Very unsuccessful attempts to quit: examining correlates in the 13 countries where almost 2/3 of smokers live
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Clima Clinic, São Paulo, SP, Brazil
Department of Psychiatry, Medical School, University of São Paulo, São Paulo, SP, Brazil
Department of Neuroscience, Medical School, Fundação do ABC, Santo André, SP, Brazil
João Mauricio Castaldelli-Maia   

Clima Clinic, São Paulo, SP, Brazil, Rua Guarara 529 Cj 127, 01425-001 São Paulo, Brazil
Publish date: 2017-05-25
Submission date: 2017-05-10
Acceptance date: 2017-05-10
Tob. Prev. Cessation 2017;3(May Supplement):78
Every year, millions of smokers try to quit smoking. Unfortunately, a significant portion of these smokers fails to maintain abstinence for more than 24 hours, resulting in a Very Unsuccessful Attempt to Quit (VUAQ). Previous studies have shown that VUAQ is related to both levels of dependence and the severe symptoms of nicotine withdrawal. However, there are indications that other variables may also play a role. This study aimed to investigate the correlates of VUAQ using a cross-national sample.

Material and Methods:
We used data from the Global Adult Tobacco Survey (GATS) - designed to produce national estimates among all non-institutionalized men and women 15 years of age or older - from the 13 countries where almost 2/3 of smokers live. Those smokers who reported having tried to quit at least once were included in the present analysis: Bangladesh (n = 1,058); Brazil (n = 2,928); China (n = 489); Egypt (n = 1,577); India (n = 3,499); Indonesia (n = 821); Mexico (n = 839); Philippines (n = 1,288); Russia (n = 1,403); Thailand (n = 1,503); Turkey (n = 1,028); Ukraine (n = 832); Vietnam (n = 1,168). We carried out weighted regression models for VUAQ including sociodemographic, smoking, treatment, and media/perceptions as dependent variables.

VUAQ varied from 1.0% in the Philippines to 13.6% in Brazil. The category most consistently associated with VUAQ was less time to first cigarette (7 countries), followed by female gender and older age (5 countries) and cigarette advertising in stores (4 countries). Nicotine Replacement Treatment (NRT) was negatively associated with VUAQ in only two countries and Counseling and Brief Advice in none. Sociodemographic variables were more important in America, and level of dependence was less important in Asia. Treatment and Media/Perception variables were not important for VUAQ (with the exception of advertising in stores).

Our findings support both the multicausality and great prevalence variability of VUAQ. Although reinforcing the importance of dependence level in many countries, the use of medications that alleviate withdrawal had hardly any effect. Interestingly, there is a justification for special interventions for women and the elderly, and also the banning of in-store advertising, in the attempt to reduce VUAQ.