Reasons for smoking cessation attempts among Japanese male smokers vary by nicotine dependence level: a cross-sectional study after the 2010 tobacco tax increase

BMJ Open. 2015 Mar 20;5(3):e006658. doi: 10.1136/bmjopen-2014-006658.


Objectives: To examine the association between smoking cessation attempts during the previous 12 months, motivators to quit smoking and nicotine dependence levels among current male smokers after Japan's massive 2010 tobacco tax increase.

Design: Cross-sectional study.

Setting: A self-reported questionnaire about smoking habits, nicotine dependence levels and factors identified as motivators to quit smoking was administered to 9378 employees working at a company located in Fukuoka Prefecture in Japan (as of 1 October 2011).

Participants: A total of 2251 male current smokers 20-69 years old.

Primary and secondary outcome measures: Nicotine dependence level assessed by Fagerström Test for Cigarette Dependence (FTCD), smoking cessation attempts during the previous 12 months and motivators for smoking cessation.

Results: The proportion of current smokers who had attempted to quit smoking within the previous 12 months was 40.6%. Nicotine dependence level of current smokers was negatively associated with cessation attempts during the previous 12 months. Motivators for smoking cessation differed by nicotine dependence levels. 'The rise in cigarette prices since October 2010' as a smoking cessation motivator increased significantly at the medium nicotine dependence level (OR 1.44, 95% CI 1.09 to 1.90); however, this association was not statistically significant for individuals with high nicotine dependence (OR 1.24, 95% CI 0.80 to 1.92). 'Feeling unhealthy' was significantly negatively associated for medium (OR 0.42, 95% CI 0.27 to 0.65) and high (OR 0.31, 95% CI 0.14 to 0.71) nicotine dependence levels. Trend associations assessed by assigning ordinal numbers to total FTCD score for those two motivators were statistically significant.

Conclusions: The efficacy of smoking cessation strategies can be improved by considering the target group's nicotine dependence level. For smokers with medium and high nicotine dependence levels, more effective strategies aimed at encouraging smoking cessation, such as policy interventions including increasing tobacco taxes, are needed.

Keywords: Fagerström Test for Cigarette Dependence; male workers; motivator; nicotine dependence; smoking cessation; tobacco tax increase.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Commerce*
  • Cross-Sectional Studies
  • Habits
  • Health
  • Humans
  • Japan
  • Male
  • Middle Aged
  • Motivation*
  • Nicotine / adverse effects*
  • Odds Ratio
  • Self Report
  • Smoking / economics
  • Smoking Cessation / economics*
  • Smoking Prevention*
  • Surveys and Questionnaires
  • Taxes*
  • Tobacco Products / economics
  • Tobacco Use Disorder / economics*
  • Tobacco Use Disorder / therapy
  • Young Adult


  • Nicotine