The association between smokers’ self-reported health problems and quitting: Findings from the ITC Four Country Smoking and Vaping Wave 1 Survey
Lin Li 1, 2  
Ron Borland 1, 2
Geoffrey T. Fong 4, 5, 6
Ann McNeill 7, 8
Pete Driezen 4
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School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
Nigel Gray Fellowship Group, Cancer Council Victoria, Melbourne, Australia
Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
Department of Psychology, University of Waterloo, Waterloo, Canada
School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
Ontario Institute for Cancer Research, Toronto, Canada
National Addiction Centre, King’s College London, London, United Kingdom
UK Centre for Tobacco & Alcohol Studies, London, United Kingdom
Department of Psychiatry and Behavioural Sciences, Medical University of South Carolina, Charleston, United States
Hollings Cancer Center, Medical University of South Carolina, Charleston, United States
Lin Li   

School of Psychological Sciences, The University of Melbourne, Level 7, Redmond Barry Building, Melbourne, Victoria 3010, Australia
Publication date: 2019-12-11
Submission date: 2019-10-02
Final revision date: 2019-10-31
Acceptance date: 2019-11-17
Tob. Prev. Cessation 2019;5(December):49
This study aimed to systematically examine whether having health conditions or concerns related to smoking are associated with quitting activities among smokers across four western countries.

Data came from the 2016 International Tobacco Control Four Country Smoking and Vaping Survey conducted in Australia, Canada, England and US. We asked smokers and recent quitters (n=11838) whether they had a medical diagnosis for heart disease, cancer, chronic lung disease, depression, anxiety, alcohol problems, diabetes, severe obesity and chronic pain (nine conditions), and whether they believed smoking had harmed/would harm their health, along with questions on quitting activities.

General concerns about smoking harming health and all specific health conditions, except for alcohol problems, were positively associated with quit attempts, but the relationships between health conditions and other quitting measures (being abstinent, planning to quit, use of quitting medications) were less consistent. Positive associations between conditions and use of quitting medications were only significant for depression, anxiety and chronic pain (adjusted odds ratios ranged from 1.4 to 1.5). There was a general tendency to report lower self-efficacy for quitting among those with the health conditions.

While those with smoking related conditions are somewhat more aware of the links to their smoking, and are largely taking more action, the extent of this is lower than one might reasonably expect. Enhanced awareness campaigns are needed and health professionals need to do more to use health conditions to motivate quit attempts and to ensure they are made with the most effective forms of help.

The authors thank Stella Dickens for her assistance in preparing the tables used in the manuscript.
The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. RJO reports personal fees from World Health Organization, grants and personal fees from Food and Drug Administration, grants and personal fees from National Institutes of Health, outside the submitted work. KMC has received payment as a consultant to Pfizer, Inc., for service on an external advisory panel to assess ways to improve smoking cessation delivery in health care settings. KMC has also served as paid expert witness in litigation filed against the tobacco industry.
This work was supported by grant P01 CA200512 from the US National Cancer Institute, a Foundation Grant (FDN-148477) from the Canadian Institutes of Health Research, and the National Health and Medical Research Council of Australia (APP1106451). Additional support was provided to GTF from a Senior Investigator Award from the Ontario Institute for Cancer Research. The funding bodies had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.
All authors made significant contributions to the work reported. Conceptualization: LL, RB, GTF, AM, and KMC. Methodology: LL, RB, RJO and PD. Formal analysis: LL and RB. Writing draft preparation: LL and RB. Writing of final manuscript for approval and editing: All authors.
Not commissioned; externally peer reviewed.
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