Factors Determining Attempt to Quit Smoking Among Adult Current Smokers in Sarikei, Sarawak, Malaysia

Last reviewed: March 2026

Background and Context

Smoking remains one of the most significant preventable causes of premature death worldwide. In Malaysia, nearly five million individuals aged 15 years and above are estimated to be current smokers, placing the nation among the higher-prevalence countries in the Southeast Asian region. Despite extensive government efforts — including the establishment of smoking cessation clinics across public healthcare facilities since 2004 and the implementation of progressively stronger tobacco control legislation — smoking prevalence has remained stubbornly resistant to decline.

The state of Sarawak, located on the island of Borneo, presents unique challenges for tobacco control. Its population is geographically dispersed across vast rural areas, with limited access to cessation services in many districts. Sarikei Division, the site of this study, is a predominantly rural district where agriculture and fishing are primary economic activities. Understanding what motivates smokers in these communities to attempt quitting is essential for designing culturally appropriate interventions.

Previous research in Peninsular Malaysia had identified factors such as health concerns, family pressure, and cost as motivators for quitting. However, data from East Malaysian states remained limited prior to this study, creating a significant gap in the evidence base for region-specific tobacco control programming.

Study Design and Methodology

This cross-sectional study was conducted between January and May 2019 in two districts of Sarikei Division, Sarawak. The researchers employed a multistage cluster sampling technique to select participants from 99 clusters across the division. The calculated sample size was 806, accounting for a 30% attrition rate and based on a baseline prevalence of 28% for quit attempts among rural smokers, with 5% precision.

Smokers were defined as individuals who smoked at least one cigarette per week. Those with pre-existing mental illness or cognitive impairment were excluded. Data were collected through face-to-face interviews using a validated structured questionnaire that assessed demographic information, smoking history, motivation levels, self-efficacy, and intention to quit.

Self-efficacy was measured using the Smoking Abstinence Self-Efficacy Questionnaire (SASEQ), where a higher score indicated greater confidence in one’s ability to quit smoking. A hierarchical multiple linear regression analysis was performed using IBM SPSS version 22.0 to determine the factors associated with quit attempts, with a p-value of 0.05 or less considered statistically significant. The study received ethical approval from the Ethics Committee of Universiti Malaysia Sarawak, and all participants provided written informed consent.

Key Results

A total of 777 smokers completed the survey. The sample was predominantly male, with the average age of 43.46 years and a male-to-female ratio of 8.96:1. The median age of smoking initiation was 20 years, while the median age of becoming a regular smoker was 23 years.

Predictors of Quit Attempts

The hierarchical multiple linear regression analysis revealed four significant predictors of quit smoking attempts. Motivation emerged as the strongest predictor (β = 0.220, p < 0.001), followed by intention to quit (β = 0.148, p < 0.001), age at regular smoking (β = 0.131, p < 0.01), and gender (β = 0.088, p < 0.01). Notably, self-efficacy showed a negative association with quit attempts (β = −0.101, p < 0.05).

The Self-Efficacy Paradox

Perhaps the most intriguing finding was the negative relationship between self-efficacy and quit attempts. While it might seem counterintuitive, this finding aligns with emerging literature suggesting that smokers with high self-efficacy may believe they can quit at any time, thereby reducing the urgency to make actual quit attempts. This phenomenon — sometimes called the “overconfidence effect” — has been observed in other health behaviour contexts and suggests that cessation counselling should address not only building confidence but also translating that confidence into concrete action.

Implications for Public Health

The findings carry several important implications for smoking cessation programming in rural Sarawak and similar settings. First, interventions should prioritise enhancing motivation among smokers, as this was the strongest predictor of quit attempts. Motivational interviewing techniques — which have demonstrated effectiveness in other Malaysian settings — could be adapted for community health workers in Sarikei Division.

Second, healthcare providers should focus on strengthening smokers’ intention to quit through comprehensive counselling that addresses health, self-esteem, and long-term benefits. The study also suggests that individuals who began regular smoking at a later age may be more amenable to quitting, indicating that age of initiation could serve as a useful screening criterion for targeted interventions.

Third, the finding that self-efficacy was negatively associated with quit attempts calls for a nuanced approach to cessation counselling. Rather than simply boosting confidence, counsellors should help smokers develop concrete quit plans with specific timelines and strategies, ensuring that self-assurance translates into tangible action.

Smoking Cessation in the Malaysian Context

Malaysia’s smoking cessation infrastructure has expanded significantly since the introduction of Quit Smoking Clinics (QSC) by the Ministry of Health in 2004. These clinics are available at public health facilities nationwide and provide counselling, pharmacotherapy (including nicotine replacement therapy), and follow-up support. Despite this, data from other Malaysian studies have shown quit failure rates exceeding 60% among clinic attendees, highlighting the ongoing challenges in achieving sustained cessation.

The National Health and Morbidity Survey has documented smoking prevalence at approximately 21-23% among Malaysian adults, with consistently higher rates among males, rural populations, and lower socioeconomic groups. Sarawak, with its unique cultural composition — including significant indigenous populations such as the Iban, Bidayuh, and Melanau — may require culturally tailored approaches that account for the social and ceremonial roles of tobacco in some communities.

Limitations

Several limitations should be considered when interpreting these findings. The cross-sectional design precludes causal inferences about the relationships between predictors and quit attempts. Self-reported smoking status and quit attempts may be subject to social desirability bias. The study was conducted in one division of Sarawak, and generalisability to other regions — particularly urban areas in Peninsular Malaysia — may be limited. Additionally, the predominance of male participants, while reflecting the gender distribution of smokers in the region, limits the ability to draw firm conclusions about female-specific factors.