Decreasing of motivation to quit in Hong Kong community smokers: A secondary analysis of Quit-to-Win smoking cessation trails (2009-2018)

Abstract

Aim: To investigate the trends of intention, attempts and self-efficacy on quitting (i.e., motivation to quit) of participants in the Quit-to-Win (QTW) Contests (an annual smoke-free community campaign) during 2009-2018. Methods QTW participants (N=9837) were actively recruited daily smokers aged 18 or above from community settings (18.5% female, 44.1% aged 18-39 years). Baseline questionnaires collected information on intention to quit, quit attempts (yes/no) and perceived importance and confidence on quitting, nicotine dependence (Heaviness of Smoking Index, range 0-6) and sociodemographic. All data were weighted to the sex-age distribution of participants in 2009. We used multivariable ordinal logistic and linear regressions to analyse motivation to quit by study years, adjusted for sociodemographic and nicotine dependence. Results: Prevalence of high nicotine dependence (score >4) was decreasing (odds ratio per year 0.97, 95%CI 0.96-0.99). Proportion of participants intended to quit in 7 days decreased from 66.4% in 2009 to 20.2% in 2018 (P<0.001). The increase of no intention to quit was associated with study year (adjusted ß 0.15, 95%CI 0.14, 0.17). Prevalence of past year and lifetime quit attempt decreased from 25.5% and 71.0% (2009) to 19.6% and 61.8% (2018) (both Ps<0.001). Perceived importance and confidence on quitting decreased from 7.9 ± 2.3 (standard deviation) and 6.2 ± 2.6 to 6.6 ± 2.5 and 5.3 ± 2.4, respectively (both Ps<0.001). Conclusions: Participants have become less motivated to quit. Smoking cessation interventions need to be modified to support quitting as the proportion of hard-core smokers appears increasing, even when nicotine dependence appears decreasing.