{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:37:31Z","timestamp":1791394651696,"version":"4.3.3"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2021,1,12]],"date-time":"2021-01-12T00:00:00Z","timestamp":1610409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["P20GM103644"],"award-info":[{"award-number":["P20GM103644"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["U54DA036114"],"award-info":[{"award-number":["U54DA036114"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>A common criterion for being labeled a \u201cnever smoker\u201d is having smoked &amp;lt;100 lifetime cigarettes. This category is often used as an unexposed reference group to estimate the relative harm from cigarettes. We examined the amount of current and past cigarette and non-cigarette tobacco\/nicotine use among adults who met this \u201cnever smoker\u201d criterion.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analyzed cross-sectional data from 17 179 adult \u201cnever smokers\u201d (ie, reported &amp;lt;100 lifetime cigarettes) in Wave 4 (2016\u20132018) of the Population Assessment of Tobacco and Health (PATH) Study, a United States nationally representative sample. We used PATH-derived variables to describe \u201cnever smokers\u2019\u201d demographics as well as cigarette and non-cigarette tobacco\/nicotine use.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Approximately half of \u201cnever smokers\u201d were young adults (49.3%). Most were white (68.6%) with some college or more (64.4%). Most \u201cnever smokers\u201d had tried any cigarette or non-cigarette tobacco\/nicotine in their lifetime (66.7%), 8.5% smoked cigarettes in the past 30 days, and 5.3% were current experimental (ie, some days or every day) cigarette smokers. By definition, \u201cnever smokers\u201d reported smoking &amp;lt;100 lifetime cigarettes. One fifth (22.8%) had a lifetime history of established regular non-cigarette tobacco\/nicotine use and 8.6% were current established regular non-cigarette tobacco\/nicotine users. In total, 9.4% of \u201cnever smokers\u201d were current experimental or established regular users of combustible tobacco.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The 100-cigarette lifetime threshold includes substantial amounts of current and past tobacco use and thus does not represent lack of exposure to cigarette or non-cigarette tobacco. \u201cNever smoker\u201d reference groups may produce underestimates of the relative harms from cigarettes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications<\/jats:title>\n                  <jats:p>The &amp;lt;100 lifetime cigarettes criterion may not capture what many would consider true \u201cnever smokers.\u201d Relying on the current definition of \u201cnever smokers\u201d as a reference group will include a substantial number of those currently and recently using combustible tobacco and thus produce data that may underestimate the relative harm from cigarettes. Prospective longitudinal research is needed to compare how the 100-cigarette lifetime threshold versus other definitions of regular cigarette smoking differ in predictive validity of clinically meaningful outcomes and health harms to determine the optimal criteria to define established cigarette smoking.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ntr\/ntab009","type":"journal-article","created":{"date-parts":[[2021,1,13]],"date-time":"2021-01-13T04:24:19Z","timestamp":1610511859000},"page":"1199-1207","source":"Crossref","is-referenced-by-count":30,"title":["Tobacco and Nicotine Use Among US Adult \u201cNever Smokers\u201d in Wave 4 (2016\u20132018) of the Population Assessment of Tobacco and Health Study"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7985-0870","authenticated-orcid":false,"given":"Elias M","family":"Klemperer","sequence":"first","affiliation":[{"name":"Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT"},{"name":"Department of Psychological Science, University of Vermont, Burlington, VT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9893-7843","authenticated-orcid":false,"given":"John R","family":"Hughes","sequence":"additional","affiliation":[{"name":"Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT"},{"name":"Department of Psychological Science, University of Vermont, Burlington, VT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3840-4081","authenticated-orcid":false,"given":"Peter W","family":"Callas","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Vermont, Burlington, VT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia C","family":"West","sequence":"additional","affiliation":[{"name":"Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT"},{"name":"Department of Psychological Science, University of Vermont, Burlington, VT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3104-966X","authenticated-orcid":false,"given":"Andrea C","family":"Villanti","sequence":"additional","affiliation":[{"name":"Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT"},{"name":"Department of Psychological Science, University of Vermont, Burlington, VT"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,1,12]]},"reference":[{"key":"2021060814300662600_CIT0001","volume-title":"The Health Consequences of Smoking\u201450 Years of Progress: A Report of the Surgeon General","author":"US Department of Health and Human 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