Defining a never-smoker: results from the nonsmokers survey

Addict Behav. 2004 Aug;29(6):1149-54. doi: 10.1016/j.addbeh.2004.03.008.


The U.S. Centers for Disease Control defines a never-smoker as someone who has smoked < 100 cigarettes per lifetime. In an attempt to explore differences among nonsmokers and to validate this cutpoint, we surveyed 69 nonsmokers who had smoked between 1 and 200 cigarettes in their lifetime on their experiences during the time they smoked. Of the 7 who classified themselves as ex-smokers, 2 met DSM-IV criteria for nicotine dependence, compared with none who classified themselves as never-smokers. No respondents provided data permitting the computation of a Fagerstrom Test for Nicotine Dependence (FTND) score. Withdrawal effects were minimal, but craving, tolerance, and subjective effects showed a pattern of significant differences that were most prominent between those who smoked only 1 cigarette and those who smoked at least a pack. Our data indicate a graded effect but also suggest that 19 cigarettes per lifetime is a more conservative cutpoint than 99 for defining the never-smoker phenotype. Further investigation of the smoking trajectory and characteristics associated with development of signs of dependence in never- vs. ever-smokers may help refine this cutpoint and shed light on what protects some people who experiment with smoking from becoming chronic users.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Attitude
  • Diagnostic and Statistical Manual of Mental Disorders
  • Drug Tolerance
  • Female
  • Humans
  • Male
  • Middle Aged
  • Motivation
  • Psychiatric Status Rating Scales
  • Self-Assessment
  • Smoking / psychology*
  • Smoking Cessation / psychology
  • Tobacco Use Disorder / psychology