## 4 Discussion  
The key elements for successful smoking cessation are people's knowledge of the detrimental effects of smoking and their intentions or motivation for quitting smoking. The critical findings of this study are that most people know the detrimental effects of smoking, but based on a combined score from seven items related to quitting smoking, it is only 50% probable that people are willing to quit or plan to quit smoking. Compared to smoking, people are more likely to quit SLT use. Younger people, people with a low level of education, and farmers are less likely to quit smoking. However, younger people, along with people with a higher level of education, and businesspersons are more likely to quit using SLT. In this study, the prevalence of current smoking was the highest in people aged 40-59 years and in people who had below a secondary school certificate (SSC) level of education. The higher prevalence of smoking in those 40-59 years of age indicates that most smokers are in the workforce, and this includes daily laborers or landowners, who have a higher prevalence of tobacco smoking [34; 43; 45]. The lower prevalence of smoking later in life, especially after 60 years of age, may be associated with poorer health, which is expected during the later stages of the lifespan. This may motivate people to stop smoking or to switch to other forms of tobacco consumption, such as SLT use. We found smokeless tobacco use was higher among people aged 60 years or older. Another reason older people have lower smoking rates is that people who smoke are more likely to die before they reach old age [62]. High rates of mortality in tobacco smokers can simultaneously account for decreased smoking prevalence and increased SLT use in older adults [34; 35; 43; 45]. The lower percentage of tobacco smoking among older adults is also influenced by the fact that \begin{table}
\begin{tabular}{l l l l l l} \hline \hline  & \multicolumn{2}{l}{**Smoking: Combined Score (\%)**} & \multicolumn{2}{l}{**SLT Use: Combined Score (\%)**} \\ \hline
**Characteristics** & **No. at Risk** & **Percentage (95\% CI) \({}^{\star}\)** & \(p\)** & **No. at Risk** & **Percentage (95\% CI) \({}^{\star}\)** & \(p\)** \\ \hline Total & 62 & 50.4 (39.9, 60.9) & & 87 & 64.0 (55.3, 72.7) & \\ \hline Age, years & & & & & \\ Below 40 & 5 & 36.3 (9.3, 63.4) & 0.11 & 6 & 67.4 (49.3, 85.6) & 0.49 \\
40–59 & 34 & 53.2 (44.7, 61.8) & & 43 & 59.7 (49.8, 69.6) & \\
60 years or older & 23 & 61.6 (52.4, 70.9) & & 38 & 64.9 (55.9, 73.9) & \\ \hline Level of education & & & & & \\ No education & 20 & 44.8 (32.3, 57.3) & 0.13 & 39 & 53.2 (42.6, 63.7) & 0.02 \\ Primary to high school & 30 & 56.1 (45.5, 66.6) & & 40 & 63.8 (54.3, 73.3) & \\ SSC or above & 12 & 50.3 (34.1, 66.6) & & 8 & 75.0 (57.4, 92.6) & \\ \hline +SES & & & & & \\ Poor & 18 & 50.6 (36.9, 64.2) & 0.34 & 30 & 61.6 (50.8, 72.4) & 0.35 \\ Middle class & 44 & 54.4 (49.3, 59.5) & & 57 & 66.4 (57.3, 75.5) & \\ \hline +Occupation & & & & & \\ Homemaker & 0 & – & 0.01 & 51 & 55.7 (46.8, 64.6) & 0.28 \\ Businessperson & 9 & 50.7 (35.6, 65.9) & & 6 & 72.9 (52.3, 93.6) & \\ Employee & 13 & 58.9 (45.1, 72.6) & & 16 & 62.1 (49.3, 74.9) & \\ Farmer (Agriculture or any & 38 & 41.6 (29.4, 53.9) & & 12 & 65.3 (50.4, 80.2) & \\ hard work), & & & & & \\ Unemployed & 2 & 56.4 (49.5, 63.2) & & 2 & 51.4 (31.5, 69.5) & \\ \hline \hline \end{tabular} \({}^{\star}\) Mean (95% confidence interval (CI)) adjusted for variables in the model.  
\end{table} 
Table 6: Intention and attitudes about quitting smoking and SLT use in people who are tobacco smokers (\(n=62\)) and SLT users (\(n=87\)). those who smoke tobacco are more likely to be successful at quitting smoking due to other health problems [63]. In this study, the overall intention to quit smoking or plans or efforts to quit smoking was in the middle of the continuum (50.4%), which is similar to previous findings [64; 65; 66; 24; 58]. For example, 52% of Hong Kong Chinese planned to quit [67], and 49.5% of men in a U.S. study [65] were willing to quit smoking.