We investigated sources and predictors of smoking cessation support, both received and asked advice. The study had two limitations, first: it was based on smokers’ report, which might have been prone to recall bias; second: it was not examined whether received and asked advice has had any impact on the motivation of the smoker for cessation or affected smoking cessation rate. More than half of smokers had received smoking cessation advice during the previous year. Relatively low proportion of smokers reported seeking support for smoking cessation. Sources of ‘receiving smoking cessation advice’ in decreasing order were family members, friends, physicians and other health care providers. Sources of ‘ask for cessation help’ were mainly family and friends. Receiving advice was evidently associated with more seeking support. Received advice was lower among women and single smokers. Smokers with heavier pattern of smoking received less advice. Moreover, hookah smokers received and asked for cessation help less than cigarette smokers.
Providing smoking cessation advice to smokers is a major component of all efforts to control and limit smoking4
. In our study, smokers received advice mainly from family and friends so that 66.8 per cent of smokers had received advice. In a similar study on 429 adult smokers and recent quitters, patient self-report of receiving advice about smoking in the previous year was about 66 per cent14
. These similar findings are in the setting of the demographic differences between our sample and the Minnesota study that included both smokers and recent quitters with half of them being women, married and with more than high school education. Other studies have reported advice ranging from 37 to 46 per cent, a range that does not meet present standards of patient care which is 75 per cent15,16
In our study, 14.4 per cent of smokers had asked for smoking cessation help. This is consistent with previous studies indicating that about 95 per cent of smokers in the population do not seek treatment for smoking cessation17
. Compared with this report, our study showed higher rates of seeking support, regardless of their motivation for smoking cessation.
Support persons are usually partners, friends or other family members6,18
. In our study the smokers were more attracted towards family and friends as sources of smoking cessation help, probably as they received more advice from them rather than health professionals. This may be due to unawareness of Iranian smokers about available smoking cessation services. It may also be explained by less accessibility of cessation services that makes smokers ask their family/friends as the main sources for cessation support. This highlights the need for effective smoking cessation services in Iran, while it offers an opportunity for tobacco control programmes to take advantage of smokers` families and friends to encourage smokers to stop smoking. While clinic-based treatments produce the highest smoking cessation rates and the lowest population coverage19
, interventions provided by family and friends can reach the majority of smokers who do not seek treatment for smoking cessation20
In our study, gender and marital status were the only demographic predictors affecting ‘received smoking cessation advice’. Being married may enhance smoker’s motivation for smoking cessation through reliance on a close supporting one or through exposing the smoker to more frequent advice for smoking cessation21,22
. Moreover, community surveys have found that success in stopping smoking is associated with not being exposed to smokers23,24
In a population-based study on 3037 adult cigarette smokers, higher education level and greater number of cigarettes smoked per day were related to a higher rate of counselling16
. In our study education did not show significant effect on smoking cessation. Also, heavier use was inversely associated with seeking help. Contrary to the findings of this study16
, in our study smokers asked for help less frequently with advancing age, which might be due to a feeling of disappointment for a successful smoking cessation attempt as older smokers are usually chronic, heavy smokers who are highly addicted25
Hookah smokers receive and asked for cessation help less than cigarette smokers. Hookah is usually known as a social hobby in Iran, served in gatherings and more common among women and younger ages26
. There is also less awareness about its many hazards such as lung cancer, respiratory illness, low birth-weight and periodontal disease27
. This might explain the less cessation advice by hookah smokers28
Unlike developed countries, in many developing countries, smoking cessation counselling services are less frequently available or actively offered by health professionals. This problem needs consideration in developing countries like Iran, that is at the beginning of provision of tobacco control measures at national level. Our results also show a potentially available source for implementing smoking cessation interventions by relying on the smokers’ interests and the most of smoking cessation support, i.e., smokers` families and friends. Family and friends can be considered as available sources for smoking cessation support in countries in which smoking cessation counselling services are less available. However, the role of physicians in the smoking cessation counselling should be promoted by providing smoking cessation counselling services at the community level.