Factors motivating smoking cessation: a cross-sectional study in a lower-middle-income country

Abstract

Introduction Only one-quarter of smokers in Pakistan attempt to quit smoking, and less than 3% are successful. In the absence of any literature from the country, this study aimed to explore factors motivating and strategies employed in successful smoking cessation attempts in Pakistan, a lower-middle-income country. Methods A survey was carried out in Karachi, Pakistan, amongst adult (≥ 18 years) former smokers (individuals who had smoked ≥100 cigarettes in their lifetime but who had successfully quit smoking for > 1 month at the time of survey). Multivariable logistic regression, with number of quit attempts (single vs. multiple) as the dependent variable, was performed while adjusting for age, sex, monthly family income, years smoked, cigarettes/day before quitting, and having suffered from a smoking-related health problem. Results Out of 330 former smokers, 50.3% quit successfully on their first attempt with 62.1% quitting “cold turkey”. Only 10.9% used a cessation aid (most commonly nicotine replacement therapy: 8.2%). Motivations for quitting included self-health (74.5%), promptings by one’s family (43%), and family’s health (14.8%). Other social pressures included peer-pressure to quit smoking (31.2%) and social avoidance by non-smokers (22.7%). Successful smoking cessation on one’s first attempt was associated with being married (OR: 4.47 [95% CI: 2.32–8.61]), employing an abrupt cessation mode of quitting (4.12 [2.48–6.84]), and telling oneself that one has the willpower to quit (1.68 [1.04–2.71]). Conclusion In Pakistan, smoking cessation is motivated by concern for self-health and family’s health, family’s support, and social pressures. Our results lay a comprehensive foundation for the development of smoking-cessation interventions tailored to the population of the country. Implications Little is known about the patterns and strategies employed by smokers who are attempting to quit smoking, especially in lower-middle-income countries like Pakistan. Likewise, there are very few smoking cessation programs designed to assist in quitting. Our study will allow for a better understanding of the culture-specific motivating factors and strategies that most contributed to successful quit attempts. Based on these results, evidence based smoking cessation interventions can be developed tailored to the socioeconomic demographic of our country and region, including smoking cessation clinics and public outreach and media campaigns highlighting key elements of successful smoking cessation.

Smoking cessation interventions in South Asian Region: a systematic scoping review

“…Additionally, tobacco-associated diseases and deaths create economic damage due to healthcare costs and loss of human capital [ 3 ]. Individuals experiencing tobacco-related chronic health issues, mainly cancer, cardiovascular, and pulmonary diseases, are more motivated for smoking cessation (SmC) with an odds ratio ranging from 1.22 (95% CI 0.91–1.63) to 13.28 (95% CI 8.45–20.88) [ 7 , 8 ].…”

“…Smoking cessation interventions, like anti-tobacco campaigns via mass media; increased cost of tobacco; widespread smoke-free regulations; accessible SmC support programs; and smoking health hazards warnings in films, have been effective in developed countries. The United States of America (USA) reduced smoking prevalence from 20.9 to 15.5% between 2005 and 2016; but the same trend has not been achieved in developing countries [ 8 , 14 , 15 ]. Countries in the South Asian Region (SAR) have utilized different SmC strategies; some are based on FCTC or MPOWER; others are unique to Asian cultural and societal norms.…”

Smoking cessation: health system challenges and opportunities

“…11 cessation is essential to enhance the development and efficacy of cessation programmes. 13 In many settings, the integration of smoking cessation programmes with tuberculosis control services affords specific opportunity. 14 The need 'especially in LMICs to place a greater spotlight on smoking cessation after a cancer diagnosis' has been emphasised.…”

“…Developing solutions specific to the needs of LMICs ‘is a key to effective tobacco control’ 11 12. An understanding of the cultural factors that motivate cessation is essential to enhance the development and efficacy of cessation programmes 13. In many settings, the integration of smoking cessation programmes with tuberculosis control services affords specific opportunity 14.…”

Methods and factors influencing successful smoking cessation in Thailand: A case-control study among smokers at the community level

“…Previous international studies show which individual-level factors influence successful smoking cessation. These factors include: taking medications and using counseling services 3 ; lifetime tobacco exposure (pack-years), education level, alcohol drinking status, and smoker’s age 7 ; severity of nicotine dependence and the presence of comorbidity (such as cardiovascular diseases and hypertension) 8 ; concerns for self-health and family’s support 9 , social pressures 9 , 10 , and encountering environments previously associated with smoking (e.g. establishments that serve alcohol) 3 .…”