The natural history of quitting smoking: findings from the International Tobacco Control (ITC) Four Country Survey

Abstract

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.

Cross validation of the prognostic and diagnostic utility of tobacco craving in a general and a pregnant sample of treatment-seeking smokers

“…Examination of the timelines of Expectancy, Purposefulness, and craving to smoke craving remained relatively stable from 2 weeks post-quitting through the 16th week of the study in pregnant women continuing to smoke, whereas these aspects of craving decreased in pregnant smokers who were abstinent. The current analysis suggests no distinction between pregnant smokers and the general population of smokers for changes in craving over time; during smoking abstinence, craving decreases, and during a failed quit attempt, it does not, consistent with studies of non-pregnant smokers(Berlin et al, 2011, 2013, Herd and Borland 2009). Indeed, researchers (Heil et al, 2006 have posited that the rationale for using nicotine replacement therapy (NRT) with pregnant smokers was supported by the characterization of craving and withdrawal as salient predictors of relapse in the general sample of smokers.…”

Ecological momentary assessment in the investigation of craving and substance use in daily life: A systematic review

“…For example, men seem to experience lower craving than women in some studies (Elman et al, 2001;Robbins et al, 1999;Saladin et al, 2012;Yu et al, 2007), while individuals with higher impulsivity or novelty seeking traits tend to have higher craving levels (Franken, 2002;Papachristou et al, 2012;Powell et al, 1992;Zilberman et al, 2003). Craving ratings are also influenced by substance use characteristics such as levels of use, duration of abstinence, or dependence severity (Herd and Borland, 2009;Hughes, 1992;Watson et al, 2010), and by period of assessments relative to the target quit date (Hughes, 1992;McCarthy et al, 2006). Given the growing role of EMA in clinical research, but also important variation in findings, the objective of this systematic review was to: (1) assess the link between craving and substance use in all published studies using EMA; and (2) identify the relevant moderators of this relationship among substance users.…”

Predictors of smoking relapse by duration of abstinence: findings from the International Tobacco Control (ITC) Four Country Survey

“…were drawn from established psychosocial models of health behaviour (refer to Fong et al (23)) and have been used in past research exploring predictors of quitting (24). Responses to each item were recorded on four- or five-point Likert scales (for more details of each measure see Herd et al (13)).…”

“…Results in the corresponding trends paper (13) found that the majority of proposed predictors of relapse changed according to a logarithmic or square-root function. Therefore, for duration of abstinence in the current study, we used the transformation that best fitted each of the dependent variables in the previous paper; a log transformation of days quit was used for proposed predictors that changed over time according to a log function and a square root transformation was used for those that changed according to a square root function.…”

“…In a companion paper (13), we showed that smoking related beliefs and experiences change systematically after quitting. Measures of most variables studied (e.g., frequency of urges to smoke, abstinence self-efficacy) changed relatively rapidly during the first few weeks of quitting before beginning to asymptote; however, the rate of asymptoting varied from a rapid, logarithmic, function to a slower, square-root function of time.…”