‘It’s only one’: The impact of social smoking

The effects of smoking heavily and often are known universally, however, the effects of light and social smoking are far from clear

socialsmoking2On introducing tobacco to Columbus, it is unlikely that the Mayans of Central America could have predicted the immense political, economic and health impact now associated with tobacco consumption.

Recent times have seen increasing numbers of young adults diversifying social situations by cigarette smoking. Although the risks of long-term tobacco smoking are well known, the impact of infrequent or social smoking is less well documented.

Occasional, light, or non-daily smokers irregularly utilise cigarettes. Among these groups are those simply wishing to experiment, or established smokers seeking to decrease their intake. Social smokers specifically restrict their activity to bars and clubs, smoking only among peer groups and never in isolation. Friends are often smokers, which creates a platform of acceptance further potentiating smoking behaviours. Moreover, smoking acts as an enabler of interactions with others.

Non-daily smokers often perceive themselves as immune from the health consequences of smoking, because their usage is comparatively less and more controlled than chronic users. Health risks associated with long-term smoking include cardiovascular disease, chronic obstructive pulmonary disease, infertility and cancer. Furthermore, addiction and dependence are not experienced to the same degree in social smokers.

A lung cancer cell

A lung cancer cell

Studies suggest that university students are more likely to partake in social smoking, often as a means of passing time in a structured way, for relaxation or to promote weight-loss. Generally, smoking is more likely if there is a pre-disposed personality type, as a progression from adolescent use, and if there are smokers among families or peer groups. Although some light smokers always maintain low-levels of consumption, others transiently increase smoking frequency. Additionally, alcohol is a potent initiator of social smoking. American studies in 2004 reported that 74% of all smoking occasions among university students occurred alongside alcohol consumption, more so in light smokers (86%) than regular smokers (63%).

Demographically, social smokers are typically of higher educational attainment, middle-class and from ethnic minority groups. Studies indicate that occasional highly educated smokers generally have the lowest desire to stop smoking. Contrastingly, their long-term smoking counterparts are more likely to want to quit.

Indeed, there is a fundamental difference between nicotine dependent individuals who self-administer nicotine to potentiate dopaminergic pathways, and social smokers who enjoy the temporary boost of nicotine and the social aspect of smoking.

Nicotine is one of thousands of ingredients present in cigarettes, and promotes the release of neurotransmitter dopamine and catecholamine noradrenalin. Moreover, dopamine is an instrumental intermediary influencing the desire to utilise drugs. These in turn heighten mood and promote alertness through increased glucose availability, raised blood pressure. The effects are rapid, causing a surge after only a few inhalations. With long-term smoking, the body acclimatises to the nicotine, thus smoking must continue to maintain the desired state, as the effects of nicotine are temporary.

Nicotine augments neurological pathways to develop and enhance primary re-enforcement mechanisms, which contribute to a desire to obtain the pleasurable effects of smoking. A cascade of neuro-psychological events underpins future use. Hence the brain is conditioned to smoking behaviours. There are additional practical aspects associated with smoking addiction including its availability and advertising strategies, which have historically brandished images of elegance, glamour and later rebellion, circa James Dean and John Wayne. Ultimately, all of these factors are contributory to our perceptions and the addictive potential of cigarettes.

Your isolated, seemingly innocent cigarette is actually a complex, ergonomic and effective drug delivery device. Nicotine is introduced to the body with each inhalation. On average, a person will take ten puffs per cigarette. Therefore, if five cigarettes are smoked in one evening, the brain is exposed to nicotine at least fifty times.

Evidently, there is a whole host of factors to consider when addressing smoking behaviours. Multifaceted research initiatives are therefore necessary to address the spectrum of social, psychological and health implications of smoking.

Historically research has focussed less on low-levels of consumption, since these were outside the well-accepted models of smoking such as twenty-per day. Small patient cohorts and lack of long-term studies further limit current studies. Additionally, since intermittent smoking occurs in response to different situations, consumption habits alter transiently, which is difficult to standardise in research. Studies therefore may under- or over-reflect true smoking patterns depending on the individual.

Crucially, casual smoking carries the propensity for establishing ingrained habits. American studies quantify progression to long-term smoking amongst casually smoking university students as between 15-25%. Although health implications of chronic smoking have been well documented in literature, research into low smoking consumption is in its infancy.

Although there is little conclusive evidence regarding the health implications of social smoking, research has indicated dangers associated with prolonged light but daily smoking. Studies conducted on middle-aged light but daily smokers suggest that these levels of smoking (4-7 cigarettes per day) have 70% of the impact of heavy smoking (e.g. 23 cigarettes per day). There is also a three-fold increase in the risk of ischaemic heart disease in those aged between 35-59 years smoking 1 – 4 cigarettes per day. Older low but daily smokers (1 – 4 cigarettes per day) have greater risks of cardiac events (11%) than non-smoking men (3.7%), and risk of death from aortic aneurysm is three-fold greater in light smokers of both genders. There is also a distinct dose-response relationship between tobacco exposure and lung cancer. Light smoking women aged 35 – 49 have a five-fold increased risk of lung cancer later in life, and men of the same age range carry a three-fold greater risk than non-smokers. The susceptibility to cancer in ethnic minorities such as Afro-Caribbean’s is greater than in Caucasians. Hence greater health implications are possible if social smoking habits transcend to low levels of daily smoking.

4-7 cigarettes per day have 70% of the impact of heavy smoking

4-7 cigarettes per day have 70% of the impact of heavy smoking

Encouragingly, evidence also suggests that light smokers stopping within their twenties or soon after smoking initiation, stand the best chance of preventing malignant changes or cardio-vascular implications. The sooner smoking cessation occurs, the greater the potential for re-establishing physiological normality.

Very few entities have sparked such thorough debate as smoking, nor has a trend undergone mass fluctuations in social acceptance and rejection as smoking has. With regards to social smoking, more understanding about behavioural patterns is necessary to tailor public health prevention strategies. Identifying predictors and at-risk groups may aid in formulating these strategies to limit smoking initiation, and promote cessation.

All that being said, we are all entitled to freedom of choice and expression. Individuals should not suffer stigmatisation or denigration for their lifestyle preferences. The most important thing is to understand the facts and make your choice.

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