title: Independent and interactive effects of real-time risk factors on later temptations and lapses among smokers trying to quit.
abstract: OBJECTIVE
  The current study sought to expand our understanding of relapse mechanisms by identifying the independent and interactive effects of real-time risk factors on temptations and the ability to resist temptations in smokers during a quit attempt.
  
  
  METHODS
  This study was a secondary analysis of data from 109 adult, treatment-seeking daily smokers. Ecological momentary assessment data was collected 4 times a day for 21 days following a quit attempt and was used to assess affect, urge, impulsiveness, recent cigarette exposure, and alcohol use as predictors of temptations to smoke and smoking up to 8h later. All smokers received nicotine replacement therapy and smoking cessation counseling.
  
  
  RESULTS
  In multinomial hierarchical linear models, there were significant main (agitation odds ratio (OR)=1.22, 95% CI=1.02-1.48; urge OR=1.60, 95% CI=1.35-1.92; nicotine dependence measured by WISDM OR=1.04, 95% CI=1.01-1.08) and interactive effects (agitation×urge OR=1.12, 95% CI=1.01-1.27; urge×cigarette exposure OR=1.38, 95% CI=1.10-1.76; positive affect×impulsiveness OR=2.44, 95% CI=1.02-5.86) on the odds of temptations occurring, relative to abstinence without temptation. In contrast, prior smoking (OR=3.46, 95% CI=2.58-4.63), higher distress (OR=1.30, 95% CI=1.06-1.60), and recent alcohol use (OR=3.71, 95% CI=1.40-9.89) predicted smoking versus resisting temptation, and momentary impulsiveness was related to smoking for individuals with higher baseline impulsiveness (OR=1.12, 95% CI=1.04-1.22).
  
  
  CONCLUSIONS
  The risk factors and combinations of factors associated with temptations and smoking lapses differ, suggesting a need for separate models of temptation and lapse.
authors.affiliation: Rutgers, The State University of New Jersey, Department of Psychology, 152 Frelinghuysen Road, Piscataway, NJ 08854-8020, USA; Institute for Health, Health Care Policy, and Aging Research, 112 Paterson Street, New Brunswick, NJ 08901-1293, USA; Yale School of Medicine, Department of Psychiatry, CMHC, 34 Park Street, New Haven, CT 06519, USA. Electronic address: krysten.bold@yale.edu.
authors.forename: Krysten W
authors.initials: KW
authors.lastname: Bold
authors.affiliation: Rutgers, The State University of New Jersey, Department of Psychology, 152 Frelinghuysen Road, Piscataway, NJ 08854-8020, USA; Institute for Health, Health Care Policy, and Aging Research, 112 Paterson Street, New Brunswick, NJ 08901-1293, USA.
authors.forename: Danielle E
authors.initials: DE
authors.lastname: McCarthy
authors.affiliation: Rutgers, The State University of New Jersey, Department of Psychology, 152 Frelinghuysen Road, Piscataway, NJ 08854-8020, USA; Institute for Health, Health Care Policy, and Aging Research, 112 Paterson Street, New Brunswick, NJ 08901-1293, USA; Fordham University, Department of Psychology, 441 E. Fordham Road, Bronx, NY 10458, USA.
authors.forename: Haruka
authors.initials: H
authors.lastname: Minami
authors.affiliation: Rutgers, The State University of New Jersey, Department of Psychology, 152 Frelinghuysen Road, Piscataway, NJ 08854-8020, USA; Institute for Health, Health Care Policy, and Aging Research, 112 Paterson Street, New Brunswick, NJ 08901-1293, USA; Deloitte Consulting LLP, 25 Broadway, New York, NY 10004, USA.
authors.forename: Vivan M
authors.initials: VM
authors.lastname: Yeh
authors.affiliation: Rutgers, The State University of New Jersey, Department of Psychology, 152 Frelinghuysen Road, Piscataway, NJ 08854-8020, USA; Institute for Health, Health Care Policy, and Aging Research, 112 Paterson Street, New Brunswick, NJ 08901-1293, USA.
authors.forename: Gretchen B
authors.initials: GB
authors.lastname: Chapman
authors.affiliation: Uniformed Services University of the Health Sciences, Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Waters
mesh_terms: D000328:Adult; D066249:Craving; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D012008:Recurrence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000523:psychology* / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology*; D013997:Time Factors; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D016896:Treatment Outcome
keywords: Ecological momentary assessment; Relapse; Smoking cessation; Temptation; Tobacco