Intended for healthcare professionals


Prevalence of hardcore smoking in England, and associated attitudes and beliefs: cross sectional study

BMJ 2003; 326 doi: (Published 15 May 2003) Cite this as: BMJ 2003;326:1061
  1. Martin J Jarvis, professor of health psychology1 (martin.jarvis{at},
  2. Jane Wardle, professor of clinical psychology1,
  3. Jo Waller, research psychologist1,
  4. Lesley Owen, public health adviser on smoking2
  1. 1 Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, London WC1E 6BT,
  2. 2 Health Development Agency, London SW1 2HW
  1. Correspondence to: M Jarvis
  • Accepted 20 March 2003


Objective To quantify the prevalence and characteristics of hardcore smokers in England.

Design Cross sectional survey.

Setting Interview in respondents' household.

Participants 7766 adult cigarette smokers.

Main outcome measures Hardcore smoking defined by four criteria (less than a day without cigarettes in the past five years; no attempt to quit in the past year; no desire to quit; no intention to quit), all of which had to be satisfied.

Results Some 16% of all smokers were categorised as hardcore. Hardcore smoking was associated with nicotine dependence, socioeconomic deprivation, and age, rising from 5% in young adults aged 16-24 to 30% in those aged ≥ 65 years. Hardcore smokers displayed distinctive attitudes towards and beliefs about smoking. In particular they were likely to deny that smoking affected their health or would do so in the future. Prevalence of hardcore smoking was almost four times higher than in California.

Conclusion Hardcore smoking presents a serious challenge to public health efforts to reduce the prevalence of smoking, but the proportion of hardcore smokers does not necessarily increase as overall prevalence in a population declines. More hardcore smokers could be persuaded to quit, but this will require interventions that are targeted to the particular needs and perceptions of both socially disadvantaged and older smokers.


  • Contributors MJJ had the idea for the study, analysed the data, and drafted the paper. J Wardle and J Waller contributed to data analysis and drafting. LO was responsible for designing the questionnaires and the survey methodology, and for overseeing data collection. MJJ is guarantor for this study.

  • Funding MJJ, J Wardle, and J Waller are funded by Cancer Research UK. The guarantor accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.

  • Competing interests None declared.

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