Tobacco use and motivation to quit across clinical and community settings: evidence from a public health intervention model

Abstract

Tobacco smoking remains one of the leading preventable causes of disease and mortality, requiring public health systems to adopt integrated strategies that combine prevention, early identification of need, and specialized treatment. In 2025, as part of the health promotion activities of ASL Napoli 1 Centro, an observational study was conducted on adult smokers recruited in two different settings: the Center for the Prevention and Treatment of Tobacco Dependence (CPTT) and community-based information and awareness initiatives. Using the Fagerström Test for Nicotine Dependence and a Questionnaire on Motivation to Quit Smoking, nicotine dependence levels and readiness to change were analyzed in relation to the recruitment context. 

The analysis highlights differences in the characteristics of smokers identified in the two settings. Individuals accessing the CPTT show higher levels of dependence, including early-morning smoking and a greater number of cigarettes smoked per day, along with a more structured and conscious motivation to quit, often reinforced by already compromised health conditions. In community settings, a more heterogeneous population emerges, characterized by lower average dependence and more variable motivation, primarily oriented toward preventing future diseases and influenced by economic and social factors.  

The results confirm that the recruitment setting represents a determining variable in defining the smoker’s profile, both in terms of level of dependence and motivation to change. These findings highlight the need for differentiated interventions: multidisciplinary therapeutic pathways in cases of high dependence and in the presence of early or subclinical symptoms (indicated prevention), and brief counselling and empowerment interventions in universal and selective prevention contexts (Institute of Medicine, 1994). Integration between specialized services and community‑based actions thus appears to be an effective public health model to identify needs, support change, and promote long‑term cessation.