Light and intermittent smoking: The road less traveled

Tobacco control research is at a crossroads. Increasingly, investigators, policy makers, and practitioners recognize the need for concerted efforts to reduce smoking around the globe and across the entire spectrum of smokers. Research and public health efforts have targeted primarily moderate to heavy smokers and those who smoke every day. The National Household Interview Surveys that have monitored U.S. tobacco use since the 1960s did not even distinguish between daily and nondaily smoking until 1992 (Centers for Disease Control and Prevention [CDC], 1994). Our interventions, theoretical frameworks, and concepts of addiction and quitting processes were modeled on heavy daily smoking. Because the frequency, intensity, and duration of tobacco exposure are related in a dose-dependent manner to the risk of health consequences, this strategy focused on those smokers at highest risk of tobacco-related disease. However, no level of cigarette smoke is safe (U.S. Department of Health and Human Services [USDHHS], 2006). Even secondhand smoke exposure in children of light smokers has been associated with the biologically effective dose of two known carcinogen–protein adducts and general measures of genetic damage (Tang et al., 1999). Tobacco consumption among current smokers has declined over several decades (Orzechowski & Walker, 2003), and one-fifth of U.S. smokers are now intermittent or occasional smokers, defined as non-daily smokers (CDC, 2007). Many smokers, especially those in low- and middle-income countries, may be light smokers (i.e., smoking < 10–15 cigarettes/day). If we are to curb the global tobacco pandemic, that is, avoid 1 billion tobacco-related deaths in the 21st century (World Health Organization [WHO], 2008), then nicotine and tobacco researchers and researchers from other fields must expand their focus and make a concerted effort to reduce light and intermittent smoking as well as heavy, daily smoking.