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Smoking rates in the USA declined from 42.4% in 1965 to 20.6% in 2008 but have remained essentially unchanged in recent years.1 2 This plateau has caused public health advocates to evaluate current programming and seek better understanding of smoking subpopulations.3 One subpopulation of interest is ‘hardcore’ smokers, who are more addicted, less open to cessation interventions and have been deemed a ‘small but intractable public health problem.’3
Previous studies have examined the prevalence of hardcore smokers and compared them to other smokers,4–7 finding hardcore smokers comprise 5.2%–14% of US smokers.4 5 Part of the variability in prevalence estimates is likely due to definitional differences between studies.8 State-level hardcore …
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