Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Department of Computer Science, University of Saskatchewan, Saskatoon, Canada.
Sci Rep. 2021 Jan 21;11(1):1866. doi: 10.1038/s41598-021-81460-9.
According to the 'hardening hypothesis', average nicotine dependence will increase as less dependent smokers quit relatively easily in response to effective public health interventions, so that sustained progress in reducing smoking prevalence will depend on shifting the emphasis of tobacco control programs towards intensive treatment of heavily dependent smokers (who comprise an increasing fraction of continuing smokers). We used a system dynamics model of smoking behaviour to explore the potential for hardening in a population of smokers exposed to effective tobacco control measures over an extended period. Policy-induced increases in the per capita cessation rate are shown to lead inevitably to a decline in the proportion of smokers who are heavily dependent, contrary to the hardening hypothesis. Changes in smoking behaviour in Australia over the period 2001‒2016 resulted in substantial decreases in current smoking prevalence (from 23.1% in 2001 to 14.6% in 2016) and the proportion of heavily dependent smokers in the smoking population (from 52.1% to 36.9%). Public health interventions that have proved particularly effective in reducing smoking prevalence (tobacco tax increases, smoke-free environment legislation, antismoking mass media campaigns) are expected to also contribute to a decline in population-level nicotine dependence.
根据“硬化假说”，随着越来越多的轻度尼古丁依赖者由于有效的公共卫生干预措施而相对容易戒烟，平均尼古丁依赖程度将会增加，因此，要降低吸烟率，就必须将烟草控制计划的重点转向对重度尼古丁依赖者（他们构成了持续吸烟者中越来越大的一部分）进行强化治疗。我们使用吸烟行为的系统动力学模型来探讨在一个长期暴露于有效烟草控制措施的吸烟者群体中出现硬化的可能性。研究表明，与硬化假说相反，政策引起的人均戒烟率的增加不可避免地会导致重度尼古丁依赖者的比例下降。2001 年至 2016 年期间澳大利亚的吸烟行为变化导致当前吸烟率（从 2001 年的 23.1%降至 2016 年的 14.6%）和吸烟人群中重度尼古丁依赖者的比例（从 52.1%降至 36.9%）大幅下降。已被证明在降低吸烟率方面特别有效的公共卫生干预措施（烟草税增加、无烟环境立法、反吸烟大众媒体运动）预计也将有助于降低人群尼古丁依赖水平。
