Understanding the role of cessation fatigue in smoking relapse: Findings from the International Tobacco Control Four Country Smoking and Vaping Survey

AbstractBackground and AimRelapse risk among people who formerly smoke is influenced by task difficulty. Cessation fatigue (CF) may be a better predictor than measures such as reported strength of urges to smoke (SUTS) and abstinence self‐efficacy (ASE). It may also be affected by quit length and use of other nicotine products. The current study investigated whether post‐quitting CF predicts higher relapse risk, its predictive utility relative to ASE and SUTS and whether the CF‐relapse prediction was moderated by time since quitting.DesignData drawn from longitudinal cohort surveys conducted between 2016 and 2022 of the International Tobacco Control Four Country Smoking and Vaping Survey.SettingCanada, the United States, England and Australia.ParticipantsPeople aged 18 + years who formerly smoked (n = 1914).MeasurementsGeneralised estimating equations logistic regression models were used to test for associations and moderation.FindingsIn separate individual analyses, CF, ASE and SUTS were statistically significant independent relapse predictors; however, when analysed together, CF was the only statistically significant relapse predictor [moderate CF: odds ratio (OR) = 1.64, 95% confidence interval (CI) = 1.21–2.23, P = 0.002; high CF: OR = 1.81, 95% CI = 1.07–3.07, P = 0.027) on top of continuing main effects of vaping and time since quitting, but time since quitting was not a moderator.ConclusionsCessation fatigue appears to predict smoking relapse risk better than other measures related to task difficulty and does so independently of vaping and time since quitting, which are both protective.