Development and initial validation of a cessation fatigue scale

Abstract

Background Smoking cessation fatigue, or tiredness of attempting to quit smoking, has been posited as a latent construct encompassing loss of motivation, loss of hope in cessation success, decreased self-efficacy, and exhaustion of self-control resources. Despite the potential clinical impact of characterizing cessation fatigue, there is currently no validated measure to assess it. Using a rational scale development approach, we developed a cessation fatigue measure and examined its reliability and construct validity in relation to a) smokers’ experience of a recently failed quit attempt (QA) and b) readiness to engage in a subsequent QA. Methods Data were drawn from an online cross-sectional survey of 484 smokers who relapsed from a QA within the past 30 days. Results Exploratory factor analysis identified three factors within the 17-item Cessation Fatigue Scale (CFS), which we labeled: emotional exhaustion, pessimism, and devaluation. High internal consistency was observed for each factor and across the full scale. As expected, CFS overall was positively associated with withdrawal severity and difficulty quitting. CFS was negatively associated with previously validated measures of intention to quit, self-efficacy, and abstinence-related motivational engagement, even after adjusting for nicotine dependence. Conclusions Findings provide initial validation for a new tool to assess cessation fatigue and contribute needed information on a theory-driven component of cessation-related motivation and relapse risk.

Longer duration of smoking abstinence is associated with waning cessation fatigue

“…In this study, we found several sociodemographic variables that predicted cessation fatigue. Younger quitters reported higher cessation fatigue, consistent with findings from two prior studies (Heckman et al, 2018;Mathew et al, 2017). Higher education was associated with higher fatigue.…”

“…This study also provides insights about factors associated with cessation fatigue which may provide clues about how cessation fatigue influences risk of relapse. In general, the findings from this population-based study on correlates of cessation fatigue correspond to those from studies based on convenience samples of smokers and those recruited for treatment studies (Bekiroglu et al, 2017;Heckman et al, 2018;Liu et al, 2013;Mathew et al, 2017;Piper et al, 2011). In this study, we found several sociodemographic variables that predicted cessation fatigue.…”

“…These findings are consistent with the initial conceptualization of cessation fatigue (Piasecki et al, 2002), and a recently proposed workload-capacity model of health behaviors (Heckman, Mathew, & Carpenter, 2015;Mathew et al, 2017). The latter predicts cessation fatigue will emerge as workload (i.e., demands from quitting and general life demands) increases or capacity (i.e., coping resources) decreases.…”

“…Higher ratings of cessation fatigue were reported in those who used stop smoking medications and nonpharmacological methods to aid their quit attempt. These results are similar to those from another cross-sectional survey study (Mathew et al, 2017), but opposite to those from a clinical trial in which smokers randomized to receive active medications had lower fatigue relative to the placebo condition (Liu et al, 2013). This discrepancy may be due to selection bias, as smokers who use these treatments are typically more nicotine dependent and experience more severe nicotine withdrawal (Shiffman, Di Marino, & Sweeney, 2005).…”

“…These studies strongly suggest that task difficulty is a cause of fatigue, as might be expected. Finally, an observational study used a multi-item Cessation Fatigue Scale (Mathew, Heckman, Meier, & Carpenter, 2017) to examine how fatigue unfolds naturalistically over three months (Heckman et al, 2018). Peak fatigue values were observed at around six weeks at which point they plateaued and remained stable through three months.…”