BACKGROUND: Motivation is the key variable during quit attempts to smoking abstinence, however, trajectories over time and its impact on quitting remain unclear.
METHODS: This secondary analysis utilized data from six community-based smoking cessation trials in Hong Kong from 2015 to 2021 (excluding 2019). Two or three brief interventions were independently implemented annually, including very brief advice, brief advice, text messages, chat-based support, and active referral to services, with follow-ups at 1, 2, 3, and 6 months. A total of 3561 adult daily cigarette smokers at baseline who attempted to quit at follow-ups were included. Sociodemographic and smoking characteristics were surveyed at baseline. Motivation for quit attempts was assessed at 4 follow-ups, categorized into intrinsic motivations (commitment to quitting, health considerations or family considerations) and extrinsic motivations (financial savings, public regulations or external advice). Motivation trajectories were identified by Group-based multi-trajectory modeling. The association between these trajectories and smoking cessation outcomes, including self-reported and biochemically validated (primary outcome) 7-day point prevalence abstinence, smoking reduction, and utilization of smoking cessation services at 6 months, were assessed by Robust Poisson regression models adjusted covariates.
RESULTS: Three motivation trajectories emerged: increasing motivation group (17.9%), decreasing motivation group (55%), and stable motivation group (27.1%). The 6-month validated abstinence was significantly higher in the stable motivations group (33.5% vs 4.0, adjusted incidence risk ratio [IRR] 8.04; 95% confidence interval [CI] 6.32-10.24) and the increasing motivation group (16.1% vs 4.0%, adjusted IRR 4.95; 95% CI 3.73-6.55) than the decreasing motivation group. Similar associations were observed for the self-reported abstinence and smoking reduction (P<0.05). Utilization of cessation services was significantly higher in the stable motivation group than in the decreasing motivation group (adjusted IRR 1.34; 95% CI 1.16-1.54).
CONCLUSIONS: Half of smokers experienced decreasing motivation over time. Stable and increasing motivation were associated with higher smoking abstinence.