Characteristics of Participants
37 male and 3 female eligible participants were interviewed, among which were 22 ex-smokers and 18 current smokers. Participants’ mean age was 45 (SD = 16.2), and the average duration of smoking was 19 years (SD = 14.1). The demographic characteristics and smoking history of participants are shown in Table 3.
Table 3
Summary of participants’ demographic characteristics and smoking profiles (n = 40)
Characteristics
|
n (%)
|
Age
|
|
18–40
|
20(50)
|
40–60
|
11(27.5)
|
> 60
|
9(22.5)
|
Gender
|
|
Male
|
37(92.5)
|
Female
|
3(7.5)
|
Education
|
|
Middle school and below
|
6(15)
|
High school
|
9(22.5)
|
College and above
|
25(62.5)
|
Smoking status
|
|
Current smoker
|
18(45)
|
Ex-smoker
|
22(55)
|
Duration of smoking
|
|
≤ 10
|
11(27.5)
|
10–20
|
11(27.5)
|
> 20
|
18(45)
|
Number of quit attempts
|
|
0
|
7(17.5)
|
1–3
|
25(62.5)
|
> 3
|
8(20)
|
Smokers’ motivation to stop smoking
1. Beliefs About The Harmfulness Of Smoking On Own Health
Many current smokers were poorly convinced that smoking is detrimental to their own health, and they tended to neglect the health risk of smoking, so they had insufficient motivation to quit smoking. But many ex-smokers and some current smokers reported that their belief in the health consequences of smoking got stronger when they or people around them suffered from serious illnesses, and that was the reason why they decided to quit at that time.
You can't live to 200 years old even if you don’t smoke, can you? (Interviewee 15, current smoker)
This time I am determined to quit because I had lung nodules, and this resulted in the strongest impulse to quit I have ever had. (Interviewee 4, ex-smoker)
It was when my sister had her stent insertion that I decided to quit, the doctor said her disease may be caused by smoking and staying up late, and we could have lost her with any delay in treatment. These (smoking and staying up late) were exactly what I were doing then, and it scared me, so I made my decision to quit that time. (Interviewee 2, current smoker)
2. Beliefs About The Harmfulness Of Smoking On Family
Nearly all participants believed that smoking could cause damage to their family, especially a fetus and child, and their concern for families’ health had boosted their motivation to quit. Some participants stopped smoking because of their families, among other things, expecting a baby was the most important reason for some ex-smokers to quit smoking, and many current smokers also claimed that they would seriously consider quitting smoking when they plan to have a baby. On top of that, some current smokers tried to reduce or avoid the adverse effects of smoking on their families, even if they could not quit immediately.
The most important reason I quit smoking was because I worried about my family's health. (Interviewee 1, ex-smoker)
I quit smoking after my wife was pregnant. (Interviewee12, current smoker; Interviewee 21, ex-smoker)
I guess I will quit smoking when preparing to have a baby, many people quit because of this. All my friends who have quit successfully were quitting for their babies. (Interviewee 11, current smoker)
I have set up a smoking room in my house, which is separated from other rooms and is equipped with a fan to dissipate the smoke. (Interviewee6 & Interviewee 12, current smoker)
3. Views And Attitudes Towards Smoking
Many smokers contended that smoking is their personal choice, and as long as it doesn’t affect others, they have the right to smoke, thus they felt justified to smoke. Some smokers also expressed that smoking is their habit and hobby, which helps them enjoy their life. These were the two reasons mentioned most in the current smoker group for their unwillingness to quit smoking.
I mean, smoking is your choice and right, it deserves respect. (Interviewee 3, current smoker)
In fact, that (other people’s bad impression about smoking) did not bother me at all, I only realized that smoking is unattractive after I quit smoking. (Interviewee 25, ex-smoker)
I know nonsmokers believe smoking is very terrible, but for us, it is just our habit, exactly the same as fishing and drinking tea. (Interviewee 10 & Interviewee 12, current smoker)
4. Confidence In Quitting
Many current smokers had low confidence in quitting, mainly because they believe that willpower is the determinant of a successful smoking cessation attempt. Smokers were convinced that only people with great willpower and self-discipline could achieve sustained cessation. As a result, for ex-smokers, becoming a non-smoker was viewed as an impressive accomplishment and a proud boast, while for current smokers, many of them would be afraid that they were not strong enough to soldier on and resist the temptation of cigarettes.
You have been smoking for decades, this has become a part of your life, it is definitely not easy to quit. (Interviewee 2, current smoker)
It is hard to make up your mind to quit smoking especially when you have failed several times, because that the relapse will make things worse, it erodes your confidence. Some may think: since I cannot keep abstinence for sure, I would rather not to quit at all. (Interviewee 4, ex-smoker)
Smokers’ opportunity to smoking cessation
1. Social Climate About Smoking
Most of the participants reported that the smoking atmosphere has changed gradually, social attitude towards smoking now is very different from decades ago. Many participants expressed that smoking, especially in public places, is deemed an undesirable behavior nowadays. Some participants also recalled that some people had expressed strong disapproval of their smoking in public places. In addition, some participants reported that cigarette gifting is deemed inappropriate for some people because of its hazards. These situations would have been unthinkable in China even a few decades ago.
I have talked about it with my friends, we all agreed that calls for quitting smoking will gain momentum in China, look at the no-smoking signs in public places, and how people react when you smoke, it makes me feel awkward to smoke here. (Interviewee 1, ex-smoker)
The current social atmosphere is relatively better than before. Smoking used to be attractive and predominant, but now, it is an unwelcome behavior for most people. (Interviewee 6, current smoker)
The social norm is turning against smoking nowadays; I used to deliver high-end cigarettes to my clients, which were deemed a fancy gift. But it is forbidden by my company now as it is believed that cigarettes are harmful to people’s health and they convey malice rather than goodwill. (Interviewee 6, current smoker)
2. Smoking Cessation Services
Awareness about available smoking cessation services is low in China. Most participants commented that they have never heard of smoking cessation services, including smoking cessation clinics and Quitline. Some participants who have heard of these casted doubts on their efficacy because of their confusion that what is the differences between aided quit and unaided quit and how can these smoking cessation services help them quit. In addition, participants who had heard about cessation clinics and Quitline, especially those who had attended these, often complained that seeking support from the existing smoking cessation services is laborious and time-consuming.
I have never heard of these (both cessation clinics and Quitline). (Interviewee 13 & Interviewee 16 … & Interviewee 32, ex-smoker)
I would not turn to these (both cessation clinics and Quitline). If I want to quit, I think what matters is my willpower. I mean, what can they do? Psychotherapy? Medication? I totally have no idea. (Interviewee 2, smoker)
I have waited for the appointment for months, and this time I called for sick to see the doctor here, it is such a laborious process. (Interviewee 6, smoker)
3. Family Support
It was repeatedly mentioned that smokers’ family members often encourage them to quit smoking. However, many participants also expressed that they would not seek family support when they are quitting smoking because of their belief that quitting smoking was their own business and did not need support from others, including their families. Moreover, some smokers expressed their worry that their family may respond in an inappropriate manner such as criticizing instead of encouraging smokers when they lapse.
My family numbers care about me, and they often urge me to quit. Every time I was found smoking, they showed disapproval. It has had a subtle effect on me. (Interviewee 30, ex-smoker)
I have never discussed it with my family in my previous quit attempts, I mean, it is my own business, I cannot image what can they do to help me. (Interviewee 16, ex-smoker)
You should never discuss it (quitting smoking) with your family when you are about to make a quit attempt. For example, if you told your wife you are going to quit, she may question your ability or mock you when you relapse. It makes you feel more guilty when you relapse because you feel obligated to live up to their expectation. (Interviewee 25, ex-smoker)
Smokers’ capability to stop smoking
1. Cognitive And Interpersonal Skills Needed To Maintain Smoking Cessation
Self-regulation and willpower were the capabilities mentioned throughout this study, both current smokers and ex-smokers believe that the key to successful smoking cessation is one’s willpower, and nearly every participant thought the lack of willpower was to blame when they failed at quitting. However, the overemphasis on willpower made them overlook their real problems in quitting smoking. In fact, smokers have trouble handling invitations from others and dealing with negativity. Many smokers who had tried to quit expressed that they could have done better without the invitations from others or the unpleasant thing.
I don't think people need help to quit smoking, what is essential is their willpower. (Interviewee 10, current smoker)
If you want to quit smoking, you must make up your mind and perseverance to succeed. (Interviewee 13, ex-smoker)
I did not know how to reject others’ invitations properly, I was afraid that if I kept rejecting others that way, the relationship between my friends and me would be destroyed. (Interviewee 10, current smoker)
The greatest difficulty in the process of quitting smoking was that my colleagues around me were inviting me to smoke. (Interviewee 18; ex-smoker)
Last time I relapsed because I encountered difficulties in my life, and I was in a bad mood. (Interviewee 16 & Interviewee32, ex-smoker)
2. Knowledge About Smoking
Many participants had an inadequate understanding of the health consequences of smoking. Although most participants confidently assured themselves that they knew smoking is harmful, most of them could only name several aspects of the health consequences concerning smoking, mainly lung cancer and respiratory symptoms, overlooking numerous other adverse effects caused by smoking. In addition, many of them did not understand to which extent smoking is associated with these conditions. This inadequate understanding could render a weak belief in the health consequences of smoking.
Everyone says smoking is harmful, but that is all, what exactly will it cause? (Interviewee 12, current smoker)
Many people do not smoke or drink in their lives, but they still suffer from cancer. So what is the relationship between smoking and cancer? It is very ambiguous for me. (Interviewee 2, current smoker)
3. Knowledge About Cessation
Many participants did not have sufficient knowledge about the withdrawal symptoms. Some participants had suffered from some mild or moderate withdrawal symptoms in previous quit attempts, but they did not know exactly why these symptoms occurred and whether or when these symptoms would fade away. In the meantime, they did not know what to expect and how to handle it when they made a quit attempt. What is more, some participants even believe that these symptoms are omens of severe diseases due to the abrupt withdrawal from cigarettes after decades of smoking, which was why they did not want to quit.
After quitting smoking, it was not as painful as I have thought, but my eating and sleeping order was disrupted. It made me afraid. (Interviewee 12, current smoker)
In fact, many people have thought about quitting smoking. But after quitting smoking, many people’s physical condition deteriorated. This is worrying. (Interviewee 17, current smoker)