Examining a Quarter-Century of Smoking Cessation Trials: Is the Target Becoming Harder to Treat?*

Are tobacco smokers becoming harder to treat? Anecdotal reports by smoking-cessation providers would suggest that they are. The notion is that as the prevalence of smoking in the United States has declined, those smokers who have not yet quit represent the “hardcore ” recalcitrant subset of the historical smoking population. Between 1974 and 1995, the prevalence of smoking dropped from 43.1 % to 27.0 % among men and from 32.1 % to 22.6 % among women (U.S. Bureau of the Census 1998). This decline in smoking prevalence can be attributed to factors such as increased knowledge about the health consequences of smoking, the deleterious effects of secondhand smoke on nonsmokers, antismoking public health campaigns, antismoking legislation (e.g., limitations on smoking in public places), and the availability of relatively effective behavioral and pharmacological smoking cessation interventions. Moreover, the last two decades were characterized by a dramatic decline in the social acceptance of smoking, which has led to increased social pressure to quit smoking. Indeed