Aubin et al. BMC Public Health 2010, 10:100 http://www.biomedcentral.com/1471-2458/10/100 Table 4 Barriers to smoking cessation Barriers to smoking cessation Yes Smoking helps me control stress 62% Without cigarettes, I would feel too irritable to be around 51% Without cigarettes, I would feel too anxious or worried about 42% things I enjoy smoking too much to give it up 41% It would be too hard to control my weight without smoking 33% I don’t know how to go about quitting smoking 29% There are too many difficult things going on in my life right now 28% I can’t afford or find a smoking cessation program 28% Smoking helps me control other behaviours that I have already 17% changed I have tried to quit smoking in the past so many times, 14% I’ve given up Without cigarettes, I would fell too down or sad 14% My family and friends don’t think it is important to quit smoking 12% Questionnaire adapted from [11] (8%), arrival of a new smoking cessation medication (7%), the feeling that smoking behavior is marginalizing (4%), and information campaigns by the media (2%). Forty-three percent of smokers who intended to quit definitively reported considering using a smoking cessa- tion treatment. Nicotine patch was the most quoted treatment (18%), followed by nicotine gums (10%), bupropion (9%), varenicline - that was to be marketed several months after the survey - (5%), nicotine tablets (2%), and nicotine inhaler (1%). Other methods such as acupuncture, homeopathy, and hypnosis were quoted by 8% of the subjects. Barriers to smoking cessation were mainly fear of increased stress, irritability, and anxiety, enjoying smok- ing, and weight concerns (table 4). Discussion This survey found a surprisingly low smoking prevalence (21%) in the French population aged 15 or more. Of these, 85% were daily smokers. Thus, prevalence of daily smoking was 18%. Mean smoking rate was between 14.2 and 14.7 cigarettes per day, depending on the method used to convert non cigarette tobacco use. Prevalence of ex-smoking was 26%. Competing numbers come from the European survey on tobacco performed in 2008 in a representative sample of subjects aged 15 or more, showing a 34.2% smoking prevalence in France, a 28.3% daily smoking prevalence, and a 22.1% ex-smoking pre- valence [8]. A French survey performed in 2005 in a representative sample of subjects aged 12-75 showed a smoking prevalence of 29.9%, a daily smoking preva- lence of 24.9%, and an ex-smoking prevalence of 27.3% [6]. In this survey, mean smoking rate was 14.8 cigar- ettes per day in daily smokers, comparable to our results. Finally, a telephone survey performed in 2008 Page 6 of 8 showed a smoking prevalence of 31% [7]. Why we found a lower smoking prevalence than others is unclear. To the least, our result suggests previously pub- lished smoking prevalence numbers [6-8] could be over- estimated. Our results also show a lower rate of smoking cessa- tion attempts (63%) in current smokers than in the 2005 national survey (76.5%) [6]. Yet, only one week success were taken into account in the 2005 survey, as our study considered all attempts, even of shorter duration. Other European surveys have shown smoking cessation attempts rate exceeding 70% [15]. Few of these attempts were prompted by physicians. This lack of medical involvement has been emphasized by others in France [6] and in other countries [16-19]. In our study, family circle seemed to have the lead in triggering smoking attempts, even though about half of the quit attempts weren’t prompted by a third party. Unlike most studies [20-23] our survey didn’t show that health concern was the primary reason for quitting smoking. Cost was the first reported reason for having made the last quit attempt or for a future attempt in our study. Dramatic increases of cigarette taxes in France in 2003 and 2004 have probably boosted this reason to quit in the lead position. Social pressure also ranked high in the reasons to quit smoking, reported second for the last attempt and forth for a future attempt. The idea of improving physical fitness was the most reported reason to quit smoking in the health concern category. Here again, this result differs from what is usually reported [20-22]. Information campaigns were not considered as a signifi- cant trigger of quit attempts in our study. Interestingly, the report of smoking ban as a reason to quit doubled when moving from last attempt to a future attempt. This survey took place several months before the intro- duction of the smoking ban in France (February 2007). It seems that some smokers anticipated the ban as a potential trigger for smoking cessation. The relationship between reasons of relapse and duration of attempts is of some interest. Craving and some withdrawal symptoms (anxiety, irritability) tended to trigger the relapse quickly. Other withdrawal symptoms (weight gain and depression) triggered relapse much later. Anxiety, irritability, and depression are withdrawal symptoms that last 2-4 weeks [24]. In our study, not only depression was rarely reported, but it triggered relapse far later (median 12 months). Weight gain is considered more as an offset symptom [24], and indeed triggered delayed relapses in this study (median 4 months). Post-cessation weight gain was reported as a middle range barrier to smoking ces- sation (33%). French smokers, and particularly female smokers, are known to have a particularly high level of weight concerns [25].