Smokers' time to first cigarette after a serious quit attempt: A three-year population based cohort study

Most reports of relapse and quitting among smokers come from clinical observations or cross-sectional studies. We explored the natural history of quitting in a population-representative cohort of smokers. Data from 2370 current adult smokers (18+) making their first serious quit attempt were compiled from the Ontario Tobacco Survey, a representative telephone survey of Ontario adults which followed smokers every six months for up to three years. Life tables were constructed to estimate length of continuous abstinence. The median length of a serious quit attempt was 7 days. By two years after a quit attempt, 91% had reported smoking again. Among respondents who were able to abstain for at least 30 days, 25% were still abstinent after two years. Among those who had not smoked by one year, 76% were abstinent after two. Older smokers (45+) were less likely than younger smokers (18 – 45) to maintain abstinence up to two years (7.7 % vs. 9.4%, respectively). While 19% of occasional smokers maintained abstinence after a quit attempt, only 7% of baseline daily smokers continued not to smoke. This study is one of few reports of long-term quitting in a population-representative sample and demonstrates that the likelihood of continuous abstinence increases with the duration of a quit attempt. A substantial number of people, however, return to smoking even after a year of continuous abstinence. Understanding relapse is important in developing successful smoking cessation interventions that engage participants for longer periods, at the population level.