One of the supposed perks of smokeless tobacco, as well as its younger cousin, the e-cigarette, is its ability to wean people off traditional cigarettes, particularly among those unwilling or unable to quit nicotine altogether. But a new study adds to growing evidence that those so-called "hardcore smokers" aren't so hardcore after all, and harm-reduction strategies like switching to vaping aren't worth those alternatives' risks.
Harm-reduction approaches are based "on the assumption that as those who are able and willing to quit do so, a group of hardcore smokers will be left behind," researchers Margarete Kulik and Stanton Glantz write in the journal Tobacco Control. Yet an analysis of smoking patterns in the United States and 31 European countries revealed "evidence of softening, not hardening, among remaining smokers as [smoking] prevalence decreased over time," the authors write.
Smoking remains common in the U.S., where 42.1 million people still smoke, and cigarettes directly or indirectly kill nearly half a million people every year, according to Centers for Disease Control and Prevention statistics. In the early 1970s, Michael Russell suggested it was more realistic to get people to use alternatives to tar-heavy cigarettes than to get them off nicotine altogether. That way, they'd at least avoid lung cancer, emphysema, and other respiratory diseases.
For every two percent drop in the fraction of Americans who smoke, there's a roughly one percent increase in the fraction of smokers who try to quit.
But whether hardcore smokers actually exist isn't entirely clear. If they do, Kulik and Glantz argue, then as the overall number of smokers declines over time, the remaining smokers would be less likely to try to quit, a hypothesis called hardening. Hardening in turn suggests the related hypothesis that remaining smokers would smoke more cigarettes a day over time.
To test that hypothesis, Kulik and Glantz turned to data from the Current Population Survey's Tobacco Use Supplement, which surveyed about 50,000 American households several times over the past two decades, and Eurobarometer survey data from 2006, 2009, and 2012. Both surveys asked how often people smoked and whether they'd tried to quit.
Contrary to the hardening hypothesis, frequent smokers in the U.S. attempted to quit more often as smoking's prevalence declined—for every two percent drop in the fraction of Americans who smoke, there's a roughly one percent increase in the fraction of smokers who try to quit—and smokers are burning up fewer cigarettes per day as well. Roughly the same is true in Europe, where quit attempts have remained steady and the number of cigarettes smoked per day has declined.
"While there will always be more and less addicted smokers ... what the data show is that, over a long period of time, the smoking population is shifting to smokers who are making more quit attempts and consuming fewer cigarettes," Kulik and Glantz write. "Tobacco control policies should continue to move the population down these softening curves rather than changing these policies to promote new forms of nicotine delivery."
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