Light smokers last bastion of anti-tobacco efforts
They call themselves social smokers or light smokers, or they take a puff so infrequently that they don't call themselves smokers at all.
Public health experts see something else: a group of people who ought to quit cold to mark the new year.
Smoking rates have plummeted in the United States and California in the past two decades, since the launch of aggressive public health campaigns that made it harder and a lot more socially unacceptable to light up.
But in recent years the rates have hit a plateau, and some public health experts say it's going to take new campaigns, targeted at a different kind of smoker from the traditional two-pack-a-day folks, to make further strides against smoking, and maybe even wipe out cigarette use altogether.
"People used to think that if you cut smoking rates down, you'd get to a hard core of dedicated smokers that are hard to address. But it's just the opposite," said Dr. Stanton Glantz, director of UCSF's Center for Tobacco Control Research and Education. "People who are smoking are pretty much light smokers, and if we could get an aggressive campaign for them, within two or three years tobacco would be effectively gone."
A little less than 20 percent of American adults are smokers, meaning they have a cigarette at least "some days," according to the U.S. Centers for Disease Control and Prevention. The rate is lower in California, where 13 percent of adults smoke.
Rates flat over 5 years
That's a huge drop nationally, and in California in particular, over the past 25 years - 30 percent of U.S. adults smoked in 1985, and 28 percent of Californians smoked. But the rates have been flat for the past five years.
In 1992, almost 18 percent of California smokers were going through at least a pack of cigarettes a day; in 2008, only 7 percent were smoking that much. And the percentage of smokers who don't light up every day climbed from 15 percent in 1992 to 28 percent in 2008.
So not only are fewer people smoking, but those who do light up are smoking less. That's a good sign, public health officials said, if only because it will probably be easier to get the "light" smokers to quit for good.
'No safe level'
But any amount of smoking, even one or two cigarettes a week, is a major health hazard, doctors say. In December, the U.S. surgeon general issued a report advising that just one cigarette can have an immediate, negative effect on the heart and lungs.
"There is no safe level of smoking. People who are light smokers are still smoking, and there's still damage being done to their body," said Colleen Stevens, chief of the tobacco control media campaign for California's public health department.
Public health officials said huge media campaigns and increasingly restrictive state and federal regulations have cut into smoking rates. In California especially, it's become increasingly difficult for people to buy cigarettes and find places to legally smoke them.
Meanwhile, health providers such as Kaiser Permanente have attacked smoking from a different angle, confronting patients head-on about their habit. Since 2003, Kaiser has had a program in place to ask every patient, during every office visit, about his or her smoking habits and offer programs to help patients quit.
In that time, smoking rates among Kaiser members have fallen from about 12 percent to 9 percent, said Ali Goldstein, chair of the Kaiser Northern California tobacco dependence program.
Other health care providers have gone after smokers' pocketbooks - most insurers charge higher premiums for people who smoke. In fact, smoking has become increasingly expensive over the past decade as state and federal regulators piled on heftier taxes.
The U.S. Food and Drug Administration, which has been given more control of tobacco manufacturing and promotion regulations, is proposing rules that would require tobacco companies to revamp cigarette packaging, showing large, possibly gruesome images of the damage smoking can do to the body.
On the state level, public health officials are reinvigorating media campaigns and focusing on groups with the highest rates of smoking, especially in rural counties where smoking is most prevalent.
Glantz suggested that the campaigns to end smoking - and the programs designed to help people quit - probably need to shift now that the demographic of smokers has changed.
Medications and nicotine-replacement therapies for heavy smokers might not work for people who smoke one or two cigarettes a day. They might just need a motivation to stop, not a major intervention to help them kick a serious addiction.
"The thing about there being a lot more light smokers is, if we had a really big push, we could probably get most of them to quit. The physical addiction they have is much easier to break," Glantz said.
"But all of the therapies we've looked at, they were developed for pack-a-day smokers, and if you have somebody who is only smoking a few cigarettes a day or a few a week, those therapies are probably not appropriate," he said. "Nobody knows quite what to do with those people yet."