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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Haile, M., Wiggers, J. H., Spigelman, A. D., Knight, J., Considine, R., & Moore, K. (2002) · ANZ Journal of Surgery · doi:10.1046/j.1445-2197.2002.02520.x · Cited by 18
Gender differences influence overweight smokers' experimentation with electronic nicotine delivery systems
Strong, D. R., Myers, M. G., Linke, S., Leas, E. C., Hofstetter, R., Edland, S. E., & Al‐Delaimy, W. K. (2015) · Addictive Behaviors · doi:10.1016/j.addbeh.2015.05.003 · Cited by 17
“…managing weight, concerns about weight remain a powerful motive predictive of tobacco use initiation (Potter, Pederson, Chan, Aubut, & Koval, 2004), persistent nicotine dependence and a barrier to cessation (Jeffery, Hennrikus, Lando, Murray, & Liu, 2000; Meyers et al., 1997; Ockene et al., 2000).”
Background
The Relationship Between Adverse Childhood Experience and Heavy Smoking in Emerging Adulthood: The Role of Not in Education, Employment, or Training Status
Lin, W., & Chiao, C. (2021) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2021.07.022 · Cited by 17
Relationships Between Craving Beliefs and Abstinence Self-Efficacy are Mediated by Smoking Motives and Moderated by Nicotine Dependence
Reese, E. D., & Veilleux, J. C. (2015) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntv054 · Cited by 20
Situational and psycho-social factors associated with relapse following residential detoxification in a population of Irish opioid dependent patients
Ducray, K., Darker, C. D., & Smyth, B. P. (2012) · Irish Journal of Psychological Medicine · doi:10.1017/s079096670001733x · Cited by 17
Predictors of Retention in an Adult Text Messaging Smoking Cessation Intervention Program: Cohort Study
Wiseman, K. P., Coa, K. I., & Prutzman, Y. M. (2019) · JMIR mhealth and uhealth · doi:10.2196/13712 · Cited by 17
“Time to first cigarette is an indicator of the level of nicotine dependence [12], and smokers with higher levels of nicotine dependence are more likely to relapse [46,47].”
Recaída en el abandono del consumo de tabaco: una revisión
Laborda, M. Q., Carreras, J. M., & Sánchez, L. (2002) · Adicciones · doi:10.20882/adicciones.514 · Cited by 15
Smoking As an Outcome Moderator In the Treatment of Alcohol Use Disorders
van Amsterdam, J., & van den Brink, W. (2022) · Alcohol and Alcoholism · doi:10.1093/alcalc/agac027 · Cited by 16
“For instance, with respect to smoking cessation, older age, female, having higher education, smoking rate and one’s own will to quit smoking have been identified as significant determinants of successful cessation (Ockene et al., 2000; Lee and Kahende, 2007; Marti, 2010; Kim, 2014; Smith et al., 2016).”
Background
Motivational Interviewing and Smoking Behaviors: A Critical Appraisal and Literature Review of Selected Cessation Initiatives
Mantler, T., Irwin, J. D., & Morrow, D. (2012) · Psychological Reports · doi:10.2466/02.06.13.18.pr0.110.2.445-460 · Cited by 16
Self-efficacy as a pathway to long-term smoking cessation among low-income parents in the multilevel Kids Safe and Smokefree intervention
Lepore, S. J., Collins, B. N., & Sosnowski, D. W. (2019) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2019.05.027 · Cited by 16
“, 2008) and that self-efficacy plays a role in long-term cessation success (Gwaltney et al., 2009; Ockene et al., 2000).”
Background
Comparative effectiveness trial of family-supported smoking cessation intervention versus standard telephone counseling for chronically ill veterans using proactive recruitment
Bastian, L. A., Fish, Gierisch, Rohrer, Stechuchak, & Grambow (2012) · Comparative Effectiveness Research · doi:10.2147/cer.s33447 · Cited by 16
“We also found self-efficacy was significantly associated with abstinence at 5 months, which is consistent with previous findings identifying self-efficacy as a strong predictor of abstinence and relapse.(49,50) Recent research has suggested that self-efficacy may be both a causal factor in quitting, as suggested by So…”
Smoking relapse reasons among current smokers with previous cessation experience in Shanghai: A cross-sectional study
Wang, R., Shenfan, L., Song, Y., Wang, Q., Zhang, R., Kuai, L., & Li, B. (2023) · Tobacco Induced Diseases · doi:10.18332/tid/167963 · Cited by 18
“Among the 838 smokers with cessation experience, the median value of cessation times was 2 (IQR: 1–3), and the smoking cessation days for the longest ranged from 1 to 2000, with a median value of 30 days (IQR: 10–120).”
Longitudinal associations between people's cessation-related experiences and their satisfaction with cessation
Baldwin, A. S., Rothman, A. J., Hertel, A. W., Keenan, N. K., & Jeffery, R. W. (2008) · Psychology and Health · doi:10.1080/08870440701639377 · Cited by 15
“Email: austin.baldwin@va.gov ISSN 0887–0446 print/ISSN 1476–8321 online 2009 Taylor & Francis DOI: 10.1080/08870440701639377 http://www.informaworld.com maintenance (Jeffery et al., 2000; Ockene et al., 2000; Rothman, 2000; Rothman, Baldwin, & Hertel, 2004).”
BackgroundInfluential
Effect of Depression and Psychosocial Stressors on Cessation Self-Efficacy in Mothers who Smoke
Prusakowski, M. K., Shofer, F. S., Rhodes, K. V., & Mills, A. M. (2010) · Maternal and Child Health Journal · doi:10.1007/s10995-010-0640-5 · Cited by 15
“Beyond socioeconomic factors, other risks such as living with another smoker, comorbid substance abuse, and depression may compound a mother’s inability to sustain a quit attempt [18].”
Background
Affective reactivity during smoking cessation of never-quitters as compared with that of abstainers, relapsers, and continuing smokers.
Lam, C. Y., Robinson, J. D., Versace, F., Minnix, J. A., Cui, Y., Carter, B. L., Wetter, D. W., & Cinciripini, P. M. (2011) · Experimental and Clinical Psychopharmacology · doi:10.1037/a0026109 · Cited by 15
“, 2000), education (Ockene et al., 2000), level of nicotine dependence (Killen, Fortmann, & Kraemer, 1992), and impulsivity (Doran, Spring, McChargue, Pergadia, & Richmond, 2004).”
Background
Long-term Maintenance of Smoking Cessation and Related Factors of Relapse
Lee, J.-S., Kang, S.-M., Kim, H.-J., Lee, K.-Y., Cho, B., & Goh, E. (2009) · Korean Journal of Family Medicine · doi:10.4082/kjfm.2009.30.3.203 · Cited by 14
Smoking Cessation After Hospital Discharge: Factors Associated With Abstinence
Streck, J. M., Chang, Y., Tindle, H. A., Regan, S., Park, E. R., Levy, D. E., Singer, D. E., Ylioja, T. E., & Rigotti, N. A. (2018) · Journal of Hospital Medicine · doi:10.12788/jhm.2997 · Cited by 15
“Psychosocial PHQ-2, Depression (median, IQR) GAD-2b, Anxiety (median, IQR) AUDIT-Cc (median, IQR) Ever used drugs intravenously (%) Illicit drug use in past yeard (%) Illicit opioid use in past year (%) 2 (0-3) 3 (1-5) 1 (0-5) 7 7 3 1 (0-3) 3 (1-4) 2 (0-5) 4 4 1 2 (0-3) 3 (1-5) 1 (0-4) 8 8 3 .”
Method
Readiness to Quit Smoking in Rural Communities
Rayens, M. K., Hahn, E. J., & Hedgecock, S. (2008) · Issues in Mental Health Nursing · doi:10.1080/01612840802319860 · Cited by 15
“In another study, stress was one of the major barriers to quitting smoking; smokers with fewer stressors are more likely to quit (Ockene et al., 2000).”
Background
Weight Gain as a Barrier to Smoking Cessation among Military Personnel
Russ, C. R., Fonseca, V. P., Peterson, A. L., Blackman, L. R., & Robbins, A. S. (2001) · American Journal of Health Promotion · doi:10.4278/0890-1171-16.2.79 · Cited by 15
The Tobacco Industry in New Zealand: A Case Study of the Behaviour of Multinational CompaniesPreprint
Thomson, G., & Wilson, N. (2003) · RePEc: Research Papers in Economics · Cited by 15
Extending smoking abstinence after release from smoke-free prisons: protocol for a randomised controlled trial
Puljević, C., Kinner, S. A., & de Andrade, D. (2017) · Health & Justice · doi:10.1186/s40352-016-0046-6 · Cited by 14
“The rationale for a 3-month end point is that the majority of smoking relapses occur within the first 3 months post-release (Ockene et al., 2000).”
Background
Personalized Feedback for Smoking and Anxiety Sensitivity: A Randomized Controlled Trial
Garey, L., Smit, T., Neighbors, C., Gallagher, M. W., & Zvolensky, M. J. (2021) · Substance Use & Misuse · doi:10.1080/10826084.2021.1900255 · Cited by 15
“High relapse rates have brought into question the effectiveness of current smoking cessation treatments (Ockene et al., 2000; Piasecki, 2006) and encouraged research to elucidate targetable and malleable mechanisms that maintain smoking behavior and impede cessation success (Elfeddali et al.,…”
Background
Tailored Mobile Messaging Intervention for Waterpipe Tobacco Cessation in Young Adults: A Randomized Trial
Mays, D. M., Johnson, A. C., Phan, L., Sanders, C., Shoben, A. B., Tercyak, K. P., Wagener, T. L., Brinkman, M. C., & Lipkus, I. M. (2021) · American Journal of Public Health · doi:10.2105/ajph.2021.306389 · Cited by 14
Cross-Cultural Validation of a Smoking Abstinence Self-Efficacy Scale in Korean American Men
Kim, S. S., Kim, S., & Gulick, E. (2009) · Issues in Mental Health Nursing · doi:10.1080/01612840802370582 · Cited by 16
“…self-efficacy predicts the outcome of smoking cessation interventions (Amodei & Lamb, 2005; Condiotte & Lichtenstein, 1981; Gwaltney et al., 2001; Ockene et al., 2000; Prochaska, DiClemente, Velicer, Ginpil, & Norcross, 1985; Shadel & Cervone, 2006; Smith, Kraemer, Miller, DeBusk, & Taylor,…”
Self-perceived ability to cope with stress and depressive mood without smoking predicts successful smoking cessation 12 months later in a quitline setting: a secondary analysis of a randomized trial
Nohlert, E., Öhrvik, J., & Helgason, Á. R. (2018) · BMC Public Health · doi:10.1186/s12889-018-5973-9 · Cited by 14
Varenicline: progress in smoking cessation treatment
Glover, E. D., & Rath, J. M. (2007) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.8.11.1757 · Cited by 14
“Some lapses may be due to psychological and behavioural aspects associated with smoking, such as environmental or social cues [31] , or due to motivational factors such as low self-efficacy or weight concerns [32] .”
Background
Nicotine Addiction: Past and Present
Office on Smoking (2010) · Cited by 14
Development of a Virtual Reality Coping Skills Game to Prevent Post-Hospitalization Smoking Relapse in Tobacco Dependent Cancer Patients
Krebs, P. M., Burkhalter, J. E., Lewis, S., Hendrickson, T., Chiu, Y. O., Fearn, P., Perchick, W., & Ostroff, J. S. (2009) · Journal of Virtual Worlds Research · doi:10.4101/jvwr.v2i2.470 · Cited by 13
A randomized comparative effectiveness study of Healthy Directions 2—A multiple risk behavior intervention for primary care
Emmons, K. M., Puleo, E., Greaney, M. L., Gillman, M. W., Bennett, G. G., Haines, J., Sprunck‐Harrild, K., & Viswanath, K. (2014) · Preventive Medicine · doi:10.1016/j.ypmed.2014.03.011 · Cited by 13
“There have been several calls to enhance the effectiveness of brief interventions in the health care setting and to boost their sustainability (Coups EJ et al. 2004; Ockene et al. 2000; Orleans 2004; Prochaska et al. 2010; Spring et al. 2012a); (Glasgow et al.”
Self-citation
Health Shocks in the Family
Margolis, R. (2013) · Journal of Aging and Health · doi:10.1177/0898264313494411 · Cited by 13
“This unhealthy behavior change may be due to increased stress, anxiety, or depressive symptoms, which may be managed by smoking (Ockene et al., 2000).”
Background
Electronic cigarette users lack intention to quit vaping
Skerry, A., Lusher, J. M., & Banbury, S. A. (2018) · MOJ Addiction Medicine & Therapy · doi:10.15406/mojamt.2018.05.00121 · Cited by 13
Outcome research methodology of smoking cessation trials (1994–1998)
Gutmann, L. B., Sobell, L. C., Prevo, M. H., Toll, B. A., Gutwein, C. L., Sobell, M. B., & Hyman, S. M. (2003) · Addictive Behaviors · doi:10.1016/j.addbeh.2003.08.019 · Cited by 13
“Because a reliable period of time beyond which relapses are unlikely to occur has not yet been identified (Brownell et al., 1986; Ockene et al., 2000), the surgeon general (U.”
BackgroundInfluential
Conscientiousness, perceived risk, and risk-reduction behaviors: A preliminary study.
Hampson, S. E., Andrews, J. A., Barckley, M., Lichtenstein, E., & Lee, M. E. (2000) · Health Psychology · doi:10.1037//0278-6133.19.5.496 · Cited by 105
Evidence-Based Smoking Cessation for College Students
Butler, K. M., Fallin‐Bennett, A., & Ridner, S. L. (2011) · Nursing Clinics of North America · doi:10.1016/j.cnur.2011.10.007 · Cited by 12
“However, because there are multiple definitions of smoking abstinence (24 hours, 7 days, 6 months, or years) and not every lapse in smoking cessation results in relapse, assessment of college student relapse is difficult.(50,51) Because there is no clear-cut definition of abstinence, it is difficult to discern where s…”
Background
A Randomized Phase II Clinical Trial of High-Dose Nicotine Patch Therapy for Smokeless Tobacco Users
Ebbert, J. O., Croghan, I. T., Schroeder, D. R., & Hurt, R. D. (2013) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntt097 · Cited by 12
Smoking Relapse Prevention Programs and Factors That Predict Abstinence: A Controlled Study Comparing the Efficacy of Workplace Group Counselling and Proactive Phone Counselling
Mayer, C., Vandecasteele, H., Bodo, M., Primo, C., Slachmuylder, J., Kaufman, L., & Razavi, D. (2010) · The Journal of Smoking Cessation · doi:10.1375/jsc.5.1.83 · Cited by 12
Quitting and restarting smoking: cohort study of patients with angina in primary care
Corrigan, M., Cupples, M. E., & Stevenson, M. (2002) · BMJ · doi:10.1136/bmj.324.7344.1016 · Cited by 12
“Since more than a third of self reported smokers subsequently reported quitting there is value in promoting smoking cessation among patients with established cardiovascular disease. Similar cycles of abstinence and relapse have been reported in other study populations”
Result

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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