New research: Behavioural factors and cessation outcomes in low-income South African communities

Sam Filby and a former colleague at REEP, Dr Laura Rossouw, recently published a paper in BMJ Open titled "Behavioural factors associated with cigarette quitting behaviour: an analysis of cross-sectional survey data collected in three low-income South African communities".

The study explores behavioural factors influencing cigarette smoking cessation outcomes and aimed to identify key traits linked to sustained quitting and attempts to quit, drawing insights from 675 respondents in the sampled areas.

The authors find that the likelihood of sustained cessation and of making a recent attempt to quit were significantly associated with higher levels of self-control, and negatively associated with stress and preferences for risk-taking behaviour. Having more confidence in one’s ability to stay quit also increased the odds of sustained smoking cessation.

The research shows that people who have a tendency to delay continuously the decision to quit, and stay quit, reduce the likelihood of being able to sustain cessation efforts. Similarly, amongst current cigarette smokers, a tendency to postpone important tasks was shown to reduce the likelihood of making a quit attempt, as was being impatient. This suggests that people who place more value on current rewards (e.g., the satisfaction derived from smoking a cigarette) than on future rewards (e.g., avoiding smoking-related illness) are less likely to make a quit attempt.

Focusing on smokers with low incomes is particularly relevant in South Africa, where existing research shows that individuals from lower socioeconomic backgrounds tend to have lower nicotine dependence. This suggests that non-pharmacological interventions, such as behavioural counselling, may be more effective for this group, as they are often able to quit without medication.

These findings offer may offer useful insights for healthcare providers and practitioners looking to tailor local smoking cessation frameworks to better address the behavioural barriers and facilitators that impact low-income smokers. Sam and Laura suggest that this behavioural support should challenge potential quitters to practice self-control, equip them with tools to manage stress, and tackle temptations to time-discounting.

They further argue that healthcare providers should question people who smoke about their behavioural attributes and use this information to deliver behavioural support that motivates and facilitates sustained smoking cessation. An additional finding of the study -- that the odds of attempting to quit increase when people receive medical advice to do so -- is consistent with other local research, and further points to the important role that health workers can play in the smoking-cessation process.

The full paper is available here.