Hardening is dead, long live softening; time to focus on reducing disparities in smoking

The hardening hypothesis proposes that as smoking prevalence declines, the proportion of ‘hard-core’ or ‘hardened’ smokers increases. The intuitively plausible logic is that less addicted and more motivated smokers are more likely to quit, leaving behind a growing proportion of ‘hardened’ smokers. If true, the hypothesis has implications for policy formulation and smoking cessation practice. For example, smokefree policies, health promotion campaigns and smoking cessation support services may need to be modified to ensure they reach and support quitting among the growing proportion of hardened smokers. Also, hardening would strengthen the justification for harm reduction strategies due to the need to provide less harmful alternatives to the increasing proportion of ‘hardened’ smokers who struggle to quit.

There are many ways in which hardening could manifest, creating multiple hypotheses which can be tested. For example, the population of smokers could become: (1) more highly addicted (eg, an increase in heavier...

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