Evaluating Cigarette Relighting Behavior: Prevalence, Correlates, Toxicant Exposure, and Implications for Cessation

点击翻译按钮获取中文摘要

Although smoking prevalence has decreased, more than 34 million Americans continue to smoke. Disenfranchised groups increasingly comprise the remaining smoking population, and cigarette relighters may be some of the most disenfranchised (e.g., low socioeconomic status). Relighting refers to extinguishing, saving, and later relighting unfinished cigarettes. Research suggests this is a prevalent behavior engaged in by 44-73% of smokers, with 17-21% of smokers reporting they relight ‘usually’ or ‘frequently’, thus impacting millions of Americans. Apparent reasons for relighting include cost, perceived benefits for health and cessation, and smoking bans. This behavior may increase harms to smokers such as lung cancer and chronic bronchitis. For example, relighting could contribute to worse cessation and health outcomes if relighters (who tend to be highly nicotine-dependent) have lower motivation toward total abstinence because they believe they are minimizing the amount they smoke. They may also be inadequately treated and advised by clinicians because they appear to be less dependent or smoke fewer numbers of cigarettes per day (CPD) compared to non-relighters, despite a greater number of smoking sessions per day and exposure to toxicants. This could lead to under-dosing of pharmacotherapy. Given that reasons for relighting include the increasing cost of cigarettes, prevalence of relighting may grow in the future (especially during this economic crisis) and may continue to impact disproportionately those with greater existing tobacco-related disparities. More research is needed to address these challenges by investigating who relights and why, and potential effects of relighting on tobacco dependence, cessation, and health. Understanding relighting is critical because: 1) current assessments (i.e., CPD) may underestimate toxicant exposure and nicotine dependence among relighters and 2) if relighting continues to be largely ignored by providers, a high proportion of smokers may be undertreated. Specific aims of this four-year project are to: 1) Establish criteria and reasons for, as well as prevalence, frequency, and correlates of relighting in a national survey; 2) Evaluate potential toxic effects of relighting using topography and toxicant analyses; 3) Investigate the potential impact of relighting by observing tobacco treatment and outcomes of relighters in a state-wide tobacco treatment program. Preliminary studies need to be replicated and extended to be more rigorous, comprehensive, and on a larger scale to address numerous remaining questions that would lay the groundwork for understanding the individual and public health impact of relighting. This study will provide important information about the extent, frequency, contextual factors, and potential dangers of this understudied behavior. The study has implications for both surveillance and treatment such as new measures to screen for relighting clinically and in population surveys as well as potentially informing clinicians in prescribing appropriate-intensity treatments for relighters. Together, data from the proposed specific aims will provide a clearer picture of the extent and impact of cigarette relighting.