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Stull SW, Linden-Carmichael AN, Scott CK, Dennis ML, Lanza ST. Time-varying effect modeling with intensive longitudinal data: Examining dynamic links among craving, affect, self-efficacy and substance use during addiction recovery. Addiction 2023; 118:2220-2232. [PMID: 37416972 DOI: 10.1111/add.16284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 05/22/2023] [Indexed: 07/08/2023]
Abstract
Time-varying effect modeling (TVEM), a statistical technique for modeling dynamic patterns of change, presents new opportunities to study biobehavioral health processes. TVEM is particularly useful when applied to intensive longitudinal data (ILD) because it permits highly flexible modeling of outcomes over continuous time, as well as of associations between variables and moderation effects. TVEM coupled with ILD is ideal for the study of addiction. This article provides a general overview of using TVEM, particularly when applied to ILD, to better enable addiction scientists to conduct novel analyses that are important to realizing the dynamics of addiction-related processes. It presents an empirical example using ecological momentary assessment data from participants throughout their first 90 days of addiction recovery to estimate the (1) associations between morning craving and same-day recovery outcomes, (2) association between morning positive and negative affect and same-day recovery outcomes and (3) time-varying moderation effects of affect on the association between morning craving and recovery outcomes. We provide a didactic overview in implementing and interpreting the aims and results, including equations, computer syntax and reference resources. Our results highlight how affect operates as both a time-varying risk and protective factor on recovery outcomes, particularly when considered in combination with experiences of craving (i.e. dynamic moderation). We conclude by discussing our results, recent innovations and future directions of TVEM for advancing addiction science, including how 'time' can be operationalized to probe new research questions.
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Affiliation(s)
- Samuel W Stull
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - Ashley N Linden-Carmichael
- The Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, University Park, PA, USA
| | | | | | - Stephanie T Lanza
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- The Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, University Park, PA, USA
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Kendall AD, Hedeker D, Diviak KR, Mermelstein RJ. The Mood Boost from Tobacco Cigarettes is More Erratic with the Additions of Cannabis and Alcohol. Nicotine Tob Res 2022; 24:1169-1176. [PMID: 34999839 PMCID: PMC9278821 DOI: 10.1093/ntr/ntac001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/18/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION A large body of literature indicates that nicotine results in an acute mood "boost," including increased positive affect and decreased negative affect. Young adults frequently engage in polysubstance use of cigarettes with cannabis and alcohol-a trend that is likely to accelerate with the expanding legalization of cannabis. However, little is known about whether polysubstance use, defined here as combustible tobacco cigarette use within the same hour as cannabis and alcohol, is associated with changes in the nicotine mood boost. The present study aimed to address this gap. METHODS Young adults (N = 202, 52% female, mean age = 21 years at time 1) provided ecological moments assessment (EMA) reports of cigarette use over two 7-day bursts spaced 1 year apart. In each report, participants rated mood levels before and after smoking, and indicated cannabis and alcohol use. Mixed-effects location-scale modeling simultaneously tested changes in mood levels and variability related to smoking events with cannabis and/or alcohol compared with smoking-only events. RESULTS From before to after smoking, positive affect increased and negative affect decreased, on average. Overall, the additions of cannabis and/or alcohol had nonsignificant associations with these mean changes. However, polysubstance use, as well as cigarette-cannabis co-use, were each associated with significantly greater within-person variability in the positive and negative affect changes related to smoking. CONCLUSIONS The mood benefits associated with smoking were more erratic in the contexts of polysubstance use and cigarette-cannabis co-use. Potential implications for young adults' long-term nicotine use trajectories are discussed. IMPLICATIONS Among young adults who smoke cigarettes, the mood "boost" from smoking may be more erratic-which is to say, more likely to be either amplified or attenuated-with the additions of cannabis and alcohol together, or cannabis alone. On occasions when young adults seek out cannabis and alcohol to enhance their smoking mood boost, but instead experience a dampening effect, they might consume more nicotine, contributing over time to greater dependence. Future investigation is warranted, with particular attention to nicotine-cannabis co-use.
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Affiliation(s)
- Ashley D Kendall
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Kathleen R Diviak
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Robin J Mermelstein
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
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Koslovsky MD, Hébert ET, Businelle MS, Vannucci M. A Bayesian time-varying effect model for behavioral mHealth data. Ann Appl Stat 2020; 14:1878-1902. [DOI: 10.1214/20-aoas1402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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An Ecological Momentary Assessment of Affect, Mental Health Symptoms, and Decisions to Drink Among First-Year College Women: A Pilot Study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:753-764. [PMID: 30498934 DOI: 10.1007/s11121-018-0966-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
College women experience more consequences (e.g., blacking out, unprotected/unwanted sex) on days when they engage in their heaviest drinking. To inform prevention efforts, research is needed to understand decision-making processes that influence women's drinking behaviors at the event level. The present study used ecological momentary assessment (EMA) methods to examine: (1) associations between positive affect (PA) and negative affect (NA) and decision-making processes on days leading up to, during, and following heavy drinking events; and (2) mental health symptoms as moderators of these associations. Female undergraduate drinkers (N = 57) completed a 14-day EMA protocol on their smartphones, which included three daily assessments of PA, NA, and willingness and intentions to drink. Trait anxiety and depressive symptoms were measured before the EMA protocol and assessed as moderators. Time-varying effect models were used to examine covariation among PA, NA, and willingness and intentions to drink on the days leading up to participants' heaviest drinking events, the day of the event itself, and the days following the event. Results revealed PA was positively associated with willingness to drink the 2 days before, the day of, and the day after the heaviest drinking event. Similar effects were observed for PA and intentions to drink. Trait anxiety moderated the association between PA and intentions to drink. Findings underscore that positive affect may influence drinking-related decision-making processes surrounding heavy drinking events, particularly in those college women low in anxiety. Results identify potential entry points for real-time intervention efforts targeting college women during times of elevated PA.
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Treloar Padovano H, Merrill JE, Colby SM, Kahler CW, Gwaltney CJ. Affective and Situational Precipitants of Smoking Lapses Among Adolescents. Nicotine Tob Res 2020; 22:492-497. [PMID: 30624745 DOI: 10.1093/ntr/ntz002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 01/07/2019] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Most adolescent smokers report a desire to quit, and many have made several unsuccessful quit attempts; however, when adolescents attempt to quit, they often resume smoking quickly. This ecological study aimed to (1) characterize affective and situational precipitants of smoking lapses among adolescents and (2) explore the moderating influence of nicotine dependence severity on lapse precipitants. METHODS Adolescent daily smokers (n = 166; ages 14-18 years) completed electronic diaries of cigarettes smoked, craving and affective states, and situational variables on handheld computers in their natural environment for 2 weeks following an unassisted quit attempt. On average, adolescents were moderately nicotine dependent (Modified Fagerström Tolerance Questionnaire [mFTQ] score = 4.9; SD = 1.6). RESULTS Craving was a significant episodic cue for lapse and stable influence on lapse, relating to 44% and 15% increased odds of lapse, respectively. High-arousal affective states-regardless of valence-were associated with 12%-13% increased odds of lapse. Low-arousal positive affective states were associated with 17% decreased odds of lapse. A 1-unit difference in a teen's mFTQ score related to 27% increased odds of lapse, but dependence severity did not moderate proximal lapse influences. CONCLUSIONS This report provides some of the first ecological data characterizing adolescent smoking lapses following a quit attempt. As in prior work with teens, lapses were nearly universal and quickly followed the quit attempt. Specific situational and affective contexts of smoking lapses for adolescents were implicated, indicating the need for cessation interventions to address craving and high-arousal affective states as precipitators of lapse in this high-risk group. IMPLICATIONS This report provides some of the first ecological data characterizing smoking lapses among teens attempting to quit smoking on their own. Like adults, adolescents face many barriers when making quit attempts. The present work provides ecological data to suggest that the experience of heightened arousal in teens' daily lives interferes with their efforts to quit smoking. Thus, this work highlights the importance of affective dysregulation, or amplitude of emotional feelings, for teen smoking lapses. Moment-to-moment fluctuation in craving was also implicated as a dynamic precipitator of smoking lapse in this high-risk group.
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Affiliation(s)
- Hayley Treloar Padovano
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI.,Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Jennifer E Merrill
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI.,Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Chad J Gwaltney
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
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Miller S, Pike J, Shono Y, Beleva Y, Xie B, Stacy AW. The role of negative affect in the persistence of nicotine dependence among alternative high school students: A latent growth curve analysis. Drug Alcohol Depend 2020; 209:107883. [PMID: 32065940 PMCID: PMC7127931 DOI: 10.1016/j.drugalcdep.2020.107883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/23/2019] [Accepted: 01/23/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous research has demonstrated how negative affect (i.e., depression, anxiety, stress) is often a correlate of and precursor to nicotine dependence. Although recent evidence shows a gradual decline in tobacco use in the United States, subgroups that report higher levels of negative affect may continue to be at risk of becoming dependent on nicotine. One high-risk subgroup is students who attend alternative high schools. The current longitudinal investigation examined the effect of negative affect on nicotine dependence in this youth population. METHODS 1060 students from 29 alternative high schools in Southern California completed a series of attitudinal and behavioral measures once per year over a three-year period. The main outcome was nicotine dependence i.e., feeling a strong urge to use nicotine products or experiencing withdrawal symptoms after a period of abstinence, measured using a version of the Fagerstrom Tolerance Questionnaire designed for adolescents. A latent growth curve model was utilized to examine the effect of negative affect on nicotine dependence during this timeframe. RESULTS The analysis revealed that negative affect had both a concurrent and prospective relationship with nicotine dependence. Moreover, the association between negative affect and nicotine dependence in the present was not statistically significant once the influence of negative affect reported one year earlier was accounted for. CONCLUSIONS Negative affect may play a critical role in the persistence of nicotine dependence among high-risk youth. Providing resources to help manage negative affect may be critical to curtailing nicotine dependence in this population.
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Affiliation(s)
- Stephen Miller
- Department of Research and Evaluation, Didi Hirsch Mental Health Services, 323 N. Prairie Ave, Suite 325, Inglewood, CA 90301, USA.
| | - James Pike
- School of Community and Global Health, Claremont Graduate University, 675 West Foothill Boulevard, Suite 310, Claremont, CA 91711-3475, USA
| | - Yusuke Shono
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE 45th Street, Suite 300, Box 354944, Seattle, WA 98195-4944, USA
| | - Yuliyana Beleva
- School of Community and Global Health, Claremont Graduate University, 675 West Foothill Boulevard, Suite 310, Claremont, CA 91711-3475, USA
| | - Bin Xie
- School of Community and Global Health, Claremont Graduate University, 675 West Foothill Boulevard, Suite 310, Claremont, CA 91711-3475, USA
| | - Alan W Stacy
- School of Community and Global Health, Claremont Graduate University, 675 West Foothill Boulevard, Suite 310, Claremont, CA 91711-3475, USA
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Deutsch AR. Dynamic Change Between Intimate Partner Violence and Contraceptive Use Over Time in Young Adult Men's and Women's Relationships. JOURNAL OF SEX RESEARCH 2019; 56:985-998. [PMID: 30156880 PMCID: PMC6395544 DOI: 10.1080/00224499.2018.1509291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The negative association between intimate partner violence (IPV) and contraceptive use is well established, but much of this research treats the association as static (e.g., similar across all relationships over development or time). Such studies do not account for individual development of sexual and romantic relationship mental, social, and behavioral well-being, which relate to contraceptive use. These studies are also predominantly woman-focused; such work could be complemented by examining men's associations. The current study examined how associations between sexual and physical IPV and consistent condom and birth control (BC) use changed across up to seven sequential relationships in young adulthood over a five-year period within a nationally representative sample. Results indicated that physical IPV-contraception associations were significant only across earliest or latest relationships. Sexual IPV-contraception associations were significant over more relationships but often changed in valence (negative to positive). There were few significant differences in these associations between men and women. Developmental context (e.g., prior relationship/IPV experience) may be important when considering IPV-contraception associations. In addition, although the IPV-contraception association does not appear to be a unique problem for women, research needs to explore how underlying mechanisms explaining this association may be a result of gendered and nongendered contexts.
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Berg CJ, Haardörfer R, Payne JB, Getachew B, Vu M, Guttentag A, Kirchner TR. Ecological momentary assessment of various tobacco product use among young adults. Addict Behav 2019; 92:38-46. [PMID: 30579116 DOI: 10.1016/j.addbeh.2018.12.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Young adults are at high risk for using traditional and novel tobacco products. However, little is known about daily/weekly use patterns or psychosocial triggers for using various tobacco products. METHODS This ecological momentary assessment (EMA) study examined timing, tobacco cravings, affect, social context, and other substance use (alcohol, marijuana) in relation to use of cigarettes, electronic nicotine delivery systems (ENDS), and any tobacco product (i.e., cigarettes, ENDS, cigars, hookah), respectively. We also examined interactions between these predictors, sex, and race/ethnicity. From a longitudinal study of 3418 18-25 year-olds from seven Georgia colleges/universities, we recruited 72 reporting current tobacco use to participate in the 21-day EMA study; 43 participated, of which 31 completed ≥66% assessments and were analyzed. Cravings, affect, social context, and substance use were assessed daily across four four-hour windows. RESULTS Of the 31 participants, average age was 21.10 years (SD = 1.95), 45.2% were female, and 71.0% non-Hispanic White; 71.0% used cigarettes, 58.1% ENDS, 38.7% cigars, and 25.8% hookah (25.6% used one product, 46.5% two, 27.9% ≥ three). Predictors of cigarette use included higher anxiety, greater odds of marijuana and alcohol use, and higher boredom levels among women. Predictors of ENDS use included being non-White and greater odds of marijuana use, as well as higher tobacco cravings among women and higher boredom among men. Predictors of any tobacco product use included being non-White, higher boredom levels, and greater odds of marijuana and alcohol use. CONCLUSIONS Distinct interventions may be needed to address use of differing tobacco products among young adults.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States; Winship Cancer Institute, Emory University, 1365 Clifton Rd NE, Atlanta, GA 30322, United States.
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Jackelyn B Payne
- Winship Cancer Institute, Emory University, 1365 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Betelihem Getachew
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Alexandra Guttentag
- College of Global Public Health, New York University, 715 Broadway, 12th Floor New York, NY 10003, United States
| | - Thomas R Kirchner
- College of Global Public Health, New York University, 715 Broadway, 12th Floor New York, NY 10003, United States
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Lanza ST, Vasilenko SA, Russell MA. Time-varying effect modeling to address new questions in behavioral research: Examples in marijuana use. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2016; 30:939-954. [PMID: 27736149 DOI: 10.1037/adb0000208] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Time-varying effect modeling (TVEM), a statistical approach that enables researchers to estimate dynamic associations between variables across time, holds enormous potential to advance behavioral research. TVEM can address innovative questions about processes that unfold across different levels of time. We present a conceptual introduction to the approach and demonstrate 4 innovative ways to approach time in TVEM to advance research on the etiology of marijuana use. First, we examine changes in associations across historical time to understand how the link between marijuana use attitudes and marijuana use behavior has shifted from 1976 to present; gender differences in the relevance of attitudes diminished over time and were no longer significant after 2004. Second, we examine age-varying associations between heavy episodic drinking and marijuana use across developmental time and demonstrate that this dynamic association is substantially stronger during ages 14 to 16 compared with later ages. Third, we explore the complex association between age of onset of marijuana use and adult marijuana use to identify precise age ranges during which the onset of use is most risky, and demonstrate how this complex association is more salient for males. Finally, we examine changes in marijuana use as a function of time relative to the birth of first child and show how this transition is more crucial for females. All empirical examples in this methodological demonstration rely on existing data from cross-sectional or panel studies. We conclude with thoughts on future directions for the application and further development of TVEM in behavioral research. (PsycINFO Database Record
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Lanza ST, Vasilenko SA. New methods shed light on age of onset as a risk factor for nicotine dependence. Addict Behav 2015; 50:161-4. [PMID: 26151579 DOI: 10.1016/j.addbeh.2015.06.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 06/04/2015] [Accepted: 06/05/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Early onset of substance use is a risk factor for later drug use, abuse, and dependence. This study examines how the rate of nicotine dependence differs as a function of age of onset of regular smoking in continuous time, in order to identify critical age periods that are most predictive of later dependence for males and females. METHODS Time-varying effect modeling (TVEM) can reveal specific ages of onset that confer greatest risk for adult nicotine dependence. The rate of dependence in adulthood is modeled as a flexible function of age of onset using a subset of adults (N = 15,748) from the National Epidemiologic Survey on Alcohol and Related Conditions who ever smoked regularly. RESULTS The peak risk of adult nicotine dependence coincides with onset of regular use at approximately 10 years old, with an elevated risk persisting to 20 years. The risk of dependence is significantly higher for females compared to males for onset of regular use between ages 9 and 18. CONCLUSIONS Results suggest that the risk of adult nicotine dependence is highest when onset of regular smoking occurs at around 10 years, though the associated risk is high for ages of onset into young adulthood. Early onset of regular use is a relatively stronger risk factor for adolescent females than males. Smoking prevention programs should focus on late childhood through early adolescence, particularly among females. TVEM provides a more nuanced understanding of the risk associated with different ages of onset of health risk behaviors.
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