Cited by 337Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesBehavioral Health and Interventions

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Relapse and maintenance issues for smoking cessation

Ockene, Judith K., Mermelstein, Robin J., Bonollo, Debra S., Emmons, Karen M., Perkins, Kenneth A., Voorhees, Carolyn C., Hollis, Jack F.·2000·Health Psychology

DOI 10.1037/0278-6133.19.suppl1.17

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Abstract

This article reviews short-term (6 months) and longer term (12-24 months) maintenance of cessation and relapse in adult smokers and the factors and treatments that affect these outcomes. MedLine and PsycLIT searches were done for research published in English between 1988 and 1998 meeting a defined set of criteria. Intensive intervention, telephone counseling, and use of pharmacotherapy were found to improve outcomes; however, compared with public health approaches, they reach relatively few smokers. Brief interventions during medical visits are cost-effective and could potentially reach most smokers but are not consistently delivered. Predictors of relapse include slips, younger age, nicotine dependence, low self-efficacy, weight concerns, and previous quit attempts. Potential areas for research, recommendations for longer follow-up assessments, and standard definitions for slip, relapse, and long-term maintenance are discussed.

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BackgroundResultInfluential
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Influential
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Gender Differences in Associations between Lifetime Alcohol, Depression, Panic Disorder, and Posttraumatic Stress Disorder and Tobacco Withdrawal
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Background
Proactive Telephone Counseling for Smoking Cessation: Meta-analyses by Recruitment Channel and Methodological Quality
Tzelepis, F., Paul, C. L., Walsh, R. A., McElduff, P., & Knight, J. (2011) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djr169 · Cited by 64
Quitting smoking in China: findings from the ITC China Survey
Jiang, Y. Z., Elton‐Marshall, T., Fong, G. T., & Li, Q. (2010) · Tobacco Control · doi:10.1136/tc.2009.031179 · Cited by 63
“In addition to increasing public awareness about the risks of smoking, it is also important to increase smokers’ confidence that they can quit smoking.(19) These findings demonstrate that smokers lack the self-efficacy to be able to quit smoking.”
Background
It Takes Two
Franks, M. M., Pienta, A., & Wray, L. A. (2002) · Journal of Aging and Health · doi:10.1177/08964302014003002 · Cited by 59
“A recent review of smoking cessation treatments and outcomes (Ockene et al., 2000) reveals the complexity of decisions to smoke, to 336 AUTHORS’NOTE: American Association of Retired People (AARP) Andrus Foundation and theNational Institute onAging provided partial support for this research.”
Influential
Bupropion for the treatment of nicotine withdrawal and craving
Mooney, M. E., & Sofuoglu, M. (2006) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.6.7.965 · Cited by 65
The effects of controlled deep breathing on smoking withdrawal symptoms in dependent smokers
McClernon, F. J., Westman, E. C., & Rose, J. E. (2004) · Addictive Behaviors · doi:10.1016/j.addbeh.2004.02.005 · Cited by 62
“, 1984) and are reportedly strong predictors of relapse (Ockene et al., 2000).”
Background
The role of self‐efficacy, recovery self‐efficacy, and preparatory planning in predicting short‐term smoking relapse
Elfeddali, I., Bolman, C. A. W., Candel, M. J. J. M., Wiers, R. W. H. J., & de Vries, H. (2011) · British Journal of Health Psychology · doi:10.1111/j.2044-8287.2011.02032.x · Cited by 63
“…self-efﬁcacy showed that low levels of self-efﬁcacy predict relapse and conﬁrm the results of previous studies (Amodei & Lamb, 2005; Dijkstra & Borland, 2003; Dijkstra & de Vries, 2000;Gwaltney, et al ., 2009; Gwaltney, Shiffman, Balabanis, & Paty, 2005; Mudde, et al. , 1995; Ockene et al. , 2000).”
Result
Comparative efficacy of rapid‐release nicotine gum versus nicotine polacrilex gum in relieving smoking cue‐provoked craving
NIAURA, R. S., Sayette, M. A., Shiffman, S. S., Glover, E. D., Nides, M., Shelanski, M. V., Shadel, W. G., Koslo, R., Robbins, B., & Sorrentino, J. (2005) · Addiction · doi:10.1111/j.1360-0443.2005.01218.x · Cited by 61
Calorie restriction increases cigarette use in adult smokers
Cheskin, L. J., Hess, J. M., Henningfield, J. E., & Gorelick, D. A. (2004) · Psychopharmacology · doi:10.1007/s00213-004-2037-x · Cited by 61
“1998) and smoking cessation is associated with weight gain (Froom et al. 1998; Jeffery et al. 2000; Ockene et al. 2000; Varner 1999)—an average of 6 kg in continuously abstinent individuals (Klesges et al.”
BackgroundInfluential
Unaided smoking cessation and predictors of failure to quit in a community sample: effects of gender.
Westmaas, J. L., & Langsam, K. L. (2005) · Addictive Behaviours · doi:10.1016/j.addbeh.2005.03.001 · Cited by 64
What does it mean to want to quit?
Balmford, J., & Borland, R. (2007) · Drug and Alcohol Review · doi:10.1080/09595230701710829 · Cited by 61
Patterns of motivations and ways of quitting smoking among Polish smokers: A questionnaire study
Siemińska, A., Buczkowski, K., Jassem, E., Lewandowska, K., Ucińska, R., & Chełmińska, M. (2008) · BMC Public Health · doi:10.1186/1471-2458-8-274 · Cited by 60
Smokers in Pain Report Lower Confidence and Greater Difficulty Quitting
Zale, E. L., Ditre, J. W., Dorfman, M. L., Heckman, B. W., & Brandon, T. H. (2014) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntu077 · Cited by 59
“…initiation of quit attempts (e.g., Vangeli, Stapleton, Smit, Borland, & West, 2011), and self-reported confidence in quitting (i.e., abstinence self-efficacy) has been shown to reliably predict duration of smoking abstinence (e.g., Gwaltney, Metrik, Kahler, & Shiffman, 2009; Ockene et al., 2000).”
Background
Personality traits, perceived risk, and risk-reduction behaviors: A further study of smoking and radon.
Hampson, S. E., Andrews, J. A., Barckley, M., Lichtenstein, E., & Lee, M. E. (2006) · Health Psychology · doi:10.1037/0278-6133.25.4.530 · Cited by 58
“Because of their previous associations with smoking and risk perceptions, we also controlled for the effects of education, and examined the interactive effects of age and gender (Hampson et al., 2000; Ockene et al., 2000; Slovic, 1992).”
Background
Long-Term Smoking Cessation Outcomes Among Childhood Cancer Survivors in the Partnership for Health Study
Emmons, K. M., Puleo, E., Mertens, A. C., Gritz, E. R., Diller, L., & Li, F. P. (2008) · Journal of Clinical Oncology · doi:10.1200/jco.2007.13.0880 · Cited by 58
Self-citation
Changes in smoking associated with an acute health event: Theoretical and practical implications
Boudreaux, E. D., Baumann, B. M., Camargo, C. A., O’Hea, E., & Ziedonis, D. M. (2007) · Annals of Behavioral Medicine · doi:10.1007/bf02879900 · Cited by 56
Heterogeneity in 12‐month outcome among female and male smokers
Swan, G. E., Javitz, H. S., Jack, L. M., Curry, S. J., & McAfee, T. A. (2004) · Addiction · doi:10.1111/j.1360-0443.2003.00629.x · Cited by 56
Lower Prevalence of Cigarette and Waterpipe Smoking, But a Higher Risk of Waterpipe Dependence in Lebanese Adult Women Than in Men
Salameh, P., Khayat, G., & Waked, M. (2012) · Women & Health · doi:10.1080/03630242.2012.656885 · Cited by 56
“, 1986), and females were less likely to respond to smoking cessation therapy (Scharf & Shiffman, 2004; King et al., 2006; Ockene et al., 2000).”
Background
Using Decision Tree Analysis to Identify Risk Factors for Relapse to Smoking
Piper, M. E., Loh, W.-Y., Smith, S. S., Japuntich, S. J., & Baker, T. B. (2011) · Substance Use & Misuse · doi:10.3109/10826081003682222 · Cited by 53
“, 1997), length of abstinence in previous quit attempts (Garvey et al., 1992; Ockene et al., 2000), marital status (Derby et al.”
Background
Self-Efficacy and Motivation to Quit of Smokers Seeking to Quit: Quantitative Assessment of Smoking Cessation Mobile Apps
Rajani, N. B., Mastellos, N., & Filippidis, F. T. (2021) · JMIR mhealth and uhealth · doi:10.2196/25030 · Cited by 52
“Behavioral support interventions, particularly individual and group counseling, often use techniques targeting self-efficacy and motivation to quit of smokers, which are factors found to increase the likelihood of smokers making quit attempts and successfully quitting [7-11].”
Background
Reasons for not using smoking cessation aids
Gross, B., Brose, L. S., Schümann, A., Ulbricht, S., Meyer, C., Völzke, H., Rumpf, H., & John, U. (2008) · BMC Public Health · doi:10.1186/1471-2458-8-129 · Cited by 54
“It has been shown that smoking more cigarettes per day, having a higher degree of nicotine dependence, and less quit attempts in the past are associated with less success in quitting smoking [13].”
Background
Retreatment With Varenicline for Smoking Cessation in Smokers Who Have Previously Taken Varenicline: A Randomized, Placebo-Controlled Trial
Gonzales, D. H., Hájek, P., Pliamm, L., Nackaerts, K., Tseng, L.-J., McRae, T. D., & Treadow, J. (2014) · Clinical Pharmacology & Therapeutics · doi:10.1038/clpt.2014.124 · Cited by 52
Advice as a smoking cessation strategy: A systematic review and implications for physical therapists
Bodner, M. E., & Dean, E. (2009) · Physiotherapy Theory and Practice · doi:10.1080/09593980903011887 · Cited by 51
“There appears to be no set duration of abstinence in which a safe point for cessation maintenance occurs (Gilpin, Pierce, and Farkas, 1997; Ockene et al, 2000).”
Background
Self-efficacy to refrain from smoking predicted by major depression and nicotine dependence
John, U., Meyer, C., Rumpf, H., & Hapke, U. (2004) · Addictive Behaviors · doi:10.1016/j.addbeh.2004.02.053 · Cited by 51
Exploring Refinements in Targeted Behavioral Medicine Intervention to Advance Public Health
King, A. C., Ahn, D. K., Atienza, A. A., & KRAEMER, H. C. (2008) · Annals of Behavioral Medicine · doi:10.1007/s12160-008-9032-0 · Cited by 52
“Among the health contributions made by the behavioral and social sciences are advances in methods and interventions for reducing tobacco use [2]; contributions to behavioral risk factor management that have contributed to reductions in cardiovascular disease and enhanced chronic disease management [3, 4]; successes in…”
Background
Randomized controlled trial of physical activity counseling as an aid to smoking cessation: 12 month follow-up
USSHER, M. H., West, R., McEwen, A., Taylor, A. H., & Steptoe, A. (2007) · Addictive Behaviors · doi:10.1016/j.addbeh.2007.04.009 · Cited by 49
“Consistent with previous reports (Ockene et al., 2000; Swan, Ward, & Jack, 1996) smoking abstinence was predicted by greater confidence in quitting before the quit date and by lower depression in the early phase of abstinence.”
Result
Promoting repeat tobacco dependence treatment: are relapsed smokers interested?
Fu, S. S., Partin, M. R., Snyder, A., An, L. C., Nelson, D. B., Clothier, B. A., Nugent, S. M., Willenbring, M. L., & Joseph, A. M. (2006) · PubMed · Cited by 49
Reward Sensitization: Effects of Repeated Nicotine Exposure and Withdrawal in Mice
Hilário, M. R. F., Turner, J. R., & Blendy, J. A. (2012) · Neuropsychopharmacology · doi:10.1038/npp.2012.130 · Cited by 48
“The magnitude of nicotine dependence, as well as the negative state and dysphoria associated with nicotine withdrawal, are good predictors of smoking relapse (Ockene et al, 2000).”
Background
Methods of the International Tobacco Control (ITC) China Survey
Wu, C., Thompson, M. E., Fong, G. T., Li, Q., Jiang, Y., Yang, Y., & Feng, G. (2009) · Tobacco Control · doi:10.1136/tc.2009.029900 · Cited by 48
A Call for More Effectively Integrating Behavioral and Social Science Principles Into Comprehensive Diabetes Care
Fisher, L., & Glasgow, R. E. (2007) · Diabetes Care · doi:10.2337/dc07-1166 · Cited by 47
Can transtheoretical model measures predict relapse from the action stage of change among ex-smokers who quit after calling a quitline?
Segan, C., Borland, R., & Greenwood, K. M. (2005) · Addictive Behaviors · doi:10.1016/j.addbeh.2005.05.023 · Cited by 47
Coronary heart disease multiple risk factor reduction
Rosal, M. C., Ockene, J. K., Luckmann, R., Zapka, J. G., Goins, K. V., Saperia, G. M., Mason, T. H., & Donnelly, G. (2004) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2004.04.020 · Cited by 47
Self-citation
Effect of Network Social Capital on the Chances of Smoking Relapse: A Two-Year Follow-up Study of Urban-Dwelling Adults
Moore, S., Teixeira, A., & Stewart, S. (2014) · American Journal of Public Health · doi:10.2105/ajph.2014.302239 · Cited by 47
Impact of Gamification on the Self-Efficacy and Motivation to Quit of Smokers: Observational Study of Two Gamified Smoking Cessation Mobile Apps
Rajani, N. B., Mastellos, N., & Filippidis, F. T. (2021) · JMIR Serious Games · doi:10.2196/27290 · Cited by 59
“The association between high self-efficacy and motivation to quit with better cessation outcomes has been established in a large number of previous studies [6-9].”
BackgroundResult
Is self-efficacy for smoking abstinence a cause of, or a reflection on, smoking behavior change?
Perkins, K. A., Parzynski, C. S., Mercincavage, M., Conklin, C. A., & Fonte, C. A. (2011) · Experimental and Clinical Psychopharmacology · doi:10.1037/a0025482 · Cited by 45
Self-citation

Authors: Ockene, J. K., Mermelstein, R. J., Bonollo, D. S., Emmons, K. M., Perkins, K. A., Voorhees, C. C., & Hollis, J. F.
Affiliations: University of Massachusetts Chan Medical School (US)
University of Massachusetts Boston (US)
Harvard University (US)
University of Pittsburgh (US)
National Cancer Institute (US)
Kaiser Permanente (US)
ORCID: Ockene, Judith K.
Mermelstein, Robin J.
Emmons, Karen M.
Perkins, Kenneth A.
Venue: Health Psychology
Publisher: American Psychological Association (APA)
Published: 2000-01
Volume: 19
Issue: 1, Suppl
Pages: 17-31
ISSN: 0278-6133 (ISSN-L)
1930-7810
DOI: 10.1037/0278-6133.19.suppl1.17
OpenAlex: W2096002727
Cited by: 337
References: 117
Citations by year: 2026: 3 · 2024: 2 · 2023: 4 · 2022: 11 · 2021: 15 · 2020: 6 · 2019: 9 · 2018: 17 · 2017: 8 · 2016: 9 · 2015: 14 · 2014: 17 · 2013: 14 · 2012: 22
FWCI: 6.73
Type: journal article
Language: en
Open access: closed
Locations: Health Psychology (publishedVersion)
PubMed (publishedVersion)
The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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, relapse, long-term maintenance, nicotine dependence, self-efficacy, slip, telephone counseling, pharmacotherapy, brief intervention, public health approach, predictors of relapse, cost-effectiveness
MeSH terms: Adult, Cardiovascular Diseases, Counseling, Follow-Up Studies, Health Promotion, Humans, Life Style, Outcome and Process Assessment, Health Care, Recurrence, Health Behavior, Smoking Cessation

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Relapse and maintenance issues for smoking cessation

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