Did hardening occur among smokers in England from 2000 to 2010?

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Abstract

Aims To assess trends in the prevalence of ‘hardcore’ smoking in England between 2000 and 2010, and to examine associations between hardcore smoking and socio-demographic variables.

Design Secondary analysis of data from the United Kingdom's General Lifestyle Survey (GLF) and the Health Survey for England (HSE).

Setting Households in England.

Participants Self-reported adult current smokers resident in England aged 26 years and over.

Measurements Hardcore smokers were defined in three ways: smokers who do not want to quit (D1), those who ‘usually’ smoke their first cigarette of the day within 30 minutes of waking (D2) and a combination of D1 and D2, termed D3. Multivariable logistic regression was used to explore associations between these variables and calendar year, age, sex and socio-economic status, and P-values for trends in odds were calculated.

Findings The odds of smokers being defined as hardcore according to D3 increased over time in both the GLF ( P < 0.001) and HSE ( P = 0.04), even after adjusting for risk factors. Higher dependence (D2) was noted in men [odds ratio (OR): 1.19, 95% confidence interval (CI): 1.13–1.24], those of 50–59 years (OR: 1.94, 95% CI: 1.80–2.09) and smokers in lower occupational groups (OR: 2.11, 95% CI: (1.97–2.26). Lack of motivation to quit (D1) increased with age and was more likely in men.

Conclusions The proportion of smokers in England with both low motivation to quit and high dependence appears to have increased between 2000 and 2010, independently of risk factors, suggesting that ‘hardening’ may be occurring in this smoker population.

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Most cited references 25

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Socioeconomic variations in nicotine dependence, self-efficacy, and intention to quit across four countries: findings from the International Tobacco Control (ITC) Four Country Survey.

M Siahpush (2006)

To examine the effect of socioeconomic status (SES) on nicotine dependence, self-efficacy, and intention to quit. Data were from the first wave (2002) of the International Tobacco Control (ITC) Four Country Survey (ITC-4), a panel study of over 2000 adult smokers from each of four countries: the United States, Canada, the United Kingdom, and Australia. Data were collected via telephone interviews. Nicotine dependence, intention to quit, and self-efficacy to quit smoking were the main outcome measures used in this study. Lower levels of education were associated with higher nicotine dependence. The effect of lower income on higher heaviness of smoking index (HIS) scores was significant in Canada, the UK, and Australia. Respondents with low education had 35% larger odds of low self-efficacy than those with high education. Respondents with low education had 40% larger odds of having no intention to quit than those with high education. Respondents with low income had 23% larger odds of having no intention to quit than those with high income. Country was not a moderator of the association of SES with self-efficacy and intention to quit. To the extent that lower SES smokers are more addicted, they are likely to need more intensive support if they are to be successful in their attempts to quit. Given their lower incomes, this places a special responsibility on government to provide or subsidise such services. This should include access to the widest possible range of effective pharmacotherapies complemented with evidence based counselling and support.

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Interventions to increase smoking cessation at the population level: how much progress has been made in the last two decades?

Madeleine Lee, Shu Zhu, Anthony Gamst … (2012)

This paper reviews the literature on smoking cessation interventions, with a focus on the last 20 years (1991 to 2010). These two decades witnessed major development in a wide range of cessation interventions, from pharmacotherapy to tobacco price increases. It was expected that these interventions would work conjointly to increase the cessation rate on the population level. This paper examines population data from the USA, from 1991 to 2010, using the National Health Interview Surveys. Results indicate there is no consistent trend of increase in the population cessation rate over the last two decades. Various explanations are presented for this lack of improvement, and the key concept of impact = effectiveness × reach is critically examined. Finally, it suggests that the field of cessation has focused so much on developing and promoting interventions to improve smokers' odds of success that it has largely neglected to investigate how to get more smokers to try to quit and to try more frequently. Future research should examine whether increasing the rate of quit attempts would be key to improving the population cessation rate.

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Smoke-free air policies: past, present and future.

Andrew Hyland, Joaquin Barnoya, Juan Corral (2012)

Smoke-free policies have been an important tobacco control intervention. As recently as 20 years ago, few communities required workplaces and hospitality venues to be smoke-free, but today approximately 11% of the world's population live in countries with laws that require these places to be smoke-free. This paper briefly summarises important milestones in the history of indoor smoke-free policies, the role of scientific research in facilitating their adoption, a framework for smoke-free policy evaluation and industry efforts to undermine regulations. At present, smoke-free policies centre on workplaces, restaurants and pubs. In addition, many jurisdictions are now beginning to implement policies in outdoor areas and in shared multiunit housing settings. The future of smoke-free policy development depends on credible scientific data that documents the health risks of secondhand smoke exposure. Over the next 20 years smoke-free policies will very likely extend to outdoor and private areas, and changes in the types of tobacco products that are consumed may also have implications for the nature and scope of the smoke-free policies of the future.

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Author and article information

Journal

Journal ID (nlm-ta): Addiction

Journal ID (iso-abbrev): Addiction

Journal ID (publisher-id): add

Title: Addiction (Abingdon, England)

Publisher: John Wiley & Sons Ltd

ISSN (Print): 0965-2140

ISSN (Electronic): 1360-0443

Publication date (Print): January 2014

Publication date (Electronic): 28 October 2013

Volume: 109

Issue: 1

Pages: 147-154

Affiliations

[1 ]Division of Epidemiology and Public Health, UK Centre for Tobacco Control Studies, University of Nottingham Nottingham, UK

[2 ]UK Centre for Tobacco Control Studies, National Addiction Centre, Institute of Psychiatry, King's College London London, UK

[3 ]Centre for Clinical Research, University of Queensland, Royal Brisbane and Women's Hospital Site Herston, Qld, Australia

Author notes

Correspondence to: Graeme Docherty, UK Centre for Tobacco Control Studies, University of Nottingham, Division of Epidemiology and Public Health, Clinical Sciences Building, Nottingham City Hospital, Nottingham NG5 1PB, UK. E-mail: graeme.docherty@ 123456nottingham.ac.uk

Article

DOI: 10.1111/add.12359

PMC ID: 3933730

PubMed ID: 24103060

SO-VID: 9b6c5458-af0a-430c-856c-67dde2965e1a

License:

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

History

Date received : 08 February 2013

Date revision received : 27 March 2013

Date accepted : 09 September 2013

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Did hardening occur among smokers in England from 2000 to 2010?

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Journal of Behavioral Addictions

Most cited references 25

Socioeconomic variations in nicotine dependence, self-efficacy, and intention to quit across four countries: findings from the International Tobacco Control (ITC) Four Country Survey.

Interventions to increase smoking cessation at the population level: how much progress has been made in the last two decades?

Smoke-free air policies: past, present and future.

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