title: Change in anxiety following successful and unsuccessful attempts at smoking cessation: cohort study.
abstract: BACKGROUND
  Despite a lack of empirical evidence, many smokers and health professionals believe that tobacco smoking reduces anxiety, which may deter smoking cessation.
  
  
  OBJECTIVE
  The study aim was to assess whether successful smoking cessation or relapse to smoking after a quit attempt are associated with changes in anxiety.
  
  
  METHODS
  A total of 491 smokers attending National Health Service smoking cessation clinics in England were followed up 6 months after enrolment in a trial of pharmacogenetic tailoring of nicotine replacement therapy (ISRCTN14352545).
  
  
  RESULTS
  There was a points difference of 11.8 (95% CI 7.7-16.0) in anxiety score 6 months after cessation between people who relapsed to smoking and people who attained abstinence. This reflected a three-point increase in anxiety from baseline for participants who relapsed and a nine-point decrease for participants who abstained. The increase in anxiety in those who relapsed was largest for those with a current diagnosis of psychiatric disorder and whose main reason for smoking was to cope with stress. The decrease in anxiety on abstinence was larger for these groups also.
  
  
  CONCLUSIONS
  People who achieve abstinence experience a marked reduction in anxiety whereas those who fail to quit experience a modest increase in the long term. These data contradict the assumption that smoking is a stress reliever, but suggest that failure of a quit attempt may generate anxiety.
authors.affiliation: Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK. mairtin.mcdermott@gmail.com
authors.forename: Máirtín S
authors.initials: MS
authors.lastname: McDermott
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Marteau
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Hollands
authors.forename: Matthew
authors.initials: M
authors.lastname: Hankins
authors.forename: Paul
authors.initials: P
authors.lastname: Aveyard
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety / Q000453:epidemiology*; D015331:Cohort Studies; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D009538:Nicotine / Q000627:therapeutic use; D012008:Recurrence; D012907:Smoking / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D016540:Smoking Cessation / Q000523:psychology*; D013222:State Medicine; D013315:Stress, Psychological / Q000517:prevention & control*; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control; D061485:Tobacco Use Cessation Devices; D016896:Treatment Outcome
chemical_list: D009538:Nicotine