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
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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)
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Research Aims
To examine how withdrawal parameters and reactivity to temptation events are related to short-term cessation success
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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
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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
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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)
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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
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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
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EMA Questions – Every prompt
In the last 15 minutes rate:– Negative and positive affect– Craving– Hunger– Difficulty Concentrating– Restlessness
Smoking since last prompt
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EMA Questions – Every prompt
Self-efficacy Cessation fatigue Motivation to work hard to quit Positive smoking expectancies Temptation events and coping
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EMA Questions – Evening Prompt
Cessation medication usage Alcohol and caffeine use Menstruation Stressor occurrence and coping Pleasurable daily activities
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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
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Mean Negative Affect
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Mean Daily Craving
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Negative Affect for 4 Participants
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Craving for 4 Participants
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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
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Temptation and Negative Affect
F(1, 63340) = 7.85p = .005
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Temptation and Craving
F(1, 63340) = 105.17p < .001
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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
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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
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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
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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
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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
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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)
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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
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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
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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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Negative Affect Assessment
PostQuit - Lozenge
I have been TENSE or ANXIOUS.
Next
Previous
Disagree!! Agree!!
PostQuit - Lozenge
I have been TENSE or ANXIOUS.
Next
Previous
Disagree!! Agree!!