Research Shows Even Nondaily Smokers Face Increased Health Risks

Sneaking the occasional cigarette has greater health consequences than most people may realize. A new study published in 2020 in JAMA Network Open found that even low levels of cigarette smoking is hazardous. In fact, smoking just 6 to 10 cigarettes per month can still increase your risk of death and disease.

To determine the mortality risks facing nondaily smokers, the researchers, which included Maki Inoue-Choi, PhD, MS, RD, a staff scientist at the National Cancer Institute's Division of Cancer and Epidemiology, looked at tobacco use and health outcomes for roughly 505,500 U.S. adults between 1992 and 2011, including daily and nondaily users. The daily users, they found, smoked a mean of 20 cigarettes per day (600 cigarettes per month), and the lifelong nondaily smokers typically smoked 40 cigarettes per month.

Based on their findings, both daily and nondaily smokers had substantially higher mortality risks than people who have never smoked. And more specifically, Inoue-Choi and her colleagues found that daily smokers had 2.32 times higher mortality risk, and lifelong nondaily smokers had 1.82 times higher mortality risk than those who never smoked at all.

Nondaily Smokers Face High Mortality Rate

“This study makes clear, again, the fact that there is no safe level of tobacco use,” says pulmonologist Andrew Martin, MD, FCCP, Chair, Pulmonary Medicine at Deborah Heart and Lung Center in New Jersey.

For Herman Gaztambide-Rodriguez, MD, a pulmonary and critical care medicine physician at Orlando Health in Florida, this study is a reminder of the importance of reaching the population (nondaily smokers) who are only sneaking a cigarette here or there with the false belief that a few cigarettes can’t really be harmful. “This is the group that believes that smoking a few cigarettes once a week cannot be the same as smoking daily,” he explains.

But the study, says Gaztambide-Rodriguez, is showing that even the nondaily smokers are not exempt from the complications that daily smokers face. “Right out of the gate, you’ve doubled your mortality risk just by being a nondaily smoker,” he says. He specifically points out the increased cancer risk: “If you come from a family with a heavy cancer history and you’re sneaking occasional cigarettes, you are at risk,” he adds.

Nondaily Smokers' Risk of Disease

According to the authors of the study, the strongest associations for cigarette smoking among both nondaily and daily smokers were observed for deaths from lung cancer and respiratory disease. They also noted deaths from cardiovascular and other diseases, but these were not as prevalent as lung cancer and respiratory disease.

Compared with never-smokers, the researchers identified risks for smoking-related cancers that were 2.16 times higher in lifelong nondaily smokers, 3.65 times higher in nondaily smokers who had previously been daily smokers, and 4.88 times higher in daily smokers. Moreover, when looking specifically at lung cancer, these risks increased substantially.

Plus, all smokers are also at increased risk for multiple types of cancer, including lung, bladder, colon, and pancreatic cancer, among others.

Daily Smokers Who Became Nondaily Smokers

Another significant finding from this study was the association of reducing the level of smoking from daily to nondaily with mortality risks. In examining daily smokers who became nondaily smokers, researchers noted a decreased mortality risk after 10 years of reduction. This required participants to substantially reduce their monthly cigarette consumption.

That said, the mortality risks remained substantially greater than both never- and former smokers, which points to the importance of smoking cessation beyond even substantial reductions in cigarette smoking.

Smoking Cessation Works

“The most effective smoking cessation strategy starts with a decision to become a non-smoker,” says Martin. For his patients, Martin advises them to treat smoking cessation as if they are approaching surgery.

“A date should be scheduled at which time the patient will get rid of all the cigarettes they have in their possession, and once that plan has been made, they should discuss with their physician the use of products that may make it easier to quit by decreasing withdrawal symptoms,” he explains.

Martin says products may include nicotine (various forms), varenicline (Chantix), or bupropion (Zyban or Wellbutrin). While effective, Martin reminds his patients that these medicines decrease, but do not eliminate, nicotine withdrawal symptoms. “So, just as if they have had surgery, patients should expect to suffer a bit after they stop smoking,” he adds.

And Gaztambide-Rodriguez agrees. “I’m always honest with my patients about the monumental task of smoking cessation. The body gets really addicted to nicotine, and quitting is not easy,” says Gaztambide-Rodriguez. That’s why not giving up is the right answer. “Very few people quit successfully their first try, which shows how ugly the addiction is,” he says.

Support groups, which include family, friends, and other groups, definitely help, along with newer medications like nicotine replacement, but Gaztambide-Rodriguez says there is no magic bullet. “These are all excellent additions to a smoking cessation program, but any one of these on their own is not the answer,” he adds. Instead, a combination of all possible treatments, and knowing what it means not to quit is the key. “I don’t think there is a better way to solve this."