Softening up on the hardening hypothesis

Cohen, Joanna E.; McDonald, Paul; Selby, Peter

doi:10.1136/tobaccocontrol-2011-050381

Cited by 23 publications

(15 citation statements)

References 11 publications

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“…Some authors argue that in the USA, hardcore smokers make up only a very small part of the population, and that hardening in the general population is not (yet) in sight 9 21 22 23. Augustson and Marcus24 estimated that in 1998/1999, the percentage of hardcore smokers was as high as 13.7% nationally and 8.0% in California.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Section: Discussionmentioning

confidence: 99%

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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“…The measure of ‘hardcore’ smoking usually includes a mixture of motivational, dependence and behavioral variables [6,8,14]. Motivational and behavioral measures, such as intention to quit, may predict a failure of making quit attempts [15].…”

Section: Methodsmentioning

confidence: 99%

“…The “hardening hypothesis” suggests that as smoking prevalence decreases, lighter smokers will quit first, leaving more “hardcore” smokers in the population for whom smoking cessation may be especially difficult [4-6]. However, in some reports the hardening hypothesis is discounted, and there are suggestions that hardening occurs among treatment seekers, and there remains no clear evidence of hardening in the general population [4-8]. Some authors suggest that hardening occurs in the sense that, many of today's smokers possibly do have greater difficulty quitting, or are inherently less willing to do so when compared with earlier generations [9].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and factors associated with hardcore smoking in Poland: Findings from the Global Adult Tobacco Survey (2009–2010)

Kaleta

Usidame

Dziankowska-Zaborszczyk

et al. 2014

BMC Public Health

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BackgroundEstimating the prevalence of hardcore smoking and identifying linked factors is fundamental to improve planning and implementation of effective tobacco control measures. Given the paucity of data on that topic, we aimed to assess the prevalence of and factors associated with hardcore smoking in Poland.MethodsWe used data from the Global Adult Tobacco Survey (GATS). GATS is a representative, cross-sectional, household based survey conducted in Poland between 2009 and 2010. Binary logistic regression analysis was used to explore the associations of socio-demographic and smoking related variables with hardcore smoking among daily smokers.ResultsThe prevalence of hardcore smoking was 10.0% (13.0% among men and 7.3% among women) in the whole population of Poland at age 26 years and above. Hardcore smokers constitute 39.9% (41.6% among men and 37.7% among women) of all daily smokers in analyzed age frame. Being older, having started smoking at earlier ages, living in large cities (in women only), being less aware of negative health effects of smoking, having less restrictions on smoking at home was associated with higher risk of being hardcore smoker. Educational attainment and economic activity were not associated with hardcore smoking among daily smokers.ConclusionsHigh prevalence of hardcore smokers may be a grand challenge for curbing non-communicable diseases epidemic in Poland. Our findings should urge policy makers to consider hardcore smoking issues while planning and implementing tobacco control policies. Prevention of smoking uptake, education programs, and strengthening cessation services appeared to be the top priorities.

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“…Because of disagreement about whether hardening is an important phenomenon-and about whether it exists at all-several researchers have suggested that it may be time to redirect research efforts [6,7]. As explained by Docherty & McNeill in a commentary entitled 'The hardening hypothesis: does it matter?…”

Section: Hardcore Smoking Does Not Necessarily Indicate Hardeningmentioning

confidence: 99%

Hardcore smoking does not necessarily indicate hardening

Winter

2014

Addiction

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Softening up on the hardening hypothesis

Cited by 23 publications

References 11 publications

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

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

Prevalence and factors associated with hardcore smoking in Poland: Findings from the Global Adult Tobacco Survey (2009–2010)

Hardcore smoking does not necessarily indicate hardening

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