title: Hardcore smokers: what do we know?
abstract: OBJECTIVE
  The existence of smokers who are resistant to smoking cessation treatment has long been noted in the literature. There has been ongoing debate as to whether the proportion of these smokers is increasing as smoking prevalence rates stagnate. Studies define hardcore smokers inconsistently and within the context of specific illnesses, addiction, population, and/or theoretical paradigms. This review examines the existing literature related to hardcore smokers to develop a better understanding of what is known and not known about this group to guide smoking cessation treatment.
  
  
  METHODS
  PubMed MESH search and review of research publications from 1998 to 2012 (N=61).
  
  
  RESULTS
  Inconsistent definitions of hardcore smoking make it difficult to estimate prevalence rates and to identify specific characteristics of persistent smokers. Generally, persistent smokers have higher levels of nicotine dependence, are disproportionately from lower socioeconomic groups, start smoking at an earlier age, and are more likely to have a psychological co-morbidity.
  
  
  CONCLUSIONS
  Defining some smokers as hardcore is limiting. Targeted and tailored interventions for smoking cessation for persistent smoking have demonstrated effectiveness in a small number of studies. Treatment access barriers need to be addressed to improve the reach and effectiveness of cessation with persistent smokers. Efforts to limit early age initiation of tobacco use are a critical element in averting persistent smoking.
authors.affiliation: UK HealthCare, USA; University of Kentucky College of Nursing, 450F College of Nursing, Lexington, KY 40536-0232, USA. Electronic address: audrey.darville@uky.edu.
authors.forename: Audrey
authors.initials: A
authors.lastname: Darville
authors.affiliation: University of Kentucky College of Nursing, 450F College of Nursing, Lexington, KY 40536-0232, USA; Tobacco Policy Research Program and Kentucky Center for Smoke-free Policy, USA; Center for Biobehavioral Research in Self-Management, Lexington, KY, USA.
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Hahn
mesh_terms: D017668:Age of Onset; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology; D015995:Prevalence; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology / Q000628:therapy; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000628:therapy*; D014481:United States / Q000453:epidemiology
keywords: Hardcore smokers; Smoking cessation; Tobacco dependence