Behavioral Driven Pattern Of Unassisted Smoking Cessation And Likelihood Of Effectiveness:A Population Based Study In China

BackgroundThe WHO reported that smoking is currently the most severe yet preventable cause of mortality in the world,which causes over 7 million deaths each year.Quit smoking could reduce the risk of smoking-related mortality and even reverse adverse health outcomes.Considering the kind of approach that could promote more smokers to quit smoking is a main issue in China’s tobacco control strategies.Although several smoking cessation clinics and hot lines have been established,most of them are severely underused with far less visitors than estimated and planned.The cause of this phenomenon is not actually few Chinese smokers have quitted attempt.A research in 2015 showed that 41%of the smokers have quitting attempts and three National Tobacco Use Investigations suggested amount of Chinese smokers had attempt quit and more than 90%of them were unassisted quitting.As the main method Chinese smokers used,research on unassisted smoking cessation(USC)was ignored for a long time.There are only few population-based studies on this topic,but none of them explored China’s case.ObjectivesThis study aims to understand the current epidemic situation of USC and its effectiveness behavioral patterns.Based on Health Behavioral Theories,this study focuses on the inner mechanism of how individual factors,perceived behavior control factors,and environmental factors effect on USC.The results of this study could be used to advise public health policy and help combat the tobacco epidemic in China.MethodA population based cross-sectional survey with multi-staged stratified randomize sampling method was conducted.The participants are 15 years old or above male residents who had lived in this area for more than one year.The sample size is 5782.The status of USC and self-efficacy were measured by a newly developed instrument.Self-exempting beliefs and mental stress were assessed by Oakes’ Self-exempting beliefs questionnaire and the Chinese Perceived Stress Status(CPSS).The SPSS 22.0 and Amos 24.0 were applied to analyze the data.Cronbach’s alpha coefficient and exploratory factor analysis were used to examine the reliability and validity of the self-designed questionnaire.T-test,Chi-square test and multiple logistic regression models were used to analyze the determinant factors of USC.A structure equation model was built to verify our hypothesis.Results1.The rate of USC attempts is 93.44%,and quit rate by USC is 33.72%.The USC adoption rate showed no significant difference among varying demographic groups.However,age(X2=13.512,P<0.01),education level(X2=17.454,P<0.01),occupation(X2=43.203,P<0.01),family income(X2=18.528,P<0.01)and marital status(X2=27.540,P<0.01)are significantly associated with USC quit rate.And USC quit rate is significantly higher among old people,low education level,retired people and low income family than other groups.Single men have the lowest USC quit rate compared with other marital status groups.Smokers who are willing to use smoking cessation drugs have lower USC quit ratethan those who do not(x2=24.09,P<0.01).2.The results from multiple logistic regression model showed that people with lower self-exempting beliefs(OR=1.637,95%CI:1.217-2.202),lower mental stress level(OR=1.327,95%CI:1.042-1.691)or higher self-efficacy(OR=1.732,95%CI:1.371-2.189)have higher USC quit rate.Besides,the effectiveness of USC will be reduced if there are no smoking restrictions in family or work place.3.Structural equation model demonstrated that the correlation between self-exempting belief and successful USC is-0.143 and the correlation between self-efficacy and successful USC is 0.071.The total correlation between mental stress and successful USC is-0.144,including a direct path(β’=-0.121,P=0.001)and indirect path(β’=0.160,P<0.001).Environmental restrictions have indirect effect on successful USC.ConclusionThis study’s findings underscore the extremely high USC adoption prevalence and good effectiveness potential among the Chinese smokers,implying a kind of behavioral response to unique Chinese culture.This study explores the behavioral driving patterns of Unassisted Smoking Cessation:how to understand mechanisms that,perceived behavior control and environmental smoking restrictions to USC theoretically.Ideally our research should inform policymakers and legislators to develop more effective tobacco control policies,and provide scientific evidence for smoking cessation program design.