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Open Access 01-12-2018 | Research article

Experiences of young smokers in quitting smoking in twin cities of Pakistan: a phenomenological study

Authors: Kanwal Shaheen, Oyinlola Oyebode, Haleema Masud

Published in: BMC Public Health | Issue 1/2018

Abstract

Background

Smoking is highly prevalent in Pakistan claiming the lives of over 100,000 individuals every year. A significant proportion of smokers (24.7%) make an attempt to quit each year but 97.4% fail to quit successfully. Little is known about the reasons for, and experiences of, failed quit attempts. This study was carried out to explore the experiences of young male smokers in quitting smoking in the twin cities of Pakistan

Method

A qualitative study was carried out using a phenomenological approach in Rawalpindi and Islamabad. A total of 11 participants were interviewed. All study participants were male and had made at least one quit attempt. Study participants were a mix of smokers who failed to quit smoking, intermittent smokers and successful quitters. Streubert’s (1991) method of phenomenology was followed during data analysis.

Results

The experiences of smokers while smoking “the smoking phase” have major effects on their journey towards quitting smoking. The smoking phase consists of three major stages: contact with initial smoking stimuli, the journey from first puff to enjoying smoking and then finally smoking becoming part of life. However, the journey towards quitting smoking is not as simple as the journey towards becoming a smoker. Instead, smokers get trapped in three overlapping cycles of smoking and quit attempts: smoking & forced quitting, smoking & intentional quitting, and smoking & intermittent smoking before successful quitting. Breaking the cycle is not easy in the presence of trapping factors (addiction, high availability, easy affordability, conducive social setup and low perceived risks of smoking). Three factors play a major role in breaking these cycles which are strong will power, continuous peer support and avoidance of smokers’ company.

Conclusion

A young smoker, during his experience of quitting smoking gets entrapped in several overlapping cycles of smoking & quit attempts before successful quitting. There are known entrapping factors as well as factors which help in breaking these cycles. Targeted interventions are needed to facilitate smoking cessation among young smokers in Pakistan.

Available only for authorised users

World Health Organization (WHO): Fact Sheet on Tobacco control in Pakistan [2015]. Retrieved from http://www.who.int/tobacco/about/partners/bloomberg/pak/en/. Accessed 15 Jan 2018.

Global Adult Tobacco Survey (GATS). Fact Sheet Pakistan 2014. 2014. Retrieved from http://www.who.int/tobacco/surveillance/survey/gats/pakfactsheet.pdf.

Ferreira SAL, Teixeira CC, Corrêa APA, et al. Reasons that make individuals in a higher education institution to become or not to become smokers. Rev Gaúcha Enferm. 2011;32(2):287-93.

D’Argenzio A, D’Argenio P, Ferrante G, et al. 40% of smokers try to stop smoking, only 8% succeed in. Epidemiol Prev. 2011;35(5-6):362.

Centers for Disease Control and Prevention (CDC). Quitting smoking among adults-United States, 2001-2010. Morb Mortal Wkly Rep. 2011;60(44):1513-9.

Irfan M, Haque AS, Awan S, et al. Reasons of failure to quit smoking: a cross sectional survey in major cities of Pakistan. Eur Respir J. 2014;44(Suppl 58):P4466.

Jarvis MJ, McIntyre D, Bates C, Foulds J. Effectiveness of smoking cessation initiatives. Efforts must take into account smokers' disillusionment with smoking and their delusions about stopping. BMJ. 2002;324:608.

Rafful C, García-Rodríguez O, Wang S, Secades-Villa R, et al. Predictors of quit attempts and successful quit attempts in a nationally representative sample of smokers. Addict Behav. 2013, 2013;38 https://doi.org/10.1016/j.addbeh.2012.12.019.

Scollo MM, Winstanley MH. Tobacco in Australia: facts and issues. Melbourne: Cancer Council Victoria; 2012.

10.

Lee C, Kahende J. Factors associated with successful smoking cessation in the United States, 2000. Am J Public Health. 2007;97 https://doi.org/10.2105/AJPH.2005.083527.

11.

Malik AK, Chaudhry A, Karamart A. Cigarette smoking and health care professionals at Mayo Hospital, Lahore, Pakistan. J Pak Med Assoc. 2010;60(6):509-12.

12.

Qidwai W. Barriers to smoking cessation: results of a survey among family practice patients. Middle East J Fam Med. 2004;5(5). Retrieved from https://ecommons.aku.edu/pakistan_fhs_mc_fam_med/146.

13.

Abdullah ASM, Husten CG. Promotion of smoking cessation in developing countries: a framework for urgent public health interventions. Thorax. 2004;59 https://doi.org/10.1136/thx.2003.018820.

14.

Jesus MCP, Silva MH, Cordeiro SM, Kortchmar E, Zampier VSB, MAB M. Understanding unsuccessful attempts to quit smoking: a social phenomenology approach. Rev Esc Enferm USP. 2016;50 https://doi.org/10.1590/S0080-623420160000100010.

15.

Girma E, Assefa T, Deribew A. Cigarette smokers' intention to quit smoking in Dire Dawa town Ethiopia: an assessment using the Transtheoretical model. BMC Public Health. 2010;10:320. https://doi.org/10.1186/1471-2458-10-320.

16.

Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179–211. https://doi.org/10.1016/0749-5978(91)90020-T.

17.

Prochaska JO, DiClemente CC. The Transtheoretical approach: crossing traditional boundaries of therapy. Homewood, IL: Dow Jones-Irwin; 1984.

18.

Bandura A. Social-cognitive theory: an agentic perspective. Asian J Soc Psychol. 1999;2:21-41.

19.

Becker MH. The health belief model and personal health behavior. Thorofare, NJ: Slack; 1974.

20.

Streubert HJ. Phenomenological research as a theoretic initiative in community health nursing. Public Health Nurs. 1991;8(2):119-23.

21.

Nisar N, Qadri MF, Fatima K, et al. A community based study about knowledge and practices regarding tobacco consumption and passive smoking in Gadap town. Karachi J Pak Med Assoc. 2007;57:186–8. http://jpma.org.pk/full_article_text.php?article_id=1071 PubMed

22.

Gupta PC, Ray CS. Smokeless tobacco and health in India and South Asia. Respirology. 2003;8:419–31. https://www.ncbi.nlm.nih.gov/pubmed/14708551 CrossRefPubMed

23.

Masud H, Oyebode O. Inequalities in smoking prevalence: a missed opportunity for tobacco control in Pakistan. J Public Health. https://doi.org/10.1093/pubmed/fdx044.

24.

Jha P, Ramasundarahettige C, Landsman V, et al. 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med. 2013;368:341–50. https://doi.org/10.1056/NEJMsa1211128.CrossRefPubMed

25.

Sakata R, McGale P, Grant EJ, et al. Impact of smoking on mortality and life expectancy in Japanese smokers: a prospective cohort study. BMJ. 2012;345:e7093. https://doi.org/10.1136/bmj.e7093.CrossRefPubMedPubMedCentral

26.

Schane R, Glantz S, Ling P. Nondaily smoking: an increasingly prevalent pattern. Arch Intern Med [2009]. [169] https://doi.org/10.1001/archinternmed.2009.315.

27.

Husten CG. How should we define light or intermittent smoking? Does it matter? Nicotine Tob Res. 2009;11 https://doi.org/10.1093/ntr/ntp010.

28.

DiFranza JR, Savageau JA, Fletcher K, et al. Symptoms of tobacco dependence after brief intermittent use: the development and assessment of nicotine dependence in Youth-2 study. Arch Pediatr Adolesc Med. 2007;161(7):704-10.

29.

Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction. 2004;99:29-38. https://doi.org/10.1111/j.1360-0443.2004.00540.x.

30.

Yeomans K, Payne KA, Marton JP: Smoking, smoking cessation and smoking relapse patterns: A web-based survey of current and former smokers in the US. Int J Clin Pract. 2011;65. doi: 10.11 l/j.1742-1241.2011.02758.x.

31.

Starks H, Trinidad SB. Choose your method: a comparison of phenomenology, discourse analysis, and grounded theory. Qual Health Res. 2007;17(10):1372–80. https://doi.org/10.1177/1049732307307031.CrossRefPubMed

32.

Kvale S. InterViews: an introduction to qualitative research interviewing. California: Sage publications; 1996. p. 81–173.

33.

Morse JM. Using Shadowed Data. Qual Health Res. 2001;11(3):291–2. https://doi.org/10.1177/104973201129119091.

34.

Wang IJ, Gjengedal E, Larsen T. ‘Passed and cleared’ – former tobacco smokers’ experience in quitting smoking. Glob Health Promot. 2014;21 https://doi.org/10.1177/1757975914523480.

35.

Fowkes FJ, Stewart MC, Fowkes FG. Scottish smoke-free legislation and trends in smoking cessation. Addiction. 2008;103 https://doi.org/10.1111/j.1360-0443.2008.02350.x.

36.

Fong GT, Hyland A, Borland R. Reductions in tobacco smoke pollution and increases in support for smoke free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK survey. Tob Control. 2006;15 https://doi.org/10.1136/tc.2005.013649.

37.

Wakefield M, Cameron M, Murphy M. Potential for smoke-free policies in social venues to prevent smoking uptake and reduce relapse: a qualitative study. Health Promot Pract. 2009;10 https://doi.org/10.1177/1524839907302736.

38.

Eckerdt NS, Corradi-Webster CM. Meanings about smoking for women participant in a group for smokers. Rev Lat Am Enfermagem. 2010;18(spe):641-7.

39.

Uppal N, Shahab L, Britton J, et al. The forgotten smoker: a qualitative study of attitudes towards smoking, quitting, and tobacco control policies among continuing smokers. BMC Public Health. 2013;13 https://doi.org/10.1186/1471-2458-13-432.

40.

Bommelé J, Schoenmaker TM, Kleinjan M, et al. Perceived pros and cons of smoking and quitting in hard-core smokers: a focus group study. BMC Public Health. 2014;14 https://doi.org/10.1186/1471-2458-14-175.

41.

Gabble R, Babayan A, DiSante E, Schwartz R. Smoking cessation interventions for youth : a review of the literature. Toronto: Ontario Tobacco Research Unit; 2015.

42.

Chan SSC, Cheung YTD, Fong DYT, Emmons K, Leung AYM, Leung DYP, Lam TH. Family-based smoking cessation intervention for smoking fathers and nonsmoking mothers with a child: a randomized controlled trials. J Pediatr. 2017;182:260-6.e4. ISSN:1097-6833.

43.

Hubbard G, Gorely T, Ozakinci G, Polson R, Forbat L. A systematic review and narrative summary of family-based smoking cessation interventions to help adults quit smoking. BMC Fam Pract. 2016;17 https://doi.org/10.1186/s12875-016-0457-4.

44.

Dawson AP, Cargo M, Stewart H, et al. Aboriginal health workers experience multilevel barriers to quitting smoking: a qualitative study. Int J Equity Health. 2012;11:27. https://doi.org/10.1186/1475-9276-11-27.CrossRefPubMedPubMedCentral

45.

Brown J, West R. Quit success rates in England 2007-2017. Smoking in Britain. 2017;5:1-8.

46.

Ford P, Clifford A. Gussy et al: a systematic review of peer-support programs for smoking cessation in disadvantaged groups. Int J Environ Res Public Health. 2013;11 https://doi.org/10.3390/ijerph10115507.

47.

May S, West R. Do social support interventions (“buddy systems”) aid smoking cessation? A review. Tob Control. 2000;9 https://doi.org/10.1136/tc.9.4.415.

48.

Caponnetto P, Keller E, Bruno CM, et al. Handling relapse in smoking cessation: strategies and recommendations. Intern Emerg Med. 2013;8 https://doi.org/10.1007/s11739-012-0864-z.

49.

Hughes JR. Motivating and helping smokers to stop smoking. J Gen Intern Med. 2003;18 https://doi.org/10.1111/j.1525-1497.2003.20640.

50.

Abdullah AS, Ho WW. What Chinese adolescents think about quitting smoking: a qualitative study. Subst Use Misuse. 2006;41 https://doi.org/10.1016/S0140-6736(12)60826-5.

51.

Bottorff JL, Radsma J, Kelly M, et al. Fathers' narratives of reducing and quitting smoking. Sociol Health Illn. 2009;31 https://doi.org/10.1111/j.1467-9566.2008.01126.x.

52.

Robson N, Bond A, Wolff K. A comparison of smoking behaviour characteristics between Caucasian smokers in the United Kingdom and Malay smokers in Malaysia. Prev Med. 2013;57 https://doi.org/10.1016/j.ypmed.2013.04.010.

53.

Oldenburg B, Glanz K, French M. The application of staging models to the understanding of health behaviour change and the promotion of health. Psychol Health. 1999;14 https://doi.org/10.1080/08870449908407343.

54.

Bezinović P, Malatestinić Đ. Perceived exposure to substance use and risk-taking behavior in early adolescence: cross-sectional study. Croat Med J. 2009;50:2. https://doi.org/10.3325/cmj.2009.50.157.

55.

Burki SJ, Pasha AG, Pasha HA, et al. The economics of tobacco and tobacco taxation in Pakistan. Paris: International Union Against Tuberculosis and Lung Disease; 2013.

56.

Local cigarette brands being sold below legal price: The Nation. 2015. Retrieved from https://nation.com.pk/09-May-2015/local-cigarette-brands-being-sold-below-legal-price. Accessed 28 Jan 2018.

57.

Mahapatra L. The Price of Cigarettes: How Much Does a Pack Cost in Each US State? International Business Times. 2014. Retrieved from http://www.ibtimes.com/price-cigarettes-how-much-does-pack-cost-each-us-state-map-1553445. Accessed 28 Jan 2018.

58.

Tobacco Manufacturers’ association. UK cigarette price [n.d.]. Retrieved from http://globalcigarettebrands.com/uk-cigarette-prices-tobacco-manufacturers-association/. Accessed 28 Jan 2018.

Title: Experiences of young smokers in quitting smoking in twin cities of Pakistan: a phenomenological study
Authors: Kanwal Shaheen
Oyinlola Oyebode
Haleema Masud
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-018-5388-7

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Springer Medicine

Experiences of young smokers in quitting smoking in twin cities of Pakistan: a phenomenological study

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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