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Cigarettes – Why One-a-Day Won’t Keep the Doctor Away

Many smokers of five-a-day or fewer cigarettes, or those who have cut down while trying to stop, believe the occasional cigarette causes them little or no harm. Dual users of vaping products and tobacco also imagine their lowered intake of smoke reduces their risk of smoking-related disease to negligible levels. Unfortunately, their sense of low risk is misplaced. This explains why Life insurers insist on higher premiums for people who smoke only infrequently or who disclose very low daily consumption.

A meta-analysis showed smoking one cigarette per day carries around 40%-50% of the excess risk for developing coronary heart disease and stroke that smoking 20 cigarettes per day carries, while smoking five cigarettes has around 55%-65% of the excess risk.1 And the news gets little better for “light” smokers. A mortality study of low-intensity smoking in the U.S. showed nondaily smokers, those who smoke just a few cigarettes per month, have substantially higher mortality risks than people who have never smoked. The report concludes with stark advice for all smokers to quit, regardless of how infrequently they smoke.2

Of course, many smokers attempt to stop by first reducing intake. Health Survey for England (2013 and 2014) reported the percentage of smokers who consume one to five cigarettes per day has steadily risen (from 18.2% to 23.6% between 2009 and 2014), very similar to the pattern in the U.S., where the proportion of smokers inhaling less than 10 cigarettes a day increased from 16% to 27% between 2005 and 2014.

Smoking fewer cigarettes is beneficial and in 2020 unprecedented numbers of smokers are quitting during the pandemic. Analysis by University College London and the charity Action on Smoking and Health, shows across Britain as many as 400,000 people aged 16 to 29 and 240,000 aged over 50, gave up in the first few months following the 23 March lockdown.3 The total is now estimated at more than a million.

It is thought restrictions on socialising, a reduction in earnings and pressure from those sharing living accommodation has driven many smokers to finally kick the habit. It is unclear if this trend will be reversed once clubs and parties start up again, but it is encouraging for the UK Government, which has set a target for the country to become smoke-free by 2030. However, much remains to be done to achieve this. In England, a study of the COVID-19 lockdown and smoking found the combination of the two factors were not associated with a significant change in smoking prevalence but were associated with increases in the rate of quit attempts and cessation.4

The International Union Against Tuberculosis and Lung Disease has expressed its “deep concern” about the impact of coronavirus on the world’s 1.3 billion smokers – particularly those in poorer countries whose healthcare systems are already overburdened. The World Health Organisation and the European Centre for Disease Control and Prevention also warned that smokers may possibly have an increased risk of more severe reactions to COVID-19, just as tobacco consumption makes people more susceptible to respiratory illnesses.

The message as always is that there is no safe level of smoking. Individuals seeking Life insurance, who disclose only occasional tobacco, are at risk of all the health problems facing more determined smokers and the higher rates of premium reflecting this are fair. Whether the coronavirus convinces more of them to stop completely or not, it does at least provide a further incentive.

Hackshaw A et al. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports,
Maki Inoue-Choi et al. Dose-Response Association of Low-Intensity and Nondaily Smoking With Mortality in the United States, JAMA Network Open. 2020;3(6):e206436. doi:10.1001/jamanetworkopen.2020.6436
Jackson SE et al. Association of the COVID-19 lockdown with smoking, drinking, and attempts to quit in England: an analysis of 2019-2020 data, doi: