The fallback into smoking a quit attempt is simply referred to as smoking relapse. Most relapses occur within days or weeks after the initial cessation attempt. The appearance of relapse signifies that point prevalence quitting percentages are not the only outcome to be considered when determining the effect of a smoking cessation intervention, as only patients who remain smoke free truly benefit from their behavioral change.



Indicators of relapse after quitting have been analyzed by many studies. Several of these factors have been identified: a lower addiction level, an older age, fewer cigarettes smoked per day, male gender, fewer years smoked more previous quit attempts, higher self-efficacy and being married as protective indicators against smoking relapse. Studies show an increase in craving and depressed mood predict the occurrence of relapse. Additionally, studies concerning pharmacological treatment, such as Nicotine Replacement Therapy and bupropion, have demonstrated a positive influence on relapse prevention.

Still, it is unclear whether gender influences the occurrence on relapse on smoking cessation. Although Borelli et al. (2001) found that female gender predicted higher relapse rates within three months after a quit attempt and weight gain predicted relapse for men only, many other studies have shown otherwise. Garvey and Bliss (1992) did not find any predictors of relapse in correlation with gender. Accordingly, more study is necessary to ascertain the probable relationship between smoking relapse and gender. The notion of relapse has been incorporated in a number of cognitive behavioral models. One of which is Marlatt and Gordon's relapse prevention model (1985) which focus entirely on the describing the indicators of relapse, stating that both overt factors - high-risk situations, coping skills, outcomes expectations and self-efficacies) and covert determinants - lifestyle factors, carvings and urges. Another model is the transtheoretical model (Prochaska et al., 1997), which states that both relapse and behavior change are in connection with the stages of change. An individual goes through different stages of intention to reach a behavioral change. When behavior is changed, the action stage is reached, for example smoking cessation. After behavioral change has been achieved, the individual can either maintain the change in behavior or fall back into the prior behavior (relapse).

A recent questionnaire-based survey in the Netherlands investigated the influence of gender and the relapse preventive quality of action plans on the emergence of relapse in smokers after drug dependence treatment strategy. Prediction of relapse was assessed by intention, utilization of pharmacy-based minimal intervention and action plans. Action plans consisted of specific behavioral changes to quit smoking, such as quitting immediately, removing all smoking materials from home, informing people around, actively seeking smoking cessations help and prospecting a reward for self. It was found out that action plans provided a protective importance against smoking relapse. Respondents were more likely to relapse if they had quit more often in the past. Bupropion therapy during the attempt to quit predicted against relapse. The use of nicotine replacement therapy was not a very significant variable in predicting the occurrence of relapse. Men and women did not differ in relapse rates, although the predictors of relapse of both genders differed. Specifically in men, relapse was predicted by a higher intention to quit smoking at baseline. Women were more likely to relapse if the addiction level was higher and a negative self-efficacy.

Drug dependence health professionals designing relapse prevention interventions should take into account the relevance of gender when developing treatment programs. Special emphasis should be directed towards women with high addiction levels and low self-efficacies. The utilization of action plans, as a relapse prophylaxis should also incorporated into pharmacotherapy so as to improve treatment outcome.