Background:
While having the largest population of smokers in the world, China is among countries with the lowest percentage of male smokers who have an intention to quit. Smoking rationalization is negatively associated with quit intention in developed countries. Our previous study has showed smoking rationalization is common among Chinese male smokers and some beliefs of smoking rationalization seem to be peculiar to China. Whether the association is generalizable to Chinese smokers remains unknown. This study aims to examine the association between smoking rationalization and quit intention among a sample of male Chinese smokers.

Methods:
A cross-sectional survey was conducted among male smokers in China in 2013. Smoking rationalization was assessed through a newly developed Chinese rationalizations scale (including 26 items under six subscales, smoking functional beliefs, risk generalization beliefs, social acceptability beliefs, safe smoking beliefs, self-exempting beliefs and quitting is harmful beliefs). Items in the scale were rated on a 5-likert scale (1 = totally disagree to 5 = totally agree). Multivariable logistic regression was performed to examine the relationship between rationalization and intention to quit, adjusted for sociodemographic variables and smoking-related variables.

Results:
A total of 3710 participants were included in the analyses. Smoking rationalization was prevalent (mean score 3.32). With 1 point increase in total rationalization scale, the odds for smokers intention to quit in the next 6 months decreased 48% (OR=0.52, 95%CI: 0.44-0.61; p< 0.001). Separate logistic regressions for six subscale of rationalization showed consistent associations with intention to quit (all p-values < 0.001). Particularly the “social acceptability beliefs” was the strongest predictor (OR=0.62, 95%CI: 0.55-0.71; p< 0.001).

Conclusions:
Smoking rationalization beliefs could be important barriers for male Chinese smokers to develop quit intention. Some beliefs have stronger association with quit intention than others. Tackling rationalization beliefs endorsed by smokers is a potential strategy for smoking cessation intervention.