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‘Occasional’ and ‘social’ smokers: potential target groups for smoking cessation campaigns?

‘Occasional’ and ‘social’ smokers: potential target groups for smoking cessation campaigns? Objective: To describe the characteristics of self-described ‘occasional’ and ‘social’ Australian smokers. Design: Analysis of a national crosssectional survey of smoking patterns, conducted in Australia in 2004. Setting and participants: Australian adults in 2004 who responded to a survey question about self-described smoking status. Main outcome measures: Demographic characteristics, patterns of alcohol and tobacco use, smoking cessation attempts in the past year, and interest in cessation. Results: Smokers who described themselves as ‘occasional’ and ‘social’ smokers comprised 29% of all smokers. A significant proportion of occasional and social smokers had been daily smokers, but the majority either believed that they had ‘already quit’ or had no intention of quitting smoking. Conclusions: Self-ascribed occasional and social smokers potentially represent an important target group for cessation. These types of smokers may be more resistant to public health messages regarding cessation because they do not view their smoking behaviour as presenting a high risk. (Aust N Z J Public Health 2006; 30: 550-4) Katherine I. Morley Genetic Epidemiology Group, Queensland Institute of Medical Research, and School of Population Health, University of Queensland Wayne D. Hall School of Population Health, University of Queensland Katrin Hausdorf, Neville Owen Cancer Prevention Research Centre, University of Queensland ver the past 30 years, many countries have implemented public health strategies that aim to reduce the uptake of smoking and encourage existing smokers to quit.1 In Australia, these have included: increasing taxes on tobacco products, banning cigarette advertising beyond point-of-sale, placing mandatory warnings about the health risks of smoking on cigarette packaging, limiting public areas in which tobacco can be smoked, banning sales to minors, and publicly funding antitobacco and quit-smoking campaigns.2,3 Tobacco control policies of the 1980s and 1990s in Australia have been associated with significant decreases in the prevalence of smoking and cigarette consumption per capita.3 Despite this decline in prevalence, a substantial proportion of the Australian population continues to smoke. The most recent national population survey (the National Drug Strategy Household Survey, 2004) found that the proportion reporting themselves to be ex-smokers (approximately 25%) has changed very little since 1998.4 This phenomenon, which has been observed in many countries where tobacco control policies have been implemented, has sparked debate about the characteristics of the remaining smokers. 5,6 Some argue that tobacco control strategies have effectively encouraged the less-dependent, morereceptive smokers to quit, leaving behind a more dependent hard core of smokers. Others argue that smoking behaviour among continuing smokers has not changed, but that current smoking cessation messages may be less effective in reaching certain groups of smokers, such as those from lower socio-economic backgrounds (for further discussion of this issue see references 5 and 6). There are also a growing number of smokers who continue to smoke at a lower rate, either daily or less frequently. This group has been described as “chippers”,7 “low-rate smokers”, 8 and non-daily or “occasional” smokers.9 Research on smokers exhibiting this type of behaviour is limited, partially because there is no definition that is consistent across studies. We took a different approach to examining the characteristics of these smokers by using data from an Australian national survey to examine the characteristics of smokers who perceived themselves to only be ‘occasional’ or ‘social’ smokers. We were particularly interested in their attitudes towards smoking cessation. We took this approach, rather than categorising smokers according to their reported cigarette consumption, to gain some insight into how these types of smokers view their own smoking behaviour. This Submitted: March 2006 Revision requested: June 2006 Accepted: October 2006 Correspondence to: Dr Katherine Morley, Genetic Epidemiology Group, Queensland Institute of Medical Research, PO Royal Brisbane Hospital, Brisbane, Queensland 4029. Fax: (07) 3362 0101; e-mail: kateM@qimr.edu.au AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2006 vol. 30 no. 6 Risks Smoking cessation campaigns and ‘occasional’ and ‘social’ smokers type of information may be useful for targeting of public health interventions to such smokers. Methods The data used for these analyses came from the 2004 National Drug Strategy Household Survey (NDSHS), obtained from the Australian Social Science Data Archive.10 This survey is one of a series of national household surveys that have aimed to assess attitudes towards, and use of, licit and illicit drugs. It was managed by the Australian Institute of Health and Welfare on behalf of the Australian Government Department of Health and Ageing, and conducted by Roy Morgan Research. Households were selected using a multi-staged, stratified random sample design, with intentional over-sampling in some States and Territories.11 The total sample consisted of 29,445 respondents. The age of the respondents was 12 years and older. The response rate was 46%, which was similar to previous surveys.11 Nonresponse to voluntary surveys is know to be associated with being male, substance use, and older age (see reference 12 for discussion), and thus it is possible that the analyses we conducted have underestimated the prevalence of smoking and may not be fully representative of Australian males, particularly those from older age groups. Our analyses were confined to those aged 18 years and over at the time of survey because younger participants were not considered to have had sufficient time to develop stable smoking behaviours. They were also not legally permitted to buy cigarettes in any Australian States or Territories. This reduced our sample size to 26,724. We used the NDSHS data to examine the characteristics of different subgroups of smokers who had classified themselves according to their own interpretation of their smoking behaviour. All participants were asked to answer the question “At the present time do you consider yourself…?”, with the response options being: a non-smoker; an ex-smoker; an occasional smoker; a light smoker; a social smoker; a heavy smoker; or, a chain smoker. Because of the small number of self-described chain-smokers (n=83), we combined heavy smokers and chain smokers for analytical purposes. We compared these self-described groups of smokers on a number of variables: birth cohort, sex, marital status, employment, education, and geographical location, on their patterns of alcohol and tobacco use, and on quit attempts. Checking the information on smoking behaviour across several different questions about smoking identified a number of inconsistencies that were dealt with as follows. First, 118 persons who reported not having tried tobacco or not having smoked a full cigarette yet, but subsequently classified themselves as smokers were removed. Second, we excluded 206 self-classified smokers who were not asked to complete the smoking behaviour questions because they had not smoked more than 100 cigarettes in their lifetime. We excluded from the analyses 1,201 self-classified non-smokers who reported smoking in the past year because their smoking status could not be determined with confidence. A small number of ex-smokers who reported smoking in the past year (n=62) were also excluded. We reclassified as ex-smokers 2006 vol. 30 no. 6 4,729 respondents who classified themselves as non-smokers, but reported previously smoking regularly and who had not smoked in the previous 12 months. In total (excluding those under 18 years) 1,587 were excluded from our analyses, leaving 25,137 eligible respondents of whom 284 did not answer any of the smoking selfclassification categories. The final sample was 24,853. Of these respondents, 2,241 were missing a response for the demographic variables. Those missing data differed only in employment (more likely to be employed full time; p<0.01) and education (more likely to have less education; p<0.05) from those without missing data. There were no significant differences in relation to other demographic variables or smoking status, so those missing data were removed from further analysis. Among smokers, 11 were missing information on tobacco use. There were no significant differences between those with and without missing data for tobacco use, so only those with complete data were analysed. We did not exclude those missing data for the two questions on quit attempts and plans to quit. This was because an individual’s perception of their smoking behaviour may have influenced whether or not they felt those questions applied to them. The final sample was 22,601 respondents. Data were analysed with Stata version 8,13 using options for analysis of survey data. Conventional χ2 tests were used to test for associations between smoking subgroups and variables of interest. Results Just over 23% of the final sample classified themselves as current smokers, with these comprising: occasional smokers (12%), social smokers (17%), light smokers (32%), and heavy or chain smokers (39%). Smokers were all more likely to be born in the youngest birth cohorts than non-smokers or ex-smokers (see Table 1), although the proportion of heavy smokers born 1970-1986 was lower than for other types of current smokers. The proportion of females ranged from 42% to 50% among smokers, and was similar for ex-smokers (45%) but substantially higher among non-smokers (56%). The smoking subgroups differed substantially in terms of demographic variables (see Table 1). Occasional smokers were the most likely subgroup to be married or in a de facto relationship (64%), followed by light and heavy smokers (both 58%), while social smokers were the most likely to be single (37% never married). One of the most striking differences between the smoking subgroups was in socio-economic indicators. Occasional smokers were the most likely to be employed (74%) compared with around 65% for social, light and heavy smokers. Occasional smokers were also more likely to have a tertiary qualification than any other smoking subgroup (30% versus between 12% and 16% for the other groups). In fact, the proportion with tertiary education was higher than that of ex-smokers (23%), and similar to that of non-smokers (31%). Occasional smokers were also more likely to live in urban areas (68%) compared with the other smoking subgroups (between 59% and 61%). Occasional and social smokers reported similar patterns of AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Morley et al. Article drinking frequency; the majority of both groups (approximately 50%) reported drinking alcohol on 1-4 days each week. In comparison, light and heavy smokers were more likely to report drinking alcohol less than weekly. Smokers were generally heavier drinkers than non-smokers or ex-smokers, and social and heavy smokers generally reported drinking more on those days when they drank. The smoking subgroups differed significantly in their use of tobacco (see Table 2). More than 90% of light and heavy smokers smoked daily. While only 68% of social smokers smoked daily, a further 21% reported a past history of daily smoking. In comparison, only 19% of occasional smokers smoked daily although an additional 61% had previously smoked daily. Interestingly, 20% of occasional and 11% of social smokers reported that they had never been daily smokers. Occasional and social smokers were the only subgroups in which smoking less than daily was endorsed by a substantial proportion of respondents. Among occasional smokers, 29% reported smoking weekly and 33% reported smoking less than weekly. Of social smokers, 13% reported smoking weekly and a further 12% reported smoking less than weekly. The majority of occasional smokers (89%) reported smoking less than 36 cigarettes per week, whereas only 38% of social smokers reported this low level of cigarette consumption. The majority of light and social smokers reported smoking between 36 and 150 cigarettes per week. Most heavy smokers reported smoking more than 70 cigarettes per week. Occasional smokers also differed from other types of smokers in their attitudes towards smoking cessation (see Table 2). They were the least likely to have made a quit attempt in the past 12 months: 16% compared with around 38% among light and social smokers and 66% among heavy smokers. There were also striking differences in future plans to quit: 28% of occasional smokers reported that they were not planning a quit attempt because they had “already quit”; 7% of social smokers reported the same. A further 25% of occasional smokers reported that they were not planning to give up, a figure similar to that for the other smoking subgroups (range 28-34%). A large proportion of occasional and social smokers (23% and 10% respectively) did not provide a response to the question regarding quit attempts in the past 12 months. However, 58% of those who did not answer this question subsequently said that they had “already quit” (data not shown), suggesting that the majority of non-response to this question was due to the fact that occasional and social smokers did not believe the question applied to them. Table 1: Characteristics of persons with different self-described smoking status. Percentages are shown with standard errors (SE). Non-smoker % SE Number Birth cohort 1906-39 1940-69 1970-86 Percentage female Martial status Never married Widowed/divorced/sep Married or de facto Percentage employed Highest education Incomplete high school High school Certificate or diploma Tertiary qualification Percentage urban Drinking frequency Current non-drinker 2-3 days per month or less 1-4 days per week 5-7 days per week Drinking quantity Current non-drinker 1-4 drinks 5-10 drinks 11+ drinks 11,282 15.1 49.7 35.3 55.6 24.8 9.9 65.4 60.0 17.9 21.0 30.3 30.8 67.2 19.8 34.7 32.9 12.6 19.8 67.3 10.7 2.3 0.4 0.6 0.6 0.6 0.5 0.3 0.5 0.5 0.4 0.5 0.5 0.5 0.4 0.5 0.5 0.5 0.4 0.5 0.5 0.4 0.2 Ex-smoker % SE 6,114 23.4 64.3 12.4 45.3 7.2 13.2 79.5 55.4 23.4 14.9 38.7 23.1 61.3 9.2 25.8 34.0 31.1 9.2 77.2 12.6 1.1 0.6 0.7 0.5 0.7 0.4 0.4 0.6 0.7 0.6 0.5 0.7 0.6 0.6 0.4 0.6 0.7 0.7 0.4 0.6 0.5 0.2 Occasional % SE Light SE 1,680 Social % SE Heavy % SE 2,107 p value <0.001 6.3 51.1 42.6 50.0 28.4 13.8 57.8 66.0 19.7 22.6 42.7 15.0 59.0 8.0 33.5 40.0 18.6 8.0 61.8 23.8 6.4 0.6 1.5 1.5 1.5 1.4 0.9 1.5 1.4 1.1 1.3 1.5 1.1 1.4 0.8 1.4 1.5 1.2 0.8 1.5 1.3 0.8 4.0 58.7 37.4 46.7 26.4 16.1 57.6 63.2 29.5 21.6 37.1 11.8 60.1 8.6 34.5 31.4 25.5 8.6 54.6 28.3 8.5 0.4 1.3 1.3 1.3 1.2 0.8 1.3 1.3 1.2 1.2 1.3 0.8 1.2 0.7 1.3 1.2 1.1 <0.001 0.7 1.3 1.2 0.8 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2006 vol. 30 no. 6 Risks Smoking cessation campaigns and ‘occasional’ and ‘social’ smokers Discussion Self-described occasional and social smokers make up a substantial proportion (some 29%) of the smoking population. They are more likely to be present in younger birth cohorts and to have patterns of drinking and smoking behaviour that are somewhat different to those of light or heavy smokers. The occasional smokers in this sample are of particular interest. They generally smoked less frequently (weekly rather than daily) and consumed less tobacco on a weekly basis than other smoking subgroups. Additionally, their socio-economic attributes were more similar to non-smokers than to other current smokers. This self-categorisation of smoking behaviour was undefined so we cannot be sure that all smokers interpreted the categories in the same fashion. Indeed, some self-described occasional smokers reported smoking every day. Nonetheless, there were some consistent differences between occasional and social smokers as compared with light and heavy smokers. Only among occasional and social smokers were there substantial proportions of ex-daily and never-daily smokers, and they were the only types of smokers who believed that they had “already quit” smoking. This suggests that while self-description of smoking status has its limitations, it may provide some important insights into how smokers view their behaviour and the necessity to quit smoking. These findings mirror those from research in the United States (US) on occasional smokers, which suggests that former daily smokers who now smoke occasionally, and also occasional smokers who have never smoked daily, are less likely than current daily smokers to believe that they are addicted to tobacco. They are also more likely to believe that they will be successful in quitting if they decide to do so.9 Thus these smokers may be less receptive to messages about the need to quit if they perceive their smoking to be less risky than do daily smokers. Occasional smokers have often been considered as an anomaly, but it is clear that they represent a significant proportion of the continuing smokers in Australia as well as in the US.5,6 Occasional, and possibly social, smoking may represent a stable pattern of smoking, or a transitional phase either between initiation and daily smoking, or between regular smoking and cessation. Research from Australia and elsewhere suggests that these types of smokers represent a combination of all three trajectories.9,14-16 What remains unclear is whether this type of smoking behaviour is a response to increased tobacco control measures, particularly bans on smoking in the workplace and increased public health messages regarding the health risks of smoking. It is of concern that high proportions of Australians who are occasional and social smokers do not plan to quit smoking or do not believe they need to consider quitting. These smokers could be targeted by quit smoking messages that emphasise the risks of this pattern of continued smoking. While consistent low-rate smoking may be associated with a lower risk of tobacco-associated health Table 2: Smoking behaviour and quit attempts among adults with different self-ascribed smoking status. Percentages are shown with standard errors (SE). Occasional % SE Proportion of smokers Daily smoking Smoke daily now Used to smoke daily Never daily Current frequency Daily Weekly Less than weekly None (but last 12 months) Not in last 12 months Weekly quantity – cigarettes 0-35 36-70 71-150 151+ Quit attempts (12 months) Did attempt Did not attempt No response Planning to quit No, already quit Yes, planning to quit Not planning to quit No response 11.9 18.7 61.5 19.8 18.7 28.7 32.7 18.2 1.8 89.4 6.8 3.3 0.5 16.5 60.6 22.9 28.4 39.1 25.2 7.4 0.5 2.0 2.4 2.0 2.0 2.2 2.3 1.8 0.6 1.9 1.3 1.3 0.5 1.9 2.4 2.0 2.2 2.4 2.1 1.3 Light % SE Social % SE Heavy+ % SE p value <0.001 0.1 0.1 0.1 <0.001 0.1 0.1 0.0 0.0 0.1 <0.001 0.6 0.9 1.4 1.4 <0.001 1.2 1.2 0.3 <0.001 0.1 1.3 1.2 0.4 2006 vol. 30 no. 6 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Morley et al. Article problems (compared with heavy smoking), quitting still provides the greatest risk reduction.17 These results also raise two important questions regarding the impact of public health interventions on smoking research. First, how will smoking bans in pubs and clubs affect the proportion of smokers who are occasional or social smokers in Australia? Second, will increasing social disapproval of smoking make people less likely to disclose their smoking behaviour and thus affect the reliability of the self-reported measures of smoking, upon which we rely in planning and assessing the impact of tobacco control initiatives? Acknowledgements We thank Dr Coral Gartner and three anonymous reviewers for helpful comments on this manuscript. Katherine Morley is supported by an Ian Scott Fellowship from the Australian Rotary Health Research Fund. The contributions of Neville Owen were supported by a Research Infrastructure Grant from Queensland Health. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

‘Occasional’ and ‘social’ smokers: potential target groups for smoking cessation campaigns?

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Publisher
Wiley
Copyright
Copyright © 2006 Wiley Subscription Services, Inc., A Wiley Company
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1467-842X.2006.tb00784.x
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Abstract

Objective: To describe the characteristics of self-described ‘occasional’ and ‘social’ Australian smokers. Design: Analysis of a national crosssectional survey of smoking patterns, conducted in Australia in 2004. Setting and participants: Australian adults in 2004 who responded to a survey question about self-described smoking status. Main outcome measures: Demographic characteristics, patterns of alcohol and tobacco use, smoking cessation attempts in the past year, and interest in cessation. Results: Smokers who described themselves as ‘occasional’ and ‘social’ smokers comprised 29% of all smokers. A significant proportion of occasional and social smokers had been daily smokers, but the majority either believed that they had ‘already quit’ or had no intention of quitting smoking. Conclusions: Self-ascribed occasional and social smokers potentially represent an important target group for cessation. These types of smokers may be more resistant to public health messages regarding cessation because they do not view their smoking behaviour as presenting a high risk. (Aust N Z J Public Health 2006; 30: 550-4) Katherine I. Morley Genetic Epidemiology Group, Queensland Institute of Medical Research, and School of Population Health, University of Queensland Wayne D. Hall School of Population Health, University of Queensland Katrin Hausdorf, Neville Owen Cancer Prevention Research Centre, University of Queensland ver the past 30 years, many countries have implemented public health strategies that aim to reduce the uptake of smoking and encourage existing smokers to quit.1 In Australia, these have included: increasing taxes on tobacco products, banning cigarette advertising beyond point-of-sale, placing mandatory warnings about the health risks of smoking on cigarette packaging, limiting public areas in which tobacco can be smoked, banning sales to minors, and publicly funding antitobacco and quit-smoking campaigns.2,3 Tobacco control policies of the 1980s and 1990s in Australia have been associated with significant decreases in the prevalence of smoking and cigarette consumption per capita.3 Despite this decline in prevalence, a substantial proportion of the Australian population continues to smoke. The most recent national population survey (the National Drug Strategy Household Survey, 2004) found that the proportion reporting themselves to be ex-smokers (approximately 25%) has changed very little since 1998.4 This phenomenon, which has been observed in many countries where tobacco control policies have been implemented, has sparked debate about the characteristics of the remaining smokers. 5,6 Some argue that tobacco control strategies have effectively encouraged the less-dependent, morereceptive smokers to quit, leaving behind a more dependent hard core of smokers. Others argue that smoking behaviour among continuing smokers has not changed, but that current smoking cessation messages may be less effective in reaching certain groups of smokers, such as those from lower socio-economic backgrounds (for further discussion of this issue see references 5 and 6). There are also a growing number of smokers who continue to smoke at a lower rate, either daily or less frequently. This group has been described as “chippers”,7 “low-rate smokers”, 8 and non-daily or “occasional” smokers.9 Research on smokers exhibiting this type of behaviour is limited, partially because there is no definition that is consistent across studies. We took a different approach to examining the characteristics of these smokers by using data from an Australian national survey to examine the characteristics of smokers who perceived themselves to only be ‘occasional’ or ‘social’ smokers. We were particularly interested in their attitudes towards smoking cessation. We took this approach, rather than categorising smokers according to their reported cigarette consumption, to gain some insight into how these types of smokers view their own smoking behaviour. This Submitted: March 2006 Revision requested: June 2006 Accepted: October 2006 Correspondence to: Dr Katherine Morley, Genetic Epidemiology Group, Queensland Institute of Medical Research, PO Royal Brisbane Hospital, Brisbane, Queensland 4029. Fax: (07) 3362 0101; e-mail: kateM@qimr.edu.au AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2006 vol. 30 no. 6 Risks Smoking cessation campaigns and ‘occasional’ and ‘social’ smokers type of information may be useful for targeting of public health interventions to such smokers. Methods The data used for these analyses came from the 2004 National Drug Strategy Household Survey (NDSHS), obtained from the Australian Social Science Data Archive.10 This survey is one of a series of national household surveys that have aimed to assess attitudes towards, and use of, licit and illicit drugs. It was managed by the Australian Institute of Health and Welfare on behalf of the Australian Government Department of Health and Ageing, and conducted by Roy Morgan Research. Households were selected using a multi-staged, stratified random sample design, with intentional over-sampling in some States and Territories.11 The total sample consisted of 29,445 respondents. The age of the respondents was 12 years and older. The response rate was 46%, which was similar to previous surveys.11 Nonresponse to voluntary surveys is know to be associated with being male, substance use, and older age (see reference 12 for discussion), and thus it is possible that the analyses we conducted have underestimated the prevalence of smoking and may not be fully representative of Australian males, particularly those from older age groups. Our analyses were confined to those aged 18 years and over at the time of survey because younger participants were not considered to have had sufficient time to develop stable smoking behaviours. They were also not legally permitted to buy cigarettes in any Australian States or Territories. This reduced our sample size to 26,724. We used the NDSHS data to examine the characteristics of different subgroups of smokers who had classified themselves according to their own interpretation of their smoking behaviour. All participants were asked to answer the question “At the present time do you consider yourself…?”, with the response options being: a non-smoker; an ex-smoker; an occasional smoker; a light smoker; a social smoker; a heavy smoker; or, a chain smoker. Because of the small number of self-described chain-smokers (n=83), we combined heavy smokers and chain smokers for analytical purposes. We compared these self-described groups of smokers on a number of variables: birth cohort, sex, marital status, employment, education, and geographical location, on their patterns of alcohol and tobacco use, and on quit attempts. Checking the information on smoking behaviour across several different questions about smoking identified a number of inconsistencies that were dealt with as follows. First, 118 persons who reported not having tried tobacco or not having smoked a full cigarette yet, but subsequently classified themselves as smokers were removed. Second, we excluded 206 self-classified smokers who were not asked to complete the smoking behaviour questions because they had not smoked more than 100 cigarettes in their lifetime. We excluded from the analyses 1,201 self-classified non-smokers who reported smoking in the past year because their smoking status could not be determined with confidence. A small number of ex-smokers who reported smoking in the past year (n=62) were also excluded. We reclassified as ex-smokers 2006 vol. 30 no. 6 4,729 respondents who classified themselves as non-smokers, but reported previously smoking regularly and who had not smoked in the previous 12 months. In total (excluding those under 18 years) 1,587 were excluded from our analyses, leaving 25,137 eligible respondents of whom 284 did not answer any of the smoking selfclassification categories. The final sample was 24,853. Of these respondents, 2,241 were missing a response for the demographic variables. Those missing data differed only in employment (more likely to be employed full time; p<0.01) and education (more likely to have less education; p<0.05) from those without missing data. There were no significant differences in relation to other demographic variables or smoking status, so those missing data were removed from further analysis. Among smokers, 11 were missing information on tobacco use. There were no significant differences between those with and without missing data for tobacco use, so only those with complete data were analysed. We did not exclude those missing data for the two questions on quit attempts and plans to quit. This was because an individual’s perception of their smoking behaviour may have influenced whether or not they felt those questions applied to them. The final sample was 22,601 respondents. Data were analysed with Stata version 8,13 using options for analysis of survey data. Conventional χ2 tests were used to test for associations between smoking subgroups and variables of interest. Results Just over 23% of the final sample classified themselves as current smokers, with these comprising: occasional smokers (12%), social smokers (17%), light smokers (32%), and heavy or chain smokers (39%). Smokers were all more likely to be born in the youngest birth cohorts than non-smokers or ex-smokers (see Table 1), although the proportion of heavy smokers born 1970-1986 was lower than for other types of current smokers. The proportion of females ranged from 42% to 50% among smokers, and was similar for ex-smokers (45%) but substantially higher among non-smokers (56%). The smoking subgroups differed substantially in terms of demographic variables (see Table 1). Occasional smokers were the most likely subgroup to be married or in a de facto relationship (64%), followed by light and heavy smokers (both 58%), while social smokers were the most likely to be single (37% never married). One of the most striking differences between the smoking subgroups was in socio-economic indicators. Occasional smokers were the most likely to be employed (74%) compared with around 65% for social, light and heavy smokers. Occasional smokers were also more likely to have a tertiary qualification than any other smoking subgroup (30% versus between 12% and 16% for the other groups). In fact, the proportion with tertiary education was higher than that of ex-smokers (23%), and similar to that of non-smokers (31%). Occasional smokers were also more likely to live in urban areas (68%) compared with the other smoking subgroups (between 59% and 61%). Occasional and social smokers reported similar patterns of AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Morley et al. Article drinking frequency; the majority of both groups (approximately 50%) reported drinking alcohol on 1-4 days each week. In comparison, light and heavy smokers were more likely to report drinking alcohol less than weekly. Smokers were generally heavier drinkers than non-smokers or ex-smokers, and social and heavy smokers generally reported drinking more on those days when they drank. The smoking subgroups differed significantly in their use of tobacco (see Table 2). More than 90% of light and heavy smokers smoked daily. While only 68% of social smokers smoked daily, a further 21% reported a past history of daily smoking. In comparison, only 19% of occasional smokers smoked daily although an additional 61% had previously smoked daily. Interestingly, 20% of occasional and 11% of social smokers reported that they had never been daily smokers. Occasional and social smokers were the only subgroups in which smoking less than daily was endorsed by a substantial proportion of respondents. Among occasional smokers, 29% reported smoking weekly and 33% reported smoking less than weekly. Of social smokers, 13% reported smoking weekly and a further 12% reported smoking less than weekly. The majority of occasional smokers (89%) reported smoking less than 36 cigarettes per week, whereas only 38% of social smokers reported this low level of cigarette consumption. The majority of light and social smokers reported smoking between 36 and 150 cigarettes per week. Most heavy smokers reported smoking more than 70 cigarettes per week. Occasional smokers also differed from other types of smokers in their attitudes towards smoking cessation (see Table 2). They were the least likely to have made a quit attempt in the past 12 months: 16% compared with around 38% among light and social smokers and 66% among heavy smokers. There were also striking differences in future plans to quit: 28% of occasional smokers reported that they were not planning a quit attempt because they had “already quit”; 7% of social smokers reported the same. A further 25% of occasional smokers reported that they were not planning to give up, a figure similar to that for the other smoking subgroups (range 28-34%). A large proportion of occasional and social smokers (23% and 10% respectively) did not provide a response to the question regarding quit attempts in the past 12 months. However, 58% of those who did not answer this question subsequently said that they had “already quit” (data not shown), suggesting that the majority of non-response to this question was due to the fact that occasional and social smokers did not believe the question applied to them. Table 1: Characteristics of persons with different self-described smoking status. Percentages are shown with standard errors (SE). Non-smoker % SE Number Birth cohort 1906-39 1940-69 1970-86 Percentage female Martial status Never married Widowed/divorced/sep Married or de facto Percentage employed Highest education Incomplete high school High school Certificate or diploma Tertiary qualification Percentage urban Drinking frequency Current non-drinker 2-3 days per month or less 1-4 days per week 5-7 days per week Drinking quantity Current non-drinker 1-4 drinks 5-10 drinks 11+ drinks 11,282 15.1 49.7 35.3 55.6 24.8 9.9 65.4 60.0 17.9 21.0 30.3 30.8 67.2 19.8 34.7 32.9 12.6 19.8 67.3 10.7 2.3 0.4 0.6 0.6 0.6 0.5 0.3 0.5 0.5 0.4 0.5 0.5 0.5 0.4 0.5 0.5 0.5 0.4 0.5 0.5 0.4 0.2 Ex-smoker % SE 6,114 23.4 64.3 12.4 45.3 7.2 13.2 79.5 55.4 23.4 14.9 38.7 23.1 61.3 9.2 25.8 34.0 31.1 9.2 77.2 12.6 1.1 0.6 0.7 0.5 0.7 0.4 0.4 0.6 0.7 0.6 0.5 0.7 0.6 0.6 0.4 0.6 0.7 0.7 0.4 0.6 0.5 0.2 Occasional % SE Light SE 1,680 Social % SE Heavy % SE 2,107 p value <0.001 6.3 51.1 42.6 50.0 28.4 13.8 57.8 66.0 19.7 22.6 42.7 15.0 59.0 8.0 33.5 40.0 18.6 8.0 61.8 23.8 6.4 0.6 1.5 1.5 1.5 1.4 0.9 1.5 1.4 1.1 1.3 1.5 1.1 1.4 0.8 1.4 1.5 1.2 0.8 1.5 1.3 0.8 4.0 58.7 37.4 46.7 26.4 16.1 57.6 63.2 29.5 21.6 37.1 11.8 60.1 8.6 34.5 31.4 25.5 8.6 54.6 28.3 8.5 0.4 1.3 1.3 1.3 1.2 0.8 1.3 1.3 1.2 1.2 1.3 0.8 1.2 0.7 1.3 1.2 1.1 <0.001 0.7 1.3 1.2 0.8 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2006 vol. 30 no. 6 Risks Smoking cessation campaigns and ‘occasional’ and ‘social’ smokers Discussion Self-described occasional and social smokers make up a substantial proportion (some 29%) of the smoking population. They are more likely to be present in younger birth cohorts and to have patterns of drinking and smoking behaviour that are somewhat different to those of light or heavy smokers. The occasional smokers in this sample are of particular interest. They generally smoked less frequently (weekly rather than daily) and consumed less tobacco on a weekly basis than other smoking subgroups. Additionally, their socio-economic attributes were more similar to non-smokers than to other current smokers. This self-categorisation of smoking behaviour was undefined so we cannot be sure that all smokers interpreted the categories in the same fashion. Indeed, some self-described occasional smokers reported smoking every day. Nonetheless, there were some consistent differences between occasional and social smokers as compared with light and heavy smokers. Only among occasional and social smokers were there substantial proportions of ex-daily and never-daily smokers, and they were the only types of smokers who believed that they had “already quit” smoking. This suggests that while self-description of smoking status has its limitations, it may provide some important insights into how smokers view their behaviour and the necessity to quit smoking. These findings mirror those from research in the United States (US) on occasional smokers, which suggests that former daily smokers who now smoke occasionally, and also occasional smokers who have never smoked daily, are less likely than current daily smokers to believe that they are addicted to tobacco. They are also more likely to believe that they will be successful in quitting if they decide to do so.9 Thus these smokers may be less receptive to messages about the need to quit if they perceive their smoking to be less risky than do daily smokers. Occasional smokers have often been considered as an anomaly, but it is clear that they represent a significant proportion of the continuing smokers in Australia as well as in the US.5,6 Occasional, and possibly social, smoking may represent a stable pattern of smoking, or a transitional phase either between initiation and daily smoking, or between regular smoking and cessation. Research from Australia and elsewhere suggests that these types of smokers represent a combination of all three trajectories.9,14-16 What remains unclear is whether this type of smoking behaviour is a response to increased tobacco control measures, particularly bans on smoking in the workplace and increased public health messages regarding the health risks of smoking. It is of concern that high proportions of Australians who are occasional and social smokers do not plan to quit smoking or do not believe they need to consider quitting. These smokers could be targeted by quit smoking messages that emphasise the risks of this pattern of continued smoking. While consistent low-rate smoking may be associated with a lower risk of tobacco-associated health Table 2: Smoking behaviour and quit attempts among adults with different self-ascribed smoking status. Percentages are shown with standard errors (SE). Occasional % SE Proportion of smokers Daily smoking Smoke daily now Used to smoke daily Never daily Current frequency Daily Weekly Less than weekly None (but last 12 months) Not in last 12 months Weekly quantity – cigarettes 0-35 36-70 71-150 151+ Quit attempts (12 months) Did attempt Did not attempt No response Planning to quit No, already quit Yes, planning to quit Not planning to quit No response 11.9 18.7 61.5 19.8 18.7 28.7 32.7 18.2 1.8 89.4 6.8 3.3 0.5 16.5 60.6 22.9 28.4 39.1 25.2 7.4 0.5 2.0 2.4 2.0 2.0 2.2 2.3 1.8 0.6 1.9 1.3 1.3 0.5 1.9 2.4 2.0 2.2 2.4 2.1 1.3 Light % SE Social % SE Heavy+ % SE p value <0.001 0.1 0.1 0.1 <0.001 0.1 0.1 0.0 0.0 0.1 <0.001 0.6 0.9 1.4 1.4 <0.001 1.2 1.2 0.3 <0.001 0.1 1.3 1.2 0.4 2006 vol. 30 no. 6 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Morley et al. Article problems (compared with heavy smoking), quitting still provides the greatest risk reduction.17 These results also raise two important questions regarding the impact of public health interventions on smoking research. First, how will smoking bans in pubs and clubs affect the proportion of smokers who are occasional or social smokers in Australia? Second, will increasing social disapproval of smoking make people less likely to disclose their smoking behaviour and thus affect the reliability of the self-reported measures of smoking, upon which we rely in planning and assessing the impact of tobacco control initiatives? Acknowledgements We thank Dr Coral Gartner and three anonymous reviewers for helpful comments on this manuscript. Katherine Morley is supported by an Ian Scott Fellowship from the Australian Rotary Health Research Fund. The contributions of Neville Owen were supported by a Research Infrastructure Grant from Queensland Health.

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Dec 1, 2006

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