Understanding the role of cessation fatigue in smoking relapse: Findings from the International Tobacco Control Four Country Smoking and Vaping Survey

TL;DR

Cessation fatigue, a measure of mental exhaustion from quitting smoking, better predicts relapse risk than other factors like urges to smoke or self-efficacy.

Contribution

Cessation fatigue is shown to be a stronger and independent predictor of smoking relapse compared to existing measures.

Findings

Cessation fatigue significantly predicts relapse risk, even when vaping and time since quitting are considered.

Cessation fatigue outperforms self-efficacy and strength of urges to smoke as a relapse predictor.

Time since quitting does not moderate the relationship between cessation fatigue and relapse.

Abstract

Relapse risk among people who formerly smoke is influenced by task difficulty. Cessation fatigue (CF) may be a better predictor than measures such as reported strength of urges to smoke (SUTS) and abstinence self‐efficacy (ASE). It may also be affected by quit length and use of other nicotine products. The current study investigated whether post‐quitting CF predicts higher relapse risk, its predictive utility relative to ASE and SUTS and whether the CF‐relapse prediction was moderated by time since quitting.

Data drawn from longitudinal cohort surveys conducted between 2016 and 2022 of the International Tobacco Control Four Country Smoking and Vaping Survey.

Canada, the United States, England and Australia.

People aged 18 + years who formerly smoked (n = 1914).

Generalised estimating equations logistic regression models were used to test for associations and moderation.

In separate individual analyses, CF, ASE and SUTS were statistically significant independent relapse predictors; however, when analysed together, CF was the only statistically significant relapse predictor [moderate CF: odds ratio (OR) = 1.64, 95% confidence interval (CI) = 1.21–2.23, P = 0.002; high CF: OR = 1.81, 95% CI = 1.07–3.07, P = 0.027) on top of continuing main effects of vaping and time since quitting, but time since quitting was not a moderator.

Cessation fatigue appears to predict smoking relapse risk better than other measures related to task difficulty and does so independently of vaping and time since quitting, which are both protective.