Similar softening across different racial and ethnic groups of smokers in California as smoking prevalence declined

Maggie Kulik and I have already published two papers showing that, contrary to  the “hardening hypothesis,” namely that there is a hard core group of smokers that “cannot or will not quit” that underlies the whole harm reduction ideology that is used to justify promoting e-cigarettes, heated tobacco products, and other new tobacco products.  The first of these papers showed that, contrary to the hardening hypothesis, as smoking prevalence fell in the USA and EU, the remaining smokers smoked less and quit more.  In other words, rather than hardening, the remaining smoking population is softening. The second paper found the same thing in people with psychological distress, a group with high baseline smoking rates. 

Now we have published the third paper in this series, “Similar softening across different racial and ethnic groups of smokers in California as smoking prevalence declined,” that examines data from California to assess whether there is softening across different racial and ethnic groups.  We found wide variations in smoking prevalence across these different groups, but that California smokers are smoking less and quitting more across all racial and ethnic groups.  In other words, tobacco control policies have benefitted all subgroups of California smokers.  At the same time, interventions are still needed to reduce baseline differences between groups.

This finding that tobacco control policies have benefited all groups equally in terms of absolute changes but have not reduced baseline differences is consistent with results Alexis Dinno and I found using national data.

Here is the abstract:

Smoking prevalence differs among different racial/ethnic groups. Previous research found that as smoking prevalence declined in the U.S., remaining smokers made more quit attempts and smoked fewer cigarettes per day (CPD), indicating so-called softening. We examined California, a state with a highly diverse population, to assess whether there is differential softening among remaining smokers in different racial/ethnic groups. We used the California Tobacco Survey (1990–2008, N: 145,128). We ran logistic and linear regressions for smoking prevalence, CPD, quit attempts and time to first cigarette (30 min) as a function of race/ethnicity (non-Hispanic White, Hispanic, African American, Japanese, Chinese, Filipino, Korean, other Asian/Pacific Islander, American Indian/Alaska Native) controlling for other demographics. Overall prevalence fell from 21.1% in 1990 to 12.3% in 2008 (p < 0.01), showing similar declining trends across all racial/ethnic groups (p = 0.44), albeit from different baseline prevalence levels. In terms of softening indicators the proportion with at least one quit attempt in the past 12 months increased from 46.2% to 59.3%, a factor of 1.25 per decade (95%CI = 1.17, 1.34) in the adjusted model. CPD declined from 16.9 to 10.9, by −2.95 CPD per decade (95%CI = −3.24, −2.67) in the adjusted model. There were no significant changes in the time to first cigarette. Interactions of race/ethnicity and time show similar trends among all subgroups expect Hispanics, whose CPD remained stable rather than declining. Although from different baseline levels, tobacco control policies have benefitted all subgroups of California smokers, exhibiting similar softening as prevalence fell. Interventions are still needed to reduce the baseline differences.

The full citation is:  Kulik M, Glantz S.  Similar softening across different racial and ethnic groups of smokers in California as smoking prevalence declined.  Prev Med 2019;120:144-149.  It is available here.