Motivations towards Smoking Cessation, Reasons for Relapse, And Modes of Quitting

Motivations towards Smoking Cessation, Reasons for Relapse, And Modes of Quitting: A Comparative Study among Former and Current Smokers


BACKGROUND: Tobacco kills more than 7 million people each year. More than 6 million of those deaths are the result of direct tobacco use while around 890,000 are the result of non-smokers being exposed to second-hand smoke.According to National Health Services, Regulations and Coordination ministry; Pakistan was ranked 54th amongst 84 countries with high prevalence of tobacco smoking. Number of smokers reaches 25 million in Pakistan. According to WHO, tobacco killed over seven million people every year, out of which 108,000 people died in Pakistan.. This study is part of a larger research project that aims to investigate factors that influence outcomes of anti-smoking counseling in health care setting; including the role of doctor, the role of nurse and patient’s experience of smoking cessation. The Objective of the study was: To determine and compare among former and current smokers, the reasons why smokers initially started smoking , the motivations towards smoking cessation, reasons for relapse ,modes of quitting and other associated factors.

STUDY DESIGN: A comparative cross-sectional Study.

PLACE AND DURATION: Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi from July 2017 till June 2018.

METHODOLOGY: Current Smokers were recruited in the study, who had been smoking cigarettes daily for ≥ one year and made an attempt to quit the smoking while former Smokers who had quit the cigarettes smoking for ≥ one year and never relapsed and previously had been daily smokers were recruited. Smokers who were using smokeless tobacco, who never quit smoking and who didn’t smoke daily were excluded from the study.

RESULTS: A Total of 1024 participants were recruited in the study. Out of which 512 were current smokers and 512 were former smokers. Mean age of the study participants was 45.3±5.8 years. The most common motivations for smoking cessation among former smokers were found to be; health concerns (Diagnosed with cardiovascular diseases) in 281(54.8%) study participants, followed by persistent cough, setting good example for children, religious inclination, smoking ban at work place and unpleasant smell to the people around while the most common reasons for relapse in current smokers were; company/friends in 290(56.6%) current smokers followed by stress in 94(18.3%) then personal tragedy, constipation/gas issue and pleasure obtained from smoking.

Our study results yielded that most of the people initiate smoking after getting influence from their company. The development of cardiovascular diseases remains the main source of motivation behind smoking cessation. Relapse causes also remain an important issue, in our study, these encompassed, most notably: company around, stress, lack of the pleasure previously obtained from smoking. It appears that it is essential to work out measures for relapse prevention to enhance the number of successful smoking cessation attempts.

KEYWORDS: Cardiovascular disease, Relapse, Smoking cessation, Stress.


  1. Danaei G, Vander Hoorn S, Lopez AD, Murray CJ, Ezzati M; Comparative Risk Assessment collaborating group (Cancers). Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet. 2005;366(9499):1784–1793.
  2. World Health Organization (WHO). WHO Report on the Global Tobacco Epidemic, 2011: Warning about the Dangers of Tobacco. Geneva: WHO; 2011. Available from: http://whqlibdoc.who.int/publications/2011/9789240687813_eng.pdf?ua=1. Accessed August 28, 2020.
  3. 2008 PHS Guideline Update Panel, Liaisons, and Staff. Treating tobacco use and dependence: 2008 update US Public Health Service Clinical Practice Guideline executive summary. Respir Care. 2008;53(9): 1217–1222.
  4. Neroth P. Stubbing out Communist habits. Lancet. 2005;366(9480): 109–110.
  5. Centers for Disease Control and Prevention (CDC). State-specific prevalence of cigarette smoking and smokeless tobacco use among adults – United States, 2009. MMWR Morb Mortal Wkly Rep. 2010; 59(43):1400–1406.
  6. CDC. Smoking-attributable mortality, years of potential life lost, and productivity losses – United States, 2000–2004. MMWR Morb Mortal Wkly Rep. 2008;57(45):1226–1228.
  7. Federico B, Costa G, Ricciardi W, Kunst AE. Educational inequalities in smoking cessation trends in Italy, 1982–2002. Tob Control. 2009;18(5): 393–398.

Corresponding Author: Dr. Rehana Khadim
Designation: Managing Editor
Department: Pakistan Armed Forces Medical Journal Office
Institution: Army Medical College, Rawalpindi
Email address: dr.rehana.butt@gmail.com
Cell no. 03345538381
Co-Authors: Maj General Farhan Tuyyab, Dr Mubbra Nasir, Dr Urooj Alam, Dr Ruqqia Tahir Dr Shazia Fatima Malik