We have been discussing this for a while. Eventually, we started a version of smoking hierarchy. After reviewing all the existing concepts containing “smoke”, “nicotine”, “cigarette” etc. it turned out the variety of attributes and their combinations are not that large, really. For example, heavy smoker does not get applied to, say, pipe or hookah. See the result here.
We are proposing a new hierarchy making the following assumptions:
- We treat tobacco, smoking and nicotine dependence as synonyms. Even though there are electronic cigarettes, which really are not smoke, in reality these are used that way.
- All non-nicotine smoke (or electronic version of that) is out, such as smoking illicit or legal drugs and marijuana.
- Family history is out. For the patient’s history see below.
- Smoke from fires etc. is out.
- All sorts of toxic effects, sequelae of nicotine abuse and allergies are out. They are separate conditions, and we don’t know how the nicotine came into the body, and whether that was an acute event, rather than smoking.
- Lab tests for nicotine are out.
- Nicotine replacement therapy are due to nicotine abuse, but still not the same thing, and therefore out
- Water pipes, shishas and hookahs as identical.
- Second hand smoking and passive smoking is treated the same.
- Only cigarette frequency is measured in the existing Concepts, cigars, pipes and hookahs almost never are. The cigarette frequency per day definition is:
- trivial=0-1 cigarettes per day
- very heavy or aggressive=>40
We don’t need the exact number of cigarettes (it is probably false precision anyway). Source concepts that ask for exact number per day or week need to be manually mapped to these five categories. If the source concept is mentioning one of the five frequencies without the type we automatically assume cigarettes.
This means we have the following dimensions:
- Type: hookah pipe, cigarette, moist tobacco, chewed tobacco, smokeless, pipe, passive, electronic cigarette, cigar and snuff.
- Amount as above: trivial, light, moderate, heavy, very heavy
- Timing: ex (=in remission), in utero, perinatal
The resulting hierarchy is much simpler than expected:
One thing we need to discuss is should we create additional concepts where we combine all of these with the various timings. The big one is “ex”, meaning the smoking behavior is in remission but happened in the past. Alternatively, we relegate those to “History of”. The “in utero” and “perinatal” are usually only combined with “Smoking” and “Cigarette”. Again, unless the Observation Period covers this period of time it might be “History of”.
Here is what we are not modeling, mostly because we didn’t actually find that many concepts:
- Time since cessation
- Episodic smoking
- Age of start of smoking
- Duration of unsuccessful cessation
- Overall time of smoking (irrespective of strength)
- Negative concepts
The latter might cause some stress with folks (as usual flavors of null do).
Please think and discuss, and let us know. In particular, let us know if the omissions make sense.