Nearly 400,000 Californians Smoke Cigarettes but Don't Identify as Smokers

Hundreds of thousands of Californians say they use cigarettes but reject being classified as a "smoker," according to researchers at the University of California, San Diego School of Medicine, who report that nearly a quarter of these non-self-identifying smokers use tobacco every day.

The research suggests that there are about 396,000 Californians who smoke but reject the label of smoker, and the phenomenon has both social and health implications, said study leader Dr. Wael Al-Delaimy chief of the Division of Global Health in the UC San Diego Department of Family and Preventive Medicine.

Al-Delaimy and his colleagues report that the by not accounting for these non-identifying smokers, or NIS, efforts to reduce tobacco consumption in the state are overlooking a large segment of the smoking population, about 12 percent. Twenty-two percent of NIS Californians said they used tobacco every day. 

Additionally, the phenomenon may impact clinical studies where researchers ask the subjects if they use tobacco. An answer of "No" may not necessarily mean that the person does not use tobacco, the researchers report.

The researchers define a NIS as a person who has smoked more than 100 cigarettes in their lifetime, who has reported smoking at least one day in the past 30 days or who said they smoked at least "some days."

In the 2011 California Longitudinal Smokers Survey, all respondents who met the definition of an NIS replied "No" when asked if they considered themselves to be smokers.

A further breakdown of the NIS group highlights two types of non-identifying smoker: the young adults who primarily smoke when out drinking and socializing and who believe they are not addicted to nicotine, and people older than 45 who are former smokers but have had trouble quitting completely.

"The younger NIS are typically college students who smoke as a means of social facilitation and who believe they can quit at any time," Al-Delaimy said. "Older NIS are likely the result of stigmatization produced by comprehensive tobacco control programs. They've become marginalized parts of society who see little advantage in identifying themselves as smokers or providing accurate reports of their smoking behavior."

"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."

The study appears in the journal Tobacco Control.