Attentional bias and tobacco smoking frequency: A reflection on Bartlett et al. (2022)

Both daily and non-daily smokers find it difficult to quit smoking long-term. One factor associated with addictive behavior is attentional bias, but previous research in daily and non-daily smokers found inconsistent results and did not report the reliability of their cognitive tasks. Using an online sample, we compared daily (n = 106) and non-daily (n = 60) smokers in their attentional bias towards smoking pictures. Participants completed a visual probe task with two picture presentation times: 200ms and 500ms. In confirmatory analyses, there were no significant effects of interest, and in exploratory analyses, equivalence testing showed the effects were statistically equivalent to zero. The reliability of the visual probe task was poor, meaning it should not be used for repeated testing or investigating individual differences. The results can be interpreted in line with contemporary theories of attentional bias where there are unlikely to be stable trait-like differences between smoking groups. Future research in attentional bias should focus on state-level differences using more reliable measures than the visual probe task.

Understanding tobacco use among nondaily and light daily cigarette smokers is needed because they are dissimilar from other smokers and may require specific prevention efforts. We compared three groups of adult male smokers in rural Egypt: light daily and nondaily smokers versus moderate-to-heavy daily smokers. Data were obtained from a household survey in 2003 in six randomly selected villages in the Nile Delta region of Egypt. There were 7,657 adult participants, of whom 48.6% were male and 51.4% were female. Among them, 1,401 males (37.6%) and 5 females (0.1%) were self-identified as current cigarette smokers; further analysis focused on males. We restricted data analysis to those who reported a stable pattern of 3+ years of smoking. There were 42 nondaily smokers. Daily smokers were subdivided into two groups: light daily smokers (who smoked no more than 10 cigarettes/day; n = 223) and moderate-to-heavy daily smokers (who smoked at least 11 cigarettes/day; n = 769). We found statistically significant differences between these groups on nearly every measure: nondaily smokers tended to be younger and unmarried, but they also had higher levels of education and professional occupations compared with the other smokers. Nondaily and the light daily smokers were more likely than moderate-to-heavy smokers to be planning to quit and to have self-efficacy for quitting, and they were less likely to be smoking in the presence of their wife and children at home. Further understanding of nondaily and light daily smokers may aid in tailoring specific interventions.

Background: This study sought to provide an epidemiological profile of non-daily (ND) smokers in South Africa. Methods: Using data obtained from the 1998 South African demographic and health survey (SADHS) – the largest nationally representative dataset available – smokers were classified as non-daily (ND) smokers or daily smokers. NDS were defined as persons aged 18 and over who had ever smoked 100 cigarettes, but did not currently smoke daily. Results: In 1998, an estimated 10% of current smokers were ND smokers (n = 255). Of the ND smokers, 69.7% had smoked daily in the past and currently smoked significantly fewer cigarettes per day (CPD) than current daily smokers (5.4 vs. 9.8). ND smokers were also significantly more likely to have made at least one attempt to quit smoking, live in smoke-free homes, have more than 12 years of schooling and live in urban areas. Compared to past daily ND smokers, those ND smokers who had never smoked daily smoked fewer CPD and were more likely to be younger than 25 years old. Conclusions: The findings of this study suggest that the majority of ND smokers in South Africa are those trying to quit smoking rather than those initiating smoking. Smoking rates among ND smokers are still at a level that has been shown to pose significant health risks, therefore health practitioners should also prioritise non-daily smokers for interventions regarding smoking cessation. This article has been peer reviewed. SA Fam Pract 2009;51(3):244-248

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessNondaily Smoking Increases in People With Mental IllnessMark MoranMark MoranSearch for more papers by this authorPublished Online:4 Oct 2018https://doi.org/10.1176/appi.pn.2018.9b13AbstractThe development of targeted tobacco control public health approaches that address common mental health and substance use problems in the community may be needed to lower the prevalence of smoking, researchers say.Nondaily cigarette smoking by U.S. adults with common mental health and substance use problems increased significantly between 2005 and 2014, while simultaneously declining among those without these disorders, according to a report in the Journal of Clinical Psychiatry. iStock/fuzznailsThe report also found daily smoking declined among those with and without these disorders. “While the decrease in daily cigarette smoking among persons with MHSUP [mental health or substance use problem] is promising, the prevalence of cigarette smoking among persons with MHSUP remained very high,” wrote Andrea H. Weinberger, Ph.D., an assistant professor of psychology of Yeshiva University in New York, and colleagues. According to the researchers, the overall prevalence of smoking among people with mental illness and substance use problems in 2014 was more than twice that of those without those conditions.“There is a commonly held view that nondaily cigarette smoking is not harmful,” the researchers wrote. “However, nondaily cigarette smoking has negative health consequences, many nondaily smokers eventually increase to daily cigarette consumption and nondaily cigarette smokers are less likely to express an intention to quit, relative to daily smokers.”Weinberger and colleagues analyzed data from the National Survey on Drug Use and Health from 2005 and 2014, comparing current, daily, and nondaily cigarette smoking among adults with and without any mental health or substance use problem. Individuals who reported experiencing past-year major depressive episode, serious psychological stress, substance use disorders, alcohol use disorders, heavy alcohol use, or daily cannabis use were classified as having a mental health or substance use problem (MHSUP). People with a history of smoking who smoked cigarettes 1 to 29 days of the previous 30 days were classified as nondaily smokers, while those who smoked 30 of the previous 30 days were classified as daily smokers.The prevalence of nondaily cigarette smoking increased from 29.54 percent in 2005 to 33.73 percent in 2014 among people with MHSUP. In contrast, nondaily smoking declined among people without these disorders from 29.13 percent in 2005 to 27.43 percent in 2014. The prevalence of daily smoking declined significantly over the same period among individuals in both groups (from 29.42 percent to 24.21 percent among people with MHSUP; from 13.48 percent to 10.21 percent among people without MHSUP).“It is not clear whether the increase in nondaily cigarette smoking for persons with MHSUP is due to persons decreasing cigarette smoking from daily to nondaily levels or incident nondaily cigarette smoking,” the researchers wrote. “Future studies should examine reasons for the increase in nondaily cigarette smoking to determine what resources are most needed. Persons who present with both mental health and substance use problems may need additional research and clinical attention to understand and address their greater increasing trend in nondaily smoking.” They noted as well that the 2008 update to the Clinical Practice Guidelines for Treating Tobacco Use and Dependence recommends routine screening for cigarette smoking, including the use by physicians of “the 5 A’s”: Ask patients if they smoke. Advise patients to quit. Assess patients’ motivation for quitting. Assist with quit attempts.Arrange follow-up contacts.“When patients enter treatment for MHSUP, it provides an opportunity to identify smokers (nondaily and daily) and provide cessation treatment options,” Weinberger and colleagues wrote. The study was supported by a National Institutes of Health/National Institute on Drug Abuse grant. ■“Nondaily Smoking Is Increasing Among People With Common Mental Health and Sub-stance Abuse Problems in the United States: Data From Representative Samples of U.S. Adults, 2005-2014” can be accessed here. “Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice Guideline” is available here. ISSUES NewArchived

An increasing proportion of US smokers smoke at low intensity and not every day. Some nondaily smokers have always had this pattern, whereas others previously smoked daily. The effect of reducing the level of smoking from daily to nondaily smoking and the dose response at low smoking levels are poorly understood. To evaluate risk of all-cause and cause-specific mortality among nondaily and daily cigarette smokers, by cigarettes per month, years after reducing from daily to nondaily smoking, and years since quitting. A prospective cohort study using harmonized data from multiple cycles of the Tobacco Use Supplements to the Current Population Survey (TUS-CPS), linked to the National Death Index, were analyzed during the period from 2018 to 2020. Adults completed the 1992-1993, 1995-1996, 1998-1999, 2000, 2001-2002, 2003, 2006-2007, or 2010-2011 TUS-CPS. Cigarette smokers were classified as daily or nondaily users; current nondaily smokers were further categorized by whether they previously smoked every day. Hazard ratios (HRs) and 95% CIs for risks of mortality vs never smoking. Age was the underlying time metric, adjusted for sex, race/ethnicity, education, survey year, and household income. Among 505 500 participants (aged 18-103 years), approximately 47 000 deaths occurred. The median number of cigarettes smoked per month was 600 (interquartile range, 300-600) (20 cigarettes per day [interquartile range, 10-20 cigarettes per day]) for daily cigarette smokers and 40 (interquartile range, 15-90) for lifelong nondaily smokers. Nevertheless, both current daily (HR, 2.32; 95% CI, 2.25-2.38) and lifelong nondaily (HR, 1.82; 95% CI, 1.65-2.01) smokers had higher all-cause mortality risks than never smokers. Associations were observed for 6 to 10 cigarettes per month and increased with greater-intensity use. Nondaily smokers who previously smoked every day had lower mortality risks than daily smokers, with similar HRs after 10 or more years of nondaily smoking as lifelong nondaily smokers (HR vs never smokers, 1.73; 95% CI, 1.56-1.92). Yet, their risks were higher than former smokers who quit 10 or more years before (HR vs never smokers, 1.18; 95% CI, 1.15-1.22). Although reducing smoking from daily to nondaily was associated with decreased mortality risk, cessation was associated with far greater benefit. Lifelong nondaily smokers have higher mortality risks than never smokers, even among those smoking 6 to 10 cigarettes per month. Thus, all smokers should quit, regardless of how infrequently they smoke.

This study aimed to calculate the prevalence of pre-pregnancy nondaily smoking (<1 cigarette/day), risk factors, and report of prenatal provider smoking education; and assess the likelihood of prenatal cessation and postpartum relapse for nondaily smokers. We analyzed data from 2009 to 2011 among women with live-born infants participating in the Pregnancy Risk Assessment Monitoring System. We compared characteristics of pre-pregnancy daily smokers (≥1 cigarette/day), nondaily smokers, and nonsmokers (chi-square adjusted p < .025). Between nondaily and daily smokers, we compared proportions of prenatal cessation, postpartum relapse (average 4 months postpartum), and reported provider education. Multivariable logistic regression calculated adjusted prevalence ratios (APR) for prenatal cessation among pre-pregnancy smokers (n = 27 360) and postpartum relapse among quitters (n = 13 577). Nondaily smokers (11% of smokers) were more similar to nonsmokers and differed from daily smokers on characteristics examined (p ≤ .001 for all). Fewer nondaily smokers reported provider education than daily smokers (71.1%, 86.3%; p < .001). A higher proportion of nondaily compared to daily smokers quit during pregnancy (89.7%, 49.0%; p < .001), and a lower proportion relapsed postpartum (22.2%, 48.6%; p < .001). After adjustment, nondaily compared to daily smokers were more likely to quit (APR: 1.65; 95% confidence interval [CI]: 1.58-1.71) and less likely to relapse postpartum (APR: 0.55; 95% CI: 0.48-0.62). Nondaily smokers were more likely to quit smoking during pregnancy, less likely to relapse postpartum, and less likely to report provider education than daily smokers. Providers should educate all women, regardless of frequency of use, about the harms of tobacco during pregnancy, provide effective cessation interventions, and encourage women to be tobacco free postpartum and beyond. Nondaily smoking (<1 cigarette/day) is increasing among US smokers and carries a significant risk of disease. However, smoking patterns surrounding pregnancy among nondaily smokers are unknown. Using 2009-2011 data from the Pregnancy Risk Assessment Monitoring System, we found pre-pregnancy nondaily smokers compared to daily smokers were 65% more likely to quit smoking during pregnancy and almost half as likely to relapse postpartum. Providers should educate all women, regardless of frequency of use, about the harms of tobacco during pregnancy, provide effective cessation interventions, and encourage women to be tobacco free postpartum and beyond.

We aimed to qualitatively examine differences in perceptions of addiction, attempts to quit, and successful quitting among nondaily versus daily college student smokers. We conducted 16 focus groups with a total of 73 college student smokers from the southeastern U.S. Focus groups were homogenous in terms of gender, smoking status (nondaily, daily), and type of school (2-year college, 4-year university). Questions centered on perceptions of addiction, their own addiction, what constitutes a quit attempt, and successful quitting. Themes that emerged among all smokers regarding conceptualization of general addiction included physiological and psychological dependence and an inability to quit smoking. In terms of their own addiction, nondaily smokers referenced their ability to quit and sense of choice to smoke as factors indicating a lack of addiction, whereas daily smokers reported dependence symptoms and their inability to control their smoking indicating addiction. Nondaily smokers discussed quit attempts in terms of making the decision to quit and avoiding situational triggers, whereas daily smokers reported taking more behavioral steps toward cessation (e.g., not buying cigarettes, reducing cigarette consumption). With regard to successful cessation, both groups identified losing the desire to smoke as a hallmark. However, nondaily smokers reported that the decision to quit might constitute successful cessation; daily smokers had more strict behavioral criteria such as abstinence for an extended period of time. The different perceptions of one's own addiction, attempting to quit smoking, and successful quitting suggest the need to improve assessments of these factors, particularly among nondaily smokers.

Nondaily and social smoking (smoking primarily in social situations) are increasingly prevalent. Social smokers differ from daily smokers in their demographics, psychological profile, and degree of nicotine addiction. Current methods used to screen for tobacco dependence often miss social smokers, who tend to self-categorize as “nonsmokers.” The available, albeit limited, literature on whether social smokers exhibit nicotine dependence is controversial. While there are no data on the direct health risks associated with social smoking, data on light active smoking and passive smoking suggest that intermittent tobacco use carries health risks, particularly for cardiovascular disease. Because social smokers consume less and tend not to show signs of nicotine dependence, pharmacotherapies, which are designed to counter withdrawal symptoms, may not be relevant. However, social smokers may be more motivated to quit when educated on the dangers of their secondhand smoke. There is a need for new research on defining the health impact of nondaily and social smoking. While daily tobacco consumption in the United States is declining,1 nondaily smoking is increasing.2 Nondaily smoking (smoking on some days but not every day) is a distinct pattern of tobacco use that falls under the broader category of light (low-volume) or intermittent smoking. There is not a consensus on how to study nondaily smokers; some investigators have grouped nondaily smoking with other forms of light tobacco use, while others have studied it as a separate entity. Regardless of the precise definition, nondaily and social smokers are intermittent tobacco users who, alone with occasional, low-rate daily and very light smokers, are often not identified in clinical practice because they do not consider themselves smokers. Because nondaily smoking is increasing in prevalence, representing up to one-fourth of current tobacco users,2 there is a need to improve clinicians' ability to identify and treat these types of smokers. Current smoking cessation strategies were developed for established smokers who consume 1 or more packs of cigarettes per day, meet clinical criteria for nicotine addiction, and experience clear physical and psychological effects of tobacco. Nondaily smoking has not been a focus of cessation efforts, nor has it been incorporated into national clinical guidelines for treating tobacco dependence, partly because nondaily smoking has been considered a transient behavior associated with smoking initiation or quit attempts.3

The aim of this study was to elucidate individual difference factors that modulate the attentional processing of game stimuli to explain the heterogeneity of extant findings. The current study examined whether individual differences in components of attentional control (AC-shifting and AC-focusing) moderated the link between internet gaming addiction symptom and attentional engagement to and disengagement biases from game-relevant cues. A total of 75 male undergraduate students who have played League of Legend (LOL) for more than 2 years completed well-established self-report questionnaires of internet gaming disorder symptoms and attentional control. The attentional bias toward game stimuli was measured for attentional engagement and disengagement using the attentional response to the distal vs. proximal emotional information (ARDPEI) task. The results revealed that attentional control was a significant moderator of the relationship between internet game addiction symptoms and attentional disengagement bias. Further analyses revealed a positive relationship between internet game addiction symptoms and attentional disengagement bias only among those with low levels of AC-shifting ability. Contrary to our expectations, AC-shifting also moderated the relationship between internet gaming disorder and attentional engagement bias. The positive relationship between internet game addiction symptoms and attentional engagement bias only appeared among those with low levels of AC-shifting ability. Individual differences in AC-focusing did not moderate the relationship between internet gaming disorder and any attentional bias. This study confirmed that the greater the symptoms of game addiction, the stronger the attentional bias, especially in individuals with low AC-shifting ability. Therefore, it is necessary to examine sub-factors of AC in understanding the nature of attentional bias mechanisms in the development of internet game addiction and consider it as a psychological intervention to improve attentional bias.

Nondaily smoking in the United States is increasing. Although differences in smoking and cessation behaviors between daily and nondaily smokers have been documented, differences among nondaily smokers are poorly understood. This study provides updated national data on smoking and cessation characteristics among nondaily versus daily smokers and between subgroups of nondaily smokers. Data were obtained from the 2009-2010 National Adult Tobacco Survey, a stratified, dual-frame telephone survey conducted in the United States. Participants were categorized into daily smokers, never-daily nondaily smokers (NDNS), recently converted (≤1 year) nondaily smokers (RCNS), and established-converted (>1 year) nondaily smokers (ECNS). Chi-square tests were used to assess differences across groups, and multivariable logistic regression was used to identify factors associated with past-year quit attempts. Among nondaily smokers (17.8% of the total sample), 27.1% were NDNS, 37.4% were RCNS, and 35.4% were ECNS. RCNS were the most likely to report ever having tried to quit (p < .0001), having tried to quit in the past year (p < .0001), having used cessation treatment during their last quit attempt (p < .05), and wanting to quit smoking for good (p < .001). Compared with NDNS, RCNS had more than twice the odds of trying to quit in the past year after adjusting for demographics and smoking characteristics (adjusted odds ratio = 2.1, 95% confidence interval = 1.3-3.2). No significant differences existed between NDNS and ECNS. RCNS are potentially more interested in quitting and should be specifically targeted with cessation interventions to avoid relapse to daily or long-term nondaily smoking.

The proportion of smokers who do not smoke daily has increased over time, but nondaily smokers are a heterogeneous group. We compare characteristics and other tobacco product use of infrequent nondaily, frequent nondaily, and daily US adult smokers. We analyzed data from the 1998, 2000, 2005, and 2010 National Health Interview Surveys. Current smokers were categorized as daily, infrequent nondaily (smoked 1-12 days in the past 30 days), and frequent nondaily (smoked 13-29 days in the past 30 days) smokers. Multinomial logistic regression analysis was used to analyze the correlates of infrequent nondaily, frequent nondaily, and daily smoking. Among current smokers, 8.3% were infrequent nondaily, 8.1% were frequent nondaily, and 83.6% were daily smokers. The prevalence of infrequent versus daily smoking increased over time, with a smaller increase among non-Hispanic Blacks than non-Hispanic Whites. The adjusted odds of both infrequent and frequent smoking versus daily smoking differed by age, race/ethnicity, education, poverty status, marital status, region, quit attempts in the past 12 months, and binge drinking. Snuff users (vs. non-snuff users) were 2.4 times as likely to be infrequent than daily smokers. There were also differences in race/ethnicity, education, marital status, region, quit attempts, and snuff use between infrequent versus frequent smokers. Infrequent smokers differ from both frequent and daily smokers in socio-demographics, quit attempts, and snuff use. The heterogeneity of nondaily smokers should be considered in developing targeted tobacco control and smoking cessation programs. Infrequent and frequent nondaily smokers were found to differ from daily smokers in age, race/ethnicity, education, poverty status, marital status, region, and quit attempts and they were different from each other in race/ethnicity, education, marital status, region, and quit attempts. Binge drinkers were more likely to be infrequent smokers and frequent smokers versus daily smokers. Current snuff users were found to have increased odds of infrequent smoking versus daily smoking and versus frequent smoking. These results highlight the importance of acknowledging the differences among nondaily smokers in smoking frequency in developing targeted tobacco control and smoking cessation programs.

Given the high prevalence of young adult smoking, we examined (i) psychosocial factors and substance use among college students representing five smoking patterns and histories [non-smokers, quitters, native non-daily smokers (i.e. never daily smokers), converted non-daily smokers (i.e. former daily smokers) and daily smokers] and (ii) smoking category as it relates to readiness to quit among current smokers. Of the 4438 students at six Southeast colleges who completed an online survey, 69.7% (n = 3094) were non-smokers, 6.6% (n = 293) were quitters, 7.1% (n = 317) were native non-daily smokers, 6.4% (n = 283) were converted non-daily smokers and 10.2% (n = 451) were daily smokers. There were differences in sociodemographics, substance use (alcohol, marijuana, other tobacco products) in the past 30 days and psychosocial factors among these subgroups of students (P < 0.001). Among current smokers, there were differences in cigarettes smoked per day, recent quit attempts, self-identification as a smoker, self-efficacy and motivation to quit (P < 0.001). After controlling for important factors, converted non-daily smokers were more likely to be ready to quit in the next month versus native non-daily smokers (OR = 2.15, CI 1.32-3.49, P = 0.002). Understanding differences among young adults with different smoking patterns and histories is critical in developing interventions targeting psychosocial factors impacting cessation among this population.

Objective: To examine use of and interest in cessation strategies among nondaily and daily college student smokers. Participants: 800 undergraduate student smokers aged 18 to 25. Methods: The authors examined nondaily versus daily smoking in relation to use of and interest in cessation strategies using an online survey. Results: Nondaily (65.8%) versus daily smokers (34.3%) were more likely to have made a quit attempt (p = .01) but less likely to have used any assistance (p < .001). Nondaily smokers were less interested in pharmacotherapy and traditional behavioral interventions; however, there was no difference in interest in technology-based interventions among nondaily versus daily smokers. Controlling for covariates, there were no significant differences in interest in traditional or technology-based behavioral interventions. Higher motivation, lower confidence, and depressive symptomatology were related to interest in each intervention. Smoking for social reasons was related to interest in technology-based interventions. Conclusions: Different intervention strategies may be appropriate for nondaily and daily smokers.

BackgroundNondaily smoking has been on the rise, especially in Mexico. While Mexico has strengthened its tobacco control policies, their effects on nondaily smokers have gone largely unexamined. We developed a simulation model to estimate the impact of tobacco control policies on daily and nondaily smoking in Mexico.MethodsA previously validated Mexico SimSmoke model that estimated overall trends in smoking prevalence from 2002 through 2013 was extended to 2018 and adapted to distinguish daily and nondaily smoking prevalence. The model was then validated using data from Mexican surveys through 2016. To gauge the potential effects of policies, we compared the trends in smoking under current policies with trends from policies kept at their 2002 levels.ResultsBetween 2002 and 2016, Mexico SimSmoke underestimated the reduction in male and female daily smoking rates. For nondaily smoking, SimSmoke predicted a decline among both males and females, while survey rates showed increasing rates in both genders, primarily among ages 15–44. Of the total reduction in smoking rates predicted by the model by 2018, tax policies account for more than 55%, followed by health warnings, cessation treatment, smoke-free air laws, and tobacco control spending.ConclusionsAlthough Mexico SimSmoke did not successfully explain trends in daily and nondaily smoking, it helps to identify gaps in surveillance and policy evaluation for nondaily smokers. Future research should consider appropriate measures of nondaily smoking prevalence, trajectories between daily and nondaily smoking, and the separate impact of tobacco control policies on each group.

Most smoking cessation approaches are modeled on heavy daily smoking. With increasing prevalence of nondaily smoking, it may be necessary to modify these approaches for nondaily smokers. To provide information about beliefs and attitudes relevant to smoking cessation for nondaily smokers. Secondary analysis of two prospective studies on young adult smokers (18-24 years of age) provided brief advice to quit smoking. Measures include baseline levels of constructs relevant to smoking cessation counseling and perceived benefits of and barriers to smoking cessation. Participants (n = 40 nondaily, 122 daily smokers) were predominantly White (70% and 84%, respectively), gender-balanced (50% and 43% female), full-time college students (89% and 95%). At baseline, nondaily smokers reported lower levels of nicotine dependence (p < .001; nondaily: Fagerström Test for Nicotine Dependence (FTND) = 0.8 ± 1.5, daily: FTND = 3.1 ± 1.9), lower urge to smoke (p < .001), greater self-efficacy when facing external smoking stimuli (p = .03), expecting to experience fewer positive effects (reduced negative affect, p = <.001, stimulation, p = .02), and valuing the importance of smoking effects less (ps < .01) than daily smokers. During counseling, nondaily smokers generated both fewer benefits of cessation (Wald X2(df = 1) = 4.91, p = .027) and fewer barriers (Wald X2(df = 1) = 5.99, p =.014) than daily smokers. Withdrawal was not listed by nondaily smokers as a barrier (p < .01). Constructs relevant to smoking cessation for daily smokers were less salient to young nondaily smokers, compared with moderately addicted young daily smokers, as indicated by responses to standardized scales and by the generation of fewer benefits and barriers in counseling. Interventions may need to find novel ways to engage nondaily smokers, particularly young adult, in smoking cessation efforts. This study is unique in eliciting benefits and barriers from nondaily smokers as they are about to make a quit attempt. This is a critically important point in time, as this is the point in time in which an action plan is formed and can be informed and enhanced by smoking cessation support. Our study further allowed direct comparison to daily smokers undergoing the same procedures, which allowed the identification of unique factors that may impact nondaily smokers in their quit attempt, which may guide intervention efforts. Use of a mixed method design further strengthen the rigor of this study.