Smoking Smoking intentions and mood preceding lapse after completion of treatment to aid smoking cessation Eleni Vangeli *, John Stapleton, Robert West Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, UK 1. Introduction The chances of an attempt to stop smoking succeeding permanently vary from less than 5% with no assistance to around 25% with optimal treatment [1]. Much is known about factors triggering relapse early in quit attempts [2], but less about what might be termed ‘late relapse’ after, for example, a month of abstinence. Studies have found that 70–75% of smokers who achieve 4 weeks of abstinence relapse within the first year [3,4] and of those still abstinent at year 1, a further 30% relapse after that [4]. A recent systematic review has concluded that there is insufficient evidence to recommend any specific interventions to prevent late relapse [5]. A better understanding of the causes may help to develop effective relapse prevention interventions. This paper reports a study examining smokers’ intentions and mood at the time of first lapse after a period of abstinence. Previous studies examining relapse have followed different criteria for what constitutes initial abstinence, making it difficult to separate predictors of relapse following a minimum of 30 days of abstinence from those for which only 24 or 48 h of abstinence was achieved. Similarly, the definition of relapse varies with some researchers interpreting any report of smoking as relapse, and others applying some criterion of consecutive smoking to qualify as relapse. Studies report various predictors of relapse. For example, recent studies report that higher levels of nicotine dependence predict relapse early on [6,7] but the association diminishes beyond the first few months of abstinence [6,8]. Other background characteristics such as gender, levels of stress and parental smoking have been reported as predictors of relapse following at least 3 months cessation [9]. A study found an interactive effect of depression symptoms, nicotine dependence and weight change on relapse [10]. Another found that negative temporal comparisons (i.e. evaluating the present non-smoking state as less desirable than the past smoking state) predicted relapse [11]. However, none of these studies examined the circumstances of the first cigarette smoked, i.e. the initial lapse. Study of first lapse could be important to an understanding of relapse since it is well known that a lapse will lead to a return to regular smoking in the large majority of cases [12,13]. Marlatt et al. found that late relapse in alcohol addiction occurs in high risk situations often characterised by negative affect, interpersonal conflict, and social pressure. This has led to a cognitive-behavioural model of relapse prevention [14]. This model has been influential in the smoking cessation field, with Patient Education and Counseling 81 (2010) 267–271 ARTICLE INFO Article history: Received 15 September 2009 Received in revised form 17 December 2009 Accepted 31 January 2010 Keywords: Smoking Relapse prevention Lapse Survey ABSTRACT Objective: To examine the situation preceding ‘‘late’’ smoking relapse, particularly the availability of tobacco, mood and intentions at first lapse. Methods: A questionnaire was sent to 1439 adults identified as abstinent after treatment with a National Health Service stop-smoking clinic over the previous 3 years. Relapsers were asked where they had obtained their first cigarette, their mood and intentions immediately before first lapse. Results: 40% (n = 556) responded, of whom 35.8% (n = 199) had relapsed. At the time of first lapse, only 27.1% had made a decision to return to smoking while 48.9% intended to smoke only one or two cigarettes before stopping again. In 45.7% of cases, respondents bought cigarettes to smoke again. Prior to lapse the majority (53.8%) reported ‘‘really needing a cigarette’’. Similarly 53.8% reported being miserable at the time, while only 16% were happy. Conclusion: The most common pattern of late lapse appears to be intending to suspend the quit attempt temporarily in circumstances of needing to smoke and of negative emotional state, and in many cases cigarettes are actually sought out. Practice implications: Promoting strong ‘not a puff’ rules, a non-smoker identity and identifying negative mood as a potential vulnerability are important components of relapse prevention intervention. ß 2010 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, WCIE 6BT, UK. Tel.: +44 203 108 3070; fax: +44 207 679 8354. E-mail address: e.vangeli@ucl.ac.uk (E. Vangeli). Contents lists available at ScienceDirect Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou 0738-3991/$ – see front matter ß 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2010.01.024