A day at a time: Predicting smoking lapse from daily urge.

Smokers who recently quit (N?=?214) monitored smoking urges for up to 26 days after quitting. Computers administered 4–5 assessments daily at random times; participants rated urges on waking and when they experienced temptation episodes. Urge intensity after cessation did not generally exceed urges reported during baseline ad lib smoking. Urge intensity and temptation frequency consistently declined over the quit period. Controlling for urge intensity at baseline, all daily urge intensity measures predicted lapse the following day in proportional hazards survival analyses. Average duration of temptation episodes also predicted lapses; frequency of temptation did not. To isolate the effect of day-to-day variations in urges, participants' nicotine dependence and urge intensity on quit day were controlled for. Only urge intensity at waking still predicted lapse risk; this was not because of this measure being closer in time to the day's lapses. Among lapsers, urge intensity at waking and in temptations rose preceding a lapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A preliminary investigation of rapid smoking as a lapse-responsive treatment for tobacco dependence.

Lapses within the first 2 weeks of a smoking cessation attempt are strongly associated with a return to regular smoking (S. L. Kenford et al., 1994). Unfortunately, little is known about how to prevent an initial lapse from progressing to a full relapse, and presently there are no validated lapse-responsive therapeutic interventions. The present study tested the efficacy and feasibility of rapid smoking plus counseling as a novel lapse-responsive intervention. Sixty-seven participants enrolled in a smoking treatment program involving brief counseling and a 9-week course of bupropion. Beginning on the quit day, participants' smoking behavior was tracked daily for 14 days. Once an early smoking lapse was identified, participants were randomly assigned to receive either 3 sessions of rapid smoking plus counseling or no intervention (usual care). Consistent with previous research, participants who smoked during the first 2 weeks of the quit attempt had significantly poorer 6-month outcomes (3% abstinent) than did those who did not smoke (64% abstinent). Compared with early abstainers, early lapsers were more nicotine dependent and reported greater cravings and lower confidence in their ability to abstain from smoking during the first 48 hours of abstinence. As expected, rapid smoking produced a variety of aversive effects, including increased nausea, dizziness, and vomiting as well as sharply decreased cravings to smoke. However, rapid smoking did not improve abstinence outcomes relative to usual care. Although rapid smoking has been shown to be an effective treatment for initial smoking cessation, in this preliminary study the authors failed to demonstrate its effectiveness as a lapse-responsive treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Remember that? A comparison of real-time versus retrospective recall of smoking lapses.

Research and treatment assessments often rely on retrospective recall of events. The accuracy of recall was tested using accounts of smoking relapse episodes from 127 participants who had quit smoking, and lapses and temptations were recorded in near-real time using a hand-held computer. These computer records were compared with retrospective accounts elicited 12 weeks later, with a focus on recall of lapses in 4 content domains: mood, activity, episode Triggers, and abstinence violation effects. Recall of lapses was quite poor: Average kappas for items ranged from 0.18 to 0.27. Mean profile rs assessing recall for the overall pattern of behavior were .36, .30, .33, and .44 for these domains, respectively. In recall, participants overestimated their negative affect and the number of cigarettes they had smoked during the lapse, and their recall was influenced by current smoking status. The findings suggest caution in the use of recall in research and intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating reactivity to ecological momentary assessment during smoking cessation.

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 = 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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Highly tempting situations associated with abstinence, temporary lapse, and relapse among participants in smoking cessation programs.

A classification scheme developed by Marlatt and Gordon (1980) was used to categorize the highly tempting situations of 596 participants in smoking cessation programs. When the distributions of relapsers, temporary lapsers (those who smoked and then resumed abstinence), and abstainers were compared, chi-square analyses revealed significant differences (p?     

Early cessation success or failure among women attempting to quit smoking: Trajectories and volatility of urge and negative mood during the first postcessation week.

Aversive symptoms of abstinence from nicotine have been posited to lead to smoking relapse and research on temporal patterns of abstinence symptoms confirms this assumption. However, little is known about the association of symptom trajectories early after quitting with postcessation smoking or about the differential effects of tonic (background) versus phasic (temptation-related) symptom trajectories on smoking status. The current study examined trajectories of urge and negative mood among 300 women using the nicotine patch during the first postcessation week. Ecological momentary assessments collected randomly and during temptation episodes were analyzed using hierarchical linear modeling yielding four individual trajectory parameters: intercept (initial symptom level), linear slope (direction and rate of change), quadratic coefficient (curvature), and volatility (scatter). Early lapsers, who lapsed during the first postcessation week, exhibited more severe tonic urge and phasic negative mood immediately after quitting, and more volatile tonic and phasic urge compared to abstainers. Late lapsers, who were abstinent during the first week but lapsed by 1 month, exhibited more severe tonic urge immediately after quitting compared to abstainers. These results demonstrate the importance of early postcessation urge and negative affect and highlight the value of examining both tonic and phasic effects of abstinence from nicotine. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Specifying the determinants of the initiation and maintenance of behavior change: An examination of self-efficacy, satisfaction, and smoking cessation.

Using data from smokers (N = 591) who enrolled in an 8-week smoking cessation program and were then followed for 15 months, the authors tested the thesis that self-efficacy guides the decision to initiate smoking cessation but that satisfaction with the outcomes afforded by quitting guides the decision to maintain cessation. Measures of self-efficacy and satisfaction assessed at the end of the program, 2 months, and 9 months were used to predict quit status at 2, 9, and 15 months, respectively. At each point, participants were categorized as either initiators or maintainers on the basis of their pattern of cessation behavior. Across time, self-efficacy predicted future quit status for initiators, whereas satisfaction generally predicted future quit status for maintainers. Implications for models of behavior change and behavioral interventions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resisting temptations to smoke: Results from within-subjects analyses.

Within-subjects analyses were used to examine differences between resisted temptations to smoke (either a specific close call or the most common temptation) and smoking lapses among 130 participants lapsing within 1 month after a self-initiated quit attempt. Participants were more likely to report coping during resisted temptations than during lapses; those who reported coping in both were more likely to report using multiple strategies and combining cognitive and behavioral strategies during the resisted temptation. Participants were more likely to report that the lapse was precipitated by others smoking, but this difference was not significant when the sample was restricted to those reporting a specific close call. No other statistically significant differences were found. Results support previous findings that the use or nonuse of coping strategies during a temptation to smoke is the variable most strongly associated with its outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rebound following failure to quit smoking: The effects of attributions and self-efficacy.

In this study the authors examined the process of rebound from failure, operationalized as a deliberate quit attempt within 6 months of failure in which the participant achieved at least 24 hr of abstinence, in a group of 63 smokers who failed to quit smoking. Guided, in part, by G. A. Marlatt and J. R. Gordon's (1985) abstinence violation effect model, the authors evaluated participants' reactions to failure by assessing causal attributions and self-efficacy immediately after the end of the failed quit effort and used these to predict rebound 3 and 6 months later in correlational and logistic regression analyses. Results showed that participants who rebounded attributed their prior failure to more unstable causes and had higher levels of self-efficacy following failure. Participants who rebounded also reported significantly more helpful attributional influences on their initial cessation effort. Logistic regression analyses indicated that more unstable reasons for failure to quit and helpful attributions moderately predict subsequent rebound. These effects are not mediated by self-efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal analysis of unaided smoking cessation.

A sample of 153 smokers who attempted to quit smoking without treatment was followed for 2 years. Follow-up assessment occurred at 1 month, 4 months, 1 year, and 2 years postquit. A subsample of 69 individuals was also interviewed prior to their quit date. The majority of participants (77%) achieved at least 24 hr of abstinence by the 1-month follow-up. However, subsequent relapse rates were high: Only 13% of the sample was abstinent at 1 year, and 19% reported abstinence at the 2-year follow-up. Variables related to short-term outcome were generally unrelated to long-term outcome. Individuals who succeeded at initial cessation were more likely to be men and to be lighter smokers. Among those who initially quit, abstainers at 1 month were less likely to have participated in prior treatment, to report smokers among their friends, and to live with other smokers. At 2 years, abstainers were younger and had smoked for fewer years. The use of multiple strategies for cessation was associated with abstinence at the 2-year follow-up. A strong motivation to quit was found to be important for both initial success and long-term maintenance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How much weight gain occurs following smoking cessation: A comparison of weight gain using both continuous and point prevalence abstinence.

Estimates of postcessation weight vary widely. This study determined the magnitude of weight gain in a cohort using point prevalence and continuous abstinence criteria for cessation. Participants were 196 volunteers who participated in a smoking cessation program and who either continuously smoked (n?=?118), were continuously abstinent (n?=?51), or who were point prevalence abstinent (n?=?27) (i.e., quit at the 1-year follow-up visit but not at others). Continuously abstinent participants gained over 13 lbs. (5.90 kg) at 1 year, significantly more than continuously smoking (M?=?2.4 lb.) and point prevalence abstinent participants (M?=?6.7 lbs., or 3.04 kg). Individual growth curve analysis confirmed that weight gain and the rate of weight gain (pounds per month) were greater among continuously smoking participants and that these effects were independent of gender, baseline weight, smoking and dieting history, age, and education. Results suggest that studies using point prevalence abstinence to estimate postcessation weight gain may be understanding postcessation weight gain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of monetary contingencies on smoking relapse: Influences of trait depression, personality, and habitual nicotine intake.

Of 56 male smokers, 34 were randomly assigned (by 60% random odds) to quit smoking immediately, whereas the remaining 22 were assigned to quit after an additional 31 days. Compensation ($300) was contingent on abstinence for a minimum of 31 or 2 days (depending on random assignment) and completion of all experimental sessions. Contingencies for the immediate-quit group required 31 days of abstinence; those for the delayed-quit group required only 2 days of abstinence. Contingency duration (31 vs. 2 days) predicted days to relapse. All but 4 of the 31-day contingency participants maintained abstinence for at least 31 days, whereas only 3 of the 2-day contingency group abstained for 31+ days. However, 31-day contingencies did not result in longer postcontingency time to relapse. Higher trait neuroticism, depression, and psychopathic deviate scores predicted decreased time to relapse. Prequit cotinine concentrations and Fagerstr?m Tolerance Questionnaire scores failed to predict time to relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A contingency-management intervention to promote initial smoking cessation among opioid-maintained patients.

Prevalence of cigarette smoking among opioid-maintained patients is more than threefold that of the general population and associated with increased morbidity and mortality. Relatively few studies have evaluated smoking interventions in this population. The purpose of the present study was to examine the efficacy of contingency management for promoting initial smoking abstinence. Forty methadone- or buprenorphine-maintained cigarette smokers were randomly assigned to a contingent (n = 20) or noncontingent (n = 20) experimental group and visited the clinic for 14 consecutive days. Contingent participants received vouchers based on breath carbon monoxide levels during Study Days 1 to 5 and urinary cotinine levels during Days 6 to 14. Voucher earnings began at $9.00 and increased by $1.50 with each subsequent negative sample for maximum possible of $362.50. Noncontingent participants earned vouchers independent of smoking status. Although not a primary focus, participants who were interested and medically eligible could also receive bupropion (Zyban). Contingent participants achieved significantly more initial smoking abstinence, as evidenced by a greater percentage of smoking-negative samples (55% vs. 17%) and longer duration of continuous abstinence (7.7 vs. 2.4 days) during the 2 week quit attempt than noncontingent participants, respectively. Bupropion did not significantly influence abstinence outcomes. Results from this randomized clinical trial support the efficacy of contingency management interventions in promoting initial smoking abstinence in this challenging population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of a brief worksite intervention to reduce smoking: The roles of behavioral and implementation intentions.

The effectiveness of worksite interventions to reduce smoking needs to be enhanced because randomized controlled trials to date have produced mixed findings. The present study tested the ability of social-cognitive variables to mediate the past behavior-future behavior relationship and the effectiveness of implementation intentions to break the past behavior-future behavior relationship in a brief theory-based worksite intervention designed to reduce smoking. Smoking behavior and psychosocial orientation to quit (operationalized by theory of planned behavior variables and temptations) were measured at baseline; participants (N=90) randomized to the experimental condition were also asked to form an implementation intention in their place of work. Identical measures taken 2 months postbaseline revealed that intention was a potent mediator of the past behavior-future behavior relationship. More important, significantly more people quit smoking in the experimental condition than in the control condition. Decomposition of these effects showed that implementation intentions worked best for individuals who were more motivated to quit at baseline and suggest that harnessing both motivational and volitional processes might enhance the effectiveness of worksite smoking cessation programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transdermal nicotine: The long and the short of it.

Cigarette smokers with a mean history of 35 smoking years (N?=?98) were randomly assigned to receive either 3 weeks or 12 weeks of transdermal nicotine treatment combined with a 5-session behavioral management program. Participants were followed for 20 weeks. At the conclusion of the study, 26% of the 3-week participants and 29% of the 12-week participants were abstinent. The number of abstinent participants and duration of abstinence were not significantly different between the 2 groups, although statistical power constraints do not rule out the possibility of small undetected differences in outcome. Most participants (68%) smoked at least once during their nicotine patch regimen. Smoking on the patch was associated with poor outcome. Those who smoked while using the patch reported more restlessness and cigarette cravings and lower confidence and intention to quit smoking than did participants who did not smoke during the drug regimen. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Twelve-Week Outcomes From an Investigation of High-Dose Nicotine Patch Therapy for Heavy Smokers With a Past History of Alcohol Dependence.

This study reports findings from an investigation of the efficacy of high-dose nicotine patch (NP) therapy for heavy smokers with a past history of alcohol dependence. One hundred thirty participants were randomly assigned to 42 mg or 21 mg of transdermal nicotine for 4 weeks, followed by an 8-week dose titration. Follow-up assessments were conducted at 4 and 12 weeks. Differences between dose conditions were nonsignificant, although unexpectedly, outcomes favored participants in the 21-mg NP condition. Nicotine abstinence at follow-up was related to longer length of alcohol abstinence at time of enrollment. Future research should investigate ways to improve smoking quit rates in this population, including more frequent counseling sessions and/or other pharmacotherapies. These investigations should focus primarily on smokers in early alcohol recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Situational Correlates of Abstinence Self-Efficacy.

Little is known about the situations that are associated with changes in self-efficacy during an attempt to quit smoking. In this study, 214 smokers used palmtop computers to record momentary self-efficacy ratings and situational context during a quit attempt. Higher urge to smoke and negative affect were associated with reduced self-efficacy. Although alcohol and coffee consumption are associated with heightened lapse risk, they were unrelated to abstinence self-efficacy. Individuals with low baseline self-efficacy generally reported lower self-efficacy across situations, but these differences were more pronounced under conditions of high urge and negative affect. These results suggest that self-efficacy may be reactive to affect-motivational states during a quit attempt. Whether these influences represent cognitive biases or objective risk assessments is not known. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do resisted temptations during smoking cessation deplete or augment self-control resources?

A resource depletion model of self-control posits that for some period following performance of a task requiring self-control, self-control will be reduced and thus less available for use in a subsequent task. Using 2 substantial data sets collected in real time from individuals who were trying to quit smoking (1,660 and 9,516 temptation episodes collected from 61 and 248 individuals, respectively), we evaluated this model by testing the hypotheses that the number and length of resisted temptations and the intensity of the most recently reported urge during the prior 4 hr predict decreased self-control and increased likelihood of lapsing. Survival and multilevel regression modeling showed that contrary to the hypothesis, the number of recently resisted temptations predicted a lower risk of lapsing in both samples. Duration of resisted temptations had no significant effect in either sample. Intensity of most recently reported urge predicted lapsing in 1 data set but not in the other. Overall, there was little support for the resource depletion model. The protective effect of successfully resisting temptations was an unexpected but provocative finding. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

First lapses to smoking: Within-subjects analysis of real-time reports.

Studies of smoking relapse and temptation episodes have relied on retrospective recall and confounded between- and within-subject variability. Real-time data on temptations and lapses to smoke were gathered using palm-top computers. We made within-subject comparisons of the initial lapse, a temptation episode, and base rate data obtained through randomly scheduled assessments. Negative affect discriminated all three situations, with lapses worse than temptations, and temptations worse than random situations. Participants attributed lapses to negative mood and smoking cues, whereas temptations were more often attributed to behavioral transitions. Participants were 12 times more likely to report coping in temptations than in lapses. However, only cognitive ( vs. behavioral ) coping strategies were effective. Lapses (vs. the other situations) were more likely to occur when smoking was permitted, when cigarettes were easily available, and in the presence of other smokers. The results have clinical implications, and the computerized monitoring methods may be applicable to an array of clinical research problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does one size fit all African American smokers? The moderating role of acculturation in culturally specific interventions.

There is a consensus that interventions for ethnic minority populations should be culturally specific (CS). A previous study found that although African American smokers indicated a preference for CS self-help materials over standard materials, several outcomes were superior for the standard information (Webb, 2008). The current study reports on a priori analyses that tested level of acculturation as a moderating variable for the efficacy of CS interventions in a sample of low-income African Americans. Participants (N = 182) completed the African American Acculturation Scale--Revised before receiving a CS smoking cessation guide or a standard guide. As hypothesized, level of acculturation predicted evaluations of the intervention content, readiness to quit smoking, and 24-hr point prevalence abstinence at the 3-month follow-up. Lower levels of acculturation (i.e., more engagement in traditional African American culture) predicted a preference for CS materials and greater readiness to quit smoking after receiving the CS guide. Yet, among participants who were less acculturated, 24-hr abstinence was greater after receiving the standard guide. Overall, these findings emphasize that individual differences in levels of acculturation to the dominant culture affect receptivity to CS written interventions. Intragroup differences should be considered prior to the provision of CS interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)