title: Reasons for failure to quit: a cross-sectional survey of tobacco use in major cities in Pakistan.
abstract: BACKGROUND
  Tobacco dependence has been defined as a chronic relapsing disease. Around 5 million annual tobacco-related deaths have been reported worldwide. The majority of smokers want to quit but are not successful.
  
  
  OBJECTIVE
  To screen our population for tobacco use, gauge the baseline demographics of tobacco users and assess factors associated with failed attempts to quit.
  
  
  METHODS
  Free health camps supervised by a physician were held across two major cities of Pakistan. All consenting participants were administered a questionnaire and had their exhaled carbon monoxide (CO) levels measured.
  
  
  RESULTS
  Of 12 969 participants successfully enrolled, the mean age was 31.4 ± 10.0 years. More than three quarters were aged 20-40 years (n = 10 168, 78.4%). The overall average CO level was 12.0 ± 8.0 ppm. The majority of the participants wanted to quit, and nearly everyone had received advice about quitting. The majority had tried smoking cessation pharmacotherapy. Friends/peer pressure (n = 1554, 12%), anxiety (n = 681, 5.3%), tobacco dependence (n = 1965, 15.2%) and stress/mood changes (n = 390, 3.0%) were the most widely observed reasons for failure to quit in study participants.
  
  
  CONCLUSIONS
  The information provided by this study can guide the development of more targeted intervention programmes for smokers who wish to quit.
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: M
authors.initials: M
authors.lastname: Irfan
authors.affiliation: Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, UK.
authors.forename: A S
authors.initials: AS
authors.lastname: Haque
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: H
authors.initials: H
authors.lastname: Shahzad
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Z A
authors.initials: ZA
authors.lastname: Samani
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: S
authors.initials: S
authors.lastname: Awan
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: J A
authors.initials: JA
authors.lastname: Khan
mesh_terms: D000328:Adult; D000339:Affect; D015415:Biomarkers / Q000378:metabolism; D001944:Breath Tests; D002248:Carbon Monoxide / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008297:Male; D009042:Motivation; D010154:Pakistan; D000067074:Peer Influence; D012008:Recurrence; D012907:Smoking / Q000009:adverse effects / Q000378:metabolism / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D000074606:Smoking Prevention; D014029:Tobacco Use Disorder / Q000517:prevention & control* / Q000523:psychology; D017211:Treatment Failure; D014504:Urban Health; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002248:Carbon Monoxide