The role of executive functioning in smoking cessation: A scoping review

Creating and implementing a plan to successfully quit smoking likely requires executive function (EF) skills such as inhibition, cognitive flexibility, attention and working memory. This scoping review consolidates the research evidence evaluating the role of EF in smoking cessation.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), researchers and a medical librarian searched PubMed, EMBASE, ERIC, CINAHL and PSYCINFO in June 2022, hand-search in September 2022 using relevant MeSH terms, and an updated search was completed in August 2024.

Fifteen articles were included. Self-regulation was the most frequently evaluated EF across all studies. Performance on measures of impulsivity was most frequently related to successful smoking cessation. Across studies, performance on measures in areas of attention, working memory, cognitive flexibility and higher-level EF was variable as it relates to smoking cessation success. There was considerable variability in the measures used to evaluate EF and definitions of cessation success. Across studies, very little research evaluates higher-level EF.

Differences in EF and cessation measures make comparisons across studies difficult. Future work is needed utilising common assessment and outcome measures that will improve our understanding of the complex cognitive skills needed for successful cessation. Particular consideration should be given to higher-level EFs including reasoning, planning, problem-solving and decision-making.