Study On Quitting Intentions And "Hardcore Smokers" Among Rural Daily Male Smokers

BackgroundChina is still the largest cigarette production and consumption country in the world.Recent national survey results indicated that Chinese tobacco-attributed deaths would rise from about 1 million in 2010 to 3 million in 2050,unless there was widespread cessation.An intention to quit,the perceived likelihood of engaging in a smoking concession behavior,was considered an important determinant and immediate predictor of actually quit smoking.Hence there is a tremendous need to increase the intention to quit among smokers.Experiences from a number of nations suggest that current tobacco control efforts have been successful in motivating a significant portion of light smokers to quit with decreased prevalence of tobacco use,but the remaining smokers will be increasingly intransigent over time.One of the theories explaining this phenomenon is called "hardening hypothesis",which has attracted considerable interest in recent years.The hardcore hypothesis postulates that there might exist a distinct subgroup of daily,long-term smokers who are unable or inherently less willing to quit and who are likely to remain so even when possessing extensive knowledge of smoking hazards and when confronting substantial social disapprobation of smoking.Objectives1.To explore the distributions of quitting intentions in rural male current smokers and use dominance analysis to figure out the relative importance of each predictor to quitting intentions among the target smokers.2.To explore the distributions of hardcore smokers in rural male current smokers and use dominance analysis to figure out the relative importance of each predictor to hardcore smokers among the target smokers.MethodsThis cross-sectional study is the baseline survey of the intervention study named"intervention study for tobacco control educated by village doctor",which was conducted from July,2012 to July,2013,among the male current daily smokers aged 18 years or more residing in 14 villages of Ju Nan county in Shandong,China.Questions were filled out by the well-trained investigators with face-to-face interview.Statistically significant determinants of quit intention identified in the multiple logistic regression were then entered into general dominance analysis to access the relative contribution of the determinants.Statistically significant predictors of hardcore smokers identified in the multiple logistic regression were then entered into general dominance analysis to access the relative contribution of the predictors.Main results1.24.7%rural daily male smokers did not intend to quit smoking within the next 6 months.2.Previous quit attempt experience,smoking intensity,the presence of chronic disease were determinants for quitting intentions.3.Dominance analysis showed previous quit attempt experience is the most important determinant of quitting intentions,followed by low smoking intensity,and the presence of chronic disease.4.Hardcore smokers constituted 32.9%of rural daily male smokers.5.Per component constructs of hardcore smokers:98.4%smokers were aged 26 or older,98%smokers have smoked daily for 5 or more years,48.8%smokers considered time to first smoke within 30 minutes after waking up,79.3%smokers had no quit attempt history,75.3%had no interest in quitting within the next 6 months.6.Smoking intensity,being farmer,starting to smoke daily under the age of 19,younger age,having fewer smokers around were determinants for hardcore smokers.7.Dominance analysis showed smoking intensity was the most important determinant of hardcore smoking,followed by being farmer,starting to smoke daily under the age of 19,younger age,having fewer smokers around.Conclusions and SuggestionsThere is huge potential space to improve the rate of intention to quit among current smokers in rural China.Future smoking cessation interventions should place greater emphasis on identifying smokers without a past quit attempt and smokers with high smoking intensity.Intervention developers should prioritize their efforts to smoking cessation strategies.The present results indicate that the prevalence of hardcore smokers among daily male smokers in rural China may be substantially high.As such,the existence of hardcore smokers may represent a significant public health issue and a meaningful barrier to further reductions in smoking prevalence.In particular,the findings suggest that hardcore smokers seem to have a particular demographic,smoking behavior,and social-environmental profile.These hardcore smokers should be given due importance during smoking cessation planning and interventions.