Identifying Subgroups among Hardcore Smokers: a Latent Profile Approach

RESEARCH ARTICLE Identifying Subgroups among Hardcore Smokers: a Latent Profile Approach Jeroen Bommelé1,2*, Marloes Kleinjan3, Tim M. Schoenmakers1,2, William J. Burk4, Regina van den Eijnden5, Dike van de Mheen1,2,6 1 IVO Addiction Research Institute, Rotterdam, The Netherlands, 2 Erasmus Medical Centre, Rotterdam, The Netherlands, 3 Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands, 4 Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands, 5 Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands, 6 Department of Health Promotion, Maastricht University, Maastricht, The Netherlands * Abstract OPEN ACCESS Citation: Bommelé J, Kleinjan M, Schoenmakers TM, Burk WJ, van den Eijnden R, van de Mheen D (2015) Identifying Subgroups among Hardcore Smokers: a Latent Profile Approach. PLoS ONE 10(7): e0133570. doi:10.1371/journal.pone.0133570 Editor: Raymond Niaura, Legacy, Schroeder Institute for Tobacco Research and Policy Studies, UNITED STATES Introduction Hardcore smokers are smokers who have little to no intention to quit. Previous research suggests that there are distinct subgroups among hardcore smokers and that these subgroups vary in the perceived pros and cons of smoking and quitting. Identifying these subgroups could help to develop individualized messages for the group of hardcore smokers. In this study we therefore used the perceived pros and cons of smoking and quitting to identify profiles among hardcore smokers. Received: April 9, 2015 Accepted: June 27, 2015 Published: July 24, 2015 Copyright: © 2015 Bommelé et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All data used in this study are publicly available from the Open Science Framework (https://osf.io/5brnq/). Funding: This work was supported by the Netherlands Organisation for Health Research and Development (www.zonmw.nl; 200120001). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Methods A sample of 510 hardcore smokers completed an online survey on the perceived pros and cons of smoking and quitting. We used these perceived pros and cons in a latent profile analysis to identify possible subgroups among hardcore smokers. To validate the profiles identified among hardcore smokers, we analysed data from a sample of 338 non-hardcore smokers in a similar way. Results We found three profiles among hardcore smokers. ‘Receptive’ hardcore smokers (36%) perceived many cons of smoking and many pros of quitting. ‘Ambivalent’ hardcore smokers (59%) were rather undecided towards quitting. ‘Resistant’ hardcore smokers (5%) saw few cons of smoking and few pros of quitting. Among non-hardcore smokers, we found similar groups of ‘receptive’ smokers (30%) and ‘ambivalent’ smokers (54%). However, a third group consisted of ‘disengaged’ smokers (16%), who saw few pros and cons of both smoking and quitting. PLOS ONE | DOI:10.1371/journal.pone.0133570 July 24, 2015 1 / 13 Profiles among Hardcore Smokers Discussion Among hardcore smokers, we found three distinct profiles based on perceived pros and cons of smoking. This indicates that hardcore smokers are not a homogenous group. Each profile might require a different tobacco control approach. Our findings may help to develop individualized tobacco control messages for the particularly hard-to-reach group of hardcore smokers. Introduction Smoking is one of the leading causes of preventable death in the world. Reducing its prevalence would improve health globally [1]. An important predictor of quitting attempts is motivation to quit smoking [2]. We therefore need to investigate ways of increasing motivation to quit smoking, especially among smokers with no or low intention to quit. Hardcore smokers are a group of smokers who have little to no intention to quit. In general, they also smoke heavily and have been smoking for a considerable number of years [3]. Previous research indicated that hardcore smokers are less affected by current tobacco control policies than non-hardcore smokers [4–6]. To reach hardcore smokers and motivate them to quit, we require specialized interventions [4,6]. These interventions should ideally contain individualized tobacco control messages (i.e. tailored information) based on individual characteristics [7]. Some studies suggest that distinct subgroups (‘profiles’) exist among smokers with low intention to quit [8–11]. Dijkstra and De Vries [12], for example, distinguished five profiles among so-called ‘pre-contemplators’ [13]. While pre-contemplators do not intend to quit smoking within 6 months, they could be occasional or light smokers. Hardcore smokers also do not intend to quit within 6 months, but they smoke at least 15 cigarettes per day and have been smoking for many years. Given that there is heterogeneity in pre-contemplators, one might also expect different profiles among hardcore smokers. Identifying such profiles could help to develop interventions using individualized health promoting messages for hardcore smokers. This could improve the smoking cessation interventions for this group. According to stage models, such as the Transtheoretical Model, perceived pros and cons indicate motivation to quit, which would predict smoking cessation [13,14]. The profiles found among pre-contemplators varied, besides quitting self-efficacy, in the number of pros and cons of quitting [12]. Among pre-contemplators, Dijkstra and De Vries [12] distinguished between motivated smokers, who have many pros of quitting and few cons of quitting; disengaged smokers, who scored below average on both pros and cons of quitting; and unmotivated smokers, who have few pros of quitting and many cons of quitting. Others also found three similar groups in pre-contemplators [8]. Based on this, we expected to find comparable profiles in our sample of hardcore smokers. As profiles among pre-contemplators vary in their perceived pros and cons, profiles among hardcore smokers may therefore also vary with regard to the perceived pros and cons. In a previous study, we qualitatively examined perceived pros and cons of smoking and quitting among hardcore smokers [15]. In that study, we found that perceived pros and cons of smoking differed from those of quitting. Weight gain, for example, is an important con of quitting, but weight maintenance was not an important pro of smoking. Also, many believed smoking helped them to maintain social contacts, but few believed they would lose friends if they quit smoking. We therefore concluded that both the pros and cons of both smoking and quitting seem theor (...truncated)