smokers had mixed findings.10,17–19 Results from these initial trials suggest that nicotine lozenges and directive counseling may be effective interventions for achieving long-term quit rates among light smokers.10,19 Only one trial examined differences between native and converted light smokers and found lower cessation rates among converted light smokers.18 For future interventions to help light smokers quit permanently, we need a better understanding of what characterizes native versus converted light smokers. The purpose of this article is to examine differences between native and converted light smokers regarding tobaccorelated and psychosocial variables with the aim of informing more effective and potentially tailored cessation interventions for light smokers.
Methods Participants Data for this report come from a larger sample of smokers who completed a cross-sectional survey administered through an online panel survey service (Survey Sampling International [SSI] Inc.). Data were collected between July 5, 2012, and August 15, 2012. Briefly, quotas were used to recruit approximately 1,200 daily smokers (further stratified to light and moderate/heavy) and approximately 1,200 nondaily smokers with equal numbers of Black, Latino, and White smokers in each group. A total of 42,715 participants were screened for the larger study; 35,666 were ineligible, 4,581 provided incomplete data (90% prior to starting the survey), and 60 participants’ responses were removed from the data due to possible duplicate surveys. This resulted in 2,408 participants completing the
547 survey—1,201 nondaily smokers and 1,207 daily smokers, of whom 604 were light daily smokers. Eligible participants self-identified as Black, White, or Latino (of any race) and were English speaking. They were at least 25 years old to exclude individuals initiating smoking, especially among Blacks who tend to start smoking later.20 In addition, participants were current smokers who smoked for at least 1 year, smoked at their current rate for at least 6 months, and had not participated in any smoking cessation treatment in the past 30 days. Women who were currently pregnant or breast feeding were excluded from the study. Data for this report on light smokers come from participants who reported daily smoking, defined as 25–30 days in the past 30 days, and reported currently smoking ≤10 CPD.10,21,22 Light smokers were categorized as native light smokers (now smoking ≤10 CPD and always smoked ≤10 CPD) and converted light smokers (smoking more than 10 CPD “during the time in their life when they smoked the most” and now smoking ≤10 CPD). Twenty-six light smokers responded inconsistently on the previous level of smoking questions and were excluded from the analysis. This resulted in a final study sample size of 522 light daily smokers, with 256 as native light daily smokers and 266 as converted light daily smokers.
Procedures All procedures were approved by the University of Minnesota Institutional Review Board. SSI used preliminary questions (e.g., smoking frequency) and existing participant information (e.g., race/ ethnicity and age) to direct smokers to this study. Potential participants gave consent and were screened; if the quota for one of the nine subgroups (three race/ethnicity groups and three smoking levels) was filled, participants with those characteristics were no longer recruited. Participants who completed the survey received SSI’s standard incentives, entry into a quarterly drawing for $12,500 available to the entire panel of 1.5 million points that could be redeemed for cash.
Measures Demographic Variables Demographic questions included participants’ age, race and ethnicity, gender, highest level of education, relationship status, employment status, and monthly household income. Monthly household income was assessed with an item containing income brackets and we dichotomized to 30 min); smoking within 30 min of waking denotes greater nicotine dependence.26 Using an item from the Cigarette Dependence Scale, participants were asked to report their level of perceived addiction to cigarettes on a scale of 0 (I am not addicted to cigarettes at all)
Nicotine & Tobacco Research, 2015, Vol. 17, No. 5
548
Smoking-Related Beliefs Perceived vulnerability to smoking-related illness was assessed using participant’s responses to three questions, “If you continue to smoke, how likely do you think it is that you will develop…”: (1) “lung cancer,” (2) “other lung diseases,” and (3) “heart disease.”11 Response options ranged from 1 (no chance) to 7 (certain to happen). Items were summed to calculate an overall measure of perceived vulnerability. Identity as a smoker was assessed using a two-item measure: “I consider myself a smoker” and “If someone casually asked if I was a smoker, I would say yes”.9 Response options for these items ranged from 1 (strongly disagree) to 10 (strongly agree). The items were summed to calculate a smoker identity score.
(p = .02), and were employed full time (p = .01) compared to converted light smokers. There were no differences between native light smokers and converted light smokers regarding education or income. On average, native light smokers smoke fewer CPD (p < .0001), were less likely to report smoking their first cigarette within 30 min of waking (p = .02), and reported smoking fewer total years (p < .0001) compared to converted light smokers. Converted light smokers were also more likely than native light smokers to report trying to cut down the number of cigarettes they smoke (p = .003). There were no differences between native and converted light smokers in overall perceived vulnerability to smoking-related illnesses. Native light smokers had a significantly lower score on the smoker identity measure compared to converted light smokers (p = .006). We conducted multivariable logistic regression with factors with significant bivariate associations. Multivariable analysis identified four variables that differentiated between native and converted light smokers (Table 2). Native light smokers were more likely to be Black than White (odds ratio [OR] = 2.16; CI = 1.31–3.56; p = .003), smoke fewer CPD (OR = 0.73; CI = 0.67–0.80; p < .0001), and smoked fewer total years than converted light smokers (OR = 0.97; CI = 0.95–0.99; p = .03). Native light smokers were less likely than converted light smokers to report trying to cut down on number of cigarettes smoked per day (OR = 0.46; CI = 0.29–0.72; p = .0006). There was a trend for native light smokers to report higher perceived vulnerability to smoking-related illnesses than converted light smokers (OR = 1.05; CI = 1.0–1.11; p = .06). We examined each of the three perceived vulnerability items separately in the model and found that higher perceived vulnerability to lung cancer (OR = 1.08; CI = 1.00–1.39; p = .04) and heart disease (OR = 1.19; CI = 1.01– 1.39; p = .04) were predictive of native light smoking (data not shown).
Statistical Analyses
Discussion
to 100 (I am extremely addicted to cigarettes).9,25 To assess changes in smoking level, participants were asked “Are you currently trying to cut down on the number of cigarettes you smoke?” (yes/no). Participants were asked about use of other tobacco products in the past 30 days including cigars, cigarillos, little cigars, pipes, smokeless tobacco, hand-rolled cigarettes, and water pipes (yes/no). Data on use of other tobacco products were summed to calculate the total number of other tobacco products used in the past 30 days. In relation to quitting, participants were asked the number of times they had made a 24-hr quit attempt in the previous year. The data were dichotomized to no quit attempt versus made a quit attempt. Intention to quit was assessed using a single-item measure that asked participants, “What describes your intention to stop smoking completely, not even a puff? Would you say you…” Four response options included “Never expect to quit,” “may quit in the future, but not in the next 6 months,” “will quit in the next 6 months,” “will quit in the next 30 days.”
The goal of the analysis was to examine demographic, smoking, and psychosocial factors that differentiate between native and converted light smokers. First, we examined bivariate associations and used Fisher’s exact tests for categorical variables and Student’s t test for continuous variables. Variables with bivariate associations with a p value of .10 or lower were included in a multivariable model using logistic regression to identify variables that were associated with native light smoking (referent group). Analysis was conducted using SAS 9.2 (SAS).
Results Due to the sampling strategy, the sample of light smokers had equal numbers of Whites, Blacks, and Latinos. The mean age was 43.8 years, 64% were female, 71% had some college or more, 59% reported a monthly income greater than or equal to $1,800/month, and 58% reported working full time. The mean number of years smoked was 19.5 (SD = 13.6), and the mean number of CPD was 7.5 (SD = 2.7). Most (63%) respondents reported smoking their first cigarette within 30 min of waking. Many (41%) reported making a quit attempt in the previous year. The sample included 49% native light smokers and 51% converted light smokers (Table 1). There were several bivariate significant differences between native and converted light smokers (Table 1). Native light smokers were younger than converted light smokers (p < .0001). A greater proportion of native light smokers were Black (p = .0009), male
This is one of the first reports to examine similarities and differences between native and converted light smokers. Our findings suggest that there are many similarities and also some differences in demographics, number of years smoking, and smoking-related beliefs between subgroups of light smokers. The differences we found have implications for possible cessation strategies for light smokers. First, we found that Blacks are more likely to be native rather than converted light smokers. Light smoking among Blacks has been well documented.2,27 Potential reasons for maintaining low levels of cigarette consumption among Blacks are slower nicotine metabolism and deeper inhalation.28 Previous cessation interventions designed specifically for light Black smokers have considered variation in daily smoking patterns but have not differentiated between native and converted light smokers.10,17 Thus, it may be important to distinguish between native and converted light smokers, especially among Blacks. Our findings suggest that smoking history is an important factor when developing cessation strategies for light smokers. On one hand, native light smokers in our sample reported smoking fewer CPD and for fewer years compared to converted light smokers. Both characteristics may be related to greater success with quitting. In an intervention trial for light smokers, Gariti et al.18 found that those with a history of heavier smoking were less likely to quit. Thus, converted light smokers may have more difficulty quitting. On the other hand, native light smokers were less likely to report trying to cut down than converted light smokers. One possible explanation for
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Table 1. Characteristics of a Sample of Native and Converted Light Smokers (N = 522) Total Characteristic Demographics Age (mean) Race/ethnicity Black Latino White Female Education: some college or more Income ≥$1,800 a month Employed full time Smoking and quitting history CPD (1–10) TTFC
