Dosage patterns of cigarette smoking in American adults.

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Abstract
Most studies involving smoking behavior, whether epidemiological or behavioral in focus, involve self-identification by respondents as to whether or not they are or were cigarette smokers. Concepts of dosage, where they are employed, are almost exclusively stated in terms of the number of cigarettes smoked over a given period of time, with the most usual temporal frame of reference being an average day. It was suggested that where concepts of dosage are involved in hypothesis testing of relationships of cigarette smoking to other variables, a relatively more accurate measure of dosage should involve other components besides the number of cigarettes smoked, and these components should be functionally related to a composite dosage index. Dosage was empirically defined in this paper in terms of 3 factors: the self-reported number of cigarettes smoked per average day, the strength of cigarette that is smoked in terms of its tar content, and the self-reported portion of the cigarette actually smoked. From answers to these questions, an index of dosage was formulated in which the smoking population from a 1964 national sample survey was placed in 5 groups based on their distribution of total scores, so that, approximately, dosage-score groups 1 (low) and 5 (high) contained 11%; groups 2 and 4, 16%; and the middle group, 3, 46% of the population of cigarette-smoking adults. Men were found to be heavier smokers in terms of number of cigarettes smoked per day, portion of cigarette claimed actually smoked, tar rating by brand and, therefore, total dosage score. Men were found to be more frequent and deeper inhalers than women. Frequency and depth of inhalation were related positively to each other and to dosage score, these relationships holding true regardless of sex. The concept of dosage might prove relatively useful in investigations of the giving up of smoking, types of gratifications involved in smoking, models of behavior change, frequency rates and length of hospitalization, work days lost through illness, over-all death rates, and specific disease mortality and morbidity rates. A possibility existed that changes in the cigarette itself, combined with changes in the ways in which people smoke might produce a level of exposure tolerable for many people, but that until the parameters of tolerability were ascertained the course for control action must be in the direction of persuading people not to take up cigarette smoking or, if they have already done so, to stop smoking cigarettes completely.

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