Hardcore smoking does not necessarily indicate hardening

Winter, Kelly

doi:10.1111/add.12453

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…however, these results have not accounted for the changes in smoking prevalence, therefore should not be interpreted as evidence suggesting hardening [35].…”

Section: Interpretation Of the Resultsmentioning

confidence: 77%

“…These findings indicate that existing tobacco control policies may be suitable to further decrease smoking prevalence in Europe as we gradually move toward endgame strategies. However, social inequalities in heavy smoking underline the need for tailored interventions targeting smokers in vulnerable socioeconomic groups who may find it more difficult to quit or reduce smoking [35,36]. Competing interests None declared.…”

Section: Resultsmentioning

confidence: 99%

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Are smokers “hardening” or rather “softening”? An ecological and multilevel analysis across 28 European Union countries

et al. 2019

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BackgroundTobacco control policies can reduce smoking prevalence. These measures may be less effective where smoking prevalence has significantly declined, as the remaining smokers have “hardened”. Our aim was to empirically evaluate the “hardening hypothesis” at the population level in the European Union (EU) and explore factors associated with hardcore smoking.MethodsWe conducted two separate analyses in the EU using data on smoking from the Eurobarometer surveys (2009–2017, n=112 745). 1) A panel-data fixed-effects linear regression to investigate changes over time in the percentage of hardcore smokers in relation to standardised smoking prevalence at the country level. 2) A multilevel logistic regression analysis with hardcore (daily smokers, ≥15 cigarettes per day who have not attempted to quit in the last 12 months) or light (<5 cigarettes per day) smoking as the dependent variable and time as the main independent variable, controlling for individual and ecological variables.ResultsWe studied 29 010 current smokers (43.8% hardcore smokers and 14.7% light smokers). The prevalence of hardcore smoking among adult smokers increased by 0.55 (95% CI 0.14–0.96) percentage points per each additional percentage point in the overall smoking prevalence. The odds of being a hardcore smoker increased over time and were higher in middle-aged males and people with financial difficulties, while the odds of being a light smoker significantly declined among females.ConclusionThis study does not support the “hardening hypothesis” in the EU between 2009 and 2017, but suggests a softening of the smoking population. Existing tobacco control policies are likely to be suitable to further decrease smoking prevalence in Europe.

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“…however, these results have not accounted for the changes in smoking prevalence, therefore should not be interpreted as evidence suggesting hardening [35].…”

Section: Interpretation Of the Resultsmentioning

confidence: 77%

Section: Resultsmentioning

confidence: 99%

Are smokers “hardening” or rather “softening”? An ecological and multilevel analysis across 28 European Union countries

et al. 2019

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“…Another found that nicotine dependence scores were higher in countries with lower smoking rates 19. However, critics of these studies have argued they do not provide strong evidence of hardening, citing a range of conceptual and methodological limitations 4 20–22…”

Section: Introductionmentioning

confidence: 99%

Hardening or softening? An observational study of changes to the prevalence of hardening indicators in Victoria, Australia, 2001–2016

et al. 2019

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BackgroundThe hardening hypothesis predicts that as smoking prevalence declines, remaining smokers will be more heavily addicted to nicotine and/or less interested in quitting. We tested this hypothesis in a population exposed to a comprehensive tobacco control programme over a 16-year period.MethodsAnnual cross-sectional surveys randomly sampled adults (aged 26+) in the state of Victoria, Australia, between 2001 and 2016. Until 2010, participants were recruited through random digit dialling to landline telephones; from 2011, sampling frames also included mobile phones. Logistic regressions assessed changes over time in the prevalence of smoking and each hardening indicator; additional models examined interactions by sex, age, education and socioeconomic status.ResultsSmoking prevalence declined significantly between 2001 and 2016 (20.1%–13.0%), as did the prevalence of seven hardening indicators: daily smoking, heavy consumption, no quit attempt in the past 5 years or past 12 months, no intention to quit in the next 6 months or next 30 days, and happiness to keep smoking. In addition, the proportion of smokers defined as ‘hardcore’ decreased from 17.2% to 9.1%. On the whole, hardening indicators decreased to a similar extent among demographic subgroups.ConclusionsThese results are inconsistent with the hardening hypothesis. Rather, they suggest that a comprehensive tobacco control programme that combines provision of cessation support to individual smokers with implementation of population-level interventions to drive all smokers towards quitting, can successfully reduce both smoking prevalence and levels of dependence and desire to keep smoking among the remaining population of smokers.

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“…The concept of harm reduction was first proposed by Russell5 6 when he suggested offering smokers a less harmful source of nicotine than combusted cigarettes. While there is no formal definition of hardening, it has been described as the smoking population becoming, on average, less willing to or less capable of quitting as smoking prevalence declines,7 8 9 so that hardcore smokers would increasingly comprise the remaining smoking population 9 10. We use the common definition of a hardcore smoker as a smoker who will not or cannot quit 7 11.…”

Section: Introductionmentioning

confidence: 99%

The smoking population in the USA and EU is softening not hardening

Kulik

Glantz

2015

Tob Control

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Background It has been argued that as smoking prevalence declines in countries, the smokers that remain include higher proportions of those who are unwilling or unable to quit (a process known as ‘hardening’). ‘Smokeless tobacco and e-cigarettes have been promoted as a strategy to deal with such smokers. If hardening is occurring, there would be a positive association between smoking prevalence and quitting, with less quitting at lower prevalence. There would also be a neutral or negative association between prevalence and the number of cigarettes smoked. Methods We examined US state-level associations using the Tobacco Use Supplement (1992/1993–2010/ 2011) and Eurobarometer surveys for 31 European countries (2006–2009–2012) using regressions of quit attempts, quit ratios, and number of cigarettes smoked on smoking prevalence over time. Results For each 1% drop in smoking prevalence, quit attempts increase by 0.55%±.07 (p<0.001) in the USA and remain stable in Europe (p=0.53), US quit ratios increase by 1.13%±0.06 (p<0.001), and consumption drops by 0.32 cig/day±0.02 (p<0.001) in the USA and 0.22 cig/day±0.05 (p<0.001) in Europe. These associations remain stable over time (p>0.24), with significantly lower consumption at any given prevalence level as time passed in the USA (−0.15 (cig/day)/year ±0.06, p<0.05). Conclusions Consistent with prior research using different data and methods, these population-level results reject the hypothesis of hardening as smoking prevalence drops, instead supporting softening of the smoking population as prevalence declines.

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Hardcore smoking does not necessarily indicate hardening

Cited by 6 publications

References 8 publications

Are smokers “hardening” or rather “softening”? An ecological and multilevel analysis across 28 European Union countries

Are smokers “hardening” or rather “softening”? An ecological and multilevel analysis across 28 European Union countries

Hardening or softening? An observational study of changes to the prevalence of hardening indicators in Victoria, Australia, 2001–2016

The smoking population in the USA and EU is softening not hardening

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