I SEE MANY children with different respiratory conditions such as asthma at my respiratory clinic in Our Lady’s Children’s Hospital, Crumlin.

When I ask parents if they smoke, the answer is often “no” which is great as their children are not being exposed to second-hand tobacco smoke.

However, if I drill down a bit further and ask “do you ever smoke occasionally?”, I tend to get a different answer and some parents admit to being a “social smoker”, or “only smoking when out socialising with friends”.

Most people are aware that smoking is bad for them but in my experience I find that not many are aware that even smoking a couple of cigarettes a week is bad for them.

Health risks

This week, the RCPI policy group on tobacco has published a position paper on occasional smoking and its associated health risks. The report presents a review of the current research on the topic and offers some recommendations on how best to tackle the issue going forward.

There are different definitions of occasional smoking but it generally refers to any smoking which is done on less than a daily basis. Most people would identify social smokers as being the most common form of occasional smoking.

Overall, cigarette smoking is on the decline but data from a recent US survey suggests that occasional smoking is increasing. This may be because smokers are trying to quit and are therefore decreasing their smoking consumption. However, the increasing rate may also be due to a lack of awareness about the dangers of occasional smoking.

Occasional smokers are a divergent group who tend to smoke in a variety of patterns at different levels and at different times. Research on occasional smokers shows they are more likely to be younger, female and have a higher level of education when compared with daily smokers.

Most occasional smokers tend to continue this pattern of smoking for many years, often not realising the dangers associated with their habit. This group of smokers are at a higher risk of becoming regular smokers and young adults who occasionally smoke are three times more likely to progress onto daily smoking compared with non-smokers. Therefore this is a group that should be identified in anti-smoking campaigns as many of these young adults are the daily smokers of tomorrow.

Negative health impact

Many people do not believe that the occasional cigarette is harmful to their health. This is simply not true and there is now robust evidence that occasional smoking has a significantly negative impact on one’s health.

Long-term prospective data collected from a number of research studies carried out over the past 15 years are highlighted in the RCPI position paper. A person who smokes one cigarette a day has half the risk of heart disease and stroke as someone who smokes 20 per day. Middle aged women who smoke 1-4 cigarettes a day are five times more likely to develop lung cancer when compared with non-smokers.

Occasional smoking is associated with a 38% increased mortality risk compared with non-smokers. I could go on with more damning facts and figures but the take-home message is that occasional smoking is not safe.

In Ireland, almost one in five adults smoke on a regular basis and occasional smokers make up almost one-fifth of all smokers. Although there has been a reduction in the prevalence of daily smoking, there has been little change in the prevalence of occasional smoking in Ireland over the past few years.

Data from the Healthy Ireland Survey 2017 shows that the demographics of the typical Irish person who occasionally smokes are similar to those identified above.

Ireland is frequently near the top of the league table when it comes to alcohol consumption rates. We have a significant problem with binge drinking and this is adding to our smoking rates as binge drinkers are much more likely to smoke than non-binge drinkers are. People who binge drink have increased craving for tobacco and vice versa.

Our occasional smoking rates will decrease if we can tackle the problem of young adults who binge drink.

Interestingly, many occasional smokers don’t consider themselves as smokers so surveys and research studies are likely underreporting the prevalence of occasional smoking. As a result, we don’t know what is the best way to help occasional smokers quit.

Also, figures from the Healthy Ireland Survey 2017 demonstrate that occasional smokers have less of a desire to quit smoking when compared to daily smokers. This may be because they don’t consider themselves smokers or are not aware they are causing harm to themselves.

The different demographics of occasional smokers and misperceptions of their habit compared with daily smokers mean we need to address this problem with different tobacco cessation strategies. With this in mind, further research into how we can motivate this group to quit smoking indefinitely is required. Public health policy makers should assist in increasing awareness about the dangers of occasional smoking.

The Tobacco Free Ireland policy was launched in 2013 with the aim of decreasing the national smoking prevalence rate to less than 5%. If we are to get anywhere near achieving this goal, more investment in tobacco cessation treatments and increased legislative measures are urgently needed.

In order to help identify and assist quitters, all healthcare professionals can and should ask more specific questions about people’s smoking habits during every patient contact. If you are thinking of quitting smoking, find your local quit service through the www.quit.ie website or speak to your general practitioner.

Dr Des Cox, Chair of the Policy Group on Tobacco at the Royal College of Physicians of Ireland and Consultant in Paediatric Respiratory Medicine, Our Lady’s Children’s Hospital, Crumlin.