Abstract
BACKGROUND: This study examined the influence of knowledge and attitudes on smoking cessation behaviors among Koreans-including both individuals who have quit smoking and those who continue to smoke-using an extended KAP (knowledge, attitude, and practice) model. METHODS: Data for this study were drawn from the Korean National Cancer Prevention Awareness and Practice Survey conducted between 2014 and 2023, encompassing 12,400 participants. After excluding responses lacking data on KAP questions and individuals who had never smoked, the final analytic sample comprised 4,794 participants. To evaluate the associations among knowledge (that smoking causes cancer), attitudes (regarding smoking cessation for cancer prevention), and practice (the decision to stop smoking), we employed multiple logistic regression and mediation analyses to assess both the direct and indirect effects of these variables on smoking behavior. RESULTS: Most participants demonstrated awareness that smoking causes cancer. In assessing the associations among knowledge, attitude, and practice, a decline in odds ratios was observed in 2023 compared with 2021. Attitudes toward smoking cessation for cancer prevention exerted a direct influence on the decision to quit smoking, with effect sizes of 0.23 in 2014, - 0.10 in 2016, 0.50 in 2018, 0.42 in 2021, and 0.40 in 2023. Furthermore, knowledge about smoking indirectly influenced the decision to quit smoking via its effect on attitudes toward cessation, with indirect effects of 0.12 in 2018, 0.10 in 2021, and 0.09 in 2023. Notably, knowledge did not directly affect practice; thus, attitudes toward smoking cessation emerged as the primary mediator between knowledge and the decision to quit smoking. CONCLUSIONS: Our findings indicate that the decision to quit smoking is significantly influenced by individuals' attitudes toward smoking. Consequently, smoking cessation policies and interventions should integrate strategies that address attitudes in tandem with knowledge and practice components among Koreans. Moreover, the gradual weakening of the relationships among knowledge, attitudes, and practices over time underscores the need to reinforce these associations through innovative smoking cessation policies.