Why are male Chinese smokers unwilling to quit? A multicentre cross-sectional study on smoking rationalisation and intention to quit

Abstract

ObjectiveWe aimed to describe the rationalisation beliefs endorsed by Chinese male smokers and to examine the association between rationalisation and the intention to quit.SettingQuestionnaires were conducted among male smokers in three cities (Shanghai, Nanning and Mudanjiang) which represent different geographical locations, economic development levels and legislative status of tobacco control in China.Design and participantsIt was a multicentre cross-sectional survey involved a total of 3710 male smokers over 18 years.Outcome measuresPrimary outcomes were intention to quit, smoking rationalisation scores and sub scores in six dimensions. Smoking rationalisation was assessed using a newly developed Chinese rationalisation scale. Multivariable logistic regression was performed to examine the relationship between rationalisation and intention to quit.ResultsOn average, smokers scored 3.3 out of 5 on the smoking rationalisation scale. With a one point increase in total rationalisation scale, the odds for intention to quit in the next 6 months decreased by 48% (OR=0.52, 95% CI: 0.44 to 0.61; p<0.001). Separate logistic regressions for six subscales of rationalisation shown consistent inverse associations with intention to quit (all p values <0.001). Believing that smoking was socially acceptable was the strongest predictor (OR=0.62, 95% CI: 0.55 to 0.71; p<0.001).ConclusionsRationalisation beliefs could be important barriers to smoking cessation. Some beliefs have stronger association with quit intention than others. Eroding rationalisation beliefs endorsed by smokers is a potential strategy for smoking cessation intervention.

Health Knowledge about Smoking, Role of Doctors, and Self-Perceived Health: A Cross-Sectional Study on Smokers’ Intentions to Quit

“…A growing body of literature is looking at the factors that are associated with smokers’ intentions to quit. Previous studies have found that sociodemographic variables, including age, educational attainment, and family income, are associated with intentions to quit [ 5 ]. Smoking-related factors, such as knowledge about smoking-related diseases [ 6 , 7 , 8 , 9 , 10 ], home smoking rules [ 11 ], nicotine dependence, and previous quit attempts also predict smokers’ quit intentions.…”

“…Smoking-related factors, such as knowledge about smoking-related diseases [ 6 , 7 , 8 , 9 , 10 ], home smoking rules [ 11 ], nicotine dependence, and previous quit attempts also predict smokers’ quit intentions. In addition, smoking rationalisation beliefs, also known as self-exempting beliefs, which justify or rationalise their smoking behaviours can also predict a lack of intention to quit [ 5 ]. Our paper is related to [ 12 ], a study conducted in 2010.…”

Antecedents and Consequences of Smoking Cessation Intention in the Context of the Global COVID-19 Infodemic

“…In antismoking studies, many studies [e.g., (66,67)] have concluded that tobacco denormalization (communicating that smoking is not a normal activity in our society) is a successful populationlevel strategy for fighting smoking [also see (68)] [cf. (69)]. Many studies have also found individual-level subjective norms to significantly influence smoking cessation intention (62,64,(70)(71)(72).…”

The short term burden of ambient gaseous air pollution on chronic obstructive pulmonary disease in Pudong New Area, China: A time-stratified case-crossover study with a distributed lag nonlinear model

“…According to WHO statistics, COPD was the fifth leading cause of mortality worldwide in 2011. By 2030, it is expected to be the third leading cause of death [15]. The global disease burden study showed that COPD was the ninth leading cause of death contributing to global YLL in 2016 [16].…”