Biochemical validation of self reported quit rates among Buddhist monks in Cambodia.

Smoking cessation programmes in Cambodia have found that Buddhist monks are highly motivated to quit smoking. Although over 23.4% of all Buddhist monks smoke, the self reported quit rates average 87%. The Adventist Development Relief Agency’s (ADRA) ‘‘Khmer Quit Now’’ programme has achieved this success through a five day smoking cessation class. ADRA has found that Buddhist monk peer support groups work well; the one year quit rate has been a consistent 87% over four years in five different Cambodian provinces. This extraordinary quit rate warranted biochemical validation and an explanation of the programme’s effective methods. To investigate the quit rate, 250 monks were identified from Cambodian Wats who had completed the smoking cessation programme. These monks were first interviewed about their smoking status, then administered a saliva test. The monks had no prior knowledge that they would be asked for a saliva sample until after they completed the survey questionnaire. Salivary cotinine, a byproduct of nicotine and marker of smoking status, was collected using the Orasure oral specimen collection device and analysed using the microplatte enzyme immunoassay technique by the Pasteur Institute in Phnom Penh. A salivary cotinine concentration greater than the cut off of 10 ng/ml determined ‘‘current smoking’’ status. Out of the 250 monks, 224 (89.6%) reported themselves as non-smokers, whereas only 12 monks (5.3% false positives) had levels above the cut off. Upon follow up, five of these monks explained that they do smoke, but felt obliged to report themselves as non-smokers during the survey. The remaining seven monks said that they chew tobacco, denied reporting themselves as nonsmokers, denied ever smoking, or were lost for follow up. This represents a concordance of 94.6% and a k statistic specifying that this study is a good (k = 0.598, SE = 0.081, p = 0.000) predictor of the monk self report quit rate (table 1). The high level of discipline and motivation among the Smoke Free Buddhist Monk quit programme is not unique to Cambodia. Any smoking cessation programme can achieve similar results with a strong peer support network, frequent motivational monitoring, and a firm quit date. Although many of the Buddhist monks had low cigarette consumption levels before they quit, this study demonstrates the success and simplicity of ‘‘natural’’ quit programmes; the Buddhist monks in this study did not rely on chemical or medicinal methods to stop smoking. They are merely a highly disciplined group of smokers who used available resources to stop smoking.