Smokers’ reasons for quitting in an anti-smoking social context

doi:10.1016/j.puhe.2010.02.011

Public Health

Volume 124, Issue 4, April 2010, Pages 225-231

https://doi.org/10.1016/j.puhe.2010.02.011 Get rights and content

Summary

Objective

To examine the impact of the social denormalization of smoking on smokers' motives for quitting and on subsequent abstinence in a context of intensified anti-smoking measures.

Study design

This study is based on data from 13,746 French smokers who were registered in cessation services nationwide between September 2006 and September 2007.

Methods

Motives freely reported by smokers on their first visit to a cessation service were explored through open coding. Bivariate methods and multivariate logistic regression analyses were used to assess the association with biochemically validated abstinence at 1 month follow-up.

Results

Motives most frequently expressed by smokers were health concerns (55.0%) and cost of smoking (24.2%), but no significant association was found with abstinence. The highest abstinence rates were achieved by smokers motivated by their social network: ‘motivated or pressured by others’ (20.9%), ‘setting a good example’ (20.7%) and ‘having a smoke-free social network’ (20.3%). Smokers could no longer bear the social constraints of smoking: ‘[my] friends and family have all quit, [I] smoke outside all alone and feel left out’ and ‘I no longer want people to say with disgust that I smell of tobacco. I would like to be freed from this addiction because I'm ashamed of smoking, not at home but on the street’.

Conclusion

French smokers' motives for quitting reflect a social unacceptability of smoking which has been buttressed by measures intended to reduce tobacco use. Through smoke-free social networks, the denormalization of smoking appears to improve short-term abstinence.

Introduction

Public measures to reduce tobacco use contribute to shaping social unacceptability of smoking.1, 2, 3, 4, 5, 6 For instance, by alerting people to the dangers of second-hand smoke, health campaigns might be responsible for smokers feeling uncomfortable about smoking in public.1, 4 Moreover, non-smokers now tend to see smokers as drug addicts whose habit threatens their health and that of others.2, 5, 6 A recent longitudinal study has revealed the association between smoking regulations and an increased perception of the unacceptability of smoking in the UK.⁷ In France, smoking has been banned in public places (workplaces, schools, public transports) since February 2007. The measure was announced in October 2006.⁸ However, as early as 2005 (when the measure was in preparation), 48.6% of French smokers believed that ‘it is more difficult to fit in when you are a smoker’.⁵

International literature reports evidence that the denormalization of smoking is an effective component of measures intended to reduce tobacco use.1, 4, 9 For instance, a longitudinal study assessing data from Canada, the USA, the UK and Australia concluded that smokers are more likely to intend to quit and to be abstinent at follow-up when they have important social denormalization beliefs about smoking, such as feeling disapproved for smoking, being uncomfortable about smoking in public, and being advised to quit by people close to them.⁴

In France, although the changing perception of smoking has been observed by health authorities,³ the authors are unaware of any published research focusing on French smokers' quit attempts and abstinence rates in light of the current anti-smoking social context. However, reducing tobacco use is a crucial national public health issue because the prevalence is still high (30%).³ There are numerous indicators of the social unacceptability of smoking in the media, at home or in workplaces.² Therefore, further understanding regarding which factors influence smokers' motivation to quit is necessary for the implementation of effective tailored smoking cessation interventions.

The study sample consisted of smokers referred to cessation services nationwide (either self-referred or referred by a third party). A longitudinal survey conducted in the USA has suggested that smoking regulations might encourage anti-smoking social norms and cessation efforts more effectively among smokers who are already engaged in the process of quitting.⁹

In the past decade, the tobacco control policy has been intensified in France, with more aggressive health campaigns and important cigarette tax increases, especially between 2002 and 2004.⁶ Consequently, concerns regarding the cost of smoking and fear of tobacco-related diseases have been the main reasons for quitting among ex-smokers, according to a 2005 national cross-sectional survey.⁵

The present study thus addressed two questions: Considering the anti-smoking social context, what are French smokers' freely expressed motives for wanting to quit? Do motives that mirror the denormalization of smoking predict biochemically validated abstinence at follow-up?

Section snippets

Population

A retrospective analysis was undertaken of the data from 13,746 smokers registered nationwide between September 2006 and September 2007 in the French national smoking cessation online database. During their first visit to a cessation service, they had completed a questionnaire that was checked and registered in the database by cessation specialists.¹⁰ One hundred and thirty-two cessation services covering all the regions of France were involved. Data were anonymized. The National Auditing

Results

Table 1 presents the baseline profile of smokers and details of the interventions according to intervention outcomes. Smokers' motivations covered seven themes (Fig. 1). Table 2 presents associations between reasons for quitting and intervention outcomes.

Discussion

In a context of intensified anti-smoking measures, motives related to smokers' social networks were associated with the highest abstinence rates: ‘motivated or pressured by others’ (20.9%), ‘setting a good example’ (20.7%) and ‘having a smoke-free social network’ (20.3%). Additionally, smokers who had a smoke-free social network were 0.64 times less likely to drop-out.

These findings confirm that the growing social unacceptability of smoking is internalized by smokers.² The only motive

Acknowledgements

The authors wish to thank Nicolas Rodon in charge of the national smoking cessation database, and Pr Gilbert Lagrue and Pr Joël Ménard for their support of the CDT programme.

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Original ResearchSmokers’ reasons for quitting in an anti-smoking social context

Summary

Objective

Study design

Methods

Results

Conclusion

Introduction

Section snippets

Population

Results

Discussion

Acknowledgements

Am J Prev Med

Public Health

J Psychosom Res

Prev Med

Prev Med

Behav Res Ther

Soc Sci Med

Individual, social-normative, and policy predictors of smoking cessation: a multilevel longitudinal analysis

Am J Public Health

Markers of the denormalisation of smoking and the tobacco industry

Tob Control

Regards croisés sur l'économie

A longitudinal study of policy effect (smoke-free legislation) on smoking norms: ITC Scotland/United Kingdom

Nicotine Tob Res

Original Research
Smokers’ reasons for quitting in an anti-smoking social context