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‘Dot Cotton’ syndrome: third of pensioners who smoke are ‘hardcore’ addicts

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by Cancer Research UK | News

15 May 2003

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Nearly a third of smokers over the age of 65 are ‘hardcore’1, with no interest in kicking their habit, according to a Cancer Research UK study published in the British Medical Journal2.

The research, carried out by the Cancer Research UK Health Behaviour Unit at University College London, found the proportion of hardcore smokers greatly increases with age – rising from five per cent of smokers aged 16-24 to 30 per cent of smokers aged 65 and above. The researchers believe that many of these smokers could be influenced by better targeted health messages.

The survey also reveals that a third of hardcore smokers believe their health is totally unaffected by smoking and will remain so in the future. Thirty-one per cent cite smoking as the main pleasure in their life – an attitude epitomized by EastEnder ‘Dot Cotton’, who rarely appears in the popular soap opera without a cigarette.

The increase with age may reflect a false sense of security after years of smoking are perceived to have had little effect on health.

Professor Martin Jarvis, Assistant Director of the Cancer Research UK Health Behaviour Unit at UCL, says: “As smokers get older more of them develop entrenched attitudes. Some just give up hoping they can ever succeed in quitting, and some are lulled into a false sense of security simply by having survived so far. The reality is that by quitting cigarettes they can add years to their life.”

A smoker giving up at age 65 still adds more than two years to their lifespan. However, the study shows that hardcore smokers actively defy pressures to quit – 56 per cent resent social pressures to give up and 40 per cent don’t think their smoking influences children.

Despite this resistance, Prof Jarvis points out that smoking can be reduced through public health messages. The research results were compared with a similar study in California, where there is a strong anti-smoking policy.

It shows that it is not necessarily the case that as smoking declines, a higher proportion of remaining smokers will have hardcore attitudes. The 1997 figures indicate that smoking is more common in England, with 28 per cent of the population classed as smokers compared to 18 per cent of Californians. However the level of hardcore smoking in England is four times the level in California.

Prof Jarvis says: “In California smoking is less socially acceptable. An intensive anti-smoking campaign has run for a decade – a state wide public smoking ban, TV campaigns, targeted health messages have all helped people understand the health risks of smoking in a clear and vivid way. That has resulted in less smokers but also a lower proportion of hardcore smokers – many are in the process of trying to give up.”

Jean King, Director Of Tobacco Control for Cancer Research UK, adds: “These older smokers are like EastEnder Dot Cotton – they just keep on smoking, unable to accept their addiction or the damage they’re doing to their health. But it really is never too late to quit. There is help and advice available from GPs or helplines and a vast array of nicotine replacement therapies available to help people beat their nicotine dependence, many available over the counter.

“Already we encourage kids not to start smoking and young adults to kick their addiction – to that we must add that older smokers can gain too by quitting smoking.”



  1. ‘hardcore’ smoker defined as less than a day without cigarettes in the past 5 years; no attempt to quit in the past year; no desire or intention to quit.
  2. British Medical Journal326 7398