Advertisement

Cancer Causes & Control

, Volume 26, Issue 1, pp 57–63 | Cite as

Hardcore smoking among continuing smokers in Canada 2004–2012

  • Sunday AzagbaEmail author
Original paper

Abstract

Purpose

Decline in adult smoking prevalence in Canada seems to have slowed, suggesting that smoking rate may have plateaued. It is unclear whether this, at least in part, can be interpreted as evidence that some groups or individuals are becoming less resistant to tobacco control measures. This study examined trends in the prevalence of hardcore smoking in Canada.

Methods

A nationally representative sample of adult daily smokers was drawn from the Canadian Tobacco Use Monitoring Survey 2004 to 2012 (n = 13,861). Hardcore smokers were defined in two ways: Hardcore 1 comprised those that reported no quit attempt, no quit intention, and smoke their first cigarette within 30 min after awakening and hardcore 2 comprised hardcore 1 plus those smoking 15 or more cigarettes per day. Logistic regression was used to examine associations between hardcore measures and year and socio-demographic variables.

Results

Overall, there was no significant difference in hardcore smoking over time for the periods covered in this study. Analysis examining a single hardcore component, time-to-first cigarette (TTFC) after awakening as a measure of nicotine dependence showed similar results. A clear marked socioeconomic gradient in TTFC was found, those with university education (OR 0.46, 95 % CI 0.37–0.57), college (OR 0.51, 95 % CI 0.42–0.63), secondary (OR 0.68, 95 % CI 0.57–0.82) were significantly less likely to have TTFC ≤ 30 min compared with less than secondary education.

Conclusions

This study does not support the hardening hypothesis when interpreted as the increase in hardcore smokers over time.

Keywords

Hardcore smoking Hardening hypothesis Nicotine dependence Time-to-first cigarette Population 

Notes

Acknowledgments

This work was supported by a research grant from the Canadian Cancer Society Research Institute (Grant Number 2011-701019).

Conflict of interest

None.

References

  1. 1.
    World Health Organization (2014) Tobacco fact sheet http://www.who.int/mediacentre/factsheets/fs339/en/
  2. 2.
    Baliunas D, Patra J, Rehm J, Popova S, Kaiserman M, Taylor B (2007) Smoking-attributable mortality and expected years of life lost in Canada 2002: conclusions for prevention and policy. Chronic Dis Can 27(4):154–162PubMedGoogle Scholar
  3. 3.
    Pierce JP, Fiore MC, Novotny TE, Hatziandreu EJ, Davis RM (1989) Trends in cigarette smoking in the United States: educational differences are increasing. JAMA 261(1):56–60PubMedCrossRefGoogle Scholar
  4. 4.
    Smoke Free Canada (2003) Tobacco in Canada http://www.smoke-free.ca/pdf_1/TOBACCOINCANADA2003.pdf
  5. 5.
    Reid JL, Hammond D, Rynard VL, Burkhalter R (2014) Tobacco use in Canada: patterns and trends, 2014 edition. Propel Centre for Population Health Impact, University of Waterloo, WaterlooGoogle Scholar
  6. 6.
  7. 7.
    Warner KE, Burns DM (2003) Hardening and the hard-core smoker: concepts, evidence, and implications. Nicotine Tob Res 5(1):37–48PubMedCrossRefGoogle Scholar
  8. 8.
    Costa ML, Cohen JE, Chaiton MO, Ip D, McDonald P, Ferrence R (2010) “Hardcore” definitions and their application to a population-based sample of smokers. Nicotine Tob Res 12(8):860–864PubMedCrossRefGoogle Scholar
  9. 9.
    Reid JL, Hammond D, Driezen P (2010) Socio-economic status and smoking in Canada, 1999–2006: has there been any progress on disparities in tobacco use? Can J Public Health 101(1):73–78PubMedGoogle Scholar
  10. 10.
    Corsi DJ, Boyle MH, Lear SA, Chow CK, Teo KK, Subramanian SV (2014) Trends in smoking in Canada from 1950 to 2011: progression of the tobacco epidemic according to socioeconomic status and geography. Cancer Causes Control 25(1):45–57PubMedCrossRefGoogle Scholar
  11. 11.
    Lund M, Lund KE, Kvaavik E (2011) Hardcore smokers in Norway 1996–2009. Nicotine Tob Res 13(11):1132–1139PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Augustson EM, Marcus SE (2004) Use of the current population survey to characterize subpopulations of continued smokers: a national perspective on the “hardcore” smoker phenomenon. Nicotine Tob Res 6(4):621–629PubMedCrossRefGoogle Scholar
  13. 13.
    Emery S, Gilpin EA, Ake C, Farkas AJ, Pierce JP (2000) Characterizing and identifying “hard-core” smokers: implications for further reducing smoking prevalence. Am J Public Health 90(3):387PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Sorg A, Xu J, Doppalapudi SB, Shelton S, Harris JK (2011) Hardcore smokers in a challenging tobacco control environment: the case of Missouri. Tob Control 20(5):388–390PubMedCrossRefGoogle Scholar
  15. 15.
    Docherty G, McNeill A, Gartner C, Szatkowski L (2014) Did hardening occur among smokers in England from 2000 to 2010? Addiction 109(1):147–154PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Jarvis MJ, Wardle J, Waller J, Owen L (2003) Prevalence of hardcore smoking in England, and associated attitudes and beliefs: cross sectional study. Br Med J 326(7398):1061CrossRefGoogle Scholar
  17. 17.
    Ferketich AK, Gallus S, Colombo P, Pacifici R, Zuccaro P, La Vecchia C (2009) Hardcore smoking among Italian men and women. Eur J Cancer Prev 18(2):100–105PubMedCrossRefGoogle Scholar
  18. 18.
    Chaiton MO, Cohen JE, Frank J (2008) Population health and the hardcore smoker: Geoffrey rose revisited. J Public Health Policy 29(3):307–318PubMedCrossRefGoogle Scholar
  19. 19.
    Clare P, Bradford D, Courtney RJ, Martire K, Mattick RP (2014) The relationship between socioeconomic status and ‘hardcore’ smoking over time–greater accumulation of hardened smokers in low-SES than high-SES smokers. Tob Control. doi: 10.1136/tobaccocontrol-2013-051436
  20. 20.
    Cohen JE, McDonald PW, Selby P (2012) Softening up on the hardening hypothesis. Tob Control 21(2):265–266PubMedCrossRefGoogle Scholar
  21. 21.
    Baker TB, Piper ME, McCarthy DE, Bolt DM, Smith SS, Kim SY (2007) Time to first cigarette in the morning as an index of ability to quit smoking: implications for nicotine dependence. Nicotine Tob Res 9(Suppl 4):S555–S570PubMedCentralPubMedGoogle Scholar
  22. 22.
    Muscat JE, Stellman SD, Caraballo RS, Richie JP (2009) Time to first cigarette after waking predicts cotinine levels. Cancer Epidemiol Biomarkers Prev 18(12):3415–3420PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Ip DT, Cohen JE, Bondy SJ, Chaiton MO, Selby P, Schwartz R (2012) Do components of current ‘hardcore smoker’ definitions predict quitting behaviour? Addiction 107(2):434–440PubMedCrossRefGoogle Scholar
  24. 24.
    Hughes JR (2011) The hardening hypothesis: is the ability to quit decreasing due to increasing nicotine dependence? A review and commentary. Drug Alcohol Depend 117(2):111–117PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Fagerström K, Furberg H (2008) A comparison of the Fagerström Test for Nicotine Dependence and smoking prevalence across countries. Addiction 103(5):841–845PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Burns DM, Major JM, Anderson CM, Vaughn JW (2003) Changes in cross-sectional measures of cessation, numbers of cigarettes smoked per day, and time to first cigarette—California and national data. In: Those who continue to smoke: is achieving abstinence harder and do we need to change our interventions? Smoking and Tobacco Control Monograph No. 15. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute, Bethesda, pp 101–125Google Scholar
  27. 27.
    Irvin JE, Brandon TH (2000) The increasing recalcitrance of smokers in clinical trials. Nicotine Tob Res 2(1):79–84PubMedCrossRefGoogle Scholar
  28. 28.
    Irvin JE, Hendricks PS, Brandon TH (2003) The increasing recalcitrance of smokers in clinical trials II: pharmacotherapy trials. Nicotine Tob Res 5(1):27–35PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.Propel Centre for Population Health Impact, Faculty of Applied Health SciencesUniversity of WaterlooWaterlooCanada
  2. 2.School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada

Personalised recommendations