摘要：Objectives. We compared the association between 3 different definitions of social smoking—a common pattern of smoking among young adults—and cessation indicators. Methods. We used a Web-enabled, cross-sectional national survey of 1528 young adults (aged 18–25 years) from a panel (recruited by random-digit dialing) maintained by the research group Knowledge Networks. Results. Among 455 smokers, 62% self-identified or behaved as social smokers. Compared with established smokers, self-identified social smokers were less likely to have cessation intentions (odds ratio [OR] = 0.83; 95% confidence interval [CI] = 0.70, 0.98) and cessation attempts lasting 1 month or longer (OR = 0.54; 95% CI = 0.45, 0.66). Behavioral social smokers (mainly or only smoking with others) were more likely than were self-identified social smokers (those who did not report these behavior patterns) to have cessation intentions (mainly ORmainly = 1.66; 95% CI = 1.05, 2.63; and ORonly = 2.02; 95% CI = 1.02, 3.97) and cessation attempts (ORmainly = 4.33; 95% CI = 2.68, 7.00; and ORonly = 6.82; 95% CI = 3.29, 14.15). Conclusions. Self-identified social smokers may be considered a high-risk group with particular challenges for cessation. Behavioral social smokers may represent a group primed for cessation. Public health efforts should address these differences when developing smoking cessation strategies. Young adults (aged 18–25 years) represent the highest risk group for smoking, with 35.7% reporting having smoked cigarettes in the past 30 days. 1 Young adults are also more likely than are older adults to quit smoking, 2 , 3 and young adult smoking cessation is particularly important because cessation before age 30 years avoids virtually all the long-term ill effects of smoking. 4 In addition, young adult smoking uptake is important because, although most smokers try their first cigarette before age 18 years, the process of becoming an addicted smoker with typical adult consumption levels takes years, extending well into young adulthood. 5 – 9 Evidence from previously secret tobacco industry documents reveals that the industry identified young adults as a vulnerable population susceptible to marketing strategies linking smoking with social activities, such as drinking alcohol and the club scene. 10 A common pattern of smoking among young adults is nondaily smoking: Wortley et al., found that 19.9% of young adults reported smoking fewer than 30 days out of the month, 11 and a prevalent pattern of nondaily smoking is social smoking, which is generally thought of as limiting smoking to social situations. 12 – 15 Compared with research on young adult daily smoking, research on social smoking is less common and usually limited to college samples. 14 , 15 These findings suggest that social smokers smoke less and are less dependent on nicotine compared with regular smokers. Previous research also suggests that occasional smokers take 1 of 3 trajectories. Approximately 50% quit smoking, 25% transition to habitual smoking, and 25% continue to sustain their intermittent smoking pattern after a 7-year follow up. 16 In this regard, about half of those who occasionally smoke continue to smoke for years. Although the health consequences of social smoking have not been specifically studied, light smoking (fewer than 10 cigarettes per day) is associated with increased cardiovascular risk 17 and an increased risk of cancer, respiratory tract infections, cataracts, impaired fertility, and fractures. 18 Thus, clinicians should address these smoking patterns. Published studies on social smoking are not consistent in the definitions and conceptualization of social smoking. Two studies defined social smoking as smokers who say they are social smokers. 14 , 19 One study defined social smoking as having smoked in the past 30 days, but mainly with others. 20 Another study defined social smoking as smoking in the past 30 days, but mainly with others or equally alone as with others. 15 Another approach has been to include smokers who smoke weekly, less than weekly, or smoke only when going out to clubs, bars, or restaurants. 21 A more exclusive approach has been to restrict social smoking to those who report only smoking with others. 12 These differing definitions have theoretical and methodological issues. Self-identification as a social smoker includes those who act like daily smokers, but deny being a smoker (i.e., identification only as a social smoker). The “mainly smokes with others” definition, like self-identification as a social smoker, may also include daily smokers. This inclusion may have important ramifications both for addiction assessments and cessation strategies. Limiting social smokers to those who “smoke only with others” is a strict behavioral definition that includes only a subset of those people who may think of themselves as social smokers; social smokers by this definition smoked fewer cigarettes, were more likely to think they could quit any time, and were less likely to think they were addicted or that their smoking was harmful to their health. 12 Given the differing operational definitions used to measure social smoking, it remains unclear whether social smokers are more apt to quit compared with regular smokers. We aimed to (1) compare 3 different definitions of social smokers (self-identified social smokers, mainly smoking with others, only smoking with others) and (2) assess the association between these different definitions of social smoking and quitting intentions and behaviors.
