摘要：Objectives. A large proportion of smokers erroneously believe that low-nicotine/low-tar cigarettes, also called “light cigarettes” or “lights,” reduce health risks and are a rational alternative to smoking cessation. However, the availability of light cigarettes may deter smoking cessation. Methods. We analyzed the 32374 responses to the US 2000 National Health Interview Survey. Current and former smokers (“ever-smokers”) were asked if they had ever used a lower tar and nicotine cigarette to reduce health risks. Multivariable logistic regression identified determinants of lights use and smoking cessation. Results were weighted to reflect the national population. Results. Of 12285 ever-smokers, 37% (N=4414) reported having used light cigarettes to reduce health risks. Current abstinence was less often reported by ever-smokers who had previously used light cigarettes than by ever-smokers who had never used lights (37% vs 53%, P <.01). Adjusted odds of cessation among ever-smokers who had used light cigarettes relative to those who had never used lights were reduced by 54% (adjusted odds ratio=0.46, 95% confidence interval=0.41, 0.51). Conclusions. Use of light cigarettes was common and was associated with lower odds of current smoking cessation, validating the concern that smokers may use lights as an alternative to cessation. Cigarette smoking is the leading preventable cause of death in the United States. 1 Many smokers who do not quit turn instead to tobacco products that tobacco companies advertise as having lower tar and nicotine levels, implying reduced health risk. Low-tar and low-nicotine cigarettes, also known as “light cigarettes” or “lights,” are the most prevalent example of so-called “potential exposure-reduction products,” 2 a heterogeneous group of products that also includes filtered cigarettes, smokeless tobacco, and products made from tobacco that is cured to reduce carcinogens. 3 Lights were introduced to the US market in the late 1960s and now account for almost 85% of the cigarettes sold in the United States. 4 Although marketed as delivering less tar and nicotine to a smoker than other cigarettes, light cigarettes do not actually contain less of these compounds than other cigarettes. Instead, they are designed to deliver less tar and nicotine when smoked in the test situation used by the US Federal Trade Commission (FTC). 5 However, numerous studies have demonstrated that light cigarettes deliver comparable amounts of tar and nicotine when smoked by humans, 6 – 8 leading to the expectation that individuals who smoked light cigarettes would have no reduction in risk of tobacco-related disease compared with smokers of regular cigarettes. 9 A large observational study with adequate follow-up time was published in 2004, and no reduction in risk was demonstrated. 10 This was particularly true when comparing lowest tar (< 6 mg) to medium tar categories (6–15 mg), which is the only relevant comparison in the United States market today. 4 , 11 The totality of evidence supports the conclusion that light cigarettes are not a safe alternative to quitting. 12 Nonetheless, as demonstrated by tobacco industry documents, light cigarettes were intended and marketed as a way of providing health-concerned smokers with false reassurance that they could continue to smoke rather than quitting smoking. 13 , 14 After decades of advertisements suggesting that light cigarettes deliver less nicotine and tar on the basis of FTC measurements, 15 a large proportion of smokers erroneously believe that smoking lights reduces health risks. 11 , 16 , 17 Furthermore, the evidence suggests that highly educated smokers, those who better understand the health consequences of smoking, and those who express more interest in quitting are more likely to switch to light cigarettes with the intention of reducing health risks. 18 The use of light cigarettes with such an intention could feasibly hinder cessation efforts by decreasing smokers’ motivation to quit. These facts have fueled an ongoing debate about the ethical dilemmas of harm reduction products in general 19 – 22 and have led to public health concerns that many smokers may use or switch to lower tar and nicotine brands as a health-protective measure instead of quitting. The impact that using light cigarettes has on subsequent cessation is unclear. The most recent longitudinal study to examine whether using low-tar cigarettes predicts smoking cessation found that switching from a “higher” to a “lower” yield product was not associated with the likelihood of future cessation. 23 However, this study included only approximately 1000 subjects. A larger, but older, longitudinal study surveyed US Air Force recruits about switching to light cigarettes to reduce health risks in the 12 months before basic military training and at 1 year follow-up. The survey found no association between brand switching to reduce health risks and subsequent cessation after adjusting for demographic factors. 24 A large cross-sectional study, the 1986 Adult Use of Tobacco Survey, demonstrated a reduced prevalence of cessation among smokers who had switched brands to reduce health risk. 25 In this context, we used data from a large, nationally representative, and more contemporary sample with the capability to adjust for a wide range of sociodemographic factors, health behaviors, and health conditions. We determined the prevalence and characteristics of smokers who used light cigarettes with the intention of reducing health risks and assessed the association between using lights to reduce health risks and subsequent cessation.
