Research article
Social Smoking: Implications for Public Health, Clinical Practice, and Intervention Research

https://doi.org/10.1016/j.amepre.2009.03.020Get rights and content

Background

Social smoking is increasingly prevalent and poses a challenge to traditional cessation practices. Tobacco companies conducted extensive research on social smokers long before health authorities did and marketed products to promote this smoking behavior.

Purpose

Research is described and mechanisms identified that are used to promote social smoking to help improve cessation strategies in this growing group.

Evidence acquisition

Searches from 2006 to 2008 of previously secret tobacco industry documents using keywords social smoker, light smoker, casual smoker, youth smoker, and occasional smoker, followed by snowball searching. Data analysis was conducted in 2008.

Evidence synthesis

Tobacco industry research identified characteristics of social smokers that include: (1) denial of personal nicotine addiction; (2) self-categorization as a nonsmoker; (3) propensity for decreased tobacco use in response to smoke-free laws; (4) variations in age, education, ethnicity, and socioeconomic backgrounds; and (5) a perceived immunity to personal health effects of tobacco but fear of consequences to others. Tobacco companies developed marketing strategies aimed at social smokers, including “non–habit forming” cigarettes.

Conclusions

Previously considered a transient behavior, social smoking is also a stable consumption pattern. Focused clinical questions to detect social smoking are needed and may include, “Have you smoked any cigarettes or used any tobacco products in the past month?” as opposed to “Are you a smoker?” Clinicians should recognize that social smokers might be motivated to quit after education on the dangers of secondhand smoke rather than on personal health risks or with pharmacotherapy.

Introduction

Nondaily smoking—smoking on some days but not every day—has been considered a transient behavior associated with smoking initiation or cessation. Newer research on nondaily smoking indicates, however, that this pattern of tobacco use may represent a stable form of chronic low-level consumption1 (fewer than ten cigarettes per day). Nondaily smokers tend to be younger, better educated, minority (in particular African American and Hispanic), and wealthier than everyday smokers.1, 2

Social smoking is one subset of nondaily smoking behavior, which is typically defined as smoking primarily in social contexts. Most published studies of social smokers have characterized them as affluent, Caucasian, experimenting college students who smoke socially to gain peer acceptance. The limited data in the public health literature indicate that social smokers, unlike other nondaily smokers, tend not to smoke alone3, 4, 5 and restrict their use to social situations such as parties, bars, or nightclubs.3, 5, 6 Social smoking also occurs in conjunction with heavy alcohol use on U.S. college campuses.7 In addition, social smokers generally categorize themselves as nonsmokers when asked by family, friends, or healthcare providers. Since they do not view their smoking as a marker of personal addiction,3, 4, 5 social smokers may fail to recognize the health risks associated with their tobacco use.3, 5

While there are no public data focused solely on social smoking, the prevalence of nondaily smoking—which includes social smoking—is increasing. In the U.S., between 1996 and 2001, rates of nondaily smoking increased in 31 of the 50 states, going from 16% in 1997 to 19% in 1999, reaching 24% of current smokers in 2001.8 Probably because California has advanced tobacco-control policies that include smoke-free workplaces, homes, and public places, the prevalence of nondaily smokers increased from 26% of current smokers in 19928 to 28% in 2002 and to 30% in 2005.9

With a profile that differs from the traditional daily smoker, clinicians need to understand the unique demographics and vulnerabilities of nondaily and social smokers. Current cessation programs have been studied and validated only in the chronic daily smoker population,10 and are probably not appropriate for social smokers who do not view their tobacco use as a sign of nicotine dependence. Counseling nondaily and social smokers to quit tobacco may involve messages that stress the dangers of secondhand smoke to the nonsmoker as opposed to messages that emphasize the individual health risks, although there have not been any formal trials of this approach.11, 12

At times, tobacco industry research has been decades ahead of the public health and medical communities, including on the addictive nature of nicotine, the phenomena of smoker compensation, the effects of secondhand smoke, and the emergence of health-concerned smokers. Likewise, the industry had an early understanding of social smoking starting over 30 years ago in response to increasing concerns about the dangers of secondhand smoke and the stigma associated with nicotine addiction.13 Tobacco companies recognized that social smoking, in particular, was an important pattern of consumption because it embodied the “social benefits” of smoking the industry wished to promote.

Industry research on social smoking enabled tobacco companies to understand social smokers' demographics and psychological vulnerabilities. They found that social smokers were especially sensitive to their environment and would decrease their consumption in response to changes in their surroundings. Public health and clinical professional awareness about the characteristics and vulnerabilities of social smokers may improve current prevention and cessation strategies for this growing group.

Section snippets

Evidence Acquisition

The current study is based on searches of the Legacy Tobacco Documents Library (legacy.library.ucsf.edu) and the British American Tobacco Documents Archive (bat.library.ucsf.edu) between July 2006 and February 2008 using established methods.14, 15 Initial search terms included social smoker, light smoker, casual smoker, youth smoker, and occasional smoker. These results were used in snowball searches (where material cited in each document is used to locate new documents or papers until no new

Tobacco Industry Research on the Social Benefits of Smoking

In the 1970s, Phillip Morris and RJ Reynolds (RJR) executives became increasingly concerned about how social and environmental triggers influence smoking. Following the 1964 U.S. Surgeon General's report,16 industry executives recruited scientists to study the social benefits of smoking. In 1976, Phillip Morris hired prominent Harvard-trained anthropologist and international tobacco expert Dr. Sherwin Feinhandler to write a series of books and papers on the social role of smoking in American

Discussion

Tobacco companies have made a longstanding commitment to better understand and market to social smokers. Their most important insights are the identification of social smoking as a stable pattern of consumption for a substantial fraction of smokers and the sensitivity of social smokers to secondhand smoke issues. In contrast to the more recent public health literature on social smoking, which focuses on college students, tobacco industry research indicates that social smokers include a much

Conclusion

Tobacco industry research indicates that social smoking includes stable patterns of chronic low-level consumption and comprises about one quarter of all smokers (and growing) of varying age, ethnicity, SES, and educational background. More important, industry research suggests that social smokers will probably not respond to current cessation strategies that are based on personal health risk and treatment of nicotine addiction. Social smokers may be more responsive to messages focused on the

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