Margarete C Kulik1, Stanton A Glantz1. 1. Center for Tobacco Control Research and Education and Department of Medicine, University of California at San Francisco, San Francisco, USA.
Abstract
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Entities:
Keywords:
Addiction; Cessation; Public policy; Surveillance and monitoring
Authors: Michelle L Costa; Joanna E Cohen; Michael O Chaiton; David Ip; Paul McDonald; Roberta Ferrence Journal: Nicotine Tob Res Date: 2010-07-02 Impact factor: 4.244
Authors: Margarete C Kulik; Gwenn Menvielle; Terje A Eikemo; Matthias Bopp; Domantas Jasilionis; Ivana Kulhánová; Mall Leinsalu; Pekka Martikainen; Olof Östergren; Johan P Mackenbach Journal: Nicotine Tob Res Date: 2013-11-09 Impact factor: 4.244
Authors: Lara N Coughlin; Erin E Bonar; Kipling M Bohnert; Mary Jannausch; Maureen A Walton; Frederic C Blow; Mark A Ilgen Journal: Drug Alcohol Depend Date: 2019-11-01 Impact factor: 4.492
Authors: Luis Zavala-Arciniega; Luz Myriam Reynales-Shigematsu; David T Levy; Yan Kwan Lau; Rafael Meza; Daniela Sarahí Gutiérrez-Torres; Edna Arillo-Santillán; Nancy L Fleischer; James Thrasher Journal: Tob Control Date: 2020-02-04 Impact factor: 7.552
Authors: Scott J Moeller; David S Fink; Misato Gbedemah; Deborah S Hasin; Sandro Galea; Michael J Zvolensky; Renee D Goodwin Journal: J Clin Psychiatry Date: 2018 May/Jun Impact factor: 4.384