Social characteristics of the hardcore smokers: What specific messages of prevention and reduction of risks?

Context: Smoking remains a public health problem, especially a significant proportion of smokers are particularly resistant to the notion of stopping smoking. These resistant smokes have been called “hard core smokers” (HCS)  Objectives: To identify characteristics of HCS in France and to discuss public health interventions for this specific population.

 Methods: HCS were defined by the following validated criteria: smokers reported no intent to quit smoking within the next months, no reporting history of quit attempts and daily smoking. Individuals were included in four emergencies departments, attended for minor complaints (without hospitalisation issue). Age, gender, education level, socio-economic characteristics (including social insurance), tobacco consumption and its characteristics were collected.  Results: Overall, 429 included, 156 were smokers (36.4%, 95% CI=31.8-41.1), of which 20 were HCS (12.8%, 95% CI=8.2%-19.3%). In the group HCS+ and HCS- (n=136), the mean of age and sex ratio were not significantly different. The median number of daily cigarettes consumed by HCS- and HCS+ did not differ significantly (15,0 vs 13,8, p=0.64). The HCS significantly had less often a complementary insurance that HCS- (50,0% vs 87,5%, p<10^-4). After adjusting (logistic regression) on age, gender, to have an individual complementary insurance, incomes and social supports, the absence of complementary insurance was the only significant risk factor associated to HCS+ (AOR=6.4, 95% CI=1.2-33.9).

 Conclusion: In our study, the prevalence of HCS is close to those found in the United States (13.7%) and the United Kingdom (16.0%). In France, the number of HCS was estimated between 1 and 2.5 millions. The HCS appear to be more socially isolated than others smokers. In a context of decreasing smoking prevalence, HCS are progressively coming to dominate the population of smokers; a better knowledge of the behaviours is challenging necessary to develop messages of prevention and to engage public health interventions among this population.