title: Stages of change of the readiness to quit smoking among a random sample of minority Arab male smokers in Israel.
abstract: BACKGROUND
  Despite advanced smoking prevention and cessation policies in many countries, the prevalence of cigarette smoking among indigenous and some ethnic minorities continues to be high. This study examined the stages of change (SOC) of the readiness to quit smoking among Arab men in Israel shortly after new regulations of free-of-charge smoking cessation workshops and subsidized medications were introduced through primary health care clinics.
  
  
  METHODS
  We conducted a countrywide study in Israel between 2012-2013. Participants, 735 current smokers; 18-64 years old; were recruited from a stratified random sample and interviewed face-to-face using a structured questionnaire in Arabic. We used ordered regression to examine the contribution of socio-economic position (SEP), health status, psychosocial attributes, smoking-related factors, and physician advice to the SOC of the readiness to quit smoking (pre-contemplation, contemplation and preparation).
  
  
  RESULTS
  Of the current smokers, 61.8% were at the pre-contemplation stage, 23.8% were at the contemplation stage, and only 14.4% were at the preparation stage. In the multinomial analysis, factors significantly (P < 0.05) contributing to contemplation stage compared to pre-contemplation stage included [odds ratio (OR), 95% confidence interval (CI)]: chronic morbidity [0.52, (0.31-0.88)], social support [1.35, (1.07-1.70)], duration of smoking for 11-21 years [1.94, (1.07-3.50)], three or more previous attempts to quit [2.27, (1.26-4.01)], knowledge about smoking hazards [1.75, (1.29-2.35)], positive attitudes toward smoking prevention [1.44, (1.14-1.82)], and physician advice to quit smoking [1.88, (1.19-2.97)]. The factors significantly (P < 0.05) contributing to preparation stage compared to pre-contemplation stage were [OR, (95 % CI)]: chronic morbidity [0.36, (0.20-0.67)], anxiety [1.07, (1.01-1.13)], social support [1.34, (1.01-1.78)], duration of smoking 5 years or less [2.93, (1.14-7.52)], three or more previous attempts to quit [3.16, (1.60-6.26)], knowledge about smoking hazards [1.57, (1.10-2.21)], and positive attitudes toward smoking prevention [1.34, (1.00-1.82)].
  
  
  CONCLUSIONS
  Most Arab men who currently smoke are in the pre-contemplation stage, indicating low readiness to quit smoking. New policies of free-of-charge smoking-cessation group sessions and subsidized medications introduced through primary health care clinics in Israel may be less effective among Arab men. For these policies to promote cessation more successfully, tailored interventions and campaigns may be needed to increase the readiness to quit smoking in this population, especially for those at the pre-contemplation stage.
authors.affiliation: Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva, 84015, Israel. daoud@bgu.ac.il.
authors.forename: Nihaya
authors.initials: N
authors.lastname: Daoud
authors.affiliation: School of Public Health. University of Haifa, Haifa, Israel. ssamah_shaiek@yahoo.com.
authors.forename: Samah
authors.initials: S
authors.lastname: Hayek
authors.affiliation: Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva, 84015, Israel. ahmad48@gmail.com.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Sheikh Muhammad
authors.affiliation: Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, 52621, Israel. kathleena@gertner.health.gov.il.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Abu-Saad
authors.affiliation: Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA. osmana@email.sc.edu.
authors.forename: Amira
authors.initials: A
authors.lastname: Osman
authors.affiliation: Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA. THRASHER@mailbox.sc.edu.
authors.forename: James F
authors.initials: JF
authors.lastname: Thrasher
authors.affiliation: Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, 52621, Israel. ofral@gertner.health.gov.il.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. ofral@gertner.health.gov.il.
authors.forename: Ofra
authors.initials: O
authors.lastname: Kalter-Leibovici
mesh_terms: D000328:Adult; D018912:Arabs; D003376:Counseling; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000523:psychology*; D012944:Social Support; D011795:Surveys and Questionnaires; D013997:Time Factors; D014029:Tobacco Use Disorder / Q000208:ethnology* / Q000523:psychology*; D055815:Young Adult