Challenges Related to Overcoming Addiction: Assessing Motivation and Readiness to Quit or Reduce Cigarette Smoking

Abstract

Introduction

The life expectancy of a cigarette smoker is reduced by an average of 10 years as a result of smoking, although this effect may be mitigated by timely cessation. It has been proven that smoking cessation is beneficial to health regardless of comorbidities and age. The objective of this study was to analyse and assess the motivation and readiness to quit or reduce smoking among conventional cigarette smokers in Poland.

Method

A representative cross-sectional study was conducted using a structured telephone survey method CATI where interviewers followed a customized script provided by a software application. The survey involved a representative sample of 5000 inhabitants of Poland aged 18 years and older. The primary data was collected between March and May 2022 by the research company in cooperation with the Medical University of Warsaw. Respondents were classified into groups based on their answers to questions regarding their age, gender, and geographical location.

Results

Almost a quarter of conventional cigarette smokers who have ever tried to cease smoking reported to have made such an attempt in the past 12 months. The proportion of individuals who attempted to quit smoking decreased with age. The most significant challenges to quitting smoking among respondents surveyed, irrespective of age group, included being around smokers at work or home, fear of not being able to cope with a stressful situation, discouragement after previous unsuccessful attempts or fear of weight gain. Concern for personal health was the predominant factor motivating individuals with a history of daily smoking to successfully discontinue conventional cigarettes. For those who had smoked conventional cigarettes daily for less than 1 year, the odds of reducing or quitting was significantly higher than among those who had smoked for 10 years or longer.

Conclusions

The formulation of effective anti-nicotine policies must consider the realities and challenges encountered by individuals addicted to nicotine. It is therefore important to understand the nature of addiction, the characteristics of smokers and ex-smokers, and to search for effective methods of treating nicotine addiction. In addition to education and health promotion, Poland’s tobacco control policy should include multi-sectoral interventions aimed at those who are already addicted.

Introduction

According to Global Burden of Disease (GBD) estimates, tobacco-related diseases (including second-hand smoke) are responsible for more than 8 million deaths per year worldwide. ¹ The 2018 World Health Organisation (WHO) report identifies smoking as 1 of the major public health concerns and risk factors contributing to premature mortality from non-communicable diseases. ² In Poland, smoking remains the Polska Akademia predominant health risk factor, surpassing hypertension and high BMI in terms of disability-adjusted years lost (DALYs). ³ The life expectancy of a cigarette smoker can be reduced by an average of 10 years as a result of smoking, although this effect can be mitigated by timely smoking cessation. ⁴ The earlier in life an individual stops smoking, the more positive the outcomes. It has been well established that smoking cessation is beneficial to health regardless of comorbidities and age. This is exemplified by a study conducted in the United States, which revealed that within the initial decade following smoking cessation, the risk of cardiovascular mortality diminished by 36%, the risk of cancer mortality declined by 47%, while the risk of mortality from respiratory disease decreased by 43% in comparison to smokers. ⁵

Implications of Smoking Cessation

Smoking cessation is a complex, multi-step process influenced by a multitude of biological, psychosocial, economic, environmental and health factors. ⁶ Although approximately 70% of people who smoke cigarettes want to quit, many find it difficult to do so permanently, often requiring an average of around 6 quit attempts before achieving long-term abstinence. ⁷ Quit success rates without support are around 50% at 1 week and less than 5% after 1 year. ⁸ Given these challenges, successfully quitting smoking and overcoming nicotine addiction requires a multifaceted approach. It is therefore important to understand the challenges related to smoking cessation, the characteristics of smokers and ex-smokers, and to search for effective methods to achieve complete smoking cessation. Identifying the most common barriers and motivating factors for quitting smoking can significantly support the process of planning effective health interventions. Recent evidence further demonstrates that cessation at every age is associated with longer survival, particularly when achieved before 40 years of age. ⁹ Among all ages and compared with continued smoking, cessation of fewer than 3 years potentially averted 5 years of life lost, while cessation for 10 or more years averted about 10 years of life lost, yielding survival similar to that of never smokers. Quitting smoking at any age, but especially in younger years, was also associated with lower excess mortality overall and from vascular, respiratory, and neoplastic diseases, with beneficial associations evident as early as 3 years after cessation. However, stopping smoking is often accompanied by withdrawal discomfort, comprising of an array of tobacco withdrawal symptoms. ¹⁰ Among dependent smokers, abstinence is most commonly associated with intense cravings, restlessness, increased appetite, irritability, and other adverse mood disturbances. ¹¹ Less common, though occasionally more severe, manifestations include insomnia, mouth ulcers, and constipation. Accordingly, physicians play a critical role not only in providing sustained motivation, encouragement, and structured support during quit attempts, but also in educating patients about the short- and long-term health benefits of abstinence, while remaining cognizant of the potential withdrawal-related challenges that may impede successful cessation. ¹² In this context, tools such as the Smoking Abstinence Expectancies Questionnaire (SAEQ) can be particularly valuable – Italian studies have shown that the SAEQ is a sensitive screening patient-reported outcome measure (PROM), with the total score allowing discrimination between individuals with different levels of smoking abstinence expectancies, while its subscales can be used to assess the severity and subjective burden of the expected psychological and physiological effects of abstinence. ¹³

Smoking Cessation Strategies

In 2024, WHO introduced a comprehensive set of tobacco cessation interventions. This includes behavioral support in clinical and community settings through digital tobacco cessation, pharmacological and systemic-level interventions, and policies to maintain the implemented tobacco cessation interventions. ¹⁴ Importantly, smoking cessation support services should not be limited to primary care physicians but should also include physicians from all specialties. ¹⁵ A key recommended approach to initiate this treatment process is a brief tobacco intervention, which consists of identifying patients who smoke and motivating them to stop. ¹⁶ The intervention uses a 5-step approach, known as the 5As strategy: (1) Ask each patient if they smoke; (2) Advise them, in a personalised and empathetic way, to stop smoking, highlighting the benefits and risks of continuing to smoke; (3) Assess the patient’s willingness to cease smoking; (4) Assist them in selecting an appropriate pharmacological treatment and refer them to a service that can provide behavioural support (eg, the Tobacco Quit Line Services); (5) Arrange follow-up visits.

Tobacco Use in Poland in the European Context

Cigarette smoking has long remained a major public health challenge in Poland. According to the 2019 declaration of the Polish Ministry of Health, Poland was to become a “tobacco-free country” by 2030, ¹⁷ which is understood as achieving a maximum prevalence of 5% of adults who smoke cigarettes nationwide by that year. However, Eurobarometer data from 2023 indicate that the prevalence of smoking in Poland is 27% (compared with the EU-27 average of 24%). ¹⁸ Among the Member States, the highest prevalence of smoking was observed in Croatia (35%), Greece (36%), and Bulgaria (37%). In contrast, the 3 countries with the lowest proportions of daily smokers were Sweden (8%), the Netherlands (11%), and Denmark (14%). Experts from the Polish Academy of Sciences emphasize that patterns of tobacco consumption are changing. ¹⁹

Trends in Novel Nicotine Consumption

In recent years, new products have become increasingly popular, such as heated tobacco, electronic cigarettes, and synthetic nicotine products. A total of 4.8% of Poles report using electronic cigarettes, and 4% report using heated tobacco. ²⁰ These products are particularly popular among Polish adolescents, who more frequently use e-cigarettes (29.6%) than conventional cigarettes (26.2%). ²¹ For comparison, Eurobarometer data show that across the European Union, 3% of adults currently use e-cigarettes and 2% use heated tobacco products. In the United States, conventional cigarettes remain the most commonly used tobacco product; however, e-cigarettes are gaining increasing popularity, particularly among younger adults. In 2022, 6% of adults reported using e-cigarettes, 3.7% cigars, and 2.1% smokeless tobacco. ²² Novel forms of nicotine products, such as electronic cigarettes (e-cigarettes) and tobacco heating systems (heated tobacco products - HTPs), have emerged as alternatives to combustible tobacco products. These new tobacco products, such as HTPs are viewed as a potential means of reducing the burden of tobacco-related diseases among smokers and as a potential mechanism to assist smokers in quitting. ²³ However, the effectiveness of these products in facilitating smoking cessation is still debated, alongside concerns about their role in promoting smoking initiation among non-smokers. Internists are among the physicians who most frequently assist patients with smoking-related diseases, and in this perspective, they cannot avoid paying attention to the progressive diffusion of smoking products alternative to the conventional cigarette, and to the controversies with respect to their use. ²⁴

Motivation and Willingness to Quit Smoking

The objective of this study was to assess the motivation and willingness to quit or reduce smoking among conventional cigarette smokers in Poland and to examine the use of novel tobacco products (e-cigarettes and HTPs) in the context of smoking cessation. Understanding the factors that influence smokers’ motivation and willingness to quit is essential for designing effective public health strategies aimed at reducing tobacco use and its associated health burden. A population study in England indicates that health concerns consistently remain the primary motivator for quitting smoking, while cost has become increasingly important, and social factors or advice from health professionals play a smaller role. ²⁵ Similarly, studies conducted in China have identified differences in the types of motivations among outpatients at smoking cessation clinics. ²⁶ Patients with high cessation intentions were primarily motivated by health and family considerations, whereas those with low cessation intentions relied more on social influences and self-management. These findings suggest that future clinical interventions should reinforce motivation through tailored strategies: for patients with high cessation intentions, providing medical evidence (eg, the impact of cessation on disease management) and strengthening family-oriented incentives (eg, protecting children from secondhand smoke) may be most effective. For patients with low cessation intentions, leveraging social support networks (eg, quit-smoking groups, peer encouragement) can help overcome barriers related to self-management.

Moreover, the growing availability and use of novel tobacco products, such as e-cigarettes and HTPs, adds a new dimension to smoking behavior that warrants careful investigation. These products are often perceived as less harmful alternatives to conventional cigarettes and are increasingly adopted by individuals who have been unsuccessful in quitting conventional smoking. Assessing their role in smoking reduction or cessation efforts is therefore crucial for informing evidence-based tobacco control policies and healthcare interventions, particularly in countries like Poland, where smoking continues to pose a significant public health challenge. Therefore, the present study seeks to systematically investigate the determinants of smokers’ motivation and willingness to quit and to evaluate the potential role of novel tobacco products in facilitating smoking cessation.

Method

Study Design

A representative cross-sectional study was conducted using a structured telephone survey method CATI (Computer-Assisted Telephone Interviewing), where interviewers followed a customized script provided by a software application. The survey involved a random sample of 5000 inhabitants of Poland aged 18 years and older. Individuals without access to a telephone were excluded. Importantly, participants’ smoking history was not known prior to the interview, and smoking status was not used as inclusion criterion. Prior to participation, respondents provided verbal consent to take part in the survey, in line with the ethical and methodological standards of professional research associations. The primary data were collected between March and May 2022 by the research company Kantar in cooperation with the Medical University of Warsaw. The average duration of the telephone interview was 10.6 min. The survey was conducted until the target sample size of 5000 respondents was reached, using stratified random sampling to ensure representativeness of the Polish adult population.

The telephone numbers used in the study were randomly generated based on the prefixes of mobile phones (the first 3 or 4 digits) registered with the Office of Electronic Communications (UKE). According to data from the UKE, 92.6% of Poles use mobile phones, while 10.6% continue to use landlines. ²⁷ The study was conducted using mobile numbers, and the survey respondents were individuals who answered the phone. Importantly, all interviews were conducted by human interviewers in person over the phone, not by automated systems, bots, or other non-human methods. Respondents were classified into groups based on their answers to questions regarding their age, gender, and geographical location.

Participants

The study was conducted on a quota-representative sample of 5000 inhabitants of Poland aged 18 years and above. The sample was stratified by age (5 categories: 18–29 years, 30–39 years, 40–49 years, 50–59 years, 60 years and older), gender (2 categories), voivodship (administrative region, 16 categories) and place of residence (5 categories). The sample structure, based on current population data, is presented in the appendix (Table S1).

Measurement

An “ever smoker” of cigarettes was defined as a person who responded affirmatively to the question “Have you smoked at least 100 conventional cigarettes during your lifetime?”. Current smokers were identified based on their responses to the question “Do you currently smoke conventional cigarettes?”. An “ever user” of e-cigarettes was defined as a person who responded affirmatively to the question “Have you ever had your own e-cigarette?”. Current e-cigarette users were identified based on their responses to the question “Do you currently use e-cigarettes?”. An “ever user” of HTPs was defined as a person who responded affirmatively to the question “Have you used at least 100 HTPs tobacco refills during your lifetime?”. Current users of HTPs were identified based on their responses to the question “Do you currently use a HTPs?”. To avoid potential misidentification of products, respondents were provided with descriptions of e-cigarettes and HTPs.

Issues related to smoking cessation were verified using a series of questions. For individuals who currently smoke conventional cigarettes, the following questions were asked: “Have you ever attempted to quit smoking conventional cigarettes?”, “Have you attempted to quit smoking conventional cigarettes in the past 12 months?”, “In the past 12 months, have you used any of the following methods to try to quit smoking conventional cigarettes?”, and “Do you plan to quit smoking cigarettes?” For individuals who had quit smoking conventional cigarettes, the following questions were asked: “Which of the following factors have or did pose the greatest challenges for you when quitting conventional cigarettes?” and “Which factor most influenced your decision to quit smoking conventional cigarettes?”

Data Analysis

Basic statistical analyses utilized descriptive statistics. Differences in selected sociodemographic factors were assessed using cross-tabulation and the chi-squared test. A P-value of less than .05 was considered the threshold for statistical significance. Multivariate analyses were performed using a logistic regression model, with all ordinal variables converted into a series of dichotomous variables. Nominal variables were also converted into dichotomous variables and included in the model. For the purpose of the multivariable logistic regression model, the following variables were recoded into 0-1 dummy variables: gender, size of place of residence, level of education, presence of children under 18 years of age in the household, information on whether the respondent started smoking traditional cigarettes daily before the age of 18, and the number of years the participant smoked traditional cigarettes daily. For each variable, 1 category was selected as the reference point for the logistic regression. The dependent variable in the multivariable logistic regression model takes the value 1 if the person has smoked traditional cigarettes daily in the past and currently does not smoke them at all or only smokes occasionally. Data analysis was conducted using SPSS version 28 (IBM, Armonk, NY, USA).

Ethics

Participation in this study was voluntary and anonymous. All participants provided informed consent. The study protocol was approved by the Ethical Committee at the Medical University of Warsaw (decision number KB/193/2021 as of 8th November 2021).

Results

Characteristics of the Study Population

The study involved a total of 5000 adult Polish residents aged 18 years and over, with a mean age of 47.7 years (Standard Error [SE] = 0.25, SD = 16.95, 95% CI: 47.12–48.09) and a median of 46.5 years. Female comprised 52% of the study population. The mean age of the female group was 47.9 (SE = 0.35, SD = 17.14), as compared to 47.6 (SE = 0.35, SD = 16.78) in the male group. 61% of the study population resided in urban areas, and 38.7% had received higher education. Detailed characteristics of the study population are presented in Table 1.

Table 1.

Characteristics of the Study Population

	In total	Users (current)
		Conventional cigarettes	E-cigarettes	HTPs
Number (n)	5000	1054 (21.1%)	164 (3.3%)	173 (3.5)
Gender
Male	48.0%	58.0%	54.3%	48.0%
Female	52.0%	42.0%	45.7%	52.0%
Age
		Mean = 46.6, median = 46.0, SD = 16.03	Mean = 33.3, median = 26, SD = 15.11	Mean = 33.1, median = 31.0, SD = 11.73
18–24	8.0%	7.0%	40.9%	23.7%
25–29	8.0%	8.5%	12.2%	20.2%
30–39	20.0%	21.5%	17.1%	28.9%
40–49	18.0%	17.8%	10.4%	14.5%
50–59	15.0%	15.8%	9.8%	9.2%
60+	31.0%	29.4%	9.8%	3.5%
Place of residence
Village a	39.0%	38.0%	31.5%	28.5%
Town with a population of up to 20 000	13.0%	12.2%	7.3%	11.0%
Town with a population of 20 000–100,000	19.0%	21.2%	21.8%	23.3%
City with a population of 100 000–500,000	17.0%	16.7%	22.4%	18.0%
City with a population of over 500 000	12.0%	11.9%	17.0%	19.2%
Education
Primary	5.2%	7.8%	10.4%	5.2%
Vocational	17.7%	26.4%	20.1%	10.4%
Secondary	38.4%	40.4%	45.7%	38.7%
Higher	38.7%	25.4%	23.8%	45.7%
Children (under the age of 18) in the household
No	66.7%	67.9%	69.5%	65.9%
Yes	33.3%	32.1%	30.5%	34.1%

^aVillage – a settlement unit with compact or dispersed buildings, having agricultural or related service or tourism functions, and without city rights or city status. This definition follows the official classification used by the Central Statistical Office of Poland.

Survey Results

42.0% of current conventional cigarette users (n = 1054) were female. The mean age of conventional cigarette users was 46.8 years (SE = 0.50), with a median age of 46 years. 62% were urban residents. In the group of current e-cigarette users (n = 164), 45.7% were female. The mean age was 33.2 years (SE = 1.12), with a median of 26 years. Urban dwellers accounted for 68.5% of this group. Among current users of HTPs (n = 173), females represented 52.0% of the sample. The mean age was 33.1 years (SE = 0.92), with a median of 31 years. 71.5% of HTPs tobacco users lived in urban areas. Detailed data are presented in Table 1.

Use of Conventional Cigarettes, Electronic Cigarettes and HTPs Tobacco Products

Of the total respondents (n = 5000), 46.7% report having smoked a minimum of 100 conventional cigarettes in their lifetime. Of this group, 86.9% (40.6% of all respondents) have ever smoked cigarettes on a daily basis. 21.1% of respondents currently use conventional cigarettes (of which 16.5% do so daily and 4.6% occasionally). 12.8% of respondents have ever owned an e-cigarette and 3.3% of respondents are current e-cigarette users (with 2.0% reporting everyday use and 1.3% occasional use). 4.0% of respondents reported consuming at least 100 heated tobacco sticks, while 3.4% currently using HTPs (1.8% daily and 1.6% occasionally). Simplified data are shown in Figure 1.

Figure 1.

Number of Respondents and Percentage of Users of Conventional Cigarettes, E-Cigarettes and HTPs in the Study Population (n = 5000)

Quitting Conventional Cigarettes

Of those who had ever smoked conventional cigarettes on a daily basis (n = 2032), 81.4% had made attempts to quit smoking. Of this group (n = 1654), 55.7% did not smoke conventional cigarettes at the time of the survey, 6.7% smoked occasionally and 37.6% did so daily. No statistically significant differences were observed between male and female in this regard (P = .823).

Of the 1654 individuals who had ever spontaneously attempted to quit conventional smoking, 22.1% had made such an attempt in the last 12 months. The proportion of those who had recently (ie, in the last 12 months) made spontaneous quit attempts decreased with age (P < .001). In the 18–24 age group, 65.6% of respondents reported having spontaneously attempted to quit smoking conventional cigarettes in the last 12 months, compared with 39.3% of 25–29-year-olds and 14.8% of the oldest respondents (60+). Variables such as gender, education, place of residence, or the presence of children under the age of 18 in the household did not differentiate the results in a statistically significant way when analyzed separately (in a univariate analysis, where each demographic characteristic was examined individually). Among the respondents who had previously attempted to quit smoking conventional cigarettes in the past 12 months (n = 366), the most commonly reported methods were nicotine replacement therapy (23.5%), e-cigarettes (21.0%), and HTPs (20.7%).

In the group of current non-smokers who used to smoke conventional cigarettes on a daily basis in the past (n = 1084), the predominant primary reason for quitting was concern for personal health (54.3%). The second most prevalent reason (indicated more than 6 times less often) was financial (8.7%), while the third was concern for the health of a partner or children (6.4%). In 75 cases (6.9%), respondents reported lack of a motivating factor other than their own personal preference.

Among current users of conventional cigarettes (n = 1054), 39.8% reported no intention to cease smoking conventional cigarettes, with a further 10.9% expressing no specific opinion on the matter. The remaining 49.3% indicated their intention to do so. Of those intending to cease smoking (n = 519), 24.9% aimed to do so within the following month, while a further 54.8% intended to quit within 12 months. The remaining 20.2% of smokers reported wanting to quit, though not within the next 12 months. Statistically significant differences in responses were identified according to the frequency of smoking conventional cigarettes (P < .05). In the group of occasional smokers (n = 230), 17.4% of respondents reported that they wished to stop using conventional cigarettes within 1 month, and a further 23.5% within the next 12 months. For daily smokers (n = 824), these percentages were 10.8% and 28.0%, respectively.

Amongst respondents who had previously made an attempt to cease smoking (n = 1654), the following were cited as the most significant challenges to quitting smoking: 1) being in the presence of smokers in the workplace or at home (38.1%); 2) fear of being unable to cope with a stressful situation (31.4%); 3) discouragement following previous unsuccessful attempts (24.2%) and 4) fear of weight gain (21.5%).

E-Cigarettes and HTPs in the Context of Smoking Cessation

In the group of respondents who had ever experimented with an e-cigarette (n = 1068), the most prevalent reasons for opting for this product included: (1) curiosity (65.0%); (2) the less offensive smell of e-cigarettes in comparison to conventional cigarettes (45.9%); and (3) the intention to either cease or reduce conventional smoking (41.5%). In the case of ever users of HTPs (n = 517), the most prevalent reasons for opting for this product included: (1) curiosity (66.0%); (2) the less offensive smell of heated tobacco in comparison to conventional cigarettes (45.3%); (3) concern for personal health (38.8%); and (4) the intention to cease conventional smoking (38.4%).

Among ever daily users of e-cigarettes (n = 423), the most frequently indicated reasons for selecting this product included: (1) the less offensive smell of e-cigarettes in comparison to conventional cigarettes (65.4%); (2) the intention to cease cigarette smoking (61.5%); (3) concern for personal health (58.2%); (4) curiosity (52.3%); and (5) appealing taste/smell of the e-cigarette (51.2%). Detailed data are presented in Figure 2.

Figure 2.

Motives for Choosing E-Cigarettes and HTPs Among (Ever) Daily Users. Respondents Could Give More than One Answer

For the group of ever daily users of HTPs (n = 226), the order of priority and the percentage of indications were comparable to that of users of e-cigarettes. The most frequently cited reasons for using HTPs over conventional cigarettes included a less offensive smell (68.1%), the intention to quit conventional smoking (59.3%), and concern for personal health (58.2%). Detailed data are presented in Figure 2.

The Role of Physicians and Healthcare Professionals Helping Quit Smoking

Of the 1054 respondents who smoked conventional cigarettes at the time of the survey, 59.5% stated that they had visited a doctor or healthcare facility within the past 12 months. Of this group (n = 627), 56.9% had been asked by a doctor or nurse about smoking or using nicotine-containing products. 5.7% of the group who had visited a doctor or healthcare facility in the past 12 months had a question about smoking or using nicotine-containing products on their health status form (questionnaire) and 1.4% reported having been asked the question by another staff member. In contrast, 37.5% indicated that no inquiries had been made regarding smoking or nicotine use during their visit. Among those who smoked conventional cigarettes at the time of the survey and who had been asked about smoking (n = 376), 63.6% reported receiving advice to stop smoking during the visit. This percentage corresponds to 22.7% of all respondents who smoked conventional cigarettes at the time of the survey (n = 1054).

The Impact of Selected Variables on Quitting or Reducing Smoking Conventional Cigarettes

A multiple logistic regression model was used to examine the impact of selected variables (gender, place of residence, education, number of children in household, being under 18 when initiating daily smoking of conventional cigarettes, years of daily smoking of conventional cigarettes) on the reduction or cessation of conventional cigarette smoking. The analysis encompassed a sample of 2032 individuals who had a history of daily smoking conventional cigarettes. Of this group, 1233 (60.7%) had either completely quit smoking or smoked occasionally. The model yielded a Cox-Snell R² fit of 0.087 and a Nagelkerke R² fit of 0.118. Of the variables included in the model, a statistically significant association was observed between the duration of daily smoking of conventional cigarettes and the odds of reducing or quitting smoking altogether. Individuals who had smoked conventional cigarettes daily for less than 1 year exhibited an almost 13-fold higher odds of reducing or quitting smoking in comparison to those who had smoked for 10 years or more (OR = 12.83; 95%CI: 4.95–33.27). For individuals who had smoked conventional cigarettes daily for 1 to 2 years, the odds ratio was 2.98 (95%CI: 1.91–4.64). A similar result was obtained for those who had been daily smokers for 3 to 5 years (OR = 3.08; 95%CI: 2.21–4.27). A statistically significant association with education level was also observed. Individuals who had received secondary education had a twofold higher odds (OR = 2.00; 95%CI: 1.32–3.03) of reducing smoking or quitting compared to those with primary education. For those with higher education, the odds ratio was 3.06 (95%CI: 1.98–1.71). The presence of a child under the age of 18 in the household was found to be associated with a reduction or cessation of smoking (OR = 1.38; 95% CI 1.12–1.71). No association was observed with gender, history of daily smoking of conventional cigarettes before the age of 18, or population at the place of residence. Detailed data are presented in Table 2.

Table 2.

Odds Ratio for the Association Between Selected Variables and a Reduction or Complete Cessation of Smoking for Individuals With a History of Daily Smoking of Conventional Cigarettes (n = 2032). Multiple Logistic Regression Model

	OR	95% CI OR	P-value
Gender
Male	1.06	0.88–1.29	.539
Female	Ref.	Ref.	Ref.
Place of residence
Village a	Ref.	Ref.	Ref.
Town with a population of up to 20 000	0.97	0.71–1.32	.844
Town with a population of 20 000-100,000	0.94	0.73–1.21	.625
City with a population of 100 000-500,000	1.04	0.79–1.37	.791
City with a population of over 500 000	1.02	0.74–1.41	.910
Education
Primary (including primary or incomplete primary and lower secondary)	Ref.	Ref.	Ref.
Vocational (basic vocational, post-secondary/non-university vocational)	1.38	0.89–2.13	.145
Secondary (general or technical high school)	2	1.32–3.03	<.01
Higher (Bachelor’s/engineering, master’s degree, postgraduate studies, or doctorate)	3.06	1.98–4.71	<.001
Children (under the age of 18) in the household
No	Ref.	Ref.	Ref.
Yes	1.38	1.12–1.71	<.01
Under 18 when initiating daily smoking of conventional cigarettes
No	Ref.	Ref.	Ref.
Yes	0.94	0.75–1.19	.619
Years of daily smoking of conventional cigarettes
Less than 1 year	12.83	4.95–33.27	<.001
1-2 years	2.98	1.91–4.64	<.001
3-5 years	3.08	2.21–4.27	<.001
6-9 years	1.41	1.03–1.94	<.05
10 years or more	Ref.	Ref.	Ref.

^aVillage – a settlement unit with compact or dispersed buildings, having agricultural or related service or tourism functions, and without city rights or city status. This definition follows the official classification used by the Central Statistical Office of Poland.

Discussion

As demonstrated by the findings of our previous study, conventional cigarettes continue to be the most currently prevalent choice of tobacco product use among respondents in Poland (21.1%). ²⁸ The current prevalence of e-cigarette and HTPs usage is comparable, at 3.3% and 3.5%, respectively. In the present study, we observed that the proportion of individuals attempting to quit cigarette smoking decreased with age. The majority of those who had made a cessation attempt in the past 12 months were in the 18–24 age group, accounting for over 65%, while this proportion dropped significantly to nearly 15% among the oldest group (60+). This trend may reflect stronger social norms against smoking among younger adults, which could contribute to their higher motivation to quit. ²⁹ In comparison, a European study analysing smoking cessation trends from 1980 to 2010 found that quit attempts peaked among individuals in their 30s, particularly during the 2000s. ³⁰

Furthermore, our results indicate that the most significant challenges to quitting smoking, regardless of age group, included exposure to other smokers at work or home, fear of being unable to cope with a stressful situation, discouragement following previous unsuccessful attempts or fear of weight gain. In contrasts, existing studies suggest that smokers who possess a strong sense of confidence in their ability to abstain from smoking in challenging circumstances report a reduced perception of the health risks associated with smoking, resulting in a diminished motivation to quit. ³¹ Rigotti et al ⁷ highlight that while approximately 70% of conventional cigarette smokers express a desire to quit, they typically make an average of 6 quit attempts before achieving sustained abstinence.

The present study also found that concern for personal health was the primary motivation for quitting smoking among former daily smokers who had successfully ceased smoking conventional cigarettes. Other motivating factors included financial reasons and concern for the health of a partner or children. These findings are consistent with results from the EUREST-PLUS ITC Europe Surveys, conducted across 6 European countries, including Poland. According to these surveys, the health harms associated with smoking, the desire to set a positive example for children, the fear of developing tobacco-related diseases, and the financial burden of smoking were all significant factors contributing to the decision to quit. In contrast, factors such as workplace or public smoking restrictions, cigarette packaging warnings, anti-smoking campaigns, and the affordability of smoking cessation products were reported to have relatively little influence on the decision to quit. ³²

Currently, there is an ongoing debate in the scientific community about the possible reduced harm of electronic cigarettes (e-cigarettes) and novel tobacco products in relation to conventional tobacco products, such as cigarettes. ³³ In the present study, individuals who had previously tried an e-cigarette or a HTP reported that curiosity and the less offensive odor of these products compared to conventional cigarettes were the main motivating factors for their use. Among daily users, the less offensive smell remained the most important factor, followed by the desire to quit conventional cigarettes and concerns about personal health. Among the individuals who had attempted to quit smoking conventional cigarettes within the past 12 months, e-cigarette use was reported by 21.0% of respondents, with similar levels of use for nicotine replacement therapy (23.5%) and HTPs (20.7%). Conversely, studies conducted in the United States have explored reasons for discontinuing e-cigarette use. Additional reasons included unpalatable taste and safety concerns over device use. ³⁴ Similarly, a Korean study revealed that users of HTPs showed lower motivation to quit those products and were less inclined to make attempts to do so, when compared to conventional cigarette smokers. This can be attributed to the prevailing belief that HTPs are less harmful than conventional cigarettes. ³⁵

In daily clinical practice, primary care physicians often lack information regarding their patients’ smoking status or readiness to quit. Consequently, a key objective of the present study was to assess the approach taken by healthcare professionals in addressing tobacco use. The findings revealed that slightly more than half (56.9%) of conventional cigarette smokers who had visited a doctor or a healthcare facility in the previous year were asked by a physician or nurse about their smoking habits or using nicotine-containing products. Among those questioned, 63.6% reported receiving advice to quit smoking. To further understand barriers to effective smoking cessation interventions, a systematic review and meta-analysis of qualitative studies (comprising 22 studies with 580 participants) identified several contributing factors. Beyond low patient motivation, barriers reported by patients, primary care physicians, and nurses included feelings of hypocrisy or discomfort among healthcare providers who had smoked themselves, lack of institutional support and a sense of professional isolation, limited consultation time, inadequate self-perceived skills and knowledge, and low confidence in their ability to deliver effective cessation support. ³⁶

The prevalence of tobacco smoking depends on smoking initiation, cessation, and relapse rates. ³⁷ Monitoring trends in these rates is therefore essential for evaluating current tobacco control policies and planning future strategies to effectively combat the tobacco epidemic. In the present study, a multiple logistic regression model was used to assess the impact of selected variables on the reduction or cessation of conventional cigarette smoking. The analysis revealed that individuals who had smoked conventional cigarettes daily for less than 1 year, the odds of reducing or quitting was nearly 13-fold higher than among those who had smoked for 10 years or more. For those with a daily smoking history of 1 to 2 years, the odds ratio was 2.98 (95% CI: 1.91–4.64), while a similar result was observed among individuals who had smoked daily for 3 to 5 years (OR = 3.08; 95% CI: 2.21–4.27). Most long-term smokers want to quit, and many have made several attempts. For instance, studies indicate that the average 40-year-old smoker who began smoking early in their life is likely to have had more than 20 unsuccessful quit attempts. Notably, many of these unsuccessful quit attempts lasted at least 1 month or up to 6 months, suggesting that a key challenge in smoking cessation is to help smokers remain free of the habit for a longer period of time. ³⁸

Education level was another factor significantly associated with quitting or reducing conventional cigarette smoking in the present study. Participants with secondary education had approximately twice the odds of reducing or quitting compared to those with primary education. This finding is consistent with a Portuguese study among patients attending an inpatient smoking cessation programme, which reported that individuals with lower education were less likely to quit and experienced higher levels of nicotine dependence and depression. ³⁹ These observations underscore the importance of providing targeted, multidisciplinary smoking cessation support for populations with lower educational attainment. Addressing such disparities is crucial for achieving a tobacco-free generation by 2040, as outlined in Europe’s Beating Cancer Plan, which aims to reduce tobacco use to below 5% of the population.

Among the variables affecting smoking reduction or cessation, the presence of a child under the age of 18 in the household was found to be associated with reduction or quitting. Parental smoking appears to be a key factor associated with intergenerational transmission, and there is a frequently reported association between parental smoking and adolescent smoking. ⁴⁰ The influence of the family context on smoking behaviours is further corroborated by French studies, which demonstrate that individuals who live with a partner and who have recently experienced pregnancy or childbirth (in the case of women) are more likely to successfully quit smoking. ⁴¹

The present study observed no association with gender, history of daily smoking of conventional cigarettes before the age of 18, or population at the place of residence. However, other available research does indicate a difference in the nature of smoking between males and females. Males were reported to be more prone to smoking due to the stimulant effects of nicotine, while females tended to smoke habitually or as a means of mood regulation. ⁴² In the context of research related to gender differences and smoking cessation, it has been observed that females appear to demonstrate a greater preference for group interventions, in which they can share their experiences and receive support from their co-participants, as opposed to quitting smoking as a result of coercion or restrictions imposed by the state. ⁴³

Conclusions

• 1. The results of this study found that almost a quarter of conventional cigarette smokers who have ever tried to cease smoking made such an attempt in the past 12 months. The proportion of individuals who attempted to quit smoking decreased with the age of respondents.

• 2. The most significant challenges to quitting smoking among respondents surveyed, irrespective of age group, included being around smokers at work or home, fear of not being able to cope with a stressful situation, discouragement after previous unsuccessful attempts or fear of weight gain.

• 3. Concern for personal health was the predominant factor motivating individuals with a history of daily smoking to successfully discontinue conventional cigarettes.

• 4. Among individuals who use e-cigarettes and HTPs on a daily basis, the most commonly reported motivations for selecting these alternative tobacco products were reduced odor nuisance compared to conventional cigarettes, the intention to quit smoking conventional tobacco products, and concerns regarding personal health. The similarity in response patterns and comparable proportions of endorsements indicate that users from both groups are influenced by analogous factors, chiefly related to usage convenience and health considerations.

• 5. For those who had smoked conventional cigarettes daily for less than 1a0year, the odds of reducing or quitting was significantly higher than among those who had smoked for 10 years or longer.

• 6. Among the respondents who had attempted to quit smoking conventional cigarettes within the past 12 months, the most prevalent cessation strategies included using nicotine replacement therapy, e-cigarettes, and HTPs.

• 7. An association between quitting or reducing smoking of conventional cigarettes and the level of education of smokers was found in this study. Individuals who had received secondary education had a twofold higher odds of reducing smoking or quitting compared to those with primary education.

• 8. The presence of a child under the age of 18 in the household was found to be associated with a reduction or cessation of smoking.

• 9. Although most smokers visited healthcare facilities, only a little over half were asked about their smoking habits, and fewer than one-quarter received advice to quit. This reveal missed opportunities for healthcare professionals to actively support smoking cessation and emphasizes the need for more consistent intervention.

Policy Implications and Recommendations

Many European countries are updating their tobacco control strategies, which, in addition to bans on advertising of conventional cigarettes, prohibitions on smoking in public places, restrictions on packaging design, and health education, include a wide range of support services and programs for individuals wishing to quit smoking. These measures encompass free medical counseling, access to nicotine replacement therapy, and other cessation aids, including approaches aimed at reducing tobacco consumption (eg, in Finland, Norway, Sweden, the United Kingdom, and the Czech Republic). According to the World Health Organization’s “Global report on trends in prevalence of tobacco use 2000-2030”, by 2030 Sweden is projected to have by far the lowest smoking prevalence in Europe, alongside the United Kingdom and Iceland, which also pursue relatively liberal policies toward alternative nicotine products. ⁴⁴ Countries such as Sweden and the United Kingdom have adopted a comprehensive approach to tackling tobacco addiction, simultaneously implementing the recommendations of the WHO Framework Convention on Tobacco Control while investing in preventive and therapeutic services and ensuring broad access to support centers for individuals with tobacco dependence.

Compared with the comprehensive tobacco control measures implemented in other European countries, Poland still faces considerable challenges, including ongoing public health debates and the lack of a long-term, coherent anti-nicotine strategy. In light of the EU’s ambitious plan to reduce the number of smokers to less than 5% of the adult population by 2040 (in 2040, there are expected to be around 30 million people over the age of 17 in Poland – 5% of this number equals 1.5 million), the number of smokers should decrease from the current 8 million to 1.5 million. ⁴⁵ However, there has been no decline in the prevalence of smoking in Poland for several years. It is imperative to formulate and implement a tobacco control policy that is designed to discourage individuals from initiating smoking, facilitate cessation, and impose restrictions on access to cigarettes and designated smoking areas. The primary focus should be on anti-tobacco education and the promotion of health-related behaviours, with a particular emphasis on children and young people. In addition, it is essential to target individuals already addicted to nicotine and implement a nicotine recovery programme. These individuals should be provided with access to specialised services, including behavioural intervention, outpatient clinics and pharmacotherapy, to support treatment of nicotine dependence irrespective of the form of nicotine intake. Finally, it is recommended that primary care physicians be activated and equipped with the appropriate tools.

ORCID iDs

Natalia Miller https://orcid.org/0009-0006-4603-8903

Piotr Samel-Kowalik https://orcid.org/0000-0002-9047-0414