When is a smoker not a smoker?

When they live in California and simply choose to self-identify as a non-smoker. Who are we to criticize the self-identify of people in a state where boys can just declare they are female and use a girl's restroom?

Smoking has plummeted in the last few decades- health statistics, rampant sin taxes and billions of dollars in anti-smoking campaigns will do that - but University of California, San Diego School of Medicine scholars wonder about people who say they use cigarettes but didn't consider themselves to be "smokers" in  the 2011 California Longitudinal Smokers Survey.

Their paper is in Tobacco Control, so they are not out to solve a psychology puzzle, this is more the name-and-shame approach. Wael K. Al-Delaimy, MD, PhD, professor and chief of the Division of Global Health in the UC San Diego Department of Family and Preventive Medicine, and colleagues estimate that, in 2011, almost 396,000 Californians (12.3 percent of the state's population of smokers) smoked on a measurable basis, but rejected the characterization of "smoker." 

Oddly, 22 percent of the people who don't considered themselves smokers consumed tobacco on a daily basis. 

Do they face the same health risks as identified smokers? "There is no safe level of smoking," says Al-Delaimy, though that is in defiance of just about every valid health study. A cigar smoker, a pipe smoker and someone who smokes one cigarette per day does not have the same health risk as someone who smokes 40 cigarettes during their waking hours. If the former were a valid characterization, more than 10 percent of smokers would get lung cancer and 50 percent of lung cancer patients would not be people who have never smoked at all.

Their concern is a social authoritarian one. By letting 0.01 of Californians self-identify as non-smokers, it hurts efforts to reduce tobacco consumption, because those people are not being vilified properly. And what if a doctor asks them if they smoke and they say they don't smoke? The doctor might miss that lung cancer.

So when is a non-smoker a smoker? The authors defined it as those who had smoked at least 100 cigarettes in their lifetime, reported smoking at least one day in the past 30 days or who said they smoked at least "some days." In all cases, when asked if they considered themselves to be a smoker, the respondents replied "No."  

According to sociology and psychology papers, smoking non-smokers consist of young adults who only smoke and drink socially and are not addicted to nicotine. The authors of the new paper created a second group; adults over the age of 45 who were formerly regular smokers and had most likely failed repeated attempts to completely quit but want to avoid the label of "smoker."

Labels matter. And the authors say the label is used more by specific ethnic minority groups, notably black and Asian.  

"There is a risk for such smokers to continue to smoke and be adversely impacted by the tobacco they smoke, yet they do not seek any assistance nor do they plan to quit because they falsely believe they are not smokers," Al-Delaimy said. "This more complex issue of identity and self-perception of smokers in today's social environment will require further studies and understanding."

Upcoming in Tobacco Control. No DOI yet.