Aim To explore predictors of smoking relapse and how predictors vary according to duration of abstinence. Design, setting and participants A longitudinal survey of 1296 ex-smokers recruited as part of the International Tobacco Control (ITC) Four Country Survey (Australia, Canada, UK, and USA). Measurements Quitters were phone interviewed at varying durations of abstinence (from one day to approximately three years) and then followed-up approximately one year later. Theorised predictors of relapse (i.e., urges to smoke; outcome expectancies of smoking and quitting; and abstinence self-efficacy) and nicotine dependence were measured in the survey. Findings Relapse was associated with lower abstinence self-efficacy and a higher frequency of urges to smoke, but only after the first month or so of quitting. Both of these measures mediated relationships between perceived benefits of smoking and relapse. Perceived costs of smoking and benefits of quitting were unrelated to relapse. Conclusions Challenging perceived benefits of smoking may be an effective way to increase abstinence self-efficacy and reduce frequency of urges to smoke (particularly after the initial weeks of quitting), in order to subsequently reduce relapse risk.

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Aims To describe the long-term natural history of a range of potential determinants of relapse from quitting smoking. Design, setting and participants A survey of 2502 ex-smokers of varying lengths of time quit recruited as part of the International Tobacco Control (ITC) Four Country Survey (Australia, Canada, UK, USA) across five annual waves of surveying. Measurements Quitters were phone interviewed at varying durations of abstinence, ranging from one to 1472 days (about 4 years) post quitting. Smoking-related beliefs and experiences (i.e., urges to smoke; outcome expectancies of smoking and quitting; and abstinence self-efficacy) were included in the survey. Findings Most theorised determinants of relapse changed over time in a manner theoretically associated with reduced risk of relapse, except most notably the belief that smoking controls weight, which strengthened. Change in these determinants changed at different rates: from a rapidly asymptoting log function to a less rapidly asymptoting square-root function. Conclusions Variation in patterns of change across time suggests that the relative importance of each factor to maintaining abstinence may similarly vary.

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