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Ending the Tobacco Problem: A Blueprint for the Nation
sons with a lifetime history of some type of psychiatric morbidity, but this needs additional confirmation (Breslau 1995; Breslau et al. 1991, 1993, 1994; Grant et al. 2004; Hughes et al. 1986; Lasser et al. 2000).
Children with psychiatric and behavioral comorbidities and adverse experiences are at risk for smoking initiation. Children with attention-deficit/ hyperactivity disorder (ADHD) were found to have a higher risk of cigarette use initiation and smoking maintenance, as well as abuse of other substances, than those in non-ADHD comparison groups (Daley 2004; Lambert and Hartsough 1998; Wilens et al. 1997). Wallace also notes that a body of literature has associated a host of adverse experiences—including direct physical or sexual abuse, the presence of depressive effect, suicide attempts, sexually transmitted diseases, and an impoverished, dysfunctional household environment—with substantially increased risks of smoking initiation (De Von Figueroa-Moseley et al. 2004; Dube et al. 2003; Mcnutt et al. 2002; Nichols and Harlow 2004).
Furthermore, Wallace notes that, although the research literature is not extensive, higher rates of smoking have been documented among incarcerated individuals, homeless individuals, and other populations. Among these populations, the highest rates of smoking have been reported among inmates. Hughes and Boland (1992) and Lightfoot and Hodgins (1988) reported a 77 percent smoking rate in the past 6 months among inmates in a penitentiary for men. High rates (71 percent) of current smoking have also been reported among women arrested in New York City (Durrah and Rosenberg 2004). The higher rates of smoking among prisoners may be influenced by the intersection of a number of other factors associated with higher rates of smoking, such as substance abuse, lower socioeconomic status, and high rates of psychiatric comorbidities among incarcerated individuals (Andersen 2004).
The literature describes a group of “hardcore” smokers who have never attempted to quit smoking. This subgroup of smokers is often described as a small but intractable public health problem. Using data from the 1998-99 Tobacco Use Supplement of the Current Population Survey, Augustson and Marcus (2004) defined “hardcore” smokers as established daily smokers (smoking for at least 5 years) who smoke more than 15 cigarettes per day with no reported history of quit attempts and who are over 25 years of age (Emery et al. 2000). They found that “hardcore” smokers represent 24.7 percent of heavy chronic smokers, 17.6 percent of all established smokers, and 13.7 percent of all current smokers. They are also more likely to be male, unmarried, not working, and to have lower education levels. Warner and Burns (2003) suggest that “hardcore” smokers represent members of a group of smokers whose behavior may be especially resistant to change (Warner and Burns 2003).
Genetic vulnerability may be one reason some “hardcore” smokers