Degree Name

DrPH (Doctor of Public Health)


Public Health

Date of Award


Committee Chair or Co-Chairs

Megan Quinn

Committee Members

Hadii M. Mamudu, Ke-Sheng Wang, Sreenivas P. Veeranki


Smoking cessation can reduce health risk and prevent millions of tobacco-related deaths. However, cessation rates are low in low-and-middle income countries (LMICs), with only a small proportion of smokers intending to quit. Given the paucity of literature to support tobacco cessation programs in LMICs, this study aimed to: 1) identify factors associated with intention to quit smoking, 2) assess the relationship between health care provider quit advice/tobacco screening and utilization of cessation assistance, and 3) examine the relationship between home smoking rule and smoking intensity across three stages of smoking cessation (precontemplation, contemplation and preparation) in LMICs. Data were obtained from the Global Adult Tobacco Survey, 2009-2012, a nationally representative household survey of noninstitutionalized civilians aged 15 years and older. Weighted multivariable regression analyses were conducted using SAS version 9.4. Adjusted odds ratios (OR), percent change in smoking intensity and associated 95% confidence intervals (CI) were estimated. Home smoking rule and exposure to anti-smoking messages were the important factors associated with contemplation and preparation to quit smoking. Approximately 1%, 7%, 9% and 15% used quitline, medical treatment, counseling/cessation clinic and cessation assistance (all three combined), respectively, in the past year. Quit advice was significantly associated with utilization of counseling/cessation clinic (OR=3.89, 95% CI=2.8–5.5), medical treatment (OR=1.71, 95% CI=1.2–2.4) and cessation assistance (OR=2.60, 95% CI=2.0–3.4). Tobacco screening was associated with utilization of counseling/cessation clinic (OR=2.60, 95% CI=1.1–5.9) and medical treatment (OR=1.71, 95% CI=1.2–2.4). Living in a completely smoke-free home was associated with a 22.5% (95% CI=17.1%–28.0%), an 18.6% (95% CI=9.0%–28.2%), and a 19.4% (95% CI=3.9%–34.9%) significant reduction in smoking intensity among smokers in precontemplation, contemplation and preparation, respectively. In conclusion, the results suggest that smoke-free home, anti-smoking campaigns, and health care provider intervention promote smoking cessation in LMICs. Therefore, comprehensive smoke-free policies, anti-smoking media campaigns and integration of tobacco screening and quit advice into the health care system are important for tobacco cessation in LMICs, suggesting the need for full implementation of the World Health Organization Framework Convention for Tobacco Control Articles 8 and 11 – 13.

Document Type

Dissertation - unrestricted


Copyright by the authors.

Included in

Epidemiology Commons