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Using EMA Data to Examine Negative Affect and Craving During a Quit Attempt

Using EMA Data to Examine Negative Affect and Craving During a Quit Attempt. Megan E. Piper, Ph.D. Assistant Professor Center for Tobacco Research & Intervention Department of Medicine UW School of Medicine and Public Health. Research Aims.

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Using EMA Data to Examine Negative Affect and Craving During a Quit Attempt

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  1. Using EMA Data to Examine Negative Affect and Craving During a Quit Attempt Megan E. Piper, Ph.D. Assistant Professor Center for Tobacco Research & Intervention Department of Medicine UW School of Medicine and Public Health

  2. 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)

  3. Research Aims • To examine how withdrawal parameters and reactivity to temptation events are related to short-term cessation success

  4. 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

  5. CONSORT figure N = 8526 Expressed interest n = 2010 Unreachable n = 1418 Declined n = 2027 Failed screen n = 3153 Passed phone screen n = 1331 Withdrew n = 1504 Randomized n = 318 Excluded Bupropion SR n = 266 Patch + Lozenge n = 267 Bupropion SR + Lozenge n = 261 Patch n = 261 Lozenge n = 260 Placebo n = 189

  6. 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) Study participants

  7. Study timeline V3 - Randomization Information Session Orientation V1 V2 V4 V5 V6 V7 V8 V9 V10 V11 V12 6 mo. Year 1 Year 2 Year 3 -4 -3 -2 -1 TQD 1 2 4 8 Baseline Treatment* Follow-up Weeks EMA period *Counseling and medication

  8. 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

  9. EMA Questions – Every prompt • In the last 15 minutes rate: • Negative and positive affect • Craving • Hunger • Difficulty Concentrating • Restlessness • Smoking since last prompt

  10. EMA Questions – Every prompt • Self-efficacy • Cessation fatigue • Motivation to work hard to quit • Positive smoking expectancies • Temptation events and coping

  11. EMA Questions – Evening Prompt • Cessation medication usage • Alcohol and caffeine use • Menstruation • Stressor occurrence and coping • Pleasurable daily activities

  12. 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

  13. Mean Negative Affect

  14. Mean Daily Craving

  15. Negative Affect for 4 Participants

  16. Craving for 4 Participants

  17. 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

  18. Temptation and Negative Affect F(1, 63340) = 7.85 p = .005

  19. Temptation and Craving F(1, 63340) = 105.17 p < .001

  20. 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

  21. 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

  22. Univariate Prediction of 8-week Abstinence – Negative Affect

  23. Univariate Prediction of 8-week Abstinence – Craving

  24. Best-Fitting Multivariate Model to Predict 8-week Abstinence

  25. 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)

  26. 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

  27. 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

  28. 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)

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