Hardcore Smokers: developing and evaluating an online intervention

___Background:___ Hardcore smokers have little to no intention to quit smoking. These ‘hardcore smokers’ are hard to reach by current tobacco control measures, and are particularly vulnerable to death and disease. In our multi-study research project, we developed and tested an online intervention that involves hardcore smokers in tobacco control. ___Methods and results:___ In study 1, we found that the prevalence of hardcore smoking in the Dutch general population decreased from 12.2% in 2001 to 8.2% in 2012. In study 2, we conducted 11 focus groups among current and former hardcore smokers, and distinguished 6 themes in the pros and cons of smoking and quitting: Finance, Health, Intrapersonal Processes, Social Environment, Physical Environment, and Food and Weight. In study 3, we used a latent profile analysis of survey data to find 3 subgroups among hardcore smokers: receptive, ambivalent and resistant hardcore smokers. In study 4, we experimentally validated a self-affirmation manipulation for hardcore smokers. In study 5, we experimentally tested an online, tailored intervention for hardcore smokers. This intervention contains a self-affirmation manipulation and multiple elements that use motivational interviewing techniques to tackle dysfunctional beliefs about smoking. The intervention increased hardcore smokers’ receptivity to information about smoking cessation. ___Conclusions:___ Hardcore smokers are a special group of smokers that require special attention in tobacco control. Contrary to common perception, they are not completely unwilling to quit and could be involved in tobacco control