Cigarette smoking is one of the modifiable risk factors for non-communicable diseases (NCDs) and is currently a major leading cause of preventable death worldwide 12. It is the main risk factor for lung cancer and a major cause of cardiovascular morbidity and mortality worldwide 34. It was estimated that 8 million people would die each year by 2030 if the current trend of smoking consumption remained unaddressed 5.

Studies have estimated that 1 in every 10 deaths in the world are caused by smoking 6; it is the leading cause of preventable deaths in the US 7. Studies have also found that over 80% of the world’s smokers lives in low and middle-income countries 89. Some developed countries around the world have seen the decline of smoking prevalence among their adult population and this is especially true for the US ^{20.9% in 2005 to 16.8% in 2014}, western Australia ^{27% in 1998 to 15% daily smokers in 2013}, and Hong Kong ^{18.8% in 1998 to 10.5% daily smokers in 2015}10. The concern with high smoking prevalence in lower socioeconomic populations is that they usually carry a greater burden of smoking related illness 11. Furthermore, researchers have found high smoking prevalence among populations who had divorced or separated from their partners, however, it also noted that smoking prevalence varies by intersection of marital status, race and ethnicity 12. In Fiji, the latest statistics about tobacco consumption available from the 2002 and 2011 STEP Survey have reported the trend of significant decline of smoking prevalence in both sexes and ethnicities. The figures stated it was 63% in 2002 compared to 52% in 2011 for I-taukei men; 54% in 2002 to 42.3% in 2011 for Indian men; 29.5% in 2002 to 24.2% in 2011 for I-taukei women; and 4.7% in 2002 to 2.3% in 2011 for Indian women 13.

As has been noted, smoking is a major cause of premature deaths worldwide and it is because of increasing risk of metabolic syndrome and diabetes which ultimately leads to cardiovascular diseases 14. It also has a detrimental effect on mental health such as schizophrenia and depression 2. Therefore, smoking cessation is especially important because it can help reduce the risk of developing cardiovascular diseases and other diseases that are associated with it 15.

One of the most important factors that can help support smoking cessation is making sure that the self-efficacy of people is higher and exposure to cigarette smoke is avoided 16. Researchers revealed that factors that can increase self-efficacy among smokers to quit smoking include motivation to quit, as well as a strong will power to quit 17. Some of the strategies to motivate smokers to attempt quitting smoking include taking advantage of teachable moments ^{post heart attack}; psychoeducation, and fear arousal via presentation of negative smoking consequences 18. It is also important to note that there are other factors such as fear of withdrawal symptoms that can also contribute to low self-efficacy 1920.

Another important factor to consider for a successful smoking cessation program is the need to look at determinants of quitting 21. Some determinants of smoking cessation included health related problems, inaccessibility of a smoking zone, pressure from non-smoking spouse and not living with a smoker 2223. On the other hand, personal factors and environmental factors such as poor knowledge of the dangers of secondhand smoke, addiction to nicotine and protective measures and the lack of smoking laws to ban smoking have been found to be the most important barriers towards quitting smoking 1622. In terms of the role of family, studies have found that some of the barriers towards abstinence from smoking, especially among adolescent smokers, includes peer pressure and weak parental control 24. Furthermore, researchers have also highlighted that high nicotine dependence and having a low level of education are also associated with low smoking cessation rates 25.

To the best of our knowledge, there has not been any study conducted in Fiji about smoking therefore, this study aimed to assess self-efficacy of smokers and to explore factors affecting confidence and quitting smoking among current adult smokers in Suva, Fiji. This information is important as it can help inform the design of an evidence-based smoking cessation program in Fiji.

Smoking is no doubt a major public health problem as it is the leading cause of preventable death 2. Henceforth, critical information is needed to successfully address smoking prevalence and improve smoking cessation programmes. Of vital information that needs to be explored is the factors affecting self-efficacy and quitting for current smokers. This section discusses these factors, considering the findings from this study and from other studies as well.

The results of our findings suggested that most smokers in this study would want to try to quit smoking by their own, and family members and health professionals, especially doctors, can play a vital role in encouraging them to do so. These findings are consistent with findings from other studies stating that smokers will successfully quit smoking if they are motivated enough, especially during teachable moments ^{during and post illness} and financial hardship moments 182829. Unfortunately, findings from the quantitative study found that majority of the study participants mentioned that they were not advised by their doctor to quit smoking when they visited the healthcare facilities. This is consistent with the findings from other studies and it could be reasoned to the, “stress of diagnosis, time constraints, inadequate resources and lack of connection between smoking, cancer and health, beliefs among health professionals that someone else should deliver intensive behavioural support” 303132. However, most participants in this study said they received more advice from their family members to quit smoking. This could be attributed to the fact that most of the smokers in this study are married and have 5-6 household members, which gives them many chances to receive advice from these family members. It could also be due to the fact that most of these smokers are aged 20-29 years old and their parents would still be alive to be advising them about making wise decisions in life. Studies have shown that having the advice from family members such as parents and spouse, is an effective way to motivate people to contemplate quitting smoking 3334. Further, findings from the qualitative study also reported the same issue with most of the study participants stating that they are not aware of any doctors or counsellors available to provide support to those who are willing to quit. This supports the influence of family support reinforcing behavioral change 35. The qualitative findings also found that the reasons behind smokers trying to quit smoking by their own include other factors such as having a strong interest to promote their own health and are experiencing financial constraints. Nevertheless, the lack of commitment from health professionals to advise current smokers to quit smoking could be a critical reason to the low self-efficacy of quitting smoking among current smokers as studies have suggested that smokers who intend to quit smoking need support over the course of smoking cessation 3236. Financial constraints could be one of the more important triggers that motivate study participants to quit smoking since we have noted from our quantitative findings that majority of them had a household income of $8,000 - $15,000 FJD per year, live in urban areas, are married and most had 5 to 6 household members. This finding supports the results of other studies stating that socioeconomic status is significantly associated with the ability to quit smoking 3738. In this study most of the study participants are seriously intending to quit smoking, and the fact that more than two thirds of the study participants were thinking of quitting smoking would confirm this. It is inconsistent with the findings from other studies that showed smokers have low levels of intention to quit, primarily because smoking is deeply integrated into their social norms 3940.

The findings of this study also revealed that majority of the smokers who quit the last time reasoned their cessation failed mostly by strong influence from smoking friends and psychological cravings. This is a crucial finding as it indicates that smokers have a low self-efficacy to quit smoking and the self-efficacy results confirmed this, noting that majority of the smokers had a low self-efficacy to quit smoking. These findings are consistent with findings from other studies, noting that smoking family members and friends are the main barriers to quit smoking, while addiction to smoking or nicotine dependence makes it an important part of life which is hard to get rid of 41424344. The findings from the qualitative study reaffirm this revelation as most study participants also highlighted that smoking friends is the main barrier to successfully quit smoking while, and as well as, the lack of will power to refuse a cigarette when it is offered by smoking friends. This is similar to the findings from other studies 4546.

In terms of stages of change model, this study found that less than half of the study participants were at the stage of pre contemplation and contemplation while very few of them were at the stage of preparation, action and maintenance 47. The lack of intention and planning to quit smoking could be attributed to the strong influences of friends’ smoking, psychological cravings for smoking among current smokers, loss of a way to handle stress and perception that smoking helps establish friendship with other smokers, as was found in both the quantitative and qualitative part of the study 4348. Other studies have also found that smokers do not intend to quit smoking mainly because of addiction or high nicotine dependence, and lack of information and perceived availability of support to quitting 4950. Our qualitative finding also noted that most participants lack the will power to say no when a cigarette is being offered by a smoking friend. It is understandable that very few of the study participants are at the stage of preparation, action and maintenance of quitting smoking because this study only recruited current smokers, and also less than half of the study participants are in the contemplation stage of quitting.

The results of this study showed a low level of confidence among smokers. Considering the results of this study and factors highlighted in both qualitative and quantitative study can help decision makers to developed smoking preventive strategies. Using theories and models that focus of changing behaviors, such as Health Belief Model (HBM), Transtheoretical Model (TTM) and Stage of change, can help smokers to quit smoking. Family support and promoting community knowledge about smoking and its harms can reduce smoking among smokers. School based education should be a priority to prevent smoking among Fijians.

MM: Conceptualization, methodology, data curation, writing manuscript. MK: writing manuscript. SK: analyzed the data. LM: data collection. TM: edited the manuscript. All authors have read and agreed to the published version of the manuscript.

This project was funded by the Fiji National University grant.

The data will be available from the corresponding author on reasonable request.

Ethical approval was obtained from the Fiji National University (FNU), College Health Research Ethics Committee (CHREC)- ID: 010.19. Written informed consent was obtained from the participants. We also confirm that all methods were carried out in accordance with relevant guidelines and regulations.