The Changing Profile of Smokers
The number of people who light up 'only for social reasons' is growing quickly, especially among the young. The trend has experts pondering the impact on people's health.
Some are posers who simply want an accessory with their designer gin, something to flick and flourish for public consumption. Others are weekend bingers who can't resist mooching a few whenever there's talk and drink around. And some are true heavyweights, cutting down, choosing their moments, trying to get clean.
Together they form the fastest-growing category of tobacco users of the modern smoke-free era: social, or occasional, smokers, who light up regularly but not daily. In 1990, about 18% of California smokers said they fit this description. By 1998, the most recent year for which data are available, the rate among California smokers had climbed to almost 30%. And although numbers on so-called occasionals are still sketchy, national trends appear headed in the same direction, even as overall consumption decreases.
"When we first reported on the size of this group a few years ago," says John Pierce, a cancer prevention specialist at UC San Diego, "no one believed us. We were all accustomed to thinking of smokers as people who smoked a pack a day or more. Now researchers everywhere are finding rates of 18% and higher. We are witnessing an enormous change in smoking behavior."
Public health researchers attribute the change in part to stricter anti-smoking laws, particularly workplace bans, which California began enforcing in 1994. But at least as important, they say, are the restraints that many smokers are placing on themselves, such as married people who have volunteered to take their smoking outside in consideration of their spouse or children.
"The result," Pierce says, "is that there's no place left to smoke, except maybe the car or the garden." In effect, public and private restrictions are stripping the habit of its most traditional, most intimate connections: the coffee break, the pre- and post-lunch treat, the emergency stress-reducer, even the after-sex smoke.
This smoke-free environment shapes the habits of younger smokers most of all, public health researchers say. Many younger than 25 who are experimenting with cigarettes haven't really had the chance to string together a pack's worth of smokes through a day, to establish a daily routine. They're not allowed to do so, at least if they work in an office. Almost half of California smokers in this age group are social users, Pierce says. The downside, addiction specialists say, is that rates of smoking are on the rise among younger people, and many who start in their late teens and early 20s seem to consider cigarettes a strictly social, and therefore mostly harmless, pleasure.
"The only time I smoke is when I'm out, drinking beer," says Gerardo Guzman, 26, a Cal State Northridge student who works for a public advocacy organization in San Fernando. Guzman goes out with friends about once a month, typically burning three or four butts each time. "That's about it. I can't smoke at work, I can't smoke at home. My environment doesn't really allow me to be a regular smoker. And thankfully, my beer habit isn't very large." He's been smoking in this way, off and on, for nine years.
Gretchen Harrington, 32, an administrative secretary at a drug and alcohol counseling center in Los Angeles, is a former everyday smoker who's down to about five cigarettes a week.
"One or two at parties, on the weekends," she says, "and sometimes I'll have one during the week, when I see co-workers smoking outside the building." A once-in-a-while smoker for four years now, Harrington isn't worried about falling back into bad habits. "I'm too busy most of the time," she says, "to be leaving the building to smoke."
Certainly, part-timers like these are no longer a curiosity; they are challenging the conventional understanding of smoking itself. These are cigarettes, after all: butts, twigs, coffin nails, cancer sticks; by any name, as habit-forming as it gets. Most rehabilitation specialists and drug users rate nicotine as the most addictive drug of all, ahead of alcohol, rock cocaine and powder, even heroin.
Yet many strongly addicted smokers appear to be maintaining social habits.
"Some of these people are not only cutting down," says Saul Shiffman, a University of Pittsburgh psychologist who has made a specialty of studying occasional smokers. "They seem to be changing the reasons they smoke. They're lighting up more for reward, as a treat, than to reduce stress or to satisfy cravings."
In a 1994 study among heavy smokers and lifelong occasional users, or "chippers," Shiffman found precisely that pattern: occasionals smoking for pleasure, as a rule, and full-timers lighting up to fend off discomfort. Some former heavy smokers probably "are being converted to chippers," Shiffman says. "And we know from other cultures that this kind of light smoking can be sustained." In some Latin American countries, for instance, regular smokers average fewer than 10 cigarettes a day, Shiffman says. The same goes for many Latino men and women in the United States.
"Certainly we find that social, occasional smoking is very common in these communities," Pierce says. "It's simply the way a lot of Latinos smoke."
As hooked as many smokers are, in short, they still exercise considerable control over their habits. When the price of cigarettes goes up, they tend to smoke less. When anti-tobacco advertising is in full force, say public policy researchers, many smokers cut down. Even the decision to buy smokes by the pack instead of by the carton is an act of self-restraint. And now, for the first time, social pressures are forcing large numbers of smokers to control themselves every day.
The danger of more modest smoking, doctors hasten to say, is that smokers don't think of it as a bad habit.
"I hear this all the time," says Dr. Vanessa Tatum, a spokeswoman for the American Lung Assn. who has a practice in Inglewood. "When I ask females between the ages of 21 and 30 whether they smoke, I'd say about 75% of them say, 'No, not really.' They don't think of themselves as smokers, and some of them are smoking a pack or more every weekend."
Tatum is afraid that many of these younger smokers may be fooling themselves, as well as setting themselves up for a lifelong habit that will be as hard to break as any old-fashioned, pack-a-day jones. By telling themselves they're just being social, she says, they avoid confronting the very real health risks of even light smoking.
To be sure, most occasionals run nowhere near the health risks that heavy smokers do. The relationship between smoking and disease is what doctors call dose-response: the more you smoke, the higher your risk of getting sick. A pack a month is much easier on the body than a pack a day, for example, which roughly quadruples your risk of developing heart disease or cancer, compared with a nonsmoker. But tobacco is still strong poison, in virtually any dose. Unlike alcohol, which in moderate doses may actually impart cardiovascular benefits, tobacco is all bad.
"For the guy who smokes a single cigarette every New Year's Eve, there's probably no increased disease risk at all," says David Burns, an authority on tobacco health risk at UC San Diego. "But the risk levels go up very quickly as soon as you start smoking weekly or even monthly."
On average, Burns says, a social smoker who has five or 10 cigarettes a week probably hikes his or her lifetime risk of lung cancer by two times and of heart disease by one and half times.
But because of genetic differences and individual quirks, some people are either far less--or far more--susceptible to tobacco's effects. As one pulmonologist put it: "That's why George Burns could smoke 10 cigars a day and live to be 100, and Mary down the street smoked for only a few years, but she's got cancer at age 40."
Since there's no way to distinguish the Georges from the Marys, doctors see social smoking as a kind of Russian roulette, especially for those with a family history of cancer or heart disease.
In short order, doctors should understand these risks a lot better--for occasionals soon may be as common as the everyday variety.
"The social costs of smoking keep going up," Pierce says. "It's becoming more like marijuana or heroin use. You can't use those drugs habitually, during the day, because it's just not acceptable. . . .
"Not long ago, everyone knew a three-pack-a-day smoker. Now no one does. Those kind of smokers barely exist anymore."