Lack of utility of cigarettes per day cutoffs for clinical and laboratory smoking research

Research output: Contribution to journalArticle


  • Jason A. Oliver
  • Lauren R. Pacek
  • Erin N. Locey
  • Laura M. Fish
  • Peter S. Hendricks
  • Kathryn I. Pollak

External Institution(s)

  • Duke University
  • University of Alabama at Birmingham


Original languageEnglish (US)
Article number106066
JournalAddictive Behaviors
StatusPublished - Nov 2019


Background: Most clinical and laboratory smoking research studies require that participants smoke at a certain level to be eligible for enrollment. However, there is limited evidence that use of these cutoffs differentiates groups of smokers along clinically meaningful criteria. Methods: Using receiver operating characteristic curves, we analyzed data from daily smokers in the National Epidemiologic Study of Alcohol Use and Related Conditions - III (NESARC-III) to examine the utility of smoking rates for determining whether participants met DSM-5 criteria for tobacco use disorder, experienced nicotine withdrawal or had a history of failed quit attempts. We also examined whether relationships between these variables differed as a function of key sample characteristics. Results: Smoking rate exhibited a weak relationship with the presence of tobacco use disorder (AUC = 0.664), whether individuals experience nicotine withdrawal (AUC = 0.672) and whether individuals had a history of failed quit attempts (AUC = 0.578). The relationship between smoking rate and a history of failed quit attempts was weaker for women than men (p <.05). Otherwise, utility did not differ as a function of sex, race/ethnicity, education, income, or use of multiple tobacco products. Optimal cutoffs varied somewhat across indices, but the largest number of correct classifications occurred at very low smoking rates. Conclusions: Researchers should consider abandoning the use of smoking rate cutoffs to determine study eligibility. If smoking rate cutoffs are used, a rationale should be presented along with justification for the specific cutoff chosen.

    Research areas

  • Cigarettes, Methodology, Nicotine dependence, Smoking, Tobacco, Withdrawal

Citation formats


Oliver, J. A., Pacek, L. R., Locey, E. N., Fish, L. M., Hendricks, P. S., & Pollak, K. I. (2019). Lack of utility of cigarettes per day cutoffs for clinical and laboratory smoking research. Addictive Behaviors, 98, [106066].


Oliver, JA, Pacek, LR, Locey, EN, Fish, LM, Hendricks, PS & Pollak, KI 2019, 'Lack of utility of cigarettes per day cutoffs for clinical and laboratory smoking research', Addictive Behaviors, vol. 98, 106066.