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Revealing the complexity of quitting smoking: a qualitative grounded theory study of the natural history of quitting in Australian ex-smokers
  1. Andrea L Smith1,
  2. Stacy M Carter1,
  3. Sally M Dunlop2,
  4. Becky Freeman3,
  5. Simon Chapman4
  1. 1 Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  2. 2 Cancer Screening and Prevention, Cancer Institute NSW, Sydney, New South Wales, Australia
  3. 3 Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  4. 4 School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Andrea L Smith, School of Public Health, University of Sydney, Sydney, NSW 2050, Australia; andrea.smith{at}


Objective To explore the quitting histories of Australian ex-smokers in order to develop an understanding of the varied contribution of smoking cessation assistance (either pharmacotherapy or professionally mediated behavioural support) to the process of quitting.

Design Qualitative grounded theory study; in-depth interviews.

Participants 37 Australian adult ex-smokers (24–68 years; 15 men, 22 women) who quit in the past 6–24 months.

Results Although participants’ individual quitting histories and their overall experiences of quitting were unique, when the 37 quitting histories were compared it was clear two experiences were common to almost all participants: almost no one quit at their first quit attempt and almost everyone started out quitting unassisted. Furthermore, distinct patterns existed in the timing and use of assistance, in particular the age at which assistance was first used, how some participants were resolutely uninterested in assistance, and how assistance might have contributed to the process of successful quitting even if not used on the final quit attempt. Importantly, three patterns in use of assistance were identified: (1) only ever tried to quit unassisted (n=13); (2) started unassisted, tried assistance but reverted back to unassisted (n=13); (3) started unassisted, tried assistance and quit with assistance (n=11). For most participants, insight into what quitting would require was only gained through prior quitting experiences with and without assistance. For a number of participants, interest in assistance was at its lowest when the participant was most ready to quit.

Conclusion Quitting should be viewed as a process drawing on elements of assisted and unassisted quitting rather than a stand-alone event that can be labelled as strictly assisted or unassisted.

  • addiction
  • cessation
  • social marketing

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  • Contributors SC conceived the study. SC, SMC, SMD and BF obtained funding. All authors were involved in designing the study and developing the methods. ALS coordinated the running of the study, conducted the interviews, read the transcripts, coded the transcripts and wrote the memos. ALS and SMC developed the analytical framework. All authors contributed to the analysis. ALS drafted the manuscript. All authors contributed to the interpretation of the analysis and critically revised the manuscript.

  • Funding This study is funded by National Health and Medical Research Council (grant no: NHMRC 1024459).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The University of Sydney Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data sets generated and analysed during the current study are not publicly available due to participant confidentiality but are available from the corresponding author on reasonable request.