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Smoking and Tobacco

Cutting Back on Cigarettes: When Less is More

Smokers who pride themselves on successfully cutting back as a step toward quitting tobacco altogether may be caught in a haze of self-deception. New research shows smokers who slash their cigarette use by half quickly change the way they smoke to compensate for less exposure – ironically, in the process, often boosting their consumption of smoke, carbon monoxide, nicotine and other cancer-causing agents with a given cigarette.

These findings hold important implications for smokers as well as for the clinicians who are trying to help them quit.

The human body really is a miracle. It knows when it is not getting what it's used to, and it automatically does something about it.

Twenty-five women were studied over six days in three different situations: smoking their usual amount, restricted intake (50 percent) and increased intake (167 percent). Thirteen of the women were black and 12 were white. The women smoked their regular brands of cigarettes and researchers noted levels of carbon monoxide (CO) and cotinine in the participants' blood before and after four of the cigarettes each day. Carbon monoxide reflects general exposure to hundreds of toxins and carcinogens in smoke while cotinine, a metabolic product of nicotine, reveals how much nicotine has been absorbed over time.

The way the women smoked, or "smoking topography," was also carefully observed, measuring such things as the number and size of the puffs per cigarette, the length of time between puffs, and how much of the cigarette was smoked before it was extinguished.

Researchers discovered that, generally, when women smoked in a restricted environment, they took larger drags and smoked more of the cigarette before putting it out. In addition, when smoking fewer cigarettes, the women had more CO in their exhaled air per cigarette, compared to when they smoked their regular number of cigarettes or increased use.

Higher CO and nicotine boosts were especially pronounced among women who were defined as efficient smokers - those who normally register high levels of cotinine per cigarette with regular smoking (>20 nanograms cotinine per milliliter of blood).

Researchers were surprised at how much the very efficient smokers could increase their levels of CO and nicotine even further. And most of these women were unaware that they were changing the way they were smoking to make up for fewer cigarettes.

There appeared to be racial differences as well, with black women registering higher percentage increases of carbon monoxide levels across all smoking situations, compared to whites. This may be due to the fact that all of the black women smoked menthol cigarettes, and menthol smokers tend to inhale greater amounts of smoke because it is somewhat easier to take in, compared to non-mentholated smoke.

Researchers also found that black menthol smokers had higher carbon monoxide levels compared to white smokers in a restricted environment. Because both black and white menthol smokers registered higher CO levels than white non-menthol smokers did, however, there is a potential influence of menthol regardless of race.

Smokers experience a lot of social pressures to quit these days. Workplaces and restaurants are increasingly adopting bans on smoking, and as taxes on tobacco increase, sales drop off. Millions of people want to quit, and they often see cutting back as the first step in a long-term strategy. Unfortunately, research suggests that this may be giving them a false sense of security and potentially delaying a complete quit attempt.

The use of pharmacotherapy increases successful quitting by 2 to 3 times. This would include nicotine patches, gum, lozenge or inhaler and other prescription medications that can help offset craving.

The bottom line for smokers is to be aware that just because they smoke 12 cigarettes a day instead of 20 doesn't mean that they are less dependent on tobacco. Clinicians need to understand that a person who smokes half a pack a day may be just as dependent as a person who smokes a whole lot more, and may need an equally aggressive treatment plan.

Reference:

Ahijevych K, Weed H, Clarke J. April 2004. Levels of cigarette availability and exposure in black and white women and efficient smokers. Pharmacology, Biochemistry & Behavior 77(4):685-93.

This article is based on information provided by The Ohio State University Medical Center Media Relations Office, and was adapted for use on NetWellness with permission, 2008.

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Last Reviewed: Sep 02, 2008

Karen L Ahijevych, PhD, RN, FAAN Karen L Ahijevych, PhD, RN, FAAN
Professor, College of Nursing
Professor, College of Public Health
College of Nursing
The Ohio State University