Most smokers have thought about quitting smoking at one point or another, for various reasons. We found that about eight in 10 Florida smokers have attempted to quit at some point in their lifetime, while four in 10 Florida smokers reported having recently tried to quit. However, the fact that they are still smoking highlights the difficulty most smokers have with achieving successful cessation as well as the importance of characterizing individuals who at least attempt to quit, since they may be more likely to benefit from smoking cessation programs. In this study, we assessed factors associated with ever attempting to quit smoking and recent quit attempts among a sample of current adult smokers in Florida.
In the present study, older smokers were more likely than younger smokers to have ever attempted quitting smoking but were less likely to have tried quitting in the past 12 months, even after controlling for nicotine dependence, perceived benefits of quitting, smoking risk perception, and history or presence of tobacco-related medical conditions. This finding is consistent with another US population based survey of smokers which found older smokers to be least likely to attempt quitting in the past year and be less likely to be successful at quitting . A potential explanation for the difference in quit attempts by age group could be due to resistance to smoking cessation advice due to difficulty quitting, particularly those with many failed attempts, as well as due to changes in social norms regarding tobacco use . It could also be that young smokers try to quit smoking more frequently than older smokers; however the number of quit attempts is not known. We also found that non-Hispanic blacks were the most likely to have reported a quit attempt in the past 12 months while Hispanics were the least likely to have tried quitting smoking in their lifetime, even after controlling for potential confounders. A US population based survey also found blacks to be more likely to report a recent quit attempt although they were least likely to be successful . Again, racial/ethnic differences in quit attempts could be related to social and cultural norms as well as frequency of quit attempts.
The results also showed that history of having a tobacco-related medical condition was associated with greater likelihood of having attempted to quit smoking, both in the last 12 months or in their lifetime. This finding is not entirely surprising given that one reason individuals give for attempting to quit is their health [17, 31, 32]. Furthermore, when smokers have been asked if being diagnosed with a medical condition (e.g., heart disease) would increase their desire to quit smoking, the majority have agreed . Studies have also shown a link between diagnosis of cardiovascular disease and increased motivation to quit smoking and smoking cessation [11, 33, 34]. In addition, nationally representative data do show the prevalence of smoking to be lower among adults with a history of stroke or myocardial infarction (18%) compared to adults without a history of cardiovascular events (26%) . However, in a study of emergency department patients it was found that patients with a diagnosis of a cigarette-related medical condition (i.e., cardiovascular and respiratory diseases, peptic ulcer disease, and cancers such as of the lip, esophagus, lung, etc.) were less motivated to quit smoking when compared to smokers without such conditions . Nevertheless, the desire to quit smoking may be contingent on whether the smoker believes their medical condition is related to their smoking, and/or whether they believe quitting will help their condition (since it is already present). In fact, in the present study we did find that smokers who perceive that there are health benefits to quitting smoking are more likely to have ever attempted to quit smoking, which is consistent with a study of emergency patients .
We also found that greater level of nicotine dependence was associated with being more likely to have ever attempted to quit smoking, although a statistically significant association was not observed for recent quit attempts. Although our findings are plausible given that greater nicotine dependence has been associated with readiness to quit smoking , our findings are inconsistent with other studies that have noted an inverse relationship between degree of nicotine dependence and quit attempts [20, 24]. However, the differing findings could be related to difference in the definition of nicotine dependence. In agreement with previous studies however , we found greater number of smoked cigarettes per day in the past 30 days was inversely related to both recent and lifetime quit attempts. Although the association between nicotine dependence and quit attempts are not entirely clear, our findings suggest that highly dependent smokers are not giving up on quitting smoking and recognize the importance of quitting.
One of the very encouraging findings from our study was related to healthcare provider advice. In agreement with previous studies [16, 17, 22, 36, 37], we found that smokers who were advised by their healthcare provider to stop smoking were about 50% more likely to attempt to quit smoking, both in their lifetime and recently. Thus, consistent with the Public Health Service Clinical Practice Guidelines Treating Tobacco Use and Dependence , healthcare providers should continue to advise their patients to stop smoking, regardless of the frequency of smoking by their patients or other patient characteristics . The importance of such advice is greatest for individuals with medical conditions, given the greater contact these smokers have with the healthcare system. In fact, increasing to 85% the proportion of healthcare professionals who counsel their high-risk patients (e.g., with coronary heart disease) about smoking cessation is one Healthy People 2010 goal .
Finally we found that those who lost more than 3 kg in the past year were more likely to have recently tried to quit smoking. This finding could be due to those with a medical condition (i.e. being medically ill), who lost weight because of their illness, deciding to quit smoking as part of their treatment or recovery regimen. Alternatively, it might be that these individuals are making an overall effort to improve their health, including both weight loss and smoking cessation attempts.
There are several limitations to this study. First, a number of variables that may also be related to quit attempts were not available in the dataset. These include extent of knowledge of the health effects associated with smoking, diagnosis of tobacco related cancers, diagnosis of mental health conditions such as depression, and the smoking status of the family and friends particularly if these individuals live with the participant [8, 20, 40]. Second, we do not know the extent of participants' awareness and perceived effectiveness of smoking cessation support, factors which have been associated with greater likelihood of a quit attempt . It would have also been beneficial to know the frequency of quit attempts as well as the timing of these quit attempts. Finally, the results may not be generalized to other populations outside Florida or the United States.