Self-reported time-to-relapse following smoking cessation: Comparison by operationalization of initial abstinence classification

Abstract

Aims: Relapse rates among cigarette smokers are high. Few studies have examined time-to-relapse using survival analysis in racially/ethnically diverse smokers and initial abstinence criteria have been inconsistent or unspecified. This study compared survival curves using two common definitions of initial abstinence. We hypothesized greater relapse rates among participants abstinent for only 24 hours (h) at the end-of-therapy (EOT) compared with 7 days. Methods: Adult smokers (59% Black, 22% Hispanic and 17% White) received 8-sessions of group cognitive behavioural therapy (CBT) plus transdermal nicotine patches and were assessed monthly up to 12 months post-EOT. Participants reporting abstinence (7-day point prevalence abstinence [ppa] or 24-h ppa) at the EOT were included in Kaplan–Meier curves. Results: Of 301 participants, 120 (40%) reported 7-day ppa at the EOT and an additional 29 (10%) reported 24-h ppa only. Over the 12-month follow-up period, nearly 50% remained abstinent. Of those who resumed smoking, most relapses occurred within the first three months. Survival curves indicated that median survival was 207 and 225 days for 7-day and 24-h definitions of abstinence, respectively. The difference in time-to-relapse between participants abstinent for 24 h at the EOT versus 7-days was not significant (p = 0.14). Conclusions: Operationalization of initial abstinence is important for relapse analyses and comparisons of survival curves across samples. Participants reported high rates of abstinence and relapse rates were relatively low. Contrary to expectations, 24-h ppa at the EOT was not associated with greater relapse than 7-day abstinence. This suggests either measure may be utilized in relapse prevention research in racially/ethnically diverse treatment-seekers.

• Cognitive behavioral therapy
• disparities
• relapse
• smoking cessation
• survival

Acknowledgements

We thank the members of the Tobacco, Obesity, and Oncology Laboratory (TOOL) for their efforts in conducting the study. Finally, we sincerely thank the participants in the study, as it would not be possible without their valuable contributions.

Declaration of interest

The authors have no financial conflicts of interest to declare.

Many thanks to the James and Esther King Biomedical Research Program of the Florida Department of Health (2KN03), The Papanicolaou Corps for Cancer Research, and the Sylvester Comprehensive Cancer Center for funding this research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.