Evid Based Nurs 9:109 doi:10.1136/ebn.9.4.109
  • Treatment

Review: existing evidence does not support behavioural or other specific interventions to prevent smoking relapse

 Q Are smoking relapse prevention interventions effective in people who have recently quit smoking?


GraphicData sources:

Cochrane Tobacco Addiction Review Group register of trials, which included the results of searches of Medline, PsycINFO, and conference abstracts (all to Aug 2005).

GraphicStudy selection and assessment:

randomised or quasi-randomised controlled trials of participants who had quit smoking on their own, were in enforced abstinence, or were in cessation programmes; had ⩾6 months of follow up; and compared relapse prevention interventions with no intervention, a shorter intervention, or an intervention not oriented toward relapse prevention. 42 trials (n = 30 580) met the selection criteria. Relapse prevention interventions included behavioural strategies and pharmacotherapy. Intensive behavioural intervention involved repeated face to face contact aimed at teaching people to identify tempting situations and apply coping and cognitive strategies to resist relapse. Less intensive interventions included written materials and brief face to face or telephone contacts.


smoking abstinence at follow up (⩾6 mo).


Most analyses showed no difference between relapse prevention interventions and control conditions for smoking abstinence (table).


Existing evidence does not support the effectiveness of behavioural or other specific interventions for prevention of relapse in people who have successfully quit smoking.

An earlier version of this review was published as



  1. E Ann Mohide, RN, MHSc, MSc
  1. School of Nursing, McMaster University
 Hamilton, Ontario, Canada

      Smoking cessation is a critical approach to decreasing the morbidity and mortality associated with diverse smoking related diseases and conditions.1 Pharmacologic agents, including nicotine replacement and bupropion, are effective cessation agents.2,3 Some behavioural strategies also have demonstrated effectiveness.4 Unfortunately, successful cessation often gives way to smoking relapse, estimated to be 35–40% after 1–5 years of cessation.1 This high relapse estimate suggests the need for effective smoking relapse prevention strategies.

      The review by Lancaster et al has several strengths. Firstly, only studies that explicitly identified interventions designed to prevent relapse were included. Secondly, broad categories of smoking cessation (ie, formal cessation programmes) were examined. Thirdly, where possible, analyses were based on biochemically validated smoking status. Finally, numerous subgroup analyses were undertaken, considering populations, interventions, and methodological issues.

      The findings clearly support the relative allocation of resources to those attempting to quit smoking, rather than those who have quit. Suggestions for further relapse prevention research are highlighted: potential interventions (ie, opportunistic use of nicotine replacement and morale enhancement) are identified, and research quality improvements are cited. Until specific interventions can be scientifically recommended, simple strategies, such as addressing weight gain or other negative issues, should be used to encourage continued abstinence.4


      Smoking relapse prevention interventions v no intervention, a shorter intervention, or an intervention not oriented toward relapse at ⩾6 months of follow up (outcome  =  smoking abstinence)*

 Q Are smoking relapse prevention interventions effective in people who have recently quit smoking?


      • For correspondence: Dr T Lancaster, University of Oxford, Oxford, UK.{at}

      • Source of funding: UK National Health Service.

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