Lower Cigarette Consumption Research Articles

Barriers and facilitators to implementation of smoke-free area policy in public places: a scoping review

Enforcing laws requiring smoke-free areas in different locations is one way the government can lower cigarette consumption and exposure to cigarette smoke. The purpose of this study was, thus, to examine and summarize studies that identified facilitators and barriers to the implementation of a smoke-free area policy in public places. The researchers carried out systematic searches in December 2023 within these specific databases: Scopus, PubMed, ProQuest, Emerald Insight, and EBSCO and included studies on the implementation of smoke-free area policy that were published in English between 2018-2021. Out of the 684 research reports that were found, only 12 were accepted into the scoping study. The findings exhibited several barriers to the implementation of smoke-free area policy, including personal characteristics, the presence of tobacco sellers and smoking aids, lack of enforcement management, lack of support and collaboration from local government, lack of examples of policy implementation by local government, and no smoking signs or smoke-free policy signs. Meanwhile, the facilitating factors encompass fines and penalties, the presence of access to tobacco cessation services, smoke-free policy campaigns, and knowledge and attitudes toward smoke-free area policies. The evidence collected from the review’s findings suggests that there are more barriers than facilitating factors. This indicates that numerous adverse behaviors in the implementation of the smoke-free area policy are still present. The subsequent step following this study is to carry out primary research to thoroughly investigate the execution of the smoke-free area policy in public places.

Performance of the Heaviness of Smoking Index in Indian Settings.

Background and objective The heaviness of smoking index (HSI) is a popular tool to assess nicotine dependence in clinical and community settings. Low cigarette consumption and concurrent use of other tobacco products raise concerns about its validity in Indian settings. This study explores the performance of HSI in Indian settings. Methods This study analyzed daily manufactured cigarette smoker data from the cross-sectional Global Adult Tobacco Surveys (GATS) from its first (GAST-1, 2009) and second waves (GATS-2, 2016), both of which were available in the public domain. The HSI scores were calculated based on the number of cigarettes smoked per day (CPD) and time to first smoke (TTFS) after waking up among the current daily cigarette users. This study examined the utility of the HSI scale in Indian settings by estimating the predictability of low dependence on quit attemptsand quit intentions using the likelihood ratio parameter. Results About nine in 10 cigarette users in India consumed less than 10 cigarettes per day, yielding a low score on the HSI scale for most of the daily cigarette users. The majority of daily cigarette smokers scored ≤ 1 (low dependence) on the HSI scale both in GATS-1 and GATS-2, irrespective of their exclusive cigarette use status. The absolute value and the 95% confidence limit of positive likelihood ratios (falling below and above one) suggest that the predictability of low dependence on quit attempts and quit intention in the Indian setting is limited. Conclusions The utility of the HSI scale in assessing nicotine dependence among cigarette users in India is limited. This may be attributed to low average cigarette consumption, concurrent use of various tobacco products, and the sociocultural milieu of Indian smokers. This highlights the need for a new rapid nicotine dependence scale tailored to the specific patterns of tobacco use behavior prevalent in the Indian context.

Prevalence and predictors of smoking cessation among smokers receiving smoking cessation intervention in primary care in Qatar: a 6-month follow-up study.

To estimate the rate and predictors of smoking cessation in smokers attending smoking cessation clinics in primary care settings in Qatar. A cross-sectional study was conducted among 759 smokers who had attended any of the 10 smoking cessation clinics in primary health care centers from January 2019 to June 2020. The sociodemographic, clinical, and smoking-related variables were assessed. Tailored behavioral and pharmacotherapy were delivered, and patients were interviewed at 6 months to estimate the 30-day point prevalence abstinence. To identify independent factors associated with smoking cessation, a multivariable logistic regression analysis was performed. The mean age of participants was 40.6 (±11.3), majority being married, Arab and employed, and having a tertiary education. Almost half of the smokers (48.7%) received varenicline alone, 42.6% received NRT, and 31.8% received a combination of both. The selection of drug therapy was based on preferences, experiences, and history of previously encountered adverse effects. The overall 30-day quit rate at 6 months follow-up was 32.4%. About three-quarters (72.5%) of participants had at least one quit attempt and 12.5% had 3 or more attempts. Later age at smoking initiation, lower cigarette consumption at baseline, lower CO concentration at baseline, use of smoking cessation pharmacotherapy, having made fewer quit attempts and non-exposure to secondhand smoke among friends were identified as significant predictors of successful quitting at 6 months. The 30-day quit rate at 6 months follow-up (32.4%) is comparable to the worldwide figure. However, further efforts should be made to plan cost-effective tobacco dependence treatment taking into account predictors and at-risk groups.

As countries improve their cigarette tax policy, cigarette consumption declines

BackgroundThis study examines the association between the Tobacconomics cigarette tax scores and cigarette consumption in 97 countries during the period of 2014–2020.MethodsData on countries’ retail cigarette sales and overall cigarette...

Assessing the Effects of a Tobacco Tax Reform on the Industry Price-Setting Strategy.

In July 2020, the Executive Power submitted Bill no. 3887-2020 as the first step towards a wide reform of the Brazilian tax system. It will replace the current PIS/COFINS (charged on turnover of companies) by the CBS (a tax on goods and services), which includes a special regime for cigarettes. The novelty is that the specific cigarette tax will be charged on the highest retail price per cigarette brand across the country. This research simulates three scenarios that differ according to the price-setting strategy of the tobacco industry in reaction to the proposed tax reform. In all simulations, the tax reform would result in considerably higher cigarette prices, lower cigarette consumption, higher tax collection, and an implicit minimum price that is far above the current official price floor. Furthermore, the price dispersion and cross-border shopping across states would be reduced because prices and tax burden per brand would tend to be the same across the country due to the dominant price-setting strategy in the cigarette industry.

Effects of the Brazilian tax reform plans on the tobacco market

BackgroundThere has been an intense debate in the Brazilian National Congress on how to reform the country’s tax system on consumption. This paper investigates the effects of the tax reform...

Cigarette Prices and Smoking Behavior in Israel: Findings from a National Study of Adults (2002-2017).

Tobacco taxation and price policies are considered the most effective for lowering demand for tobacco products. While this statement is based on research from numerous countries, scant evidence exists on this topic for Israel. Accordingly, we assessed the association between cigarette prices and smoking prevalence and intensity from a national sample of adults in Israel (2002–2017). Data on smoking behavior were derived from the Israeli Knowledge Attitudes and Practices (KAP) survey, a repeated cross-sectional survey. Price information is from the Economist Intelligence Unit (EIU) since it was not collected in the KAP survey. We used the price of a pack of 20 cigarettes for Marlboro and the local brand. These two price variables were the primary independent variables, and we adjusted for inflation. The dependent variables were current smoking (yes/no) and smoking intensity, defined as the number of cigarettes smoked per week. Multivariable analysis was employed using a two-part model while adjusting for covariates. The first step of the model utilized logistic regression with current smoking as the dependent variable. The second step examining smoking intensity as the dependent variable, used OLS regression. Price elasticity was estimated as well. Analysis revealed that a one-unit increase (Israeli currency) in the price of local brand of cigarettes was related to 2.0% (OR = 0.98; 95%CI 0.98, 0.99) lower odds of being a current smoker, adjusting for covariates including household income. Moreover, a one unit increase in the price of the local brand of cigarettes was related to consuming 1.49 (95% CI −1.97, −1.00) fewer weekly cigarettes, controlling for household income and covariates. Similar results were found with the Marlboro cigarette prices. The total price elasticity of cigarette demand, given by the sum of price elasticities of smoking prevalence and intensity, showed that a 10.0% increase in the price is associated with a 4.6–9.2% lower cigarette consumption among Israeli adults. Thus, increasing cigarette prices will likely lead to a reduction in cigarette smoking thereby improving public health in Israel.

Switching away from Cigarettes across 12 Months among Adult Smokers Purchasing the JUUL System.

Objectives: In this study, we assessed complete switching away from cigarette smoking among adult smokers who purchased a JUUL Starter Kit (JSK). Methods: Adult (age ≥ 21) established smokers (smoked ≥ 100 lifetime cigarettes) who purchased a JSK in 2018 were invited to complete online surveys 1, 2, 3, 6, 9 and 12 months after initial JSK purchase. Point prevalence of switching (no past 30-day smoking) was assessed at each follow-up. Repeated measures logistic regression models evaluated associations of sociodemographic factors, baseline smoking characteristics and time-varying JUUL System ("JUUL") use characteristics and switching across the 12-month period. Results: Respondents (N = 17,986) were 55.0% male, 78.3% white, mean age = 32.65 years (SD = 10.81), mean baseline cigarettes/day = 11.10 (SD = 8.16). The proportion self-reporting switching increased over time: one-month (27.2%[3718/13,650]), 2-month (36.4%[4926/13,533]), 3-month (41.0%[5434/13,257]), 6-month (46.6%[5411/11,621]), 9-month (49.4%[6017/12,186]), and 12-month (51.2%[6106/11,919]); 33.1% reported switching at both 9-month and 12-month follow-ups. In prospective analyses, smokers with lower cigarette dependence, shorter smoking history, lower cigarette consumption, more frequent JUUL use, greater satisfaction from initial JUUL use, and higher JUUL dependence were significantly more likely to switch. Conclusions: Rates of switching with JUUL increased over time. Over 50% of respondents reported complete switching away from cigarettes 12 months following purchase. Greater use of and dependence on JUUL predicted switching.

Methods Used in Smoking Cessation and Reduction Attempts: Findings from Help-Seeking Smokers.

In addition to traditional smoking cessation methods like nicotine replacement therapy (NRT), new methods such as mobile applications and e-cigarettes have been added to the toolbox. The purpose of this study was to examine which methods smokers currently use in quit or reduction attempts and map characteristics of users of the various methods. In this study, participants were smokers who visited a website or called a quit line for smoking cessation and who were currently in quit or reduction attempts (N = 740). Data were collected in Norway in 2013–2017 through a web survey. Most smokers were currently trying to quit, and the most frequently used methods were a smoking cessation app for mobile phones, nicotine replacement therapies (NRTs), and e-cigarettes. Logistic regression analyses identified older daily smokers with high cigarette consumption as NRT users, while the users of a cessation app were younger females. The use of e-cigarettes was associated with older, low educated smokers with low cigarette consumption. The use of the mobile phone app was associated with having made several recent quit attempts. The study provides insight into help-seeking smokers' preferences for smoking cessation methods and user characteristics. This knowledge is relevant for further work in smoking cessation planning and policies.

Ten Years of Smoking Ban - Effects of the Federal Nonsmoker Protection Act Exemplified by the Traditional Pub District of Cologne's Südstadt

Since September 2007, the Federal Nonsmoker Protection Act regulates a general legal ban on smoking in federal facilities, public transport vehicles and passenger stations. Other smoking bans are not uniformly regulated and vary from state to state. In addition to places of public interest, sports venues and the workplace, particular attention in political debates has always been paid to bars and restaurants, where smoking has always been part of the picture. The situation of the Südstadt pubs in Cologne considered in this paper is governed by the expanded law for the protection of non-smokers in North Rhine Westphalia (NRW) of December 20, 2007. A survey using a specifically created questionnaire comprising 24 items was carried out. Persons over 26 years of age visiting selected bars were interviewed in order to ensure that at the time the Nonsmoker Protection Act was introduced, participants had reached the legal age for smoking. Data acquisition was carried out both by direct surveys of participants in selected pubs in Cologne's Südstadt and by means of online surveys, attention to which had been drawn in the press, television and through social media. A total of 1318 completed questionnaires were evaluated. Participants were on average 49 years old (± 12.1). Of the 1318 respondents, 726 were active smokers in 2007 (55.1 %). In 2018, 518 (39.3 %) (p: < 0.001) respondents stated that they were still active smokers. Of the 726 active smokers, 289 (39.8 %) had been consuming more than 20 cigarettes a day in 2007. In 2018, 179 of 518 (34.6 %) (p: < 0.001) were heavy smokers. In 2007, 303 persons (41.7 % of smokers) fell into the group of medium smokers with 10 - 19 cigarettes per day, in 2018 there were 227 (43.8 %) (p: < 0.001). The group of people who smoked less and consumed 1 - 9 cigarettes per day included a total of 134 persons (18.5 %) in 2007 and 112 (21.6 %) in 2018 (p: < 0.001). Among active smokers, the smoking ban was the most relevant cause for a change in smoking behaviour in this survey. Among non-smokers or former smokers, health aspects as well as family and friends were the decisive factors in rejecting tobacco products. Based on a sample of 1318 participants among pub visitors, the study showed that the number of active smokers had significantly and distinctly decreased since the introduction of the Nonsmoker Protection Act in 2007. Furthermore, the number of people with rather low cigarette consumption showed a significant increase.

Lung function decline in former smokers and low-intensity current smokers: a secondary data analysis of the NHLBI Pooled Cohorts Study

Former smokers now outnumber current smokers in many developed countries, and current smokers are smoking fewer cigarettes per day. Some data suggest that lung function decline normalises with smoking cessation; however, mechanistic studies suggest that lung function decline could continue. We hypothesised that former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers, including among those without prevalent lung disease. We used data on six US population-based cohorts included in the NHLBI Pooled Cohort Study. We restricted the sample to participants with valid spirometry at two or more exams. Two cohorts recruited younger adults (≥17 years), two recruited middle-aged and older adults (≥45 years), and two recruited only elderly adults (≥65 years) with examinations done between 1983 and 2014. FEV1 decline in sustained former smokers and current smokers was compared to that of never-smokers by use of mixed models adjusted for sociodemographic and anthropometric factors. Differential FEV1 decline was also evaluated according to duration of smoking cessation and cumulative (number of pack-years) and current (number of cigarettes per day) cigarette consumption. 25 352 participants (ages 17-93 years) completed 70 228 valid spirometry exams. Over a median follow-up of 7 years (IQR 3-20), FEV1 decline at the median age (57 years) was 31·01 mL per year (95% CI 30·66-31·37) in sustained never-smokers, 34·97 mL per year (34·36-35·57) in former smokers, and 39·92 mL per year (38·92-40·92) in current smokers. With adjustment, former smokers showed an accelerated FEV1 decline of 1·82 mL per year (95% CI 1·24-2·40) compared to never-smokers, which was approximately 20% of the effect estimate for current smokers (9·21 mL per year; 95% CI 8·35-10·08). Compared to never-smokers, accelerated FEV1 decline was observed in former smokers for decades after smoking cessation and in current smokers with low cumulative cigarette consumption (<10 pack-years). With respect to current cigarette consumption, the effect estimate for FEV1 decline in current smokers consuming less than five cigarettes per day (7·65 mL per year; 95% CI 6·21-9·09) was 68% of that in current smokers consuming 30 or more cigarettes per day (11·24 mL per year; 9·86-12·62), and around five times greater than in former smokers (1·57 mL per year; 1·00-2·14). Among participants without prevalent lung disease, associations were attenuated but were consistent with the main results. Former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers. These results suggest that all levels of smoking exposure are likely to be associated with lasting and progressive lung damage. National Institutes of Health, National Heart Lung and Blood Institute, and US Environmental Protection Agency.

Combination therapy of varenicline and bupropion in smoking cessation: A meta-analysis of the randomized controlled trials

BackgroundThe effects of the combination therapy of varenicline and bupropion in smoking cessation are still controversial. MethodsDatabases including PubMed, EMBASE, Cochrane Library and Web of Science were scanned without time and language limitation. Subgroup analysis was performed to assess the effect of combination therapy in smokers with different level of nicotine dependence and cigarette consumption. ResultsFour randomized controlled trials involving a total of 1230 smokers were included. Compared with varenicline monotherapy, combination treatment with varenicline and bupropion could significantly improve the abstinence rate at the end of treatment (RR 1.153, 95% CI 1.019 to 1.305, P=0.024). The benefit existed at 6months follow-up (RR 1.231, 95% CI 1.017 to 1.490, P=0.033), disappeared at 12months follow-up (RR 1.130, 95% CI 0.894 to 1.428, P=0.305), and mainly concentrated in highly dependent smokers (RR 1.631, 95% CI 1.290 to 2.061, P<0.001) and heavy smokers (RR 1.515, 95% CI 1.226 to 1.873, P<0.001) rather than individuals with low nicotine dependence (RR 0.989, 95% CI 0.815 to 1.199, P=0.907) or low cigarette consumption (RR 0.985, 95% CI 0.800 to 1.212, P=0.252). For safety outcomes, the combination treatment was associated with more anxiety (RR 1.717, 95% CI 1.176 to 2.505, P=0.005) and insomnia (RR 1.268, 95% CI 1.076 to 1.494, P=0.005) symptoms compared with varenicline monotherapy. ConclusionCompared with varenicline monotherapy, combination treatment with varenicline and bupropion can significantly improve the abstinence rate at the end of treatment and 6months follow-up, mainly in highly dependent smokers and heavy smokers.

Measures of nicotine dependence enhance interpretation of number of cigarettes smoked in youth smoking surveillance

BackgroundNicotine dependence (ND) symptoms can occur soon after first puff, so that stopping smoking becomes difficult well before 100 cigarettes lifetime is attained. Yet some surveillance systems do not monitor ND symptoms and 100-cigarettes lifetime is used in at least one surveillance system to define current smokers. To assess whether these features limit interpretation of grade-specific data in surveillance, we described smoking and ND symptoms across grade in incident vs. prevalent smokers, and in smokers according to 100-cigarettes lifetime. MethodsData were available in an investigation of 1294 grade 7 students from 10 Montreal-area high schools followed every 3 months from grade 7 to 11. Analyses described cigarette consumption, 100-cigarette lifetime consumption, cravings, withdrawal symptoms, mFTQ nicotine dependence and ICD-10 tobacco dependence by grade among past 3-month smokers. ResultsDespite low cigarette consumption, 21–30% of grade 7 smokers reported ND symptoms. This increased to 27–44% in grade 8 and remained stable thereafter despite increased cigarette consumption. In grade 7, 10% of all smokers had not attained the 100-cigarette milestone but were already dependent. In grade 8, 9, 10 and 11, these proportions were 12%, 8%, 6% and 6%, respectively. ConclusionsND symptoms should be monitored in youth surveillance systems since they tell a different “story” than cigarettes and their appearance may represent a critical “point-of-no-return.” Interventions for incident smokers are needed across grades to stop smoking before ND manifests. Without a shift in focus toward incident rather than established smokers, many children who try cigarettes will become addicted.

Analysis of Gender Differences in the Impact of Taxation and Taxation Structure on Cigarette Consumption in 17 ITC Countries.

Although increasing taxes has been established as the most effective tobacco control policy, it is not clear whether these policies reduce cigarette consumption equally among women and men. In this study, we examine whether the association between taxation/taxation structure and cigarette consumption differs by gender. The data is from the International Tobacco Control Policy Evaluation (ITC) Projects in 17 countries. Cigarette consumption was measured by gender for each ITC country. Generalized estimating equations (GEE) were employed to investigate gender differences in the association between cigarette consumption and tax structures, while controlling for time-variant demographic characteristics such as unemployment rates, proportions of adults, and percent of female population. Tiered tax structures are associated with higher cigarette consumption among both males and females. Female smokers are more responsive to an average tax increase than male smokers. Among males, higher ad valorem share in excise taxes is associated with lower cigarette consumption, but it is not the case for females. Females may not be as responsive to the prices raised by ad valorem taxes, despite being responsive to average taxes, suggesting that smokers by gender may face different prices.

Tobacco Use and Cessation Behaviors in Young Adults: 2016 National Health Interview Survey.

To examine differences in tobacco use and cessation between young adults (aged 18-24 years) and adults aged 25 years or older. We used data from the 2016 US National Health Interview Survey (n = 33 028) to identify 13 494 current and former cigarette smokers (562 aged 18-24 years; 12 932 aged 25 years or older). We analyzed correlations between age group, cigarette smoking, cessation behaviors, and other tobacco and nicotine use. Among current and former smokers, those aged 18 to 24 years had lower odds of having quit for 1 year or longer and higher odds of having tried e-cigarettes, cigars, pipes, and smokeless tobacco compared with adults aged 25 years or older, as well as higher odds of daily e-cigarette and smokeless tobacco use. Young adult smokers used fewer cigarettes per day than did those aged 25 years or older (mean = 8.8 vs 12.3), had higher odds of making a past-year quit attempt (adjusted odds ratio [AOR] = 1.42), and had lower odds of having a health professional talk to them about smoking (AOR = 0.44). Greater experimentation with noncigarette products, lower cigarette consumption, and greater interest in quitting smoking invite novel intervention approaches to tobacco reduction, cessation, and relapse prevention in young adults.

Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports

ObjectiveTo use the relation between cigarette consumption and cardiovascular disease to quantify the risk of coronary heart disease and stroke for light smoking (one to five cigarettes/day).DesignSystematic review and meta-analysis.Data...

Effects of Pictorial Warning Labels for Cigarettes and Quit-Efficacy on Emotional Responses, Smoking Satisfaction, and Cigarette Consumption.

Experimental research on pictorial warning labels for cigarettes has primarily examined immediate intentions to quit. Here, we present the results of a clinical trial testing the impact on smoking during and after a 28-day period of naturalistic exposure to pictorial versus text-only warnings. Daily cigarette smokers (N = 244) at two sites in the USA were randomly assigned to receive their regular brand of cigarettes for 4 weeks with one of three warnings: (a) text-only, (b) pictures and text as proposed by FDA, or (c) the warnings proposed by FDA with additional text that elaborated on the risks of smoking. Analyses examined the effects of pictorial versus text-only warnings and self-efficacy for quitting on cigarette consumption during and 1 month after the trial as mediated by emotional and cognitive responses as well as satisfaction with smoking. Stronger emotional responses to pictorial than text-only warnings predicted reduced satisfaction with smoking during the trial and lower cigarette consumption at follow-up among the majority of smokers who continued to smoke. Consistent with the efficacy-desire model, those with moderate efficacy reported the greatest reduction in consumption at follow-up. However, a small proportion of smokers (7%) who reported 7-day abstinence at follow-up did not exhibit a significant relation with self-efficacy. Pictorial warning labels proposed by FDA create unfavorable emotional reactions to smoking that predict reduced cigarette use compared to text alone, with even smokers low in self-efficacy exhibiting some reduction. Predictions that low self-efficacy smokers will respond unfavorably to warnings were not supported.

Smoking Behaviour in Germany Evidence from the SOEP

As in most OECD countries, smoking prevalence and cigarette consumption have been decreasing in Germany since the early 2000s. This paper analyses whether smoking prevalence and cigarette consumption, as well as their development over time, differ between socio-economic subgroups. Identifying these differences provides insights into the effect of policy interventions on German smoking behaviour. Based on data from the Socio-Economic Panel (SOEP), a large longitudinal study of the German population, we find that both the decline in smoking prevalence and the decline in average cigarette consumption were probably driven by a behavioural change of younger people, as well as of those with a high educational level and those with a high income. People who quit smoking were on average more highly educated, had a higher income and had most likely a lower cigarette consumption (before quitting). In contrast, smoking prevalence increased among people who were older than 45 and had a low educational level and among those who were unemployed. Smoking prevalence among women was relatively constant over time. Indeed, the smoking prevalence of women and men converged over time, especially in older age groups. Daily cigarette consumption of smokers increased among 66-to-75-year-olds, although it decreased in all other age groups. One explanation might be that the tobacco control measures were successful only in certain socio-economic subgroups. Not only smoking prevalence, but also smoking intensity was higher among men, among those with a lower educational level and among those with a lower income. Especially for younger birth cohorts, smoking prevalence among those with a lower educational level was particularly high. Thus, based on data from 1998 through 2014, the so-called social gradient in smoking was only a distinct feature of younger birth cohorts, and not of older ones.

Low cigarette smoking prevalence in peri-urban Peru: results from a population-based study of tobacco use by self-report and urine cotinine

BackgroundA recent study found lower self-reported prevalence of tobacco smoking in a peri-urban area of Lima, Peru than previously reported in urban samples. These regions encompass substantial proportions of Peru’s population – ones at greater risk of disease due to reduced healthcare access – but have been less often studied. We validate low smoking prevalence with urine cotinine and characterize chronic disease and lung function outcomes between non-, occasional, and daily smokers.MethodsData are from the CRONICAS Cohort Study, a population-based longitudinal study in four low-resource Peruvian settings, which began in 2010. Of a baseline cohort of 2978 adults, we prospectively followed 2583 (87%) to determine prevalence of chronic illness.ResultsIn a baseline sub-sample of 382 participants, median adjusted cotinine was 0.0 mcg/mg (IQR 0–0) for both self-reported non-smokers and occasional smokers compared to 172.3 mcg/mg (IQR 0–709.2) for daily smokers. Creatinine-adjusted cotinine validated daily smoking prevalence of 4.7% at a cutoff of 100 mcg/mg. Kappa statistic for daily smoking and creatinine- adjusted cotinine ≥100 mcg/mg was 0.65 (95% CI 0.47, 0.83), indicating substantial agreement. At baseline, we found 3.3% daily and 8.9% occasional smoking by self-report for the full cohort. Follow-up indicated little difference in chronic disease prevalence between groups. Daily smokers trended toward having a greater decline in FVC (−1%; 95% CI -2.9, 0.8) and FEV1 (−1.3%; 95% CI -3.2, 0.6) over 40 months when compared to non-smokers, whereas the decline in lung function for occasional smokers was similar compared to non-smokers (−0.2% FVC; 95% CI -1.5, 1.0) and (0% FEV1; 95% CI -1.3, 1.3).ConclusionsOur data places Peru within a previously-described pattern of smoking found in much of Latin America, favoring occasional over daily smoking and low cigarette consumption. We determine that there are not significant differences between smoking groups concerning chronic disease outcomes. We favor distinguishing between daily and occasional smokers in order to accurately characterize these low-use populations.

Cigarette Smoking During Pregnancy: Do Complete Abstinence and Low Level Cigarette Smoking Have Similar Impact on Birth Weight?

Despite awareness of negative health outcomes associated with smoking, pregnant smokers might reduce their tobacco consumption thinking that a low smoking rate reduces smoking-related negative birth outcomes. We aimed to assess in a clinical sample whether there is a smoking rate that would not impact on birth weight (BW). Pregnant smokers ≥18 years, gestational age of 9-20 weeks of amenorrhea, motivated to quit smoking, smoking ≥5 cigarettes/day (cpd) and their newborns (381 singleton, live births) were included in this secondary analysis of a French smoking cessation trial. The mean BW when the mother quit smoking was 3417 g (95 % CI: 3098-3738 g); when smoking >0<5 cpd, 3081g (3003-3159 g); when smoking 5-9 cpd, 3043 g (2930-3157 g); and when smoking ≥10 cpd, 2831 g (2596-3157 g) (p = .006). The corresponding effect sizes ranged from medium to large (Cohen's d for BW: 0.54, 0.57 and 0.85) compared to BW when the mother quit. In the multivariable analysis, adjusted for all significant confounders, when the mother smoked on average >0<5 cpd, the loss in BW was 228 g; when smoking 5-9 cpd, 251 g; and when smoking ≥10 cpd, 262 g (all p ≤ .02) compared to newborns' BW of mothers who stopped smoking since quit date. Even low cigarette consumption during pregnancy is associated with BW loss. All efforts should be made to help pregnant smokers quit completely during their pregnancy. As an alternative to quitting smoking, pregnant smokers reduce their smoking rate thinking that this diminishes smoking-related negative health outcomes. No study has established whether low smoking rate (more than 0 but less than 5 cpd) during pregnancy impacts BW compared to abstinence from smoking. Among treatment-seeking pregnant smokers BW of newborns of mothers who smoked even less than 5 cpd was significantly lower than of those whose mothers quit; effect sizes of different consumption levels on BW ranged from moderate (>0<5 cpd) to large (≥10 cpd). Even low smoking rate is associated with reduced BW compared to complete maternal smoking abstinence.