Many teens try smoking. The real danger comes when they develop nicotine dependence or transition into regular smoking. This week, ASHES reviews a study by Mark L. Rubinstein and colleagues that compared intermittent adolescent smokers to regular adolescent smokers. Their goal was to learn more about preventing dangerous smoking patterns.
What was the research question?
How do daily cigarette smokers and intermittent users differ, and how difficult is quitting in both groups?
What the researchers did?
Rubinstein and colleagues recruited 202 adolescent smokers who reported smoking at least 1 cigarette a month. They compared two groups: Intermittent Smokers, who reported smoking at least monthly but less than daily; and Daily Smokers, who reported smoking every day. Participants described their smoking history and completed measures of nicotine dependence, loss of control over smoking, desire to reduce or quit smoking, confidence in the ability to reduce or quit smoking, and the top situations in which they smoke (e.g., social situations, when drinking alcohol, when angry).1 The researchers used linear regression and logistic regression to compare the groups.
What did they find?
On average, compared to daily smokers, intermittent smokers began smoking at an older age (14.4 years compared to 13.3 years), smoked fewer cigarettes per day, and reported lower nicotine dependence scores. Intermittent smokers also reported less loss of control over their smoking and more confidence in their ability to cut down or quit completely. True to the stereotype of a “social smoker,” intermittent smokers were more likely to report smoking in social situations (45%) as compared to daily smokers (26%) and were less likely to smoke when angry (26% compared to 54%) (see Figure). Even though both groups reported distinctly different smoking patterns, they were similar in their desire to cut down or quit smoking.
| Variable | %
Intermittent Smokers |
%
Daily Smokers |
Odds Ratio | 95 % Cl |
| Under stress | 53.5 | 58.0 | 0.92 | 0.46-1.87 |
| When angry | 26.4 | 54.0 | 0.43* | 0.21-0.89 |
| When tense | 10.9 | 24.0 | 0.84 | 0.30-2.34 |
| In a negative mood | 14.7 | 20.0 | 0.82 | 0.31-2.14 |
| When relaxed | 12.4 | 22.0 | 0.84 | 0.30-2.34 |
| Drinking alone | 50.4 | 48.0 | 1.14 | 0.57-2.30 |
| When socializing | 45.0 | 26.0 | 2.41* | 1.11-5.23 |
| When others are smoking | 44.2 | 38.0 | 1.39 | 0.67-2.88 |
Figure. Self-Reported Top Three Situations in Which Smoking is Most Common (adjusted for race, gender, cigarettes smoked per day, and duration of smoking careers).* indicates a statistically significant relationship
Why do these findings matter?
These findings could help treatment professionals and researchers develop interventions for adolescents. In particular, we need to learn more about teens’ reasons for smoking. Those who smoke intermittently and for social reasons might find new ways to fit in and, ideally, avoid progressing to full-blown addiction. Teens who smoke daily and when angry might need to learn new ways to regulate their emotions and, ideally, cut down or stop smoking altogether.
Every study has limitations. What about this one?
Some of the participants in the study were transitioning from intermittent to daily use, which makes it difficult to track differences between groups for the entire length of the study; some may have crossed over from one group to another. Additionally, the study sample size was small, so it may not be representative of the general population of adolescent smokers.
For more information:
The National Cancer Institute has a website called SmokefreeTeen. It provides support for teens looking to quit smoking. Visit SmokeFree.gov for a variety of resources to help you stop smoking. For additional tools, please visit the BASIS Addiction Resources page.
–Anjali A. Talcherkar
What do you think? Please use the comment link below to provide feedback on this article.
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1 The researchers used the Modified Fagerström Tolerance Questionnaire to measure nicotine dependence, the Hooked on Nicotine Checklist to measure diminished autonomy over tobacco use, The Items to Measure Readiness, Motivation, and Confidence in Ability to Change Smoking Behavior Scale to measure confidence in/desire to cut down or quit smoking. The researchers provided a 20-item list of situations in which people smoke and asked participants to rank the top three situations in which they smoke.