The present study was the first to examine the associations of smoking level with demographics, tobacco dependence, withdrawal, and abstinence among Spanish-speaking Latinos during a specific quit attempt. Three key findings emerged regarding low-level smokers, who were of particular interest due to their uniquely high prevalence among Latino smokers. First, smoking level was strongly linked to the total score and 12 of 13 subscale scores on a comprehensive, multidimensional measure of tobacco dependence (i.e., WISDM-68) as well as single-item tobacco-dependence variables. In each case, low-level smokers reported the least dependence and moderate/heavy smokers reported the greatest dependence on tobacco. Second, in withdrawal analyses (i.e., WSWS), smoking level was associated with craving longitudinally from prequit to 12 weeks postquit, but not with other withdrawal symptoms. Low-level smokers reported the least craving and moderate/heavy smokers the most craving at all points in time. Finally, smoking level was not significantly associated with abstinence at static postquit timepoints or longitudinally. Thus, despite less dependence and fewer cravings, low-level smokers were not more likely than heavier smokers to quit smoking.
The lesser levels of tobacco dependence reported by low-level smokers complement previous findings about “chippers” (nondaily and low-level smokers) who manifest less (or no) dependence on nicotine, as compared with heavier smokers (for a review of research, see Shiffman & Paty, 2006
). However, the present study extends that research to Latinos. Low-level and light smokers differed significantly in self-reported tobacco dependence; low-level smokers reported less dependence than their light smoking counterparts. This finding highlights the importance of examining low-level and light smokers separately, at least among Spanish-speaking Latino smokers.
Given that smoking level was associated with 12 of the 13 subscales of the WISDM-68, the lack of association with the remaining subscale, social/environmental goads, is of particular interest. Social/environmental goads assess contextual influences on smoking (e.g., social motives for smoking, smoking in the presence of other smokers), and the lack of association suggests that low-level smokers may be as motivated as light and moderate/heavy smokers to smoke in response to environmental cues and social motives. These results complement findings that chippers smoke for social reasons, or to enhance the enjoyment of activities, rather than in response to physiological withdrawal symptoms (Shiffman, Kassel, Paty, Gnys, & Zettler-Segal, 1994
; Shiffman & Paty, 2006
). Moreover, low-level smokers reported significantly less craving, both at baseline and during the quit attempt, than did light or moderate/heavy smokers, but they did not differ on any other withdrawal symptoms. Thus, results suggest that interventions for low-level Latino smokers need to be weighted more toward building the skills to combat smoking in response to social situations and activities, as well as altering environmental features to facilitate abstinence, rather than tolerating physiological dependence and craving. The potential efficacy of pharmacotherapy among low-level Latino smokers deserves serious study given the reduced tobacco dependence and craving among this segment of smokers.
Smoking level was not associated with abstinence during the quit attempt. This finding is notable because previous research indicates that low-level smokers are more likely than heavier smokers to maintain abstinence when quitting, perhaps due to reduced levels of, or the absence of, dependence on tobacco (cf. S. H. Zhu et al., 2003
). Although low-level smokers were less dependent on tobacco and experienced less craving during the quit attempt than did light or moderate/heavy smokers, this did not translate into higher cessation rates. However, as shown in Figure 2, there was a suggestion, albeit nonsignificant, that low-level smokers might be more likely to quit successfully, and the present study may have simply lacked sufficient power to detect the effect of smoking level on abstinence. Future research should prospectively investigate the relationship between smoking level and biochemically confirmed abstinence with larger samples of Spanish-speaking Latino smokers.
The present study has several strengths. First, the focus was on Spanish-speaking Latino smokers, a historically underserved racial/ethnic group that has been grossly understudied (Fagan et al., 2007
). Second, the sample allowed a detailed examination of the low end of the smoking-level spectrum because low-level and light smokers were included, unlike the majority of smoking-related randomized clinical trials that include only those who smoke at least 10 cigarettes/day (cf. Okuyemi et al., 2002
). Further, the sample allowed us to distinguish between low-level and light smokers in our exploration of dependence, withdrawal, and abstinence, which is particularly relevant among Latino smokers, given the smoking levels demonstrated here and in previous research (Kandel & Chen, 2000
; S. H. Zhu et al., 2007
). Finally, the present study was unique in its examination of low-level smoking because of its comprehensive assessment of tobacco dependence using the WISDM-68.
A notable limitation of the present study is the lack of biochemical verification of abstinence. However, biochemical verification of the results would likely alter the pattern of results only if there was a systematic bias for misreporting that was dependent on smoking level, which is unlikely. The participants in this study were treatment-seeking, Spanish-speaking Latinos from Texas, two-thirds of whom were of Mexican heritage; therefore, results may not generalize to other Latino population groups. Whether participants modified their smoking level prior to baseline data collection in anticipation of a quit attempt was unknown, and future studies with similar designs should account for this possibility.
To the best of our knowledge, this study was the first to examine tobacco dependence, withdrawal, and abstinence during a specific quit attempt among low-level, Spanish-speaking Latino smokers. Results indicated that low-level smokers were less dependent on tobacco and manifested less craving relative to light and moderate/heavy smoking groups. However, we found no differences between groups in abstinence during the quit attempt. This study represents a preliminary step in understanding the factors influencing tobacco dependence and smoking cessation among low-level Spanish-speaking Latino smokers, a subgroup with high prevalence in the Latino population, and is important in its focus on an understudied and underserved group.