Electronic cigarettes in physician practice

There is growing evidence for the effectiveness of e‐cigarettes as a quitting aid and, although not completely harmless, the scientific consensus is that they are substantially less harmful than smoking tobacco. More research is needed, but there is now sufficient empirical evidence and real‐world experience over more than a decade to consider their use as a legitimate tobacco harm reduction tool for smokers who are unable or unwilling to quit with conventional strategies. Smokers should be advised that the highest success rates occur with daily use with nicotine e‐liquid and newer e‐cigarette models. After quitting smoking, it is preferable to aim ultimately to cease vaping if possible, but long‐term use of e‐cigarettes is safer than relapsing to smoking.     

A framework for evaluating the public health impact of e‐cigarettes and other vaporized nicotine products

The use of vaporized nicotine products (VNPs), especially e‐cigarettes and, to a lesser extent, pressurized aerosol nicotine products and heat‐not‐burn tobacco products, are being adopted increasingly as an alternative to smoking combusted products, primarily cigarettes. Considerable controversy has accompanied their marketing and use. We propose a framework that describes and incorporates patterns of VNP and combustible cigarette use in determining the total amount of toxic exposure effects on population health. We begin by considering toxicity and the outcomes relevant to population health. We then present the framework and define different measures of VNP use; namely, trial and long‐term use for exclusive cigarette smokers, exclusive VNP and dual (cigarette and VNP) use. Using a systems thinking framework and decision theory we considered potential pathways for current, former and never users of VNPs. We then consider the evidence to date and the probable impacts of VNP use on public health, the potential effects of different policy approaches and the possible influence of the tobacco industry on VNP and cigarette use.     

Evaluation of a drop-in rolling-group model of support to stop smoking

Aims To assess longer‐term outcomes of a drop‐in rolling‐group model of behavioural support for smoking cessation and the factors that influence cessation outcomes. Design Prospective observational cohort study. Setting Fag Ends NHS Stop Smoking Service in Liverpool and Knowsley, UK. Participants A total of 2585 clients, aged 16 or over, setting a quit date. Measurements Routine monitoring data were collected from Fag Ends service users and were supplemented by survey data on socio‐economic circumstances, smoking‐related behaviour and self‐report and carbon monoxide (CO)‐validated smoking status at 52‐week follow‐up. Findings The CO‐validated prolonged abstinence rate at 52 weeks for smokers attending the groups was 5.6%, compared with 30.7% at 4 weeks (a relapse rate of 78.2%). The sample was particularly disadvantaged: 68% resided in the most deprived decile of the English Index of Multiple Deprivation. Higher socio‐economic status within the sample was a predictor of quitting. Other predictors of long‐term cessation in multivariate analysis included older age, being female, lower levels of nicotine dependence, having a live‐in partner, stronger determination to quit and use of varenicline versus other medication. Conclusions A wholly state‐reimbursed clinical stop‐smoking service providing behavioural support and medication in a region of high economic and social disadvantage has reached a significant proportion of the smoking population. Long‐term success rates are lower than are found typically in clinical trials, but higher than would be expected if the smokers were to try and quit unaided. Research is needed into how to improve on the success rates achieved.     

Smoking and coronary heart disease in the elderly.

This paper is concerned with the question of whether elderly people (ages 65-84) are more likely to develop coronary heart disease (CHD) if they continue or stop cigarette smoking. Age-standardized CHD rates and mortality ratios have been computed from data available in four major prospective cohort investigations of smoking and health. The data examined gave consistent results. For elderly men, there were no appreciable excess risks of CHD mortality or morbidity among cigarette smokers compared to ex-cigarette smokers and non-cigarette smokers. For elderly women, the CHD rates seemed lower in continuing cigarette smokers than in ex-cigarette smokers. These results obtained from cohort data are concordant with previous analyses of secular data. Among elderly people, the risk of CHD is essentially the same with persistence of cigarette smoking than with its cessation.     

The effects of water-pipe, cigarette and passive smoking on mucociliary clearance

We aimed to determine the effects of water-pipe smoking on lung mucociliary clearance system using radioaerosol ventilation scintigraphy and compare with cigarette and passive smoking and determine the level of exposure to tobacco smoke by measuring urinary cotinine in each group. Volunteer water-pipe only and cigarette only smokers from various cafés in Izmir city and passive smokers as control group were included in the study after exclusion and inclusion criteria. The ages, type of smoking, duration and daily amount of tobacco smoked and the medical histories of the volunteers were noted down. The pulmonary function tests (PFT), technetium-99m inhalation scintigraphy and urinary cotinine measurement with enzyme immunoassay (EIA) and were performed for each participant. Twenty water-pipe smokers, 23 cigarette smokers and 15 passive smokers were included into the study. There were no statistically significant differences among the mean ages, BMI and PFT parameters of all participants in study and control groups. Mucociliary clearance rates in terms of retention ratio after 1 hour and radioactivity half-life for each lung was lowest in the water-pipe smokers compared to others. Mucociliary clearance rate also decreased in the cigarette smokers compared to passive smokers. The differences in the mucociliary clearance rates among groups were statistically significant (p < 0.05). Urinary cotinine levels were highest in the cigarette smokers and higher in water-pipe smokers compared to passive smokers as statistically significant. As a conclusion mucociliary clearance rates decrease with tobacco smoking, being more prominent in water-pipe smokers in our study.     

Cigarette tax and public health: what are the implications of financially stressed smokers for the effects of price increases on smoking prevalence?

Aims This paper models the predicted impact of tobacco price increases proposed in the United States and Australia during 2009 on smoking prevalence in 2010 while taking account of the effects of financial stress among smokers on cessation rates. Methods Two models of smoking prevalence were developed for each country. In model 1, prevalence rates were determined by price elasticity estimates. In model 2 price elasticity was moderated by financial stress. Each model was used to estimate smoking prevalence in 2010 in Australia and the United States. Results Proposed price increases resulted in a 1.89% and 7.84% decrease in smoking participation among low socio‐economic status (SES) groups in the United States and Australia, respectively. Model 1 overestimated the number of individuals expected to quit in both the United States (0.13% of smokers) and Australia (0.36% of smokers) by failing to take account of the differential effects of the tax on financially stressed smokers. The proportion of low‐income smokers under financial stress increased in both countries in 2010 (by 1.06% in the United States and 3.75% in Australia). Conclusions The inclusion of financial stress when modelling the impact of price on smoking prevalence suggests that the population health returns of increased cigarette price will diminish over time. As it is likely that the proportion of low‐income smokers under financial stress will also increase in 2010, future population‐based approaches to reducing smoking will need to address this factor.     

Strength of urges to smoke as a measure of severity of cigarette dependence: comparison with the Fagerström Test for Nicotine Dependence and its components

Aims Measuring the strength of urges to smoke during a normal smoking day among smokers in a culture where smoking is restricted could provide a good measure of the severity of cigarette dependence. An important criterion for a measure of cigarette dependence is how well it predicts failure of attempts to stop smoking. This study compared ratings of Strength of Urges to Smoke (SUTS) with the Fagerström Test of Nicotine Dependence (FTND) and its components, including the Heaviness of Smoking Index (HSI). Design A longitudinal study involving a household survey of a representative sample of adult smokers at baseline and 6‐month follow‐up by postal questionnaire. Setting England. Participants A total of 15 740 smokers aged 16 and over underwent the baseline interview; 2593 were followed‐up 6 months later, of whom 513 reported having made a quit attempt following the baseline survey but at least 1 month prior to the follow‐up. Measurements SUTS, FTND, HSI, cigarettes per day, time to first cigarette, age, social grade and gender were measured at baseline. Quit attempts since the baseline assessment and self‐reported abstinence were measured at 6‐month follow‐up. Findings In logistic regressions, all dependence measures predicted success of subsequent quit attempts, but SUTS had the strongest association (beta for SUTS, FTND and HSI: 0.41: P < 0.001, 0.13: P = 0.005, and 0.19: P = 0.003, respectively). In multiple logistic regressions when SUTS was entered as a predictor of abstinence, together with other dependence measures, it remained as the only predictive dependence measure. Conclusions A simple rating of strength of urges on a normal smoking day appears to be a good predictor of at least short‐term quit success in English smokers and as such may be a useful measure of cigarette addiction.     

Cigarette smoking is associated with increased severity of gambling problems in treatment-seeking gamblers

Aims Cigarette smoking and gambling often co‐occur, but very little is known about smoking or its correlates in disordered gamblers. This study compared gambling and psychosocial problems in treatment‐seeking gamblers who smoke versus those who do not. Methods At intake to gambling treatment programs, gamblers completed the addiction severity index (ASI) and gambling questionnaires. Subjects were categorized into non‐daily smokers (n = 107) and daily smokers (n = 210). Differences in demographics, gambling variables and ASI composite scores were compared between the groups. Results The daily smokers were more likely to have a history of treatment for a substance use disorder than the non‐daily smokers. After controlling for substance abuse treatment histories, gender and age, the daily smokers demonstrated more severe gambling, family/social and psychiatric problems. Compared to non‐daily smokers, the daily smokers gambled on more days and spent more money gambling; they also ‘craved’ gambling more and had lower perceived control over their gambling. The daily smokers were more likely to be taking psychiatric medications, and they experienced psychiatric symptoms, especially anxiety symptoms, on a greater number of days than non‐daily smokers. Implications Results from this study suggest that about two‐thirds of treatment‐seeking gamblers are current daily cigarette smokers, and smoking status is associated with more severe gambling and psychiatric symptoms. These results warrant further investigation of smoking in gamblers and whether smoking adversely affects the course of treatment or outcomes among gamblers.     

Co-morbidity of smoking in patients with psychiatric and substance use disorders

This article reviews cigarette smoking in patients with psychiatric disorders (PD) and substance use disorders (SUD). Rates of smoking are approximately 23% in the U.S. population but approximately two- to four-fold higher in patients with PD and SUD. Many remaining smokers have had repeated smoking cessation failures, possibly due to the presence of co-morbid PD and SUDs. There is modest, evidence-based support for effective treatment interventions for nicotine addiction in PD and SUD. Further research is needed to increase our understanding of nicotine addiction in PD and SUD and develop more effective treatment interventions.     

Does menthol attenuate the effect of bupropion among African American smokers?

Background African Americans have higher tobacco‐related morbidity and mortality and are more likely to smoke menthol cigarettes than their white counterparts. This study examined differences between African American menthol and non‐menthol smokers in smoking characteristics and cessation. Methods The study sample consisted of 600 African American smokers enrolled in a clinical trial that assessed the efficacy of sustained‐release bupropion for smoking cessation. Menthol (n = 471) and non‐menthol (n = 129) smokers were compared on smoking‐related characteristics and abstinence rates at 6 weeks and 6 months. Results Menthol smokers were younger (41.2 versus 52.9 years), more likely to be female (73.7% versus 56.6%) and more likely to smoke their first cigarette within 30 minutes of waking up (81.7% versus 69.8%) compared to non‐menthol smokers (all P < 0.01). Cigarette taste (50% versus 40%, P = 0.054) was rated non‐significantly higher by menthol smokers. Seven‐day point‐prevalence abstinence from smoking at 6 weeks were 28% and 42% (P = 0.006) and at 6 months were 21% and 27% (P = 0.21) for menthol and non‐menthol smokers, respectively. At 6 weeks follow‐up, stepwise logistic regression revealed that among those younger than 50 years, non‐menthol smokers were more likely to quit smoking (odds ratio = 2.0; 95% CI = 1.03–3.95) as were those who received bupropion (odds ratio = 2.12; 95% CI = 1.32–3.39). Conclusion African American menthol smokers had lower smoking cessation rates after 6 weeks of treatment with bupropion‐SR, thereby putting menthol smokers at greater risk from the health effects of smoking. Lower overall cessation rates among African Americans menthol smokers may partially explain ethnic differences in smoking‐related disease risks.     

Cigarette consumption and socio-economic circumstances in adolescence as predictors of adult smoking

Aim To investigate effects of cigarette consumption level and socio‐economic circumstances during adolescence on adult smoking. Methods 1958 British birth cohort (all births 3–9 March 1958). Logistic regression used to predict (i) smoking at 41 years and (ii) persistent smoking (at 23, 33 and 41 years) from cigarette consumption and socio‐economic circumstances at 16 years, indicated by social class and educational qualifications. Results Of 6537 subjects with full smoking history, 30% smoked at 16 years, 23% smoked at 41 years and 19% smoked at 23, 33 and 41 years (persistent smokers). Heavier smokers at 16, 23 and 33 years were more likely to smoke at 41 years than lighter smokers. The odds ratio (OR) of smoking at 41 years was 2.5 for men and 3.0 for women who smoked ≥60 cigarettes/week at age 16, relative to <20 cigarettes/week. Subjects from manual social backgrounds and those with no qualifications had elevated risks of being a smoker at 41 years or a persistent smoker. These effects were robust to adjustment for adolescent consumption level (e.g. adjusted OR for no qualifications was 3.8). However, adolescent consumption level modified the effect of educational achievements. Among lighter adolescent smokers, those gaining higher qualifications had lower prevalence of smoking at 41 years (16%) than men with no qualifications (83%); among heavier adolescent smokers, prevalence was more similar for subjects with higher (56%) and no qualifications (69%). Conclusions Socio‐economic background appears to influence adult smoking behaviour separately from adolescent cigarette consumption which is a recognized measure of nicotine dependence. There was some evidence that effects of early nicotine dependence are modified by educational achievements.     

Frequency of light cigarette use on staff and students of Ankara University School of Medicine

Light cigarettes which are launched as fewer harmful threaten to community health because of so many diseases related with smoking. Therefore, research of light cigarette using rates and related factors might be beneficial along with research of smoking frequency in community. The aim of this study is to evaluate light cigarette smoking habit of staff and students of school of medicine. This cross-sectional study was conducted on staff and students of Ankara University School of Medicine in 2004. 216 (34%) light cigarette smokers of 627 people (344 students, 283 staff) were evaluated in this study. Questionarie form was applied to participants by face-to-face interview, chi-square and ANOVA analyse method were used for evaluation. Participant's profile was 51.4% male and 48.6% female. Mean age of the participants was calculated as 31.17 +/- 8.84. Light cigarette use was stated by 23.7% of smokers. Relationship between light cigarette use and various factors has been examined and it was found that light cigarette use rate was higher in females (p= 0.04). Smoking start age was detected lower in light cigarette smokers (18.59 +/- 2.87) rather than smokers (19.76 +/- 3.42). One over five person was found as light cigarette smokers among the participants. Light cigarette use rate is higher in females and smoking starting age is lower in light cigarette smokers. Relationship between female gender and smaller starting ages were considered as preference of the groups that had awareness in harmful effects of smoking especially light cigarette smoking and tried to reduce risks. In opposition to light cigarette had fewer harmful health effects, community must be made conscious about this belief may cause an increase in smoking prevalence in community.     

The relationship between insulin resistance and dyslipidaemia in cigarette smokers

AIM: Considerable evidence shows that cigarette smokers tend to have the dyslipidemic pattern of high plasma triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) concentrations, a highly atherogenic lipoprotein profile also typical of the insulin-resistant state even in the absence of cigarette smoking. However, because cigarette smokers are frequently insulin resistant, it is unclear if this dyslipidaemia is secondary to smoking, per se, or simply to the fact that smokers tend to be insulin resistant. The present study was initiated to determine whether this dyslipidaemia prevalent in cigarette smokers and characteristic of insulin-resistant individuals is a function of cigarette smoking or of insulin resistance. METHODS: As measured using vertical auto profile-II methodology, the lipid and lipoprotein concentrations were compared in 34 cigarette smokers divided into insulin-sensitive and insulin-resistant subgroups. The two groups were similar in age and body mass index, differing only in their insulin-mediated glucose uptake as quantified by the steady-state plasma glucose concentration determined during the insulin suppression test. RESULTS: While levels of TG and very low-density lipoprotein cholesterol (VLDL-C) were significantly elevated in insulin-resistant cigarette smokers, total cholesterol (C), low-density lipoprotein cholesterol (LDL-C), narrow-density (ND) LDL-C, intermediate-density lipoprotein-C (IDL-C), HDL-C and non-HDL-C were not different in the two groups. The insulin-resistant smokers also had a preponderance of small, dense LDL particles, while the reverse was true of the insulin-sensitive cigarette smokers. CONCLUSIONS: These data suggest that the dyslipidaemia previously attributed to smoking occurs primarily in those smokers who are also insulin resistant.     

‘To prove this is the industry's best hope’: big tobacco's support of research on the genetics of nicotine addiction

Background New molecular techniques focus a genetic lens upon nicotine addiction. Given the medical and economic costs associated with smoking, innovative approaches to smoking cessation and prevention must be pursued; but can sound research be manipulated by the tobacco industry? Methodology The chronological narrative of this paper was created using iterative reviews of primary sources (the Legacy Tobacco Documents), supplemented with secondary literature to provide a broader context. The empirical data inform an ethics and policy analysis of tobacco industry‐funded research. Findings The search for a genetic basis for smoking is consistent with industry's decades‐long plan to deflect responsibility away from the tobacco companies and onto individuals' genetic constitutions. Internal documents reveal long‐standing support for genetic research as a strategy to relieve the tobacco industry of its legal responsibility for tobacco‐related disease. Conclusions Industry may turn the findings of genetics to its own ends, changing strategy from creating a ‘safe’ cigarette to defining a ‘safe’ smoker.     

The relationship between addiction and reward bundling: an experiment comparing smokers and non-smokers

Aims Previous studies indicate that addicts show reduced preference for more delayed versus more immediate rewards compared to non‐addicts. This may reflect a lower propensity to view such decisions in terms of the larger sequences to which they typically belong (e.g. smoking is a frequently repeated act). Therefore, this study aims to test whether, in a sequence of decisions involving smaller, sooner (SS) versus larger, later (LL) rewards, suggesting or forcing people with a propensity to addiction to make the decision for the series as a whole would increase LL preference. It is hypothesized that people without a propensity to addiction should benefit less from being encouraged to think of reward sequences because they already tend to take that view. Design Thirty regular smokers (as exemplars of addicted individuals) and 30 non‐smokers chose between small short‐term and larger long‐term monetary rewards over a sequence of four decisions spaced 2 weeks apart. Subjects were divided into three groups: one who made each decision independently with no suggestion that they be considered as a series (‘free’), a group to whom it was suggested from the start that they consider each decision as part of the series (‘suggested’) and a group who were told that their very first choice in the series would be used for the remaining decisions (‘forced’). All subjects were paid the amounts they had chosen. Setting A laboratory room at the University of Cape Town (UCT). Participants UCT undergraduate volunteers. Analyses The proportion of LL choices in each subgroup was evaluated by χ² tests and a probit model. Findings Smokers increased their preference for LL rewards when ‘bundling’ of individual decisions into a sequence was either suggested or forced. This preference increased with repeated experience. Non‐smokers showed neither pattern. Conclusions The propensity of smokers to prefer small short‐term rewards over larger delayed rewards may be mitigated, over a sequence of decisions of this kind, by encouraging or forcing them to think of the sequence as a whole. If replicated, this finding may form the basis of an intervention that could attenuate the choice patterns characteristic of addiction.     

Leaving work to smoke

Work-place smoking bans have not only reduced work-day cigarette consumption but also been associated with going outside to smoke during working hours. We examined the extent of "exiled smoking", estimated how much work-day cigarette consumption can be attributed to it, and examined proximal predictors of both these two variables. Some 794 smokers from 42 medium-sized work-places were surveyed as the baseline for an intervention study. A self-completed questionnaire assessed smoking behaviour on work and non-working days, leaving work to smoke, and beliefs and opinions about smoking and smoking bans. Multiple regressions were used to examine predictors of leaving work to smoke, and of the amount smoked when doing so. Smokers reported consuming an average of 5.4 cigarettes during work breaks, 3.5 of which were associated with deliberately seeking opportunities to smoke; 39% reported leaving work to smoke one or more times per day during non-break periods. Indices of addiction were significant predictors of both leaving work to smoke and of cigarette consumption while doing so. Leaving work to smoke is in part an activity of addicted smokers, presumably to maintain blood nicotine levels. There is the potential to further reduce rates of cigarette consumption associated with work-place smoking bans if this "exiled smoking" can be reduced. This may be easier to achieve in light smokers.     

Plain packaging increases visual attention to health warnings on cigarette packs in non-smokers and weekly smokers but not daily smokers

Aims To assess the impact of plain packaging on visual attention towards health warning information on cigarette packs. Design Mixed‐model experimental design, comprising smoking status as a between‐subjects factor, and package type (branded versus plain) as a within‐subjects factor. Setting University laboratory. Participants Convenience sample of young adults, comprising non‐smokers (n = 15), weekly smokers (n = 14) and daily smokers (n = 14). Measurements Number of saccades (eye movements) towards health warnings on cigarette packs, to directly index visual attention. Findings Analysis of variance indicated more eye movements (i.e. greater visual attention) towards health warnings compared to brand information on plain packs versus branded packs. This effect was observed among non‐smokers and weekly smokers, but not daily smokers. Conclusion Among non‐smokers and non‐daily cigarette smokers, plain packaging appears to increase visual attention towards health warning information and away from brand information.     

Very low rate and light smokers: smoking patterns and cessation-related behaviour in England, 2006-11

Aims There is a growing interest in very low rate [fewer than one cigarette per day (CPD)] and light (one to nine CPD) smokers and in some parts of the world their numbers appear to be increasing. This paper examined changes in prevalence over the past 5 years, cessation patterns, and smoking and demographic characteristics of very low rate, light and moderate‐to‐heavy (10+ CPD) smokers in England. Design Cross‐sectional and longitudinal data from aggregated monthly waves of a household survey: the Smoking Toolkit Study. Setting England. Participants A total of 23 245 smokers interviewed between November 2006 and May 2011 and 4147 who provided data at 6‐month follow‐up. Measurements We compared the demographic and smoking characteristics between the three groups of smokers at baseline, and the rate of attempts to quit, use of aids to cessation and success of quit attempts at follow‐up. Findings Very low rate smoking remained extremely rare (1.9% of smokers in 2006 to 2.8% in 2011), but light smoking became increasingly common (23.9–32.8%). Compared with moderate‐to‐heavy smokers, very low rate and light smokers were younger, more often female and from a higher socio‐economic background. They were more motivated to quit and enjoyed smoking less. During the 6‐month follow‐up period, light smokers, but not very low rate smokers, were more likely to attempt to quit than moderate‐to‐heavy smokers. When they tried to quit, very low rate and light smokers used aids to cessation less than moderate‐to‐heavy smokers but still used them to a substantial degree: 18%, 31% and 44% used over‐the‐counter nicotine replacement therapy in their most recent quit attempt for the three types of smoker, respectively. Even very low rate smokers had a substantial failure rate: 65% failed in their most recent quit attempt within 6 months. Conclusions Very low rate (fewer than one cigarette per day) and light (one to nine cigarettes per day) smokers in England are at least as motivated to quit as heavier smokers. Although they use cessation medication less than heavier smokers and are more likely to succeed, they still use such medication and fail in quit attempts to a substantial degree.     

Do cigarette prices motivate smokers to quit? New evidence from the ITC survey

Aims To examine the importance of cigarette prices in influencing smoking cessation and the motivation to quit. Design We use longitudinal data from three waves of the International Tobacco Control Policy Evaluation Survey (ITC). The study contrasts smoking cessation and motivation to quit among US and Canadian smokers and evaluates how this relationship is modified by cigarette prices, nicotine dependence and health knowledge. Different price measures are used to understand how the ability to purchase cheaper cigarettes may reduce the influence of prices. Our first model examines whether cigarette prices affect motivation to quit smoking using Generalized Estimating Equations to predict cessation stage and a least squares model to predict the change in cessation stage. The second model evaluates quitting behavior over time. The probability of quitting is estimated with Generalized Estimating Equations and a transition model to account for the ‘left‐truncation’ of the data. Settings US and Canada. Participants 4352 smokers at Wave 1, 2000 smokers completing all three waves. Measurements Motivation to quit, cigarette prices, nicotine dependence and health knowledge. Findings Smokers living in areas with higher cigarette prices are significantly more motivated to quit. There is limited evidence to suggest that price increases over time may also increase quit motivation. Higher cigarette prices increase the likelihood of actual quitting, with the caveat that results are statistically significant in one out of two models. Access to cheaper cigarette sources does not impede cessation although smokers would respond more aggressively (in terms of cessation) to price increases if cheaper cigarette sources were not available. Conclusions This research provides a unique opportunity to study smoking cessation among adult smokers and their response to cigarette prices in a market where they are able to avoid tax increases by purchasing cigarettes from cheaper sources. Higher cigarette prices appear to be associated with greater motivation to stop smoking, an effect which does not appear to be mitigated by cheaper cigarette sources. The paper supports the use of higher prices as a means of encouraging smoking cessation and motivation to quit.     

Maintenance and attributions about smoking among smokers, nonsmokers, and ex-smokers

Attributions about smoking by smokers, nonsmokers, and sustained ex-smokers do not show evidence of an actor versus observer bias. Smokers rated most reasons for smoking as relatively less important. Attributions about smoking of ex-smokers resembled nonsmokers and differed from smokers. Ex-smokers are less likely to perceive themselves as having been addicted but more likely to perceive continued smokers as addicted. Various attributions for smoking, heavy smoking, expectancies, and desires for quitting were differentially related to perceived addiction. The data are discussed in terms of the "mindless" habitual nature of cigarette smoking, and the conscious, cognitive restructuring necessary for maintenance after smoking ceases.