Why Smokers Do and Don’t Quit Smoking

My father-in-law is in his 70s and still smokes every day. He’s tried to quit before, but in the recent years has decided that he was old enough to live his life however he wanted, and that included smoking. Nevermind the fact that he has had a quadruple bypass operation for his clogged arteries (and other coronary operations), is on polypharmacy, leads a sedentary lifestyle, and has been nagged by his doctors and us about quitting smoking for years.

I know that many doctors – especially internists and general practitioners/family doctors – often encourage their smoking patients to quit smoking, citing the harms of smoking and the benefits of not smoking relative to the patient’s capacity to heal. Even those of us who do not practice medicine but work in the healthcare field know that smoking wreaks havoc on a variety of bodily functions right down to the molecular level.

Earlier this year, three Greek researchers published a study on why smokers quit or don’t quit smoking in Harm Reduction Journal (source: Harm Reduction Journal, March 29, 2006, 3:13 doi:10.1186/1477-7517-3-13). What they found may give some insight not just to medical doctors with an interest to helping their patients quit smoking, but for those of us with a personal interest to help either our loved ones or ourselves to quit smoking.

A popular assumption many doctors have about smokers quitting smoking is to introduce cognitive dissonance – an emotional state of mind where two beliefs are in conflict with each other. A person experiencing cognitive dissonance will move to resolve that conflict of belief. If a smoker believes that smoking is harmful to one’s health yet continues to smoke, the smoker experiences this contradiction and would move to resolve that contradiction. One would assume that the smoker would then stop smoking – right?

I doubt that smokers would deny the harmful effects of smoking. We can see from what’s happening in society that this is not the case – people still smoke even when they’ve been exposed to anti-smoking campaigns, nagging from friends and loved ones (I admit, I am one of those annoying people who remind their friends that smoking is bad for them), and shock-and-awe pictures of lungs blackened by chronic smoking.

Dr. Loumakou and her colleagues looked at 401 Greeks who are chronic smokers and looked at factors that influenced a smokers ability and intention to quit smoking. Greeks were a good population to conduct this study because Greece has highest smoking rate in Europe. Dr. Loumakou observed that 38% of smokers in the study had neither the intention to quit or believed they had the ability to quit – and these smokers perceived more benefits from smoking than harm from smoking. Those smokers who gradually moved along a belief spectrum toward wanting to quit smoking were the ones who began to perceve more harm from smoking than benefit from smoking. In other words, smokers make their decisions on a risk-benefit ratio, and that drives their behaviors to continue smoking or to quit smoking.

The study’s limitations were simplifying what are complex decision making processes into a measuring scale.

Doctors who want to help their patients quit smoking may consider the “pros and cons” approach where smoking is concerned. When patients begin to put more weight on the pros of smoking against the pros of quitting, they are more likely to quit smoking. Doctors are very familiar with weighing pros and cons if drug therapies in their prescribing decisions, so helping their smoking patients clarify smoking risk-benefit ratios will be familiar exercise to physicians. Cognitive dissonance may not be an effective way to encourage smokers to quit smoking because smokers can come up with excuses that are very valid for themselves, thereby relieving their own feelings of discomfort at two contradictory beliefs – like my father-in-law.

Sample Profile
Study Sample N=401
Mean duration of smoking in years: 9.3

51% smoked 10-20 cigarettes/day
33% smoked 20-30 cigarettes/day
11% smoked 30-40 cigarettes/day
5% smoked >40 cigarettes/day

59% never attempted to quit
17% tried to quit 1x (once)
13% tried to quit 2x (twice)
11% tried to quit 3+ times

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