Attempts to quit smoking and relapse: Factors associated with success or failure from the ATTEMPT cohort study
Abstract
Objective To identify predictors of attempts to stop smoking and predictors of relapse.Methods This study included 2431 smokers from pre-existing Internet panels in the United States, United Kingdom, Canada, France, and Spain. These panel members are Internet users who have registered voluntarily and agreed to participate in various online research studies. Respondents were aged 35-65 years, smoked >or= five cigarettes per day and intended to stop smoking in the next 3 months. They were followed every 3 months for up to 18 months via Internet contact on measures relating to quit attempts, smoking status, motivation to quit, nicotine cue, weight and weight concern, health-related factors, withdrawal symptoms, and smoking cessation aids.Results In this study, recent quit attempts strongly predicted future attempts, but also predicted subsequent relapse. Motivation to quit was predictive of future attempts but not of relapse/abstinence following the attempts. Relapse to smoking was associated with nicotine dependence, exposure to smoking cues, craving, withdrawal symptoms, and lack of smoking cessation aids.Conclusions The findings lend support to a model of cessation in which level of motivation to stop generates quit attempts but plays little role in relapse. Dependence, social smoking cues, and a recently failed quit attempt are important factors in relapse.
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Nicotine abstinence is associated with symptoms of both increased negative affect and smoking urge/craving.
“Nicotine abstinence has been associated with symptoms of both increased negative affect (NA) and smoking urge/craving (Chandra, Scharf, & Shiffman, 2011; Zhou et al., 2009).”
From Modeling naturalistic craving, withdrawal, and affect during early nicotine abstinence: A pilot ecological momentary assessment study. (2015) · cites this paper as Zhou et al., 2009
Having experienced depression and pre-cessation depressed mood are associated with increased relapse.
“Having experienced depression and pre-cessation depressed mood have also been found to be associated with increased relapse [14, 15].”
From Depression and smoking cessation: evidence from a smoking cessation clinic with 1-year follow-up (2017) · cites this paper as [14]
Having attempted to stop and failed in the past few weeks or even months is strongly associated with failure of a subsequent quit attempt, even controlling for other measures of addiction.
“Having attempted to stop and failed in the past few weeks or even months is strongly associated with failure of a subsequent quit attempt, even controlling for other measures of addiction (25).”
From The Multiple Facets of Cigarette Addiction and What They Mean for Encouraging and Helping Smokers to Stop (2009) · cites this paper as [25]
Anxiety arising due to nicotine withdrawal has been correlated with relapse rates.
“This may be of special importance because anxiety arising due to nicotine withdrawal has been correlated with relapse rates (Zhou et al., 2009).”
From Activation of α4β2*/α6β2* nicotinic receptors alleviates anxiety during nicotine withdrawal without upregulating nicotinic receptors (2014) · cites this paper as Zhou et al., 2009
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- Authors
- Zhou, X., Nonnemaker, J., Sherrill, B., Gilsenan, A. W., Coste, F., & West, R.
- Affiliations
- RTI Health Solutions (US)
- Sanofi (France) (FR)
- University College London (GB)
- Corresponding author
- Gilsenan, Alicia W.
- Venue
- Addictive Behaviors
- Publisher
- Elsevier BV
- Published
- 2009-04
- Volume
- 34
- Issue
- 4
- Pages
- 365-373
- ISSN
- 0306-4603 (ISSN-L)
- OpenAlex
- W2026364558
- Cited by
- 508
- References
- 18
- Citations by year
- 2026: 15 · 2025: 15 · 2024: 27 · 2023: 35 · 2022: 23 · 2021: 29 · 2020: 25 · 2019: 29 · 2018: 36 · 2017: 37 · 2016: 39 · 2015: 39 · 2014: 44 · 2013: 40 · 2012: 24
- FWCI
- 11.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Addictive Behaviors (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Sanofi
- Economic and Social Research Council (ES/G007489/1)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- smoking cessation, quit attempts, relapse, motivation to quit, nicotine dependence, craving, withdrawal symptoms, smoking cessation aids, weight concern
- MeSH terms
- Adult, Aged, Humans, Longitudinal Studies, Male, Middle Aged, Substance Withdrawal Syndrome, Smoking Cessation, Risk Assessment, Internet, Secondary Prevention
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