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Individual and Combined Effects of Multiple High-Risk Triggers on Postcessation Smoking Urge and Lapse
Abstract
Negative affect, alcohol consumption, and presence of others smoking have consistently been implicated as risk factors in smoking lapse and relapse. What is not known, however, is how these factors work together to affect smoking outcomes. This paper uses ecological momentary assessment (EMA) collected during the first 7 days of a smoking cessation attempt to test the individual and combined effects of high-risk triggers on smoking urge and lapse.
Participants were 300 female smokers who enrolled in a study that tested an individually tailored smoking cessation treatment. Participants completed EMA, which recorded negative affect, alcohol consumption, presence of others smoking, smoking urge, and smoking lapse, for 7 days starting on their quit date.
Alcohol consumption, presence of others smoking, and negative affect were, independently and in combination, associated with increase in smoking urge and lapse. The results also found that the relationship between presence of others smoking and lapse and the relationship between negative affect and lapse were moderated by smoking urge.
The current study found significant individual effect of alcohol consumption, presence of other smoking, and negative affect on smoking urge and lapse. Combing the triggers increased smoking urge and the risk of lapse to varying degrees and the presence of all 3 triggers resulted in the highest urge and lapse risk.
... 16 studies did not meet the criteria for the quantitative assessment for three reasons. First, 12 studies did not use correlations as effect-size estimate (Serre et al., 2018;Perkins et al., 2013;Mol et al., 2005;Lam et al., 2014;Huhn et al., 2016;Cano et al., 2014;Petit et al., 2017;Cleveland & Harris, 2010;Shiyko et al., 2014;Shiyko & Ave, 2013;Park et al., 2016;Doherty et al., 1995), which did not allow them to be included in the metaanalysis. Second, two studies had missing data on correlations (Schnoll et al., 2013;Cook et al., 2004). ...
... Specifically, depression is a stronger predictor of craving among women (Petit et al., 2017;Luminet et al., 2016). Environmental cues (Shiyko et al., 2014;Lam et al., 2014) and levels of dependency (Shiyko & Ave, 2013;Lam et al., 2014) can also increase the frequency of craving. The association between negative affectivity and craving was shown to be stronger when combined with other moderators such as alexithymia (Thorberg et al., 2019;Luminet et al., 2016), emotional intelligence (Cordovil et al., 2010), positive outcomes expectancies , self-efficacy (Brodbeck et al., 2014) negative urgency (Park et al., 2016) and hedonic capacity (Cook et al., 2004). ...
... Specifically, depression is a stronger predictor of craving among women (Petit et al., 2017;Luminet et al., 2016). Environmental cues (Shiyko et al., 2014;Lam et al., 2014) and levels of dependency (Shiyko & Ave, 2013;Lam et al., 2014) can also increase the frequency of craving. The association between negative affectivity and craving was shown to be stronger when combined with other moderators such as alexithymia (Thorberg et al., 2019;Luminet et al., 2016), emotional intelligence (Cordovil et al., 2010), positive outcomes expectancies , self-efficacy (Brodbeck et al., 2014) negative urgency (Park et al., 2016) and hedonic capacity (Cook et al., 2004). ...
Background
A sizeable literature highlighted that negative affectivity and craving are both known to be implicated in relapses.
Objectives
The present study synthetized the existing litterature to determine strength of the interaction between negative affectivity and craving for substance-related disorders including illicit drugs, alcohol and tobacco.
Methods
We conducted a systematic review in accordance with PRISMA guidelines followed by a meta-analysis. Online computer databases PubMed, PsycINFO and Web of Science were searched systematically and thoroughly. Jamovi 1.8.1 Current version was used to conduct meta-analysis.
Results
Thirty studies were included in the review, and 14 of these, including 2257 subjects, were used for meta-analysis. The raw correlation ranged from 0.17 to 0.58, which indicated weak to moderate association between negative affects and craving. In total, approximately 90% of the selection revealed a positive correlation between negative affects and craving. Alcohol and tobacco use disorders have received the most attention. Additionally, negative affectivity was often defined as a transient state rather than a stable personality trait.
Conclusions
In both of our meta-analyses and in the narratively reported studies, we found that negative affectivity is an important component related to craving, but individual differences in craving reactivity existed.
... These collective findings are relevant to smoking behavior, as one of the most common precipitants of lapse and relapse is negative affect (Brandon et al., 1990;Businelle et al., 2010;Witkiewitz & Marlatt, 2004). Moreover, stressful experiences, which could include a discriminatory event as well as negative affect, are associated with stronger smoking urges and lapse, as demonstrated in several previous EMA studies (Businelle et al., 2016;Cambron et al., 2019;Lam et al., 2014;Shiffman & Waters, 2004). The impact of PD on positive affect is unknown, although it would be reasonable to hypothesize that PD reduces positive affect, which has been shown to be protective against lapse . ...
... This appears to be the first study to report on the momentary relationships among PD and lapse through specific mechanisms collected in real time. Even so, findings are consistent with other EMA studies examining individual pathways within these mediation models (e.g., Cambron et al., 2019;Lam et al., 2014;Shiffman & Waters, 2004;Vinci et al., 2017). Individual pathways revealed several significant, and important, relationships. ...
Objective:
Racial/ethnic minorities face unique stressors, including perceived discrimination (PD), that may increase the difficulty of quitting smoking relative to the general population of smokers. The current study examines the impact of acute PD on smoking lapse during a quit attempt, as well as potential mechanisms linking PD to lapse among Spanish-speaking Mexican Americans.
Method:
Participants (N = 169) were Spanish-speaking Mexican Americans living in the United States who completed ecological momentary assessments (EMAs) multiple times per day for 21 days postquit. A multilevel structural equation model decomposed the effect of PD on smoking lapse into indirect effects through negative affect, positive affect, smoking urge, motivation to quit, and self-efficacy.
Results:
Results indicated that PD operated indirectly through negative affect, positive affect, and urge to smoke, above and beyond other mechanisms, to increase risk for smoking lapse.
Conclusions:
Findings have direct implications for intervention development among this population, including the potential for developing strategies to buffer the impact of PD, as well as skills to directly manage increased negative affect and urge to smoke. Just-in-time adaptive interventions (JITAIs) might be particularly useful, given they are designed to deliver treatment in real-time (e.g., delivery of strategies to build resilience and implement coping strategies) that could counter the impact of PD on smoking lapse. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Advances in digital technologies have created unprecedented opportunities to leverage novel data collection and intervention designs to improve tobacco prevention and treatment. For example, the use of ecological momentary assessment (EMA) has revealed dynamic predictors of smoking lapse (10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Near-continuous GPS data collected from smartphones and physiological data collected from wearable sensors have been used to reveal contextual and physiological precipitants of lapse with more granularity than ever before (e.g., proximity to cues to smoke and autonomic indicators of self-regulatory capacity, which is important for tobacco cessation (20,21). ...
... The introduction of ecological momentary assessment (EMA) in studies of tobacco and substance use (1) has led to a dramatic increase in the number of studies that utilize EMAs. EMA studies are powerful in elucidating the everyday, real world processes that affect individuals' risk for tobacco use and maintaining abstinence during a quit attempt (2)(3)(4)(5)(6)(7). However, EMA studies are also especially susceptible to missingness issues related to noncompliance, attrition over time (8,9), and technological glitches (e.g. a completed EMA may not be saved or uploaded to the cloud if the smart phone crashed after a participant completed an EMA). ...
Advances in digital technology have greatly increased the ease of collecting intensive longitudinal data (ILD) such as ecological momentary assessments (EMAs) in studies of behavior changes. Such data are typically multilevel (e.g., with repeated measures nested within individuals), and are inevitably characterized by some degrees of missingness. Previous studies have validated the utility of multiple imputation as a way to handle missing observations in ILD when the imputation model is properly specified to reflect time dependencies. In this study, we illustrate the importance of proper accommodation of multilevel ILD structures in performing multiple imputations, and compare the performance of a multilevel multiple imputation (multilevel MI) approach relative to other approaches that do not account for such structures in a Monte Carlo simulation study. Empirical EMA data from a tobacco cessation study are used to demonstrate the utility of the multilevel MI approach, and the implications of separating participant- and study-initiated EMAs in evaluating individuals’ affective dynamics and urge.
... The combined use of cigarettes and alcohol is associated with a synergistic increase in the risk of morbidity and mortality (Hart et al., 2010;Vaillant et al., 1991;Xu et al., 2007), and alcohol use in the context of smoking cessation presents a considerable risk for relapse to smoking (Kahler et al., 2010;Lam et al., 2013). To date, Cognitive Behavioral Therapy (CBT) is generally considered the gold standard for treating substance use disorders, and interventions for the combined use of cigarettes and alcohol have primarily used CBT/motivational interviewing (Ames et al., 2010;Baca and Yahne, 2009;Davis et al., 2013;Fridberg et al., 2015;Joseph et al., 2004;Kahler et al., 2008Kahler et al., , 2010. ...
Background:
The combined use of cigarettes and alcohol is associated with a synergistic increase in the risk of morbidity and mortality. Continued alcohol use during a smoking quit attempt is a considerable risk factor for smoking relapse. As such, there is a need for interventions that address both behaviors concurrently. Mindfulness-based interventions hold much promise for simultaneously addressing tobacco and alcohol use.
Method:
This pilot study evaluated the feasibility and acceptability of a mindfulness-based intervention using a two-arm randomized controlled trial of Mindfulness-Based Relapse Prevention for Smoking and Alcohol (MBRP-SA) vs Cognitive Behavioral Therapy (CBT). Interventions were delivered via telehealth in a group setting; all participants received a 6-week supply of the nicotine patch. Participants (N = 69) were adults who smoked cigarettes who reported binge drinking and were motivated to both quit smoking and change their alcohol use. Primary outcomes were feasibility and acceptability of MBRP-SA compared to CBT. Changes in tobacco and alcohol use are also presented.
Results:
Participants in MBRP-SA and CBT indicated that the treatments were highly acceptable, meeting a priori benchmarks. Feasibility was mixed with some outcomes meeting benchmarks (e.g., recruitment) and others falling below (e.g., retention). Participants in both conditions demonstrated significant reductions in tobacco and alcohol use at the end of treatment.
Conclusions:
In sum, MBRP-SA had comparable outcomes to CBT on all metrics measured. Future research should evaluate the efficacy of MBRP-SA on smoking abstinence and drinking reductions in a large-scale, fully powered trial. This study was registered on clinicaltrials.gov (NCT03734666).
... Alcohol use is very common among those who smoke [8,9] and is a potent predictor of smoking relapse [10,11]. Notably, concurrently changing both behaviors can have a positive, reciprocal effect [12,13]. ...
In the midst of the COVID-19 pandemic, many research and clinical teams have transitioned their projects to a remote-based format, weighing the pros and cons of making such a potentially disruptive decision. One key aspect of this decision is related to the patient population, with underserved populations possibly benefiting from the increased reach of telehealth, while also encountering technology barriers that may limit accessibility. Early in the pandemic, our team shifted a group-based, smoking cessation and alcohol modification treatment trial to a remote-based format. Our population included individuals who concurrently wanted to quit smoking and modify their alcohol use. This paper describes technical and logistical considerations of transitioning from in-person to remote-based delivery for group-based treatment, including the impact upon study staff, group facilitators, participants, and the institution. Remotely-delivered group treatment may be valuable not only in response to pandemic-related restrictions, but it may also offer an alternative treatment-delivery modality with independent benefits in terms of population reach, costs, and pragmatics for clients, staff, and institutions.
... Although smoking in the US has declined in recent years, there is virtually no reduction in concurrently dependent subjects (West, 2017). This may be because each drug serves as a precipitating factor in eliciting craving for the other drug in subjects with this comorbid disorder (Businelle et al., 2013;Lam et al., 2014;Lisha, Carmody, Humfleet, & Delucchi, 2014). ...
Nicotine and alcohol abuse and co-dependence represent major public health crises. Indeed, previous research has shown that the prevalence of alcoholism is higher in smokers than in non-smokers. Adolescence is a susceptible period of life for the initiation of nicotine and alcohol use and the development of nicotine-alcohol codependence. However, there is a limited number of pharmacotherapeutic agents to treat addiction to nicotine or alcohol alone. Notably, there is no effective medication to treat this comorbid disorder. This chapter aims to review the early nicotine use and its impact on subsequent alcohol abuse during adolescence and adulthood as well as the role of neuropeptides in this comorbid disorder. The preclinical and clinical findings discussed in this chapter will advance our understanding of this comorbid disorder's neurobiology and lay a foundation for developing novel pharmacotherapies to treat nicotine and alcohol codependence.
Only a small minority of all attempts to stop smoking is successful, especially among smokers who are heavy drinkers and those with an alcohol use disorder. The current systematic review focusses on the negative effects of alcohol use, either before or during attempts to quit smoking, on the success rate of these attempt(s) in alcohol drinking tobacco smokers. We conducted a systematic review of naturalistic and experimental studies, which included at least 40 tobacco smokers with a recorded drinking status (non-drinking, heavy drinking, alcohol use disorder) and a clearly documented change in alcohol consumption. We could not conduct a meta-analyses and, thus, used consistency across studies to draw conclusions. The evidence presented here shows that alcohol use is associated with lower rates of success in quitting smoking in 20 out of 27 studies. This includes both lapses and relapses. Similarly, in 19 out of 20 long-term follow-up studies, the duration of smoking abstinence was shorter among persons with higher alcohol consumption. Finally, 12 out of 13 experimental studies showed that exposure of smokers to alcohol cues or to drinking of alcohol, induce a strong propensity to smoke. It is, therefore, recommended for smokers who drink alcohol and who intend to quit smoking to use an integrated approach i.e., to stop or substantial reduce their alcohol consumption before and/or during their attempt to quit smoking.
Background and aims:
Individuals of lower socioeconomic status (SES) display a higher prevalence of smoking and have more difficulty quitting than higher SES groups. The current study investigates whether the within-person associations of key risk (e.g., stress) and protective (self-efficacy) factors with smoking lapse varies by facets of SES.
Design and setting:
Observational study using ecological momentary assessment to collect data for a 28-day period following a smoking quit attempt. Multilevel mixed models (i.e., generalized linear mixed models) examined cross-level interactions between lapse risk and protective factors and indicators of SES on smoking lapse.
Participants:
A diverse sample of 330 adult U.S. smokers who completed a larger study examining the effects of race/ethnicity and social/environmental influences on smoking cessation.
Measurements:
Risk factors: momentary urge, negative affect, stress; Protective factors: positive affect, motivation, abstinence self-efficacy; SES measures: baseline measures of income and financial strain; Primary outcome: self-reported lapse.
Findings:
Participants provided 43,297 post-quit observations. Mixed models suggested that income and financial strain moderated the effect of some risk factors on smoking lapse. The within-person association of negative (odds ratio [OR] = 0.967, 95% [0.945, 0.990], p<.01) and positive affect (OR = 1.023, 95% confidence interval [CI] [1.003, 1.044], p<.05), and abstinence self-efficacy (OR = 1.020, 95% CI [1.003, 1.038], p<.05) on lapse varied with financial strain. The within-person association of negative affect (OR = 1.005, 95% CI [1.002, 1.008], p<.01), motivation (OR = 0.995, 95% CI [0.991, 0.999], p<.05), and abstinence self-efficacy (OR = 0.996, 95% CI [0.993, 0.999], p<.01) on lapse varied by income. The positive association of negative affect with lapse was stronger among individuals with higher income and lower financial strain. The negative association between positive affect and abstinence self-efficacy with lapse was stronger among individuals with lower financial strain, and the negative association between motivation and abstinence self-efficacy with lapse was stronger among those with higher income. The data were insensitive to detect statistically significant moderating effects of income and financial strain on the association of urge or stress with lapse.
Conclusion:
Some risk factors (e.g. momentary negative affect) exert a weaker influence on smoking lapse among lower compared to higher socioeconomic status groups.
Context
The Primary Care Evaluation of Mental Disorders (PRIME-MD) was developed
as a screening instrument but its administration time has limited its clinical
usefulness.Objective
To determine if the self-administered PRIME-MD Patient Health Questionnaire
(PHQ) has validity and utility for diagnosing mental disorders in primary
care comparable to the original clinician-administered PRIME-MD.Design
Criterion standard study undertaken between May 1997 and November 1998.Setting
Eight primary care clinics in the United States.Participants
Of a total of 3000 adult patients (selected by site-specific methods
to avoid sampling bias) assessed by 62 primary care physicians (21 general
internal medicine, 41 family practice), 585 patients had an interview with
a mental health professional within 48 hours of completing the PHQ.Main Outcome Measures
Patient Health Questionnaire diagnoses compared with independent diagnoses
made by mental health professionals; functional status measures; disability
days; health care use; and treatment/referral decisions.Results
A total of 825 (28%) of the 3000 individuals and 170 (29%) of the 585
had a PHQ diagnosis. There was good agreement between PHQ diagnoses and those
of independent mental health professionals (for the diagnosis of any 1 or
more PHQ disorder, κ = 0.65; overall accuracy, 85%; sensitivity, 75%;
specificity, 90%), similar to the original PRIME-MD. Patients with PHQ diagnoses
had more functional impairment, disability days, and health care use than
did patients without PHQ diagnoses (for all group main effects, P<.001). The average time required of the physician to review the
PHQ was far less than to administer the original PRIME-MD (<3 minutes for
85% vs 16% of the cases). Although 80% of the physicians reported that routine
use of the PHQ would be useful, new management actions were initiated or planned
for only 117 (32%) of the 363 patients with 1 or more PHQ diagnoses not previously
recognized.Conclusion
Our study suggests that the PHQ has diagnostic validity comparable to
the original clinician-administered PRIME-MD, and is more efficient to use.
Figures in this Article
Mental disorders in primary care are common, disabling, costly, and
treatable.1- 5
However, they are frequently unrecognized and therefore not treated.2- 6
Although there have been many screening instruments developed,7- 8
PRIME-MD (Primary Care Evaluation of Mental Disorders)5
was the first instrument designed for use in primary care that actually diagnoses
specific disorders using diagnostic criteria from the Diagnostic
and Statistical Manual of Mental Disorders, Revised Third Edition9(DSM-III-R) and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition10(DSM-IV).
PRIME-MD is a 2-stage system in which the patient first completes a
26-item self-administered questionnaire that screens for 5 of the most common
groups of disorders in primary care: depressive, anxiety, alcohol, somatoform,
and eating disorders. In the original study,5
the average amount of time spent by the physician to administer the clinician
evaluation guide to patients who scored positively on the patient questionnaire
was 8.4 minutes. However, this is still a considerable amount of time in the
primary care setting, where most visits are 15 minutes or less.11
Therefore, although PRIME-MD has been widely used in clinical research,12- 28
its use in clinical settings has apparently been limited. This article describes
the development, validation, and utility of a fully self-administered version
of the original PRIME-MD, called the PRIME-MD Patient Health Questionnaire
(henceforth referred to as the PHQ).
DESCRIPTION OF PRIME-MD PHQ
ABSTRACT
|
DESCRIPTION OF PRIME-MD PHQ
|
STUDY PURPOSE
|
METHODS
|
RESULTS
|
COMMENT
|
REFERENCES
The 2 components of the original PRIME-MD, the patient questionnaire
and the clinician evaluation guide, were combined into a single, 3-page questionnaire
that can be entirely self-administered by the patient (it can also be read
to the patient, if necessary). The clinician scans the completed questionnaire,
verifies positive responses, and applies diagnostic algorithms that are abbreviated
at the bottom of each page. In this study, the data from the questionnaire
were entered into a computer program that applied the diagnostic algorithms
(written in SPSS 8.0 for Windows [SPSS Inc, Chicago, Ill]). The computer program
does not include the diagnosis of somatoform disorder, because this diagnosis
requires a clinical judgment regarding the adequacy of a biological explanation
for physical symptoms that the patient has noted.
A fourth page has been added to the PHQ that includes questions about
menstruation, pregnancy and childbirth, and recent psychosocial stressors.
This report covers only data from the diagnostic portion (first 3 pages) of
the PHQ. Users of the PHQ have the choice of using the entire 4-page instrument,
just the 3-page diagnostic portion, a 2-page version (Brief PHQ) that covers
mood and panic disorders and the nondiagnostic information described above,
or only the first page of the 2-page version (covering only mood and panic
disorders) (Figure 1).
Figure 1. First Page of Primary Care Evaluation
of Mental Disorders Brief Patient Health QuestionnaireGrahic Jump Location+View Large |
Save Figure |
Download Slide (.ppt)
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View in Article ContextCopyright held by Pfizer Inc, but may be photocopied ad libitum.
For office coding, see the end of the article.
The original PRIME-MD assessed 18 current mental disorders. By grouping
several specific mood, anxiety, and somatoform categories into larger rubrics,
the PHQ greatly simplifies the differential diagnosis by assessing only 8
disorders. Like the original PRIME-MD, these disorders are divided into threshold
disorders (corresponding to specific DSM-IV diagnoses,
such as major depressive disorder, panic disorder, other anxiety disorder,
and bulimia nervosa) and subthreshold disorders (in which the criteria for
disorders encompass fewer symptoms than are required for any specific DSM-IV diagnoses: other depressive disorder, probable alcohol
abuse or dependence, and somatoform and binge eating disorders).
One important modification was made in the response categories for depressive
and somatoform symptoms that, in the original PRIME-MD, were dichotomous (yes/no).
In the PHQ, response categories are expanded. Patients indicate for each of
the 9 depressive symptoms whether, during the previous 2 weeks, the symptom
has bothered them "not at all," "several days," "more than half the days,"
or "nearly every day." This change allows the PHQ to be not only a diagnostic
instrument but also to yield a measure of depression severity that can be
of aid in initial treatment decisions as well as in monitoring outcomes over
time. Patients indicate for each of the 13 physical symptoms whether, during
the previous month, they have been "not bothered," "bothered a little," or
"bothered a lot" by the symptom. Because physical symptoms are so common in
primary care, the original PRIME-MD dichotomous-response categories often
led patients to endorse physical symptoms that were not clinically significant.
An item was added to the end of the diagnostic portion of the PHQ asking
the patient if he or she had checked off any problems on the questionnaire:
"How difficult have these problems made it for you to do your work, take care
of things at home, or get along with other people?" As with the original PRIME-MD,
before making a final diagnosis, the clinician is expected to rule out physical
causes of depression, anxiety and physical symptoms, and, in the case of depression,
normal bereavement and history of a manic episode.
STUDY PURPOSE
ABSTRACT
|
DESCRIPTION OF PRIME-MD PHQ
|
STUDY PURPOSE
|
METHODS
|
RESULTS
|
COMMENT
|
REFERENCES
Our major purpose was to test the validity and utility of the PHQ in
a multisite sample of family practice and general internal medicine patients
by answering the following questions:
Are diagnoses made by the PHQ as accurate as diagnoses
made by the original PRIME-MD, using independent diagnoses made by mental
health professionals (MHPs) as the criterion standard?Are the frequencies of mental disorders found by
the PHQ comparable to those obtained in other primary care studies?Is the construct validity of the PHQ comparable
to the original PRIME-MD in terms of functional impairment and health care
use?Is the PHQ as effective as the original PRIME-MD
in increasing the recognition of mental disorders in primary care patients?How valuable do primary care physicians find the
diagnostic information in the PHQ?How comfortable are patients in answering the questions
on the PHQ, and how often do they believe that their answers will be helpful
to their physicians in understanding and treating their problems?
Recent research suggests that retrospective coping assessments may not correspond well with day-to-day reports. The authors extended this work by examining the correspondence between short-term (within 48 hr) retrospective coping reports and momentary reports recorded via a palm-top computer close in time to when the stressor occurred. There was relatively poor correspondence between the 2 assessments. Some reports of momentary coping were not reported retrospectively, and some coping reported retrospectively was not reported at the time the stressor occurred. Cognitive coping was more likely to be underreported retrospectively; behavioral coping was overreported. Participants were consistent in their discrepancies, but there was no correspondence between discrepancy rates and demographic or personality variables. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Epidemiological investigations of mood and smoking have relied largely on retrospective self-reports, with little research on real-time associations. We examined the relationship of mood states to contemporaneous smoking urges and to subsequent smoking and also assessed the effects of smoking on subsequent mood. For 2 days, 25 female and 35 male smokers aged 18‐ 42 made three prompted diary entries per hour plus pre- and postsmoking entries (6882 entries). Data were analyzed with generalized estimating equations. We found significant positive associations between smoking urge and anger, anxiety, and alertness in women and men; fatigue in men only; sadness more strongly in men than women; and happiness in women only. Decreased alertness and increased anxiety predicted subsequent smoking in men only. Smoking was followed by decreased anger levels in men and women and decreased sadness in men only. In men with lower overall anger episodes, increased anger was associated with subsequent increased smoking. These findings suggest that smoking is related to negative affect and energy level, more clearly in men, and has palliative effects on sadness in men and on anger in men and women. These data demonstrate that ambulatory research can reveal targets for early intervention and smoking cessation.
Symptoms of depression have been associated with increased smoking prevalence and failure to quit smoking in several cross-sectional and population-based studies. Few studies, however, have prospectively examined the ability of current symptoms of depression to predict failure to quit smoking in treatment-motivated smokers. Pretreatment depressed mood was assessed by 3 different methods in 3 separate samples, 2 of which comprised smokers receiving combined pharmacological and behavioral treatments and a 3rd in which smokers received self-help materials only. In all studies, time in days from quit day until the Ist cigarette was ascertained to document survival. Survival analyses showed that in all 3 studies survival time was significantly and negatively related to measures of even very low levels of pretreatment depressed mood. Results were replicated across 3 independent samples and were robust and uniformly clear, indicating that low levels of depressive symptoms assessed at baseline predict time to Ist cigarette smoked after attempted quitting.
Objective.
—To identify predictors of smoking cessation success or failure with and without transdermal nicotine patch treatment.
Discusses ecological momentary assessments (EMAs), recently developed approaches for assessing behavioral and cognitive processes in their natural settings. Four qualities define EMA methods: 1) phenomena are assessed as they occur, 2) assessments are dependent upon careful timing, 3) assessments usually involve a substantial number of repeated observations, and 4) assessments are usually made in the environment that the S typically inhabits. Phenomena for which EMAs are relevant are reviewed, particularly rapidly fluctuating processes such as affect, pain perception, and coping efforts. Issues relevant to the application of EMAs are addressed, including choice of sampling scheme. (PsycINFO Database Record (c) 2012 APA, all rights reserved)