Reasons for not Using Smoking Cessation Aids
Background: Few smokers use effective smoking cessation aids (SCA) when trying to stop smoking. Little is known why available SCA are used insufficiently. We therefore investigated the reasons for not using SCA and examined related demographic, smoking behaviour, and motivational variables.
Methods: Data were collected in two population-based studies testing smoking cessation interventions in north-eastern Germany. A total of 636 current smokers who had never used SCA and had attempted to quit or reduce smoking within the last 12 months were given a questionnaire to assess reasons for non-use. The questionnaire comprised two subscales: "Social and environmental barriers" and "SCA unnecessary."
Results: The most endorsed reasons for non-use of SCA were the belief to be able to quit on one's own (55.2%), the belief that help is not necessary (40.1%), and the belief that smoking does not constitute a big problem in one's life (36.5%). One quarter of all smokers reported that smoking cessation aids are not helpful in quitting and that the aids cost too much. Smokers intending to quit agreed stronger to both subscales and smokers with lower education agreed stronger to the subscale "Social and environmental barriers".
Conclusion: Main reasons for non-use of SCA are being overly self-confident and the perception that SCA are not helpful. Future interventions to increase the use of SCA should address these reasons in all smokers.

Smoking is the most important single cause of morbidity and mortality in industrialised countries. Because smoking prevention will not affect tobacco-related mortality until the second half of the 21century, quitting by current smokers is the main way to achieve positive effects on mortality in a medium term. Many smokers are interested in quitting. More than 70% of all smokers try to quit smoking at least once in their lifetime. In the United States, 40% of all smokers reported that they had tried to quit within the last 12 months, and 70% reported that they wanted to quit. In Germany, lower rates were found. Only 34% reported at least one quit attempt within the last 12 months, and 43% said that they wanted to quit.

To support smokers in their quit attempts, a wide range of smoking cessation aids (SCA) is available. SCA comprise methods and products to assist smokers in quitting through coping with psychological or physical aspects of nicotine dependence. Meta-analyses have shown that smoking cessation courses, nicotine replacement therapy, and bupropion can significantly increase success rates in quitting. Even minimal interventions such as self-help materials have a small effect when compared with no intervention. In contrast to the evidence about the efficacy of SCA, less than 23% of current smokers actually use SCA when trying to quit smoking according to general population studies in the US. In Germany, 19% have used SCA in at least one quit attempt during their lifetime. The question arises why smokers do not sufficiently use available SCA. Therefore, we assessed reasons for not using SCA in smokers who reported an unaided quit or reduction attempt.

A limited number of studies investigating the utilisation of SCA compared users and non-users. Those studies found that the use of SCA is more likely among women, older persons, and persons with more than 12 years of education than among men, younger persons, and persons with less than 12 years of education. Smoking more cigarettes per day, having had more quit attempts in the past, and a higher Fagerström Test for Nicotine Dependence score were positively associated with SCA use. Furthermore, smokers utilising SCA are more frequently allocated to stages with enhanced motivation to stop smoking. In the current study, we therefore examined whether demographic, smoking behaviour, and motivational variables predict the reasons for not using SCA among smokers reporting an unaided quit or reduction attempt. It has been shown that smoking more cigarettes per day, having a higher degree of nicotine dependence, and less quit attempts in the past are associated with less success in quitting smoking. Furthermore, the efficacy of nicotine replacement therapy has been proven mainly for smokers smoking more than 10–15 cigarettes per day. Thus, smokers with an unfavourable smoking behaviour (heavier smokers) are most likely to benefit from the use of SCA. Therefore we furthermore investigated whether the reasons for non-use vary between heavy and light smokers.