Are smokers "hardening" or rather "softening"? An ecological and multilevel analysis across 28 European Union countries.
Adolescent
Adult
Attitude to Health
Cross-Sectional Studies
European Union
Female
Humans
Linear Models
Male
Middle Aged
Multilevel Analysis
Prevalence
Smokers
Smoking
/ epidemiology
Smoking Cessation
/ statistics & numerical data
Smoking Prevention
/ legislation & jurisprudence
Social Class
Socioeconomic Factors
Surveys and Questionnaires
Tobacco Products
Tobacco Use Disorder
/ epidemiology
Young Adult
Journal
The European respiratory journal
ISSN: 1399-3003
Titre abrégé: Eur Respir J
Pays: England
ID NLM: 8803460
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
25
03
2019
accepted:
12
06
2019
pubmed:
22
6
2019
medline:
21
10
2020
entrez:
22
6
2019
Statut:
epublish
Résumé
Tobacco control policies can reduce smoking prevalence. These measures may be less effective where smoking prevalence has significantly declined, as the remaining smokers have "hardened". Our aim was to empirically evaluate the "hardening hypothesis" at the population level in the European Union (EU) and explore factors associated with hardcore smoking. We conducted two separate analyses in the EU using data on smoking from the Eurobarometer surveys (2009-2017, n=112 745). 1) A panel-data fixed-effects linear regression to investigate changes over time in the percentage of hardcore smokers in relation to standardised smoking prevalence at the country level. 2) A multilevel logistic regression analysis with hardcore (daily smokers, ≥15 cigarettes per day who have not attempted to quit in the last 12 months) or light (<5 cigarettes per day) smoking as the dependent variable and time as the main independent variable, controlling for individual and ecological variables. We studied 29 010 current smokers (43.8% hardcore smokers and 14.7% light smokers). The prevalence of hardcore smoking among adult smokers increased by 0.55 (95% CI 0.14-0.96) percentage points per each additional percentage point in the overall smoking prevalence. The odds of being a hardcore smoker increased over time and were higher in middle-aged males and people with financial difficulties, while the odds of being a light smoker significantly declined among females. This study does not support the "hardening hypothesis" in the EU between 2009 and 2017, but suggests a softening of the smoking population. Existing tobacco control policies are likely to be suitable to further decrease smoking prevalence in Europe.
Sections du résumé
BACKGROUND
Tobacco control policies can reduce smoking prevalence. These measures may be less effective where smoking prevalence has significantly declined, as the remaining smokers have "hardened". Our aim was to empirically evaluate the "hardening hypothesis" at the population level in the European Union (EU) and explore factors associated with hardcore smoking.
METHODS
We conducted two separate analyses in the EU using data on smoking from the Eurobarometer surveys (2009-2017, n=112 745). 1) A panel-data fixed-effects linear regression to investigate changes over time in the percentage of hardcore smokers in relation to standardised smoking prevalence at the country level. 2) A multilevel logistic regression analysis with hardcore (daily smokers, ≥15 cigarettes per day who have not attempted to quit in the last 12 months) or light (<5 cigarettes per day) smoking as the dependent variable and time as the main independent variable, controlling for individual and ecological variables.
RESULTS
We studied 29 010 current smokers (43.8% hardcore smokers and 14.7% light smokers). The prevalence of hardcore smoking among adult smokers increased by 0.55 (95% CI 0.14-0.96) percentage points per each additional percentage point in the overall smoking prevalence. The odds of being a hardcore smoker increased over time and were higher in middle-aged males and people with financial difficulties, while the odds of being a light smoker significantly declined among females.
CONCLUSION
This study does not support the "hardening hypothesis" in the EU between 2009 and 2017, but suggests a softening of the smoking population. Existing tobacco control policies are likely to be suitable to further decrease smoking prevalence in Europe.
Identifiants
pubmed: 31221812
pii: 13993003.00596-2019
doi: 10.1183/13993003.00596-2019
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright ©ERS 2019.
Déclaration de conflit d'intérêts
Conflict of interest: A. Feliu has nothing to disclose. Conflict of interest: E. Fernandez has nothing to disclose. Conflict of interest: C. Martinez has nothing to disclose. Conflict of interest: F.T. Filippidis has nothing to disclose.