Predicting Smoking Lapses in the First Week of Quitting: An Ecological Momentary Assessment Study (original) (raw)
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Open Journal of Medical Psychology, 2012
Objectives: This study aimed at identifying distinct quitting trajectories over 29 days after an unassisted smoking cessation attempt by ecological momentary assessment (EMA). In order to validate these trajectories we tested if they predict smoking frequency up to six months later. Methods: EMA via mobile phones was used to collect real time data on smoking (yes/no) after an unassisted quit attempt over 29 days. Smoking frequency one, three and six months after the quit attempt was assessed with online questionnaires. Latent class growth modeling was used to analyze the data of 230 self-quitters. Results: Four different quitting trajectories emerged: quitter (43.9%), late quitter (11.3%), returner (17%) and persistent smoker (27.8%). The quitting trajectories predicted smoking frequency one, three and six months after the quit attempt (all p < 0.001). Conclusions: Outcome after a smoking cessation attempt is better described by four distinct trajectories instead of a binary variable for abstinence or relapse. In line with the relapse model by Marlatt and Gordon, late quitter may have learned how to cope with lapses during one month after the quitting attempt. This group would have been allocated to the relapse group in traditional outcome studies.
Drug and Alcohol Dependence, 2007
Smoking is associated with particular moods and activities, but it is not known whether there are individual differences in these associations and whether these differences are associated with success in smoking cessation. We assessed such associations using ecological momentary assessment: real-world, real-time data, collected by palm-top computer. Two hundred and fourteen smokers participating in a smoking cessation study provided data during ad lib smoking at baseline. Participants recorded moods and activities each time they smoked and, for comparison, at randomly selected non-smoking occasions. Situational associations with smoking were captured by examining the associations between smoking and antecedents considered relevant to lapse risk: negative affect (NA), arousal, socializing with others, the presence of others smoking, and consumption of coffee and alcohol. The associations varied across participants, confirming individual differences in situational smoking associations. Survival analyses revealed that only the NA pattern predicted first lapse. The effect was only seen in EMA assessments of NA smoking, and was not captured by questionnaire measures of negative affect smoking, which did not predict lapse risk. Moreover, the effect was not mediated by nicotine dependence.
Addiction (Abingdon, England), 2014
AimsTo investigate pathways through which momentary negative affect and depressive symptoms affect risk of lapse during smoking cessation attempts.To investigate pathways through which momentary negative affect and depressive symptoms affect risk of lapse during smoking cessation attempts.DesignEcological Momentary Assessment was carried out during two weeks after an unassisted smoking cessation attempt. A three-month follow-up measured smoking frequency.Ecological Momentary Assessment was carried out during two weeks after an unassisted smoking cessation attempt. A three-month follow-up measured smoking frequency.SettingData were collected via mobile devices in German-speaking Switzerland.Data were collected via mobile devices in German-speaking Switzerland.ParticipantsA total of 242 individuals (age 20-40, 67% men) reported 7,112 observations.A total of 242 individuals (age 20-40, 67% men) reported 7,112 observations.MeasurementsOnline surveys assessed baseline depressive symptoms and nicotine dependence. Real-time data on negative affect, physical withdrawal symptoms, urge to smoke, abstinence-related self-efficacy, and lapses.Online surveys assessed baseline depressive symptoms and nicotine dependence. Real-time data on negative affect, physical withdrawal symptoms, urge to smoke, abstinence-related self-efficacy, and lapses.FindingsTwo-level structural equation model suggested that on the situational level, negative affect increased the urge to smoke and decreased self-efficacy (β = .20; β = -.12, respectively), but had no direct effect on lapse risk. A higher urge to smoke (β = .09) and lower self-efficacy (β = -.11) were confirmed as situational antecedents of lapses. Depressive symptoms at baseline were a strong predictor of a person's average negative affect (β = .35, all p <.001). However, the baseline characteristics influenced smoking frequency three months later only indirectly, through influences of average states on the number of lapses during the quit attempt.Two-level structural equation model suggested that on the situational level, negative affect increased the urge to smoke and decreased self-efficacy (β = .20; β = -.12, respectively), but had no direct effect on lapse risk. A higher urge to smoke (β = .09) and lower self-efficacy (β = -.11) were confirmed as situational antecedents of lapses. Depressive symptoms at baseline were a strong predictor of a person's average negative affect (β = .35, all p <.001). However, the baseline characteristics influenced smoking frequency three months later only indirectly, through influences of average states on the number of lapses during the quit attempt.ConclusionsControlling for nicotine dependence, higher depressive symptoms at baseline were strongly associated with a worse longer-term outcome. Negative affect experienced during the quit attempt was the only pathway through which the baseline depressive symptoms were associated with a reduced self-efficacy and increased urges to smoke, all leading to the increased probability of lapses.Controlling for nicotine dependence, higher depressive symptoms at baseline were strongly associated with a worse longer-term outcome. Negative affect experienced during the quit attempt was the only pathway through which the baseline depressive symptoms were associated with a reduced self-efficacy and increased urges to smoke, all leading to the increased probability of lapses.
Evaluating reactivity to ecological momentary assessment during smoking cessation.
Experimental and …, 2007
Ecological momentary assessment (EMA) consists of assessing phenomena in real time in the natural environment. EMA allows for more fine-grained analyses of addictive behavior and minimizes threats to internal validity, such as recall biases and errors. However, because of the intensive monitoring involved in EMA, measurement reactivity is a concern. To test whether EMA with palmtop personal computers induces reactivity, the authors compared smoking-related outcomes between smokers using EMA and those not using EMA during a quit attempt. The use of no-EMA control groups has been rare in reactivity investigations to date. The EMA protocol included event-contingent assessments (smoking episodes, urge episodes) and random assessments. Outcomes included biologically confirmed abstinence and self-report measures of withdrawal, self-efficacy, motivation, affect, and temptations. Participants were smokers motivated to quit (N ϭ 96). They were randomized to 1 of 3 groups: EMA for the week preceding a planned quit date, EMA for the week following the quit date, and no EMA. Abstinence rates did not differ between the groups at Day 7 or at Day 28 postcessation. For the 20 subscales assessed at each of 3 assessment times, there were significant differences between participants with and without EMA experience for 3 subscales at the 1st of 3 assessment times, and significant differences for 3 different subscales at the 3rd assessment time. These differences suggest some reactivity to EMA, although the inconsistent pattern across time indicates that further research is needed to definitively conclude that EMA induces reactivity.
Experimental and clinical psychopharmacology, 2015
Despite the critical role of withdrawal, craving, and positive affect (PA) and negative affect (NA) in smoking relapse, relatively little is known about the temporal and predictive relationship between these constructs within the first day of abstinence. This pilot study aims to characterize dynamic changes in withdrawal, craving, and affect over the course of early abstinence using ecological momentary assessment. Beginning immediately after smoking, moderate and heavy smoking participants (n = 15 per group) responded to hourly surveys assessing craving, withdrawal, NA, and PA. Univariate and multivariate multilevel random coefficient modeling was used to describe the progression of craving, withdrawal/NA, and PA and to test correlations between these constructs at the subject level over the course of early abstinence. Heavy smokers reported greater craving from 1-4 hr of abstinence and greater withdrawal/NA after 3 or more hours as compared with moderate smokers. Level of withdraw...
The effect of anticipatory strategies on the first day of smoking cessation
Psychology of Addictive Behaviors, 2002
The authors tested a model hypothesizing the predictors and the effects of anticipatory strategy use on the 1st day of smoking cessation using data from 63 participants in an ecological momentary assessment study of smoking cessation. Remaining abstinent on the 1st day of cessation was not associated with mean level of urges to smoke during tempting situations but was associated with anticipatory strategy use, which accounted for 18% of the variance. Getting rid of cigarettes contributed the most to this effect ( ϭ-.397). Getting rid of cigarettes was itself predicted by 2 variables, lower nicotine dependence ( ϭ-.264) and attending a formal smoking cessation class ( ϭ .305), which accounted for 15% of its variance.
Smoking intentions and mood preceding lapse after completion of treatment to aid smoking cessation
Patient Education and Counseling, 2010
Objective: To examine the situation preceding ''late'' smoking relapse, particularly the availability of tobacco, mood and intentions at first lapse. Methods: A questionnaire was sent to 1439 adults identified as abstinent after treatment with a National Health Service stop-smoking clinic over the previous 3 years. Relapsers were asked where they had obtained their first cigarette, their mood and intentions immediately before first lapse. Results: 40% (n = 556) responded, of whom 35.8% (n = 199) had relapsed. At the time of first lapse, only 27.1% had made a decision to return to smoking while 48.9% intended to smoke only one or two cigarettes before stopping again. In 45.7% of cases, respondents bought cigarettes to smoke again. Prior to lapse the majority (53.8%) reported ''really needing a cigarette''. Similarly 53.8% reported being miserable at the time, while only 16% were happy. Conclusion: The most common pattern of late lapse appears to be intending to suspend the quit attempt temporarily in circumstances of needing to smoke and of negative emotional state, and in many cases cigarettes are actually sought out. Practice implications: Promoting strong 'not a puff' rules, a non-smoker identity and identifying negative mood as a potential vulnerability are important components of relapse prevention intervention. ß
Feasibility of Using Ecological Momentary Assessment to Study Unaided Smoking Cessation in Couples
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2017
Ecological momentary assessment (EMA) is a valuable method for studying smoking cessation, but feasibility has not been examined in committed couples. The current study examines the feasibility of conducting an EMA study of unaided smoking cessation in single-smoker couples. Participants were 62 single-smoker couples recruited to participate in a 21-day study of unaided smoking cessation. Quitters and Partners were given instructions to complete one morning report, three signaled reports, and one evening report per day, as well as lapse reports when necessary. They also completed a series of questionnaires at baseline and follow-up. This paper examines predictors of compliance with the reporting instructions. Compliance with scheduled reporting was reasonable (Quitters: 76%, Partners: 79%). Compliance with "on-time" lapse reporting (vs. make-up reporting) was poor (Quitters: 62%, Partners: 43%). Quitters' compliance with lapse reporting was strongly associated with ori...
Experimental and Clinical Psychopharmacology, 2014
Ecological momentary assessment was used to examine associations between negative affect, positive smoking outcome expectancies, and smoking urge during the first 7 days of a smoking quit attempt. Participants were 302 female smokers who enrolled in an individually tailored smoking cessation treatment study. Multilevel mediation analysis was used to examine the temporal relationship among: 1) the effects of negative affect and positive smoking outcome expectancies at one assessment point (e.g., time j) on smoking urge at the subsequent time point (e.g., time j + 1) in Model 1; and, 2) the effects of negative affect and smoking urge at time j on positive smoking outcome expectancies at time j + 1 in Model 2. The results from Model 1 showed a statistically significant effect of negative affect at time j on smoking urge at time j + 1, and this effect was mediated by positive smoking outcome expectancies at time j, both within-and between-participant. In Model 2, the within-participant indirect effect of negative affect at time j on positive smoking outcome expectancies at time j + 1 through smoking urge at time j was nonsignificant. However, a statistically significant indirect between-participant effect was found in Model 2. The findings support the hypothesis that urge and positive smoking outcome expectancies increase as a function of negative affect, and suggest a stronger effect of expectancies on urge as opposed to the effect of urge on expectancies.