using ema data to examine negative affect and craving during a quit attempt megan e. piper, ph.d....
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Using EMA Data to Examine Negative Affect and Craving
During a Quit Attempt
Megan E. Piper, Ph.D.Assistant ProfessorCenter for Tobacco Research & InterventionDepartment of MedicineUW School of Medicine and Public Health
Research Aims
To examine the patterns of negative affect and craving pre- and post-quit– Withdrawal dimensions include average intensity,
variability/volatility and trajectory (Piasecki et al. 1998; Piasecki et al. 2003a; Piasecki et al. 2000)
To examine how temptation events influence negative affect and craving– Deprivation can enhance cue reactivity, which may
influence smoking motivation (Acri and Grunberg 1992; Gloria et al., 2009; McCarthy et al. 2006; McClernon et al., 2009; Shiffman et al. 2006; Shiffman et al. 1996; Spiga et al. 1994; cf Perkins 2009a)
Research Aims
To examine how withdrawal parameters and reactivity to temptation events are related to short-term cessation success
Recruitment and inclusion/ exclusion criteria
Recruited in Madison and Milwaukee, WI – TV, radio and newspaper advertisements, community flyers– Earned media
Inclusion criteria: – Smoking ≥ 10 cigs/day for the past 6 months – Motivated to quit smoking
Exclusion criteria: – Medications contraindicated for bupropion– Consuming ≥ 6 alcoholic beverages 6-7 days/week– Self-reported history of psychosis or bipolar disorder
CONSORT figure
N = 8526Expressed interest
n = 1418Declined
n = 2010Unreachable
n = 2027Failed screen
n = 3153Passed phone screen
n = 1331Withdrew
n = 1504Randomized
n = 318Excluded
Lozengen = 260
Patchn = 261
Bupropion SR
n = 266
Patch +Lozengen = 267
Bupropion SR + Lozenge
n = 261
Placebon = 189
Study participants
N = 1504 (58.2% women) Ethnicity
– 1258 (83.9%) White – 204 (13.6%) African-American – 42 (2.8%) parents of Hispanic origin
21.9% had a 4-year college degree Mean age = 44.67 (SD = 11.08) Mean cigs. smoked/day = 21.43 (SD = 8.93) Mean number of quit attempts = 5.72 (SD = 9.65)
Weeks
TQD Year 3Year 2Year 16 mo.
V9 V10 V11 V12Infor
mation
Ses
sion
Orienta
tion
V8V7V6V5V4V3 -
Rand
omiza
tion
V2V1
1 2 4 8-1-2-3-4
Baseline Treatment* Follow-up
Study timeline
*Counseling and medication
EMA period
EMA Protocol
Palmtop computers 4 prompts per day
– Waking– 2 random during the day (separated by at least 1
hour)– Prior to going to bed
2 weeks pre-quit and 2 weeks post-quit– Analyzed data 10 days pre-quit and 10 days post-
quit
EMA Questions – Every prompt
In the last 15 minutes rate:– Negative and positive affect– Craving– Hunger– Difficulty Concentrating– Restlessness
Smoking since last prompt
EMA Questions – Every prompt
Self-efficacy Cessation fatigue Motivation to work hard to quit Positive smoking expectancies Temptation events and coping
EMA Questions – Evening Prompt
Cessation medication usage Alcohol and caffeine use Menstruation Stressor occurrence and coping Pleasurable daily activities
EMA Compliance
Of the total 80 assessments (4 times/day for 20 days):– Mean prompts completed = 50.9– Median prompts completed = 53
Missing data was significantly positively related to 8-week relapse – OR = 1.03, p < .001
When analyses controlled for missing data, the results were similar
Mean Negative Affect
Mean Daily Craving
Negative Affect for 4 Participants
Craving for 4 Participants
Temptation
“Since your last report, did anything happen that made you want to smoke?”
Pre-quit (18.9%) vs. Post-quit (19.5%)– Χ2 = 3.69, p = .055
Examine craving and negative affect with a general linear model looking at pre-quit vs. post-quit and temptation event vs. no temptation event
Temptation and Negative Affect
F(1, 63340) = 7.85p = .005
Temptation and Craving
F(1, 63340) = 105.17p < .001
Withdrawal and Cessation
8-week CO-confirmed point-prevalence abstinence
Controlling for treatment and post-quit smoking – Treatment: 0 = placebo, 1 = monotherapy, 2 =
combination therapy – Smoking: 0 = no smoking, 1 = < 1 cig/day, 2 = 1
or more cig/day
Withdrawal and Cessation
Change (post-pre) in: – Mean level– Frequency of extreme reports– Variability (SD)– Mean level when temptation event reported – Mean level when no temptation event reported
Univariate Prediction of 8-week Abstinence – Negative Affect
Withdrawal measure Wald p-value OR OR 95% CIChange in negative affect mean
8.73 .003 .82 .72, .94
Change in negative affect SD 2.83 .09 .83 .67, 1.03
Change in percent of negative affect reports greater than 4
1.81 .18 .99 .97, 1.01
Change in negative affect mean when faced with a temptation event
.92 .34 .95 .86, 1.05
Change in negative affect mean when not faced with a temptation event
4.77 .03 .85 .74, .98
Univariate Prediction of 8-week Abstinence – Craving
Withdrawal measure Wald p-value OR OR 95% CI
Change in craving mean 19.58 <.001 .89 .84, .93
Change in percent of craving reports greater than 7
9.41 .002 .99 .988, .997
Change in craving mean when faced with a temptation event
6.19 .01 .93 .88, .985
Change in craving mean when not faced with a temptation event
14.38 <.001 .90 .85, .95
Best-Fitting Multivariate Model to Predict 8-week Abstinence
Withdrawal measure Wald p-value OR OR 95% CI
Change in craving mean
6.15 .01 .90 .83, .98
Change in negative affect mean
12.92 <.001 .62 .48, .80
Change in negative affect mean when faced with a temptation event
5.43 .02 1.18 1.03, 1.37
Addressing Smoking During EMA
Considerable post-quit smoking is required to reduce withdrawal symptoms (Piasecki et al., 2003)
80% reported smoking <1 cig/day in the first 10 days – 34% reported no smoking
Results were consistent when removed participants who reported smoking 5 or more cigs/day on average for the 10 days post-quit (n = 47)
Conclusions
Relative to negative affect, craving reports are more intense, on average, more variable and are more likely to be extreme– 20% of craving reports were greater than 1 SD– 1.6% of negative affect reports were greater than
1 SD
Craving returns to pre-quit levels by 10 days but negative affect does not
Conclusions
Quitting results in reactivity (i.e., increased negative affect and craving) when confronted with temptation events
Cessation success is related to:– Various withdrawal components: negative affect,
craving and reactivity to temptation events– Various withdrawal parameters: mean level,
extreme reports
Acknowledgements
Piper, M. E., Schlam, T. R., Cook, J. W., Sheffer, M. A., Smith, S. S., Loh, W.-Y., Bolt, D. M., Kim, S.-Y., Kaye, J. T., Hefner, K. R., & Baker, T. B. (2011). Tobacco withdrawal components and their relations with cessation success. Psychopharmacology 216, 569-578. PMCID: PMC3139774
Staff and students at the Center for Tobacco Research and Intervention
NIH grants: P50 DA019706 (NIDA), M01 RR03186 (General Clinical Research Centers Program), 1UL1RR025011 from the Clinical and Translational Science Award (CTSA; Piper), K08DA021311 (Cook), 1K05CA139871 (Baker) and U. S. Army Research Office grant W911NF‑09‑1‑0205 (Loh)
Negative Affect Assessment
PostQuit - Lozenge
I have been TENSE or ANXIOUS.
Next
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Disagree!! Agree!!
PostQuit - Lozenge
I have been TENSE or ANXIOUS.
Next
Previous
Disagree!! Agree!!