Healthy Smoker: An Oxymoron? Maybe, But It Is More Complicated Than That

Tobacco use reliably increases the likelihood of chronic disease development and premature death. However, the initiation of tobacco use does not immediately result in clinical disease manifestation. We recruited 24 healthy smokers and 24 age-, sex-, and BMI-matched never smokers to examine changes in immune function prior to clinical disease manifestations (e.g., no diagnosis or drug treatment for chronic health conditions). In addition to immune cell reactivity to lipopolysaccharide (LPS) and dexamethasone (DEX), we collected psychosocial and physical and mental health data. Smokers were moderately addicted to nicotine and had been smoking for an average of 6.6 years (standard error of mean [SEM] = 1.4) and had 9.4 pack years (SEM 1.9) of tobacco exposure. Smokers endorsed poorer sleep as well as greater psychological distress including anxiety, depression, and loneliness, compared to never smokers. In addition, smokers’ immune cells were less reactive to LPS than never smokers’. Thus, smokers exhibit poorer mental and physical health and modulation of their immune response compared to never smokers, indicating that the term “healthy smoker” is an oxymoron. However, the reduction of immune function observed in smokers was also found in never smokers who had higher levels of loneliness. Hence, loneliness may be as immuno-dysregulating as smoking. Upon further investigation, replacing smoking status with self-rated health explained more of the variability in immune cell responses. Overall, these findings caution the use of one facet, like smoking, as a definitive factor driving health status. When determining global health functioning, we must factor in as many facets as possible, as a long-term or trait-like negative emotion can be just a “unhealthy” as a negative health behavior. In this sample, individuals appear to be aware of their “healthiness,” and it was linked to immune dysregulation.