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

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.