title: Postquitting experiences and expectations of adult smokers and their association with subsequent relapse: findings from the International Tobacco Control (ITC) Four Country Survey.
abstract: BACKGROUND
  This paper explores postquitting experiences and expectations of adult ex-smokers and their utility as predictors of smoking relapse after prolonged abstinence.
  
  
  METHODS
  Data are from 1,449 ex-smokers (providing 2,234 observations) recruited as smokers as part of the International Tobacco Control (ITC) Four Country Survey (Australia, Canada, the United Kingdom, and the United States) but surveyed after they had quit. Controlling for length of time quit, reported postquitting experiences, and expectations assessed at one of three waves were used as predictors. Smoking status (whether they had relapsed) at the next wave was used as the outcome of interest.
  
  
  RESULTS
  Postquitting experiences and expectations, such as capacity to enjoy life's simple pleasures, ability to cope with stress, ability to control negative emotions, and health concerns, changed systematically over time but at different rates. The trajectory of change for life enjoyment and health concerns followed a rapidly asymptoting logarithmic function, while that of stress and negative affect coping followed a slower asymptoting square root function. After controlling for sociodemographic and abstinence duration, only reported decline in capacity to control negative affect since quitting was associated with increased relapse risk.
  
  
  CONCLUSIONS
  The varying patterns of change in postquitting experiences suggest that psychological gains over time following smoking cessation do not all occur at the same rate. The relative importance of each factor in maintaining abstinence is also not the same with deficits in perceived control of negative emotions being the only one predictive of subsequent relapse. Strategies to improve impulse control over negative emotions postquitting may help to reduce relapse risk.
authors.affiliation: VicHealth Centre for Tobacco Control, Cancer Council Victoria, Victoria, Australia. hua.yong@cancervic.org.au
authors.forename: Hua-Hie
authors.initials: HH
authors.lastname: Yong
authors.forename: Ron
authors.initials: R
authors.lastname: Borland
authors.forename: Jae
authors.initials: J
authors.lastname: Cooper
authors.forename: K Michael
authors.initials: KM
authors.lastname: Cummings
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D005260:Female; D006801:Humans; D033182:Intention; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009042:Motivation; D015999:Multivariate Analysis; D040242:Risk Reduction Behavior; D055502:Secondary Prevention; D020377:Self Efficacy; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology* / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D013997:Time Factors; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult