Positive smoker identity as a barrier to quitting smoking: Findings from a national survey of smokers in England

Background

It has been proposed that positive smoker identity may be an important factor undermining smoking cessation but very little research exists on this. This study tested the hypothesis that a simple measure of positive smoker identity would predict quit attempts over and above other known predictors in a population sample. More tentatively it explored whether this measure would also predict quit success.

Methods

A representative sample of adult smokers in England (n = 9456) was included at baseline and 2099 were followed-up at six months. Demographic and smoking characteristics, a single item measure of positive smoker identity (endorsing the statement: ‘I like being a smoker’), measures of smoking-related attitudes, quit attempts and quit success were included.

Results

A total of 18.3% (95% CI = 17.5–19.2) of smokers reported a positive smoker identity. Adjusting for all other predictors, those with a positive smoker identity were more likely to be older (p < 0.001), male (p = 0.013), more nicotine dependent (p < 0.001), have lower motivation to stop (p < 0.001), have not made a quit attempt in the past year (p = 0.025), enjoy smoking (p < 0.001), and consider themselves to be addicted (p < 0.001). Having a positive smoker identity independently predicted failure to make a quit attempt at six months (p = 0.007). The independent association with quit success was similar in magnitude but did not reach statistical significance (p = 0.053).

Conclusions

Only a minority of smokers in England have a positive smoker identity. However, where it is present it may be an important barrier to quitting smoking and merits further study.