Prevalence of hardcore smoking in the Netherlands between 2001 and 2012: a test of the hardening hypothesis

Abstract

BackgroundHardcore smokers are smokers who have smoked for many years and who do not intend to quit smoking. The “hardening hypothesis” states that light smokers are more likely to quit smoking than heavy smokers (such as hardcore smokers). Therefore, the prevalence of hardcore smoking among smokers would increase over time. If this is true, the smoking population would become harder to reach with tobacco control measures. In this study we tested the hardening hypothesis.MethodsWe calculated the prevalence of hardcore smoking in the Netherlands from 2001 to 2012. Smokers were ‘hardcore’ if they a) smoked every day, b) smoked on average 15 cigarettes per day or more, c) had not attempted to quit in the past 12 months, and d) had no intention to quit within 6 months. We used logistic regression models to test whether the prevalence changed over time. We also investigated whether trends differed between educational levels.ResultsAmong smokers, the prevalence of hardcore smoking decreased from 40.8 % in 2001 to 32.2 % in 2012. In the general population, it decreased from 12.2 to 8.2 %. Hardcore smokers were significantly lower educated than non-hardcore smokers. Among the general population, the prevalence of hardcore smoking decreased more among higher educated people than among lower educated people.ConclusionsWe found no support for the hardening hypothesis in the Netherlands between 2001 and 2012. Instead, the decrease of hardcore smoking among smokers suggests a ‘softening’ of the smoking population.

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

“…Most tests of the hardening hypothesis have examined changes over time in the prevalence of hardcore behaviours (‘hardening indicators’),6–9 or correlations between smoking prevalence and the prevalence of hardening indicators 4 10. Common hardening indicators include measures of nicotine dependence and quitting intent and activity 4 11 12.…”

“…Encouragingly, most evidence to date does not support the hardening hypothesis. Hardcore smokers comprise a minority of smokers,11 and research in the USA,6 8 9 New Zealand3 and Europe7 8 13 consistently finds either no change in hardening indicators or even a ‘softening’ of the smoking population. Australian studies have similarly found no evidence of hardening among smokers overall 14 15…”

Hardening is dead, long live softening; time to focus on reducing disparities in smoking

“…For example, while a US study reported softening occurred among high but not low SES smokers, 4 a Dutch study found similar levels of softening over time by education level. 12 A New Zealand study reported little evidence for hardening, with similar findings for Māori (indigenous peoples of New Zealand) and non-Māori smokers. 13 Studies from California have found similar degrees of softening among smokers with varying levels of psychological distress and from different ethnic populations.…”

“…Investigations from a variety of countries have generally found little or no evidence in support of the hypothesis. [1][2][3][4][5][6][7][8][9][10][11][12][13] The study reported in this edition of the journal by Brennan and colleagues adds to this (lack of) evidence through a rigorous analysis of repeated cross-sectional surveys in Victoria, Australia between 2001 and 2015. 14 Strengths of the study include the long time period investigated, the wide range of hardening indicators studied, an analysis of hardening within demographic subgroups and sensitivity analyses of the findings.…”

Targeting hardcore smokers: The effects of an online tailored intervention, based on motivational interviewing techniques

“…Hardcore smokers are people who have smoked for many years and have no intention-toquit smoking (Costa et al, 2010). In 2012, 32% of Dutch smokers could be considered 'hardcore', which equals to 8% of the Dutch general population (Bommel e et al, 2016). Compared to non-hardcore smokers, they have lower quitting self-efficacy (Sorg, Xu, Doppalapudi, Shelton, & Harris, 2011) and tend to have dysfunctional beliefs about smoking (Bommel e et al, 2014).…”