Behavioural dynamics of relapse in smokers during large societal disruptions

Tobacco consumption remains the single greatest preventable cause of death globally, claiming over eight million lives annually. Although global smoking prevalence has declined, relapse among ex-smokers persists, particularly during large societal disruptions such as pandemics, armed conflicts, and economic crises. This integrative review synthesizes empirical evidence and theoretical perspectives on the behavioural dynamics of smoking relapse during such disruptions. Literature was retrieved from PubMed, Scopus, EMBASE, JSTOR, Google Scholar, Researchgate, WHO publications, and grey sources (2005–2025), focusing on studies examining relapse, initiation, cessation attempts, and service access under disruptive conditions. Drawing on Marlatt and Gordon’s Relapse Prevention Model, the Transactional Model of Stress and Coping, Socio-ecological Model, and the Resource and Opportunity Cost Model, the study identifies multifactorial relapse drivers across individual, interpersonal, community, and structural levels. Evidence indicates heterogeneous outcomes: during COVID-19, anxiety triggered relapse for some, while health concerns motivated cessation in others. In conflicts, trauma, displacement, and weakened healthcare increased relapse, whereas economic crises produced both reduced consumption and stress-induced relapse. Factors associated with smoking relapse included psychological distress, unemployment, disrupted social networks, and tobacco industry opportunism. The resilience and support systems were integrated mental health and cessation services, community support, accessible pharmacotherapies, economic safety nets, and effective public health communication. Relapse during societal disruptions is shaped by intersecting psychological, social, and structural pressures, underscoring the need for multi-level interventions. Strengthening cessation infrastructure, embedding stress and trauma supports, and safeguarding equity in tobacco control policies are essential to mitigate relapse risk during future societal disruptions. Clinical trial number: Not applicable.