Abstract
Intermittent smokers (ITS) – who smoke less than daily – comprise an increasing proportion of adult smokers. Their smoking patterns challenge theoretical models of smoking motivation, which emphasize regular and frequent smoking to maintain nicotine levels and avoid withdrawal, but yet have gone largely unexamined. We characterized smoking patterns among 212 ITS (smoking 4–27 days per month) compared to 194 daily smokers (DS; smoking 5–30 cigarettes daily) who monitored situational antecedents of smoking using ecological momentary assessment. Subjects recorded each cigarette on an electronic diary, and situational variables were assessed in a random subset (n = 21,539 smoking episodes); parallel assessments were obtained by beeping subjects at random when they were not smoking (n = 26,930 non-smoking occasions). Compared to DS, ITS' smoking was more strongly associated with being away from home, being in a bar, drinking alcohol, socializing, being with friends and acquaintances, and when others were smoking. Mood had only modest effects in either group. DS' and ITS' smoking were substantially and equally suppressed by smoking restrictions, although ITS more often cited self-imposed restrictions. ITS' smoking was consistently more associated with environmental cues and contexts, especially those associated with positive or “indulgent” smoking situations. Stimulus control may be an important influence in maintaining smoking and making quitting difficult among ITS.
Highlights
Nicotine dependence is considered the primary determinant of persistent cigarette smoking, with individuals typically smoking frequently throughout the day, every day
Maintaining nicotine levels above a threshold requires frequent and regular smoking to overcome the rapid clearance of nicotine from the body, a pattern Russell [4] referred to as ‘‘trough maintenance.’’ Trough maintenance seems to account for the behavior of daily smokers, who smoke frequently and at regular intervals over the course of the day [5]
In a recent study of Intermittent smokers (ITS) [15], we found that these adult ITS had been smoking an average of 19 years, over which time they had consumed more than 40,000 cigarettes, so they are well beyond any initial experimental or developmental period
Summary
Nicotine dependence is considered the primary determinant of persistent cigarette smoking, with individuals typically smoking frequently throughout the day, every day This serves to prevent nicotine levels from sinking below a point that may lead to the onset of withdrawal [1,2]. Despite this long smoking history, these ITS reported smoking an average of only 4 days per week, consuming about 4 cigarettes per day on the days that they smoked These ITS do not smoke often enough to maintain effective nicotine levels (to be ‘‘trough maintainers’’ in Russell’s [4] parlance); they might represent what Russell [4] called ‘‘peakseekers’’ – smokers who smoke in order to get the positively reinforcing acute effects of smoking, rather than avoid the aversive effects of nicotine withdrawal. ITS do not behave as though they are avoiding withdrawal
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