To the Editor.—
Pierce et al1 postulate that "hard-core smokers" may slow down the rate of decline in the prevalence of smoking as they come to represent a greater proportion of the smoking population. However, the authors do not identify these hard-core smokers except to imply that they are not the heavy smokers, because the proportion of heavy smokers in the population has not increased. If there is a group of hard-core smokers, it must be the alcoholics. Alcoholics have quit ratios (the proportion of "ever smokers" who are former smokers) only one seventh that of nonalcoholics (7% vs 49%).2The projections of Pierce et al can be combined with recent data comparing the quit ratios of alcoholics and nonalcoholics to illustrate how the prevalence of alcoholism among smokers will increase in coming years.2,3The projected rate of decline in the prevalence of smoking in the general
DiFranza JR. Hard-core Smokers. JAMA. 1989;261(18):2634. doi:10.1001/jama.1989.03420180058016
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