New faculty commentary highlights hidden cardiovascular risks of light smoking
Is smoking just a few cigarettes a day really safer than heavy smoking? A new article by UCLA Joe C. Wen School of Nursing Associate Professor Mary Rezk-Hanna, PhD, FAAN, FAHA, published in the Journal of the American Heart Association, challenges that belief and explains why light smoking may still pose a serious threat to heart health, particularly among Black adults who smoke lightly.
Today, more than ever, fewer people in the United States smoke cigarettes. But smoking-related heart disease remains a major public health problem, especially in Black and African American communities. The commentary notes that more than half of Black adults who smoke consume 10 or fewer cigarettes a day, often classifying them as “light smokers”. Because their cigarette use is lower, their cardiovascular risk may be underestimated in both clinical care and public health messaging.
The article highlights evidence that cardiovascular risk does not increase in a simple, straight-line fashion with cigarette count. Instead, the relationship is steep and nonlinear, meaning that even low levels of cigarette exposure can carry substantial cardiovascular harm. As the commentary explains, smoking only a few cigarettes a day may confer far more heart disease risk than many people realize.
The commentary also calls attention to the disproportionate burden faced by Black adults who smoke lightly. Cigarette count alone may not capture the full picture. Differences in toxicant exposure, menthol cigarette use, and broader social and structural conditions, including chronic stress, inequities in care, and environmental adversity, may intensify smoking-related harm and help explain why Black light smokers experience disproportionately high cardiovascular risk.
Another concern raised in the article is how smoking cessation support is delivered. Black light smokers are often overlooked in tobacco screening, counseling, and treatment, despite carrying substantial cardiovascular risk and often being ready to quit. Programs and clinical guidelines are frequently designed with heavier smokers in mind, which can leave light smokers without adequate support or evidence-based treatment options.
The article calls for a shift in how clinicians, researchers, and public health professionals approach light smoking. Rather than suggesting that simply “cutting back” is enough, the article emphasizes that there is no safe level of combustible cigarette use and that complete cessation remains the safest option for cardiovascular health, regardless of how little a person smokes. It also calls for more equitable, culturally responsive cessation strategies and greater attention to community-based approaches that can better reach Black adults who smoke lightly.
The article was co-authored by Rezk-Hanna, former UCLA doctoral student Shenita Anderson, PhD, and UCSF tobacco and nicotine expert Neal Benowitz, MD. The full article is available through the Journal of the American Heart Association.
