The Association Of Awareness Of Smoking Hazard With Successful Smoking Cessation

BackgroundTobacco use continues to be the leading global cause of preventable death. As the world’s largest tobacco consumer and producer, China is facing a public health crisis for current smoking rates. Moreover, in China, the rural population whose smoking rate and smoking amount are both higher than the urban people is in the majority. Therefore, to develop effective tobacco control programs is imperative and urgent in our country, especially in rural areas.Although several strategies are available for conducting tobacco control in the population, however, promoting smokers to quit is one of the main tactics. Successful smoking cessation is influenced by many factors. Smoker’s motivation to smoking cessation is one of the important factors in successful smoking cessation. And the awareness of smoking hazard influences the motivation to cessation. Leventhal’s Self Regulation Model (SRM) suggests that individuals’ perceptions of a health problem, including its causes, influence their perceived control over the problem and their attempts to cope with it. Many studies also showed that increasing awareness about the health hazard of smoking could promote the smoker’s intention to quit. However, currently, few studies report whether and to what extent awareness of smoking hazard influences successful smoking cessation. Therefore, in our report, we used a community-based case-control study to further examine the mediating effects of smoking abstinence self-efficacy (SASE) on the association of smoking hazard awareness with smoking cessation, and the joint effect of smoking hazard awareness and disease status on the risk of smoking cessation, which will provide evidence needed to better inform education for tobacco control intervention.Objectives1. To detect the mediating effect of smoking abstinence self-efficacy on the association of awareness of smoking hazard with successful smoking cessation2. To explore the interaction between awareness of smoking risks and disease status on the risk of smoking cessation.MethodsIn March,2009, Shandong University established a cohort of the Health Research Base (HRB) in three counties (Ping Yin, Ju Nan, and Liang Shan) covering 17 villages, in Shandong, China. A face-to-face interview was conducted based on the cohort mentioned above. After excluding current occasional smokers, a community-based case-control study was conducted with male persons aged 18 or more spontaneous successful smoking quitters as the cases, and spontaneous failed smoking quitters as the controls.Twelve items and scoring methods was used to assess the awareness of smoking hazard. Higher total score indicated higher level of awareness of smoking hazard. The Smoking Abstinence Self-Efficacy Scale was used to assess the level of self-efficacy. Higher score indicated the higher level of self-efficacy. Diseased individuals were defined as those who suffered from one or more types of diseases including hypertension, diabetes mellitus, coronary heart disease, stroke and cancer. On the contrary, individuals without any of the abovementioned diseases were considered as healthy individuals. According to the World Health Organization division standard of age, we divided age into youth, middle and old; we divided occupation into farmer and others; we divided education into below primary school, junior and senior high school and above high school; we divided marital status into married, spinsterhood and other. Logistic regression analysis based on the KHB method was used to estimate the mediating effect of SASE on the association of awareness of smoking hazard on successful smoking cessation. In addition, we explored the biological interaction between awareness of smoking hazard and disease status on the risk of smoking cessation. Interaction was assessed by the measures of synergy index (S), attributable proportion due to interaction (AP), and relative excess risk due to interaction (RERI). Potential confounding factors were age, age of smoking initiation, educational level, occupation and marital status.Main results1. After adjusting the age, age of smoking initiation, occupation, education, and marital status, the effect of awareness of smoking hazard on successful smoking cessation was statistically significant (P<0.001). And smokers with higher level of perception of smoking hazard quitted smoking more successfully (OR=1.288,95% CI=1.147-1.446). The mediating effect of self-efficacy on the association of awareness of smoking hazard with successful smoking cessation was 6.03％among the total effect while the direct effect of awareness of smoking hazard on successful smoking cessation was 93.97%.2. Concerning the three specific situations of SASE, awareness of smoking hazard had positive effect on quitting smoking successfully. The total effect was as follows:OR=1.286 (95％CI:1.145-1.443, P<0.001) for Smoking Abstinence Self-Efficacy Positive (SASEP); OR=1.288 (95％CI:1.147-1.446, P﹤0.001) for Smoking Abstinence Self-Efficacy Negative (SASEN); and OR=1.284 (95％CI: 1.144-1.441, P﹤0.001) for Smoking Abstinence Self-Efficacy Habit (SASEH). The proportions of mediating effect among total effect in three situations were 6.80％, 3.08％and 2.32％, for SASEP, SASEN, and SASEH, respectively.3. After adjusting for potential confounders, the measures of interaction between awareness of smoking risks and disease status on the risk of smoking cessation were as follows:S=1.284, AP=11.1％, and RERI=0.224. This indicated that there was a positive additive interaction between awareness of smoking hazard and disease status on the risk of smoking cessation.ConclusionsThis study indicated that SASE had part mediating effect on the association of awareness of smoking hazard with successful smoking cessation. To improve smokers’ knowledge of smoking hazard may not only promote successful smoking cessation directly, but also contribute to quit smoking through improving the score of SASE. Additionally, the awareness of smoking hazard and disease status had an additive interaction on the risk of smoking cessation. These outcomes need to be further explored.