Predictors of slips and relapse following sustained abstinence: A cohort study

Relapse to smoking often occurs early in quitting; however, there is limited understanding of relapse following sustained abstinence. We assessed relapse among 30-day abstainers in a population-based cohort of smokers. Data were collated from smokers at each wave in the Ontario Tobacco Survey–a representative panel study of Ontario smokers interviewed every six months for up to three years. Those not smoking for more than 30 days at the next wave (n=765) were re-assessed six-months later. Relapse was classified as a three-level outcome: continued abstinence, slipped (not smoking in the past 30-days but smoked since last interview) or relapsed (past 30-day smokers). Main reasons for quitting and slips/relapse were identified; multinomial regression assessed predictors of slips and relapse, accounting for the complex study design. Among 30-day abstainers, 47% remained abstinent for more than six-months; 17% slipped and 36% relapsed. Most respondents said they quit to improve their health while most reported they slipped or relapsed because of stress. Occasional smokers were more likely to slip than daily smokers; however, highly addicted daily smokers were more likely to relapse than slip. Compared to women and adjusted for covariates, men had a greater probability of relapsing than slipping. Single women were more likely to slip than maintain abstinence whereas single men were more likely to relapse than maintain abstinence compared to their single counterparts. Smoking addiction remains a key predictor in delayed relapse. Interventions for relapse prevention and cessation programs to assist those who slip or relapse are warranted.