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Ecological momentary assessment of temptations and lapses in non-daily smokers

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Abstract

Rationale

Little is known about relapse among non-daily, intermittent smokers (ITS), who have difficulty quitting, despite a lack of dependence.

Objectives

To analyze situations associated with temptations to smoke and smoking lapses among ITS trying to maintain abstinence.

Methods

Participants were 130 initially abstinent ITS in the placebo arm of a smoking cessation study. EMA data captured participants’ situations and states in temptations (n = 976), including those that eventuated in lapses (n = 147), for up to 6 weeks. Randomly timed assessments assessed background states (n = 11,446). Participants also reported coping performed to prevent lapses. Multilevel analyses compared temptations to background situations, and lapse episodes to resolved temptations.

Results

Temptations were marked by exposure to smoking cues, including others smoking, lax smoking restrictions, and alcohol consumption, as well as more negative affect. Lapses did not differ from resolved temptations in craving intensity, but were more often associated with smoking cues and availability of cigarettes, alcohol consumption, and worse affect, and were more often attributed to good moods. Both behavioral and cognitive coping responses were associated with avoiding lapsing, but behavioral coping had much larger effects. The effects of affective distress on lapse risk were mediated by its effects on coping.

Conclusions

Smoking cues play a major role in ITS’ temptations and lapses, perhaps indicating a degree of behavioral dependence. Affective distress also played a role in ITS lapses, undermining the idea that the affective distress seen in daily smokers’ lapses is due to nicotine withdrawal. The data reinforce the important role of coping in preventing lapses.

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Acknowledgments

The authors are grateful to Brian Primack for medical and administrative oversight and consultation; Allison Brown for assistance overseeing the study; to Jessica Manriquez Richard, Jessica Cheng, Christina Warner, and Jacob Burns, research assistants who conducted research sessions; to James Moorehead for data management and preparation; to Alexsys Hoesch for administrative assistance; and to support provided by the National Institute on Drug Abuse (P30 DA012393) and the National Center for Research Resources (S10 RR026437) for laboratory resources at the University of California, San Francisco. We also appreciate the contributions of members of the study Data and Safety Monitoring Board, Peter Callas (University of Vermont), Jonathan Foulds (Pennsylvania State University), and John Hughes (University of Vermont, Chair).

Funding

This work was supported by a grant (R01 DA034629) to H. Tindle and B. Primack from the National Institute on Drug Abuse at the National Institutes of Health (NIH). NIH had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations

  1. Department of Psychology, University of Pittsburgh, 130 N. Bellefield Ave, Suite 510, Pittsburgh, PA, 15213, USA

    Saul Shiffman & Sarah M. Scholl

  2. Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA

    Jason Mao

  3. College of Health & Medicine, University of Tasmania, Hobart, TAS, Australia

    Stuart G. Ferguson

  4. Department of Public Health Sciences, University of Chicago, Chicago, IL, USA

    Donald Hedeker

  5. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Hilary A. Tindle

  6. Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA

    Hilary A. Tindle

Authors
  1. Saul Shiffman
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  2. Sarah M. Scholl
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  3. Jason Mao
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  4. Stuart G. Ferguson
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  5. Donald Hedeker
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  6. Hilary A. Tindle
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Corresponding author

Correspondence to Saul Shiffman.

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Conflict of interest

At the time of this study and analysis, SS, through Pinney Associates, consulted on tobacco cessation and harm reduction (including nicotine replacement therapy and digital vapor products; by contract, combusted cigarettes are excluded) to Niconovum USA, RJ Reynolds Vapor Company, and RAI Services Company, all subsidiaries of Reynolds American, Inc. and British American Tobacco. Previously, SS consulted to NJOY on e-cigarettes, and to GlaxoSmithKline Consumer Healthcare on smoking cessation medications and treatments, including nicotine gum. Currently, SS and Pinney Associates consult to JUUL Labs on harm reduction. SS holds patents for a novel nicotine gum that is not under commercial development. HAT provided input to Achieve Life Sciences regarding study design for a future possible cessation trial of cytisine, and has led or co-led studies using smoking cessation medication donated by the manufacturer (e.g., Pfizer). SGF has worked as a consultant to GlaxoSmithKline Consumer Healthcare and Chrono Therapeutics on matters relating to smoking cessation, has received researcher-initiated project grant funding, and travel funds, from Pfizer, and has served on an advisory board for Johnson & Johnson. Other authors report no competing interests.

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Shiffman, S., Scholl, S.M., Mao, J. et al. Ecological momentary assessment of temptations and lapses in non-daily smokers. Psychopharmacology 237, 2353–2365 (2020). https://doi.org/10.1007/s00213-020-05539-3

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