Self-reported difficulty of smoking cessation among ex-smokers in the Israel Defense Force (IDF) career service personnel: observational study.

Abstract

Introduction The smoking cessation literature focuses on assisted cessation despite evidence that most ex-smokers stopped without assistance. Professional literature, clinical guidelines and tobacco control policies suggest that smoking cessation is difficult especially if unassisted. We investigated under-researched aspects of unassisted smoking cessation, focusing on self-reported difficulty. Methods Between September 2013 and June 2015 all ex-smokers amongst IDF career personnel undergoing periodic medical examination completed a computerized questionnaire assessing their smoking cessation experience. Subjects were classified into two groups: those who found cessation difficult and those who did not. Socio-demographic characteristics and questionnaire responses were then compared. Results Of 1574 ex-smokers, 83.4% reported unassisted cessation. Cessation was reported as harder/much harder than expected by 7.1%, easier/much easier than expected by 50.0%, and as expected by 42.8%. Bedouin Israeli ex-smokers were significantly more likely than Jewish Israeli ex-smokers to report difficulty in smoking cessation (31.6% versus 6.9%, p=0.001). Ex-smokers who reduced smoking gradually before cessation were significantly more likely to report difficulty than those who stopped abruptly (10.2% versus 6.5%; p=0.025.) Ex-smokers who stopped within the last 6 months were significantly more likely to report difficulty than those who stopped over 6 months ago (13.6% versus 6.4%; p=0.025). This “memory decay” effect did not persist beyond 6 months. Conclusions The majority of ex-smokers stopped smoking unassisted and did not find cessation difficult, while 50.0% found it easier than expected. Further studies of successful cessation experiences of ex-smokers are warranted.