Introduction:
Every year, millions of smokers try to quit smoking. Unfortunately, a significant portion of these smokers fails to maintain abstinence for more than 24 hours, resulting in a Very Unsuccessful Attempt to Quit (VUAQ). Previous studies have shown that VUAQ is related to both levels of dependence and the severe symptoms of nicotine withdrawal. However, there are indications that other variables may also play a role. This study aimed to investigate the correlates of VUAQ using a cross-national sample.

Material and Methods:
We used data from the Global Adult Tobacco Survey (GATS) - designed to produce national estimates among all non-institutionalized men and women 15 years of age or older - from the 13 countries where almost 2/3 of smokers live. Those smokers who reported having tried to quit at least once were included in the present analysis: Bangladesh (n = 1,058); Brazil (n = 2,928); China (n = 489); Egypt (n = 1,577); India (n = 3,499); Indonesia (n = 821); Mexico (n = 839); Philippines (n = 1,288); Russia (n = 1,403); Thailand (n = 1,503); Turkey (n = 1,028); Ukraine (n = 832); Vietnam (n = 1,168). We carried out weighted regression models for VUAQ including sociodemographic, smoking, treatment, and media/perceptions as dependent variables.

Results:
VUAQ varied from 1.0% in the Philippines to 13.6% in Brazil. The category most consistently associated with VUAQ was less time to first cigarette (7 countries), followed by female gender and older age (5 countries) and cigarette advertising in stores (4 countries). Nicotine Replacement Treatment (NRT) was negatively associated with VUAQ in only two countries and Counseling and Brief Advice in none. Sociodemographic variables were more important in America, and level of dependence was less important in Asia. Treatment and Media/Perception variables were not important for VUAQ (with the exception of advertising in stores).

Conclusions:
Our findings support both the multicausality and great prevalence variability of VUAQ. Although reinforcing the importance of dependence level in many countries, the use of medications that alleviate withdrawal had hardly any effect. Interestingly, there is a justification for special interventions for women and the elderly, and also the banning of in-store advertising, in the attempt to reduce VUAQ.

Funding:
The Global Adult Tobacco Survey (GATS) functions as a multi-partner initiative that represents global, regional, and national organizations. We acknowledge WHO, CDC, GATS Implementing Agency, Johns Hopkins Bloomberg School of Public Health, RTI International, and the National Governments of Bangladesh, Brazil, China, Egypt, India, Indonesia, Mexico, Philippines, Russia, Thailand, Turkey, Ukraine, and Vietnam, for carrying out such an important survey, and releasing data for public use. Dr. Castaldelli-Maia receives a Pfizer Independent Grant for Learning and Change (IGLC) managed by Global Bridges (Healthcare Alliance for Tobacco Dependence Treatment) hosted at the Mayo Clinic, to support free smoking cessation treatment training in addiction/mental health care units in Brazil (grant IGLC 13513957). The above had no connection to the present study.