Who does not want to quit? Determinants of no intention to stop smoking in a population-based sample of current smokers

Understanding why some people who smoke have no intention to quit is essential for designing inclusive tobacco control strategies that reach beyond already motivated individuals. This study aimed to identify factors associated with no intention to quit smoking among people who smoke in Scotland, analysing data from 2651 current smokers aged 16 years and older using the 2017, 2018, 2019, and 2021 waves of the Scottish Health Survey. The primary outcome was no intention to quit smoking. Multivariable logistic regression was used to assess sociodemographic, behavioural, and health-related predictors, applying survey weights to account for the complex sampling design. About one-third (34.1%) of those who currently smoke reported no intention to quit. Older adults (65 +) had significantly higher odds of no quit intention compared with those aged 16-24 years (adjusted odds ratio [aOR] = 2.74, 95% confidence interval [CI] 1.54-4.90, p = 0.001), as did those who began smoking before age 16 (aOR = 1.29, 95% CI 1.02-1.64, p = 0.031), had not received a doctor's advice to quit (aOR = 1.38, 95% CI 1.09-1.74, p = 0.008), or did not know their daily cigarette consumption (aOR = 2.21, 95% CI 1.19-4.10, p = 0.012). In contrast, people with one or two prior quit attempts (aOR = 0.22, 95% CI 0.17-0.29, p < 0.001) or three or more attempts (aOR = 0.15, 95% CI 0.11-0.20, p < 0.001) had substantially lower odds of reporting no intention to quit compared with those who had never tried to quit. Similarly, current e-cigarette users (aOR = 0.57, 95% CI 0.40-0.81, p = 0.002) had lower odds of reporting no intention to quit than never users. No significant association was observed with socioeconomic deprivation, suggesting that while disadvantage shapes smoking prevalence, it may not directly determine quit intention. Reaching smokers with no quit intention may call for interventions that operate outside traditional clinical settings, including targeted outreach to older adults, early initiators, and those disconnected from healthcare services.