Characteristics and health consequences of intermittent smoking: Long-term follow-up among Finnish adult twins

Abstract

other health consequences of intermittent smoking, such as cardiovascular and nonmalignant pulmonary outcomes. IntroductionSmoking behavior research has primarily targeted daily and regular smokers. However, the defi nition of a smoker as someone who smokes daily has been challenged recently, and more varied smoking patterns have been discussed ( National Cancer Institute, 2007 ). No consensus exists regarding whether intermittent smoking represents a transitional stage toward cessation or whether those smokers consistently maintain their low frequency of tobacco use ( Okuyemi et al., 2002 ).In countries with decreasing overall smoking prevalence, the proportion of nondaily smokers has been increasing. For example, according to U.S. statistics, although the overall smoking prevalence decreased from 24% in 1999 to 21% in 2006, the proportions of intermittent smokers among all smokers increased from 18% to 20%, respectively ( Centers for Disease Control and Prevention, 2001 , 2007 ). During the same time in Finland, daily smoking rates decreased from 23% in 1999 to 21% in 2006, whereas the proportion of intermittent smokers in relation to the total population remained constant at 6% ( Helakorpi, Patja, Prättälä, & Uutela, 2007 ;Helakorpi, Uutela, Prättälä, & Puska, 1999 ), indicating a relative increase of intermittent smoking among smokers. In countries where smoking is widely restricted, smokers who cannot quit may modify their smoking patterns. This intermittent smoking phenomenon in countries with a mature tobacco epidemic also challenges the hardening hypothesis of the remaining smoking population ( Hughes & Brandon, 2003 ;Warner & Burns, 2003 ). Thus, it is crucial that we learn more about characteristics of intermittent smoking. AbstractIntroduction: The defi nition of a smoker as someone who smokes daily has been challenged. No consensus exists regarding whether intermittent smoking represents transition toward daily smoking or cessation or whether intermittent smokers consistently maintain their low tobacco use frequency. Although abundant evidence supports the adverse health consequences of daily smoking, less evidence is available on intermittent smoking. Methods:We examined characteristics and health consequences of intermittent cigarette smoking among Finnish adult twins. We used longitudinal data of 21,340 persons with smoking status from questionnaires in 1975 and 1981 and data on lung cancer incidence from 1982 to 2004 from the Finnish Cancer Registry. Results:We identifi ed 641 consistent intermittent smokers comprising 3% of the study population. Consistent intermittent smokers had higher education, less use of other tobacco products, healthier lifestyles, and partly more favorable mental health profi les compared with lifetime regular smokers. However, in terms of other lifestyle factors, intermittent smokers compared mostly unfavorably with never-smokers, despite being better educated. Intermittent smoking showed substantial heritability. There were 213 incident lung cancer cases among all stu...

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