The Study On Associated Influencing Factors Of Past Smoking Cessation Attempts

BackgroundTobacco use remains the leading preventable cause of premature death and disease worldwide,causing hundreds of billions dollars of economic losses each year.China is known as the largest cigarette producer and consumer with 301 million current smokers.Additionally,the prevalence of smoking in rural areas is much higher as compared with those living in urban areas.Thus,it is imperative to develop forceful tobacco control initiatives to curtail the tobacco use in rural China.Although there are many strategies for performing tobacco control,smoking cessation is the most effective way to reduce the health risks caused by tobacco use and all ages will get benefit from quitting.Numerous studies have addressed factors associated with successful smoking cessation,such as reason of quitting,less nicotine dependence,higher self-efficacy,higher perception of smoking risks,less cigarette smoked per day,less smokers around.Among these factors,past quit attempt is an important one.Previous studies suggested that quit attempt in the past is an important predictor for subsequent quitting.People who had ever attempted to quit in the past are more likely to try again in the future.However,the association between number of quit attempts and successful smoking cessation is controversial.Some scholars believe that a smoker can quit successfully until he had tried to quit for several times.While others hold that the increasing number of quit attempt is associated with decreasing likelihood of achieving sustained abstinence.Therefore,we conducted this cross-sectional survey to investigate the relationship between number of quit attempts and successfully smoking cessation,and to further explore the influencing factors of past quit attempts,which will provide guidance for the tobacco control interventions in the future.Objectives1.To detect the association between number of past quit attempts and successful smoking cessation.2.To detect the potential predictors of past quit attempts.MethodsIn 2009,Shandong University established the Health Research Base(HRB)in three counties(Ju Nan,Liang Shan and Ping Yin)of Shandong Province.This study is based on the cohort of the HRB.In August,2010,three villages were selected respectively from the three counties mentioned above.Questionnaires designed based on Global Adult Tobacco Survey(GATS)Core Questionnaire with Optional Questions were used to collect data among residents above 15 years old.Face-to-face interviews were performed by well-trained investigators to finish the questionnaires.According to the standard division of age which was recommended by the WHO,age of the subjects was divided into youth group(<45),middle group(45-59)and old group(?60);marital status was divided into married and others;education was divided into three levels:low(below primary school),middle(primary and junior high school)and high(high school or above);according to the situation of rural residents in China,we divided occupation into farmer and others;Pack-year of smoking was defined as the number of packs of cigarettes smoked per day multiplied by the number of smoke years.The scores of attitude to smoking and perception of smoking risks were calculated by adding the scores of all corresponding items respectively and then categorized into tertiles to represent low,middle,and high levels.Number of previous quit attempts was accessed by asking the current smokers"How many times have you ever stopped smoking for any length of time because you were trying to quit smoking in your life?" For smokers that had never tried to quit smoking,the number of quit attempts was treated as 0.Logistic model was used to examine the relationship between the number of the past quit attempt and successful smoking cessation.Propensity score was included in the logistic model as the covariate to adjust the potential confounders including age,marital status,education,occupation,age of smoking initiation,reason of smoking cessation.Hurdle count data model was used to estimate predictors of the number of past quit attempts.Main results1.Disparities in the distribution of age,years of smoking,number of cigarettes smoked per day,pack-year of smoking,number of past quit attempt and reason of quitting were found between successful and unsuccessful quitters(P<0.05),while no significant difference was found between marital status,education,occupation,age of smoking initiation.2.After adjusted for the potential confounding factors age,marital status,education,occupation,age of smoking initiation and reason of quitting,the number of past quit attempt was negatively associated with successful smoking cessation(OR=0.417,95%CI=0.343-0.506).3.Disparities in the distribution of age,marital status,years of smoking,packs years of smoking,attitude towards smoking and perception of smoking risks were found between those who had ever tried to quit and those who had never(P<0.05),while no significant difference was found between education,occupation,age of smoking initiation,number of cigarette smoked per day.4.Logistic regression of the Hurdle model showed that smokers who were married(married vs.others,? =0.540,P= 0.004),had higher education level(?=0.195,P=0.040),and had higher level of perception of smoking risks(?=0.238,P= 0.009)were more likely to have tried to quit.Zero-truncated Poisson equation estimated factors associated with number of the quit attempts,given that the smoker had a positive probability of quitting.Age of smoking initiation was negatively associated with the number of past quit attempts(?=0.202,P=0.010),while perception of smoking risks was positively associated with the number of past quit attempts(?=0.141,P= 0.024).Conclusions1.The number of past quit attempts is negatively associated with successful smoking cessation.2.Factors distinguishing the smokers who had ever attempted to quit smoking are different from those that influencing the number of quit attempts.Marital status,education level and perception of smoking risks are factors associated with the probability of quitting,while age of smoking initiation and perception of smoking risk are factors associated with number of quit attempts.Tailored smoking cessation interventions should be made respectively to smokers who had never attempted and who had attempted many times but remain current smoking.