Relapse-Prevention Booklets as an Adjunct to a Tobacco Quitline: A Randomized Controlled Effectiveness Trial. Academic Article uri icon


  • Relapse prevention (RP) remains a major challenge to smoking cessation. Previous research found that a set of self-help RP booklets significantly reduced smoking relapse. This study tested the effectiveness of RP booklets when added to the existing services of a telephone quitline.Quitline callers (N = 3458) were enrolled after their 2-week quitline follow-up call and randomized to one of 3 interventions: (1) Usual Care (UC): standard intervention provided by the quitline, including brief counseling and nicotine replacement therapy; (2) Repeated Mailings (RM): 8 Forever Free RP booklets sent to participants over 12 months; and (3) Massed Mailings (MM): all 8 Forever Free RP booklets sent upon enrollment. Follow-ups were conducted at 6-month intervals, through 24 months. The primary outcome measure was 7-day-point-prevalence-abstinence.Overall abstinence rates were 61.0% at baseline, and 41.9%, 42.7%, 44.0%, and 45.9% at the 6-, 12-, 18- and 24-month follow-ups, respectively. Although RM produced higher abstinence rates, the differences did not reach significance for the full sample. Post-hoc analyses of at-risk subgroups revealed that among participants with high nicotine dependence (n=1593), the addition of RM materials increased the abstinence rate at 12 months (42.2% versus 35.2%; OR=1.38; CI=1.03 -1.85; p=.031) and 24 months (45% versus 38.8%; OR=1.31; CI=1.01-1.73; p=.046).Sending self-help RP materials to all quitline callers appears to provide little benefit to deterring relapse. However, selectively sending RP booklets to callers explicitly seeking assistance for relapse prevention and those identified as highly dependent on nicotine might still prove to be worthwhile.© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail:

publication date

  • April 2015