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Tobacco cessation in a population

over age 15 years: a community-based survey in AlexandriaR.M. Youssef,1 S.A. Abou Khatwa1 and H.M. Fouad1

1Department of Community Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

(Correspondence to R.M. Youssef: randayoussef@link.net).Received: 10/04/03; accepted: 20/12/04

ABSTRACT A survey of 2120 adults in Alexandria, Egypt, studied the determinants and patterns of tobaccocessation among ever smokers. Ever smokers were 30.7% of respondents; only 3.5% had given up

smoking (quit ratio of 11.4%). The quit ratio was significantly lower for ex-daily smokers (7.5%) than for ex-occasional smokers (44.8%). Among current smokers, 56.3% were between the contemplation and prepa-ratory phases for quitting, whereas 25.1% were in the action phase of attempting to quit, for an averageduration of 2.5 months, before relapsing. Health concerns were the motive for all ex-smokers and 95.0% ofattempters, but craving for nicotine was the commonest reason for relapse. Tobacco cessation was predict-ed by older age of tobacco initiation, shorter duration of use, presence of health problems and a perceptionof the benefits of quitting.

Le sevrage tabagique dans une population ge de plus de 15 ans : enqute communautaire AlexandrieRSUM Une enqute auprs de 2120 adultes Alexandrie (gypte) a permis dtudier les dterminants etles caractristiques du sevrage tabagique chez des personnes ayant fum un moment de leur existence.

Celles-ci reprsentaient 30,7 % des sujets enquts ; seulement 3,5 % avaient cess de fumer (tauxdabandon de 11,4 %). Le taux dabandon tait significativement plus faible pour les ex-fumeurs quotidiens(7,5 %) que pour les ex-fumeurs occasionnels (44,8 %). Parmi les fumeurs au moment de ltude, 56,3 % setrouvaient entre les phases o ils envisageaient darrter de fumer et o ils sy prparaient, tandis que25,1 % en taient laction dessayer darrter de fumer, sur une dure moyenne de 2,5 mois, avant derechuter. Les proccupations de sant constituaient les motifs communs tous les ex-fumeurs et 95,0 %des personnes qui essayaient darrter de fumer, mais le besoin imprieux de nicotine tait la raison la pluscourante de rechute. Les facteurs prdictifs du sevrage tabagique taient linitiation au tabagisme un geplus tardif, la plus courte dure de la consommation tabagique, la prsence de problmes de sant et laperception des avantages de ne pas fumer.

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288 La Revue de Sant de la Mditerrane orientale, Vol. 11, No 3, 2005

Introduction

Tobacco products have no safe level ofconsumption. Tobacco is the only legalconsumer product that causes ill health andpremature death when used exactly as themanufacturer intends [1,2]. Most people

know that tobacco is hazardous but fewappreciate how hazardous it really is [2,3].Tens of thousands of studies have docu-mented the association between cigarettesmoking and a large number of serious andfatal diseases affecting almost all body sys-tems [2,4]. The lifetime risk of a smoker

being killed by the use of tobacco productsis at least 50%. Therefore, a lifelong smok-er is more likely to die as a direct result oftobacco use than from all other potentialcauses of death combined [2,3]. It is nowreasonable to claim that tobacco use repre-sents the most extensively documentedcause of ill health ever investigated in the

history of biomedical research [4].Quitting smoking has major and imme-

diate benefits for smokers of all ages, bene-fits that accrue to those who already havesmoking-related diseases as well as tothose who do not. At any age, smokingcessation reduces the overall risk of death;

however, the reduction of risk occurs morequickly for some diseases than others[4,5]. One year after quitting, the risk ofcoronary heart diseases decreases by 50%and within 15 years the associated risk of

dying for an ex-smoker approaches that ofa never smoker. Moreover, the risk of de-veloping stroke, chronic obstructive lung

diseases and lung cancer also decreases butmore slowly [6].

Smoking cessation falls under the cate-gory of primary prevention, as does theprevention of initiation [4]. Indeed, smok-ing cessation meets the definition of prima-ry prevention by reducing the risk of

morbidity and mortality in asymptomatic

people. The considerable evidence of thebenefits of tobacco cessation prompted thestudy of ever smokers in Alexandria,

Egypt, the aim being to determine the rateof tobacco cessation in a representativesample of the population, the motives forcessation, and the determinants of tobaccocessation and attempts to quit.

Methods

A comprehensive community-based tobac-

co survey was conducted in Alexandria city

between May and August 2000. The WorldHealth Organization (WHO) modified clus-ter sample survey was adopted to enrol2120 subjects aged 15 years and over. Fur-ther details of the sampling methods andquestionnaire have been reported in earlier

papers [7,8].Data were collected using a pre-tested,

pre-coded interview questionnaire in 4 sec-tions: participants demographic character-

istics and level of physical activity;participants pattern of tobacco use and at-tempts to quit; participants knowledge oftobacco-associated morbidity; and partici-

pants perceptions of the dangers of smok-ing, smokers susceptibility to healthproblems and potential benefits of refrain-ing from tobacco use [8].

The WHO core questions for tobaccosurveys were used to classify the smoking

status of participants into current smokeror ex-smokers (minimum duration of to-bacco cessation 3 months), and daily oroccasional smokers [9].

The prevalence and the corresponding95% confidence interval (CI) as well as themean, standard deviation (SD) and the 95%CI of the mean were computed. The chi-squared and Student t-test were used to

test the significance of the obtained results.

Tobacco cessation was modelled as a func-

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tion of participants characteristics, patternof tobacco use as well as their knowledge

and perceptions.

Results

Ever-use of tobacco products was report-ed by 651 respondents (30.7%). The pro-portion of ever daily smokers (27.5%; 95%CI: 25.6029.40) was significantly higherthan that of ever occasional smokers(3.2%; 95% CI: 2.453.95) At the time of

the survey, 577 respondents (27.2%; 95%

CI: 25.3129.09) were current smokersand only 74 (3.5%; 95% CI: 2.724.28)were ex-smokers.

The quit ratio, the ratio of ex-smokersto ever smokers, was 11.4% (95% CI:8.9213.79). This was significantly lower

for ex-daily smokers (7.5%; 95% CI: 5.399.67) than for ex-occasional smokers(44.8%; 95% CI: 32.8665.67). Ex-smok-ers had abstained for a mean (SD) duration

of 4.07 (3.34) years, range 0.2518.00.The majority of ex-smokers (82.4%) hadsuccessfully given up for 1 year or morewhereas 17.6% had refrained for smoking

for less than 1 year. The majority of ex-smokers stated perceived poor health(63.5%) and the fear of tobacco-relateddiseases (35.1%) as the main reason forquitting smoking. In only 1 ex-smoker(1.4%) the motive for giving up smoking

was suffering from heart disease.Table 1 compares the demographic andhealth characteristics of ex-smokers withcurrent smokers; both were comparable inall respects except for age and existinghealth problems. Ex-smokers were signifi-cantly younger than current smokers: mean(SD) age 35.2 (13.1) years versus 39.3(12.3) years (t= 2.51, P= 0.012). In the

age group between 25 to < 45 years, the

proportion of ex-smokers (52.8%) washigher than current smokers (47.7%),

whereas among those aged 45+ years the

proportion of current smokers (36.9%)was higher than that of ex-smokers

(22.9%). These differences were signifi-cant statistically (P= 0.024) (Table 1). Asignificantly higher percentage of ex-smokers (17.6%) reported enduring achronic health problem (chronic bronchi-

tis, hypertension, heart disease or diabetes)compared with current smokers (9.9%) (P= 0.044) (Table 1).

Table 2 indicates that ex-smokers start-ed using tobacco at a significantly older age

than current smokers [mean (SD) age 18.2(4.0) years versus 20.5 (6.9)] (P< 0.0001)

and continued to be tobacco users for asignificantly shorter time [mean (SD) 21.1(12.9) years versus 10.6 (10.1)] (P