In search of anticipatory cigarette cravings: The impact of perceived smoking opportunity and motivation to seek treatment

The dynamics of smoking quit motivation in daily life: Associations with momentary self-regulation and nightly quit intentions

Due to prior work suggesting dynamic fluctuations in quit motivation over time, the current study used ecological momentary assessment (EMA) to examine contextual predictors of momentary quit motivation, most notably perceived self-regulation. The sample (n = 84) intentionally excluded smokers actively trying to quit and those who plan to never quit, focusing on the group of smokers who are interested in but not yet committed to quitting. Participants completed one week of EMA, where they responded to random prompts 7x/day and logged each cigarette. At each prompt, they completed measures assessing cigarette craving, affect (positive and negative), quit motivation, and perceived momentary self-regulation (i.e., willpower self-efficacy, distress intolerance, craving uncontrollability). Participants also completed a nightly prompt where they reported their quit intentions. Results revealed that the newly developed 4-item index of quit motivation had strong psychometric properties, and demonstrated fluctuations over time and across situations. Quit motivation was higher when craving was ideographically lower than usual, and when willpower was higher than usual. People with higher distress intolerance reported higher quit motivation. In addition, stronger quit motivation and less variability in quit motivation was associated with higher quit intentions. The current study suggests that quit motivation does shift dynamically and speaks to the potential importance of targeting craving and willpower self-efficacy to enhance people's motivation to quit.

A novel stress-based intervention reduces cigarette use in non-treatment seeking smokers

Tobacco use is the leading cause of preventable mortality worldwide. Since current smoking cessation aids show only modest efficacy, new interventions are needed. Given the evidence that stress is a potent trigger for smoking, the present randomized clinical trial tested whether stress could augment the effects of a memory updating (retrieval-extinction) intervention. Non-treatment seeking smokers (n = 76) were assigned to one of four conditions composed of either a stressful or non-stressful psychosocial challenge followed by either smoking or neutral cues. Ten minutes after this manipulation, all underwent a 60-minute extinction procedure during which they viewed smoking-related videos and images and manipulated smoking paraphernalia. Compared to participants who were not exposed to the laboratory stressor, the stressor-exposed groups exhibited greater psychophysiological responses during their intervention and greater decreases in cigarette use at two- and six-weeks follow-up independent of smoking cue exposure. Together, these findings suggest that the ability of stress to activate cigarette seeking processes can be exploited to decrease cigarette use. With replication, the stress-based intervention could become a novel strategy for decreasing cigarette use in non-treatment seeking smokers.Clinicaltrials.gov identifier: NCT04843969.

How laboratory studies of cigarette craving can inform the experimental alcohol craving literature

Interest in alcohol and other drug craving has flourished over the past two decades, and evidence has accumulated showing that craving can be meaningfully linked to both drug use and relapse. Considerable human experimental alcohol craving research since 2000 has focused on craving as a clinical phenomenon. Self-reported craving to drink typically has served as a catch-all for the craving construct in these studies, whereas few studies have considered craving as a process (or hypothetical construct) that interacts with other phenomena to affect use. In contrast to alcohol, we believe that recently there has been more mechanistic work targeting cigarette craving-related processes. Here, we briefly present a narrative review of studies of acute alcohol craving in humans that have been conducted during the past two decades. We then specify important ways in which alcohol and tobacco differ (e.g., the role of withdrawal), and we note the unique challenges in inducing robust alcohol craving states in the laboratory. Finally, we offer recommendations for how the alcohol field might advance its conceptual understanding of craving by adopting ideas and methods drawn from the smoking research literature. Specifically, we suggest that researchers extend their studies to not only examine the link between alcohol craving and relapse but also to focus on why and, in some instances, how alcohol cravings matter clinically, and the circumstances under which craving especially matters. We propose research to investigate the shifts in alcohol-related cognitive and affective processing that occur during alcohol craving states. Furthermore, we highlight the value of research examining the level of insight that individuals with varying levels of alcohol involvement possess about their own craving-related processing shifts. We believe that laboratory studies can provide rich opportunities to examine conceptual questions about alcohol craving that are central to addiction.

Non-pharmacological Considerations in Human Research of Nicotine and Tobacco Effects: A Review

Human research of nicotine and tobacco effects demonstrates that non-pharmacological factors may systematically affect responses to administered substances and inert placebos. Failure to measure or manipulate these factors may compromise study reliability and validity. This is especially relevant for double-blind placebo-controlled research of nicotine, tobacco, and related substances. In this article, we review laboratory-based human research of the impact of non-pharmacological factors on responses to tobacco and nicotine administration. Results suggest that varying beliefs about drug content and effects, perceptions about drug use opportunities, and intentions to cease drug use systematically alter subjective, behavioral, and physiological responses to nicotine, tobacco, and placebo administration. These non-pharmacological factors should be considered when designing and interpreting the findings of human research of nicotine and tobacco effects, particularly when a double-blind placebo-controlled design is used. The clinical implications of these findings are discussed, and we propose methodological strategies to enhance the reliability and validity of future research.

IMPLICATIONS

Growing research demonstrates that non-pharmacological factors systematically alter responses to acute nicotine, tobacco, and placebo administration. Indeed, varying beliefs about nicotine and/or tobacco administration and effects, differing perceptions about nicotine and/or tobacco use opportunities, and inconsistent motivation to quit smoking have been found to exert important influences on subjective, physiological, and behavioral responses. These variables are infrequently measured or manipulated in nicotine and tobacco research, which compromises the validity of study findings. Incorporating methodological strategies to better account for these non-pharmacological factors has the potential to improve the quality of addiction research and treatment.

Experiencing cigarette craving with a friend: A shared reality analysis

Cigarette craving predicts relapse to smoking, which remains the leading cause of preventable death in the United States. Understanding why individuals smoke has important clinical implications and is a research priority. Nonlaboratory studies reveal that social factors, such as the presence of other people, are associated with self-reported craving, yet laboratory smoking research has largely ignored these factors by testing participants in isolation. In this study, a shared reality framework was used to evaluate social processes that may change when smokers experience craving while in the presence of a smoking friend versus in social isolation. Sixty pairs of smoking friends (n = 120) arrived together at the laboratory following a required 5 hr of smoking abstinence. One preselected (target) participant then underwent an in vivo smoking cue-exposure craving induction with their friend either present or in another room, completing an unrelated task. Target participants who were together with their friend while craving experienced a greater sense of similarity and felt closer to their friend than did those who were alone. Furthermore, in the together condition, shared Duchenne smiles (using the Facial Action Coding System) were associated with targets' ratings of perceived similarity to their friend. Though social context did not influence affect or urge to smoke, urge was associated with targets' ratings of similarity in the together, but not the alone condition. Results highlight the potential social utility of craving (satisfying epistemic and relational goals) and highlight the need for increased laboratory research on smoking that includes a social context. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The impact of nicotine dose and instructed dose on smokers' implicit attitudes to smoking cues: An ERP study

It is unclear whether nicotine and perceived nicotine exposure can influence automatic evaluations of cigarette stimuli. In the present study, we investigated the effects of nicotine dose and instructed dose on motivational responses to smoking cues. Forty overnight nicotine-deprived smokers completed an Implicit Association Test (IAT) at each of the four laboratory sessions in a balanced-placebo design that crossed nicotine dose (Given-NIC [given nicotine] vs. Given-DENIC [given denicotinized]) with instructed dose expectancy (Told-NIC [told-nicotine] vs. Told-DENIC. [told-denicotinized]). We measured participants' behavioral performance, including reaction time (RT) and accuracy rate, and the early posterior negativity (EPN) component using the event-related potential (ERP) technique to the target pictures. During congruent trials when the categorization condition was smoking or unpleasant, smokers had greater classification accuracy, shorter RT latency, and greater EPN amplitudes compared to the incongruent trials when the categorization condition was smoking or pleasant. The Given-NIC condition was associated with increased classification accuracy, longer RT latency, and decreased EPN amplitudes compared to the Given-DENIC condition. Similarly, the Told-NIC condition was associated with increased accuracy and decreased EPN amplitudes compared to the Told-DENIC condition, but with shorter RT latency. Cigarette-related pictures produced greater EPN amplitudes than neutral pictures. Both behavioral and ERP results suggest that smokers have negative implicit attitudes toward smoking. While both nicotine dose and expected dose facilitated stimulus categorization, there was no evidence that either factor altered smokers' negative attitudes toward smoking cues. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Shifts in momentary motivation to quit smoking based on experimental context and perceptions of motivational instability

BACKGROUND

Smoking quit intentions (i.e., plans or commitments to reduce smoking) are distinct from quit motivation (i.e., desire to quit). Motivation to quit is a dynamic avoidance motivational state, likely subject to frequent fluctuations and shifts based on environmental context, similar to craving (an approach motivational state). Moreover, people's perceptions of motivational instability may influence their momentary quit motivation and beliefs surrounding their abilities to manage the quit process successfully.

METHODS

In the current study, smokers were recruited online. Baseline motivation to quit was examined along with perceptions of motivational instability. Participants who reported some interest in eventually quitting (n = 174; M_age = 45.29, SD = 14.81, 74.1% women) were randomly assigned to negative affect, cigarette or neutral cue conditions and then momentary motivation to quit was assessed, followed by a validated index of quit intentions.

RESULTS

Participants in the negative affect and cigarette cue conditions reported greater momentary motivation to quit than participants in the neutral condition (F = 3.73, p = .03), particularly for people who reported upfront that their motivation did not change from day-to-day (F = 3.97, p = .02). In addition, greater momentary quit motivation predicted stronger quit intentions (B = 0.66, p < .001).

CONCLUSION

Findings from this study suggest that motivation to quit is likely dynamic and influenced by context as well as by self-perceptions. Implications suggest that further efforts to separate motivation from intention may be useful in understanding smokers' desires and plans to quit smoking.

Predictors of Retention in an Adult Text Messaging Smoking Cessation Intervention Program: Cohort Study

BACKGROUND

Mobile health tools such as text messaging programs can support smoking cessation. However, high rates of disengagement from these tools decrease their effectiveness.

OBJECTIVE

The purpose of this study was to identify user characteristics associated with retention in an adult text messaging smoking cessation intervention.

METHODS

Adults initiating a quit attempt using the publicly available program SmokefreeTXT between March 6 and June 21, 2016 (n=6215), were included. Data were collected to assess nicotine dependence, frequency of being around other smokers, time of the day for cigarette cravings, extrinsic and intrinsic motivation to quit smoking, confidence in quitting, and long-term intention to be smoke free. Multivariable survival analysis modeling for time to opt out was conducted to identify characteristics associated with opting out over the course of the intervention, adjusting for age, sex, and smoking frequency, reset of the quit date by the user, and the number of days enrolled before initiating the quit attempt. Among those who opted out, multivariable multinomial logistic regression analysis was used to identify predictors of opting out early (within 3 days and between 4 and 7 days into the quit attempt) compared to opting out late (more than 7 days into the quit attempt), adjusting for the same confounders.

RESULTS

Survival analyses indicated that younger age, female sex, higher levels of nicotine dependence, lower intention to be smoke free, and enrolling in SmokefreeTXT ≤1 week before initiating the quit attempt were associated with an increased risk of opting out. For example, users who smoked within 5 minutes of waking up were 1.17 times more likely to opt out than those who smoked more than 5 minutes after waking up (95% CI 1.01-1.35). Among users who opted out from SmokefreeTXT, logistic regression modeling indicated that compared to users who were never or rarely around other smokers, those who were sometimes around other smokers had 1.96 times more likely to opt out within the first 3 days of the quit attempt (95% CI 1.18-3.25). In addition, compared to users with high levels of long-term quit intention, users with lower levels of intention had 1.80 times the odds of opting out between 4 and 7 days into the quit attempt (95% CI 1.02-3.18). Users who reset their quit date after initiating a quit attempt were less likely to opt out at either time point compared with those who did not reset their quit date.

CONCLUSIONS

Several user characteristics are associated with retention in an adult text messaging smoking cessation program. These results provide guidance on potential characteristics that should be addressed in future text messaging smoking cessation programs. Providing additional support to users with these characteristics may increase retention in text messaging programs and ultimately lead to smoking cessation.

Beneath the surface: Abstract construal mindset increases receptivity to metaphors in health communications

Widespread messages use metaphoric language and imagery to prompt recipients to interpret health-related concepts in terms of dissimilar, familiar concepts (e.g., "fight the war on cancer"). When do these messages work? According to Conceptual Metaphor Theory, thinking metaphorically involves looking past concepts' superficial differences to identify their similarities at a structural level. Thus, we hypothesized that when people's general construal mindset is oriented to focus on information's abstract meaning, not its concrete details, they would process a metaphor's target health concept in ways that correspond to the dissimilar concept. Accordingly, after priming an abstract, but not concrete, construal mindset: framing sun exposure as enemy confrontation (vs. literally) increased cancer risk perceptions and sun-safe intentions (Study 1; N=186); and framing smoking cessation as an arduous journey (vs. literally) increased appreciation of quitting difficulties and interest in cessation tools (Study 2; N=244). We discuss practical and theoretical implications for improving health communication.

The effects of alcohol on positive emotion during a comedy routine: A facial coding analysis

There is considerable interest in understanding the emotional effects of alcohol. While a great deal of experimental research has focused on alcohol's ability to relieve negative emotions, there has been far less focus on the effects of alcohol on positive emotions. Further, the available research on positive emotion tends to test alcohol while participants are alone. Yet alcohol is often consumed in social settings, and enhancing social pleasure is consistently identified as being a primary motive for drinking. We aimed to address this gap in the literature by investigating the impact of alcohol on positive emotional experience in a social setting. We used the Facial Action Coding System (FACS) to examine in a large sample the effects of alcohol on response to comedy in a group setting. Five hundred thirteen social drinkers (51.9% female) were assembled into groups of three unacquainted persons and administered either a moderate dose of alcohol, a placebo, or a nonalcohol control beverage. Following beverage consumption, groups listened to a roughly 5-min comedy clip while their facial expressions were video recorded. More than 5 million frames of video were then FACS-coded. Alcohol consumption enhanced enjoyment (Duchenne) smiles-but not nonenjoyment social smiles-and elevated mood ratings. Results provide multimodal evidence supporting the ability of alcohol to enhance positive emotional experience during a comedy routine delivered in a social context. More broadly, this research illustrates the value of studying emotion in a social context using both self-report and behavior-expressive approaches. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Extreme Response Style and the Measurement of Intra-Individual Variability in Affect

Extreme response style (ERS) has the potential to bias the measurement of intra-individual variability in psychological constructs. This paper explores such bias through a multilevel extension of a latent trait model for modeling response styles applied to repeated measures rating scale data. Modeling responses to multi-item scales of positive and negative affect collected from smokers at clinic visits following a smoking cessation attempt revealed considerable ERS bias in the intra-individual sum score variances. In addition, simulation studies suggest the magnitude and direction of bias due to ERS is heavily dependent on the mean affect level, supporting a model-based approach to the study and control of ERS effects. Application of the proposed model-based adjustment is found to improve intra-individual variability as a predictor of smoking cessation.

Barriers to Smoking Cessation Among Drug-Resistant Tuberculosis Patients in South Africa

BACKGROUND

Drug-resistant tuberculosis (DR-TB) remains a significant cause of morbidity and mortality. The long-term health effects of smoking and the risk of adverse TB outcomes, including increased periods of infectiousness, have been reported among DR-TB patients in South Africa.

OBJECTIVES

This study aimed to identify the barriers to smoking cessation among DR-TB inpatients at a hospital in Durban, South Africa.

METHODS

A qualitative design using in-depth interviews with a purposive sample of 20 DR-TB inpatients was employed. The sample included 15 men and 5 women aged 18-70 years who self-identified as smokers. Open-ended questions were used to explore barriers militating against smoking cessation among this sample. Data were analyzed with the aid of the software QSR NVivo10.

FINDINGS

Personal and structural-level barriers (factors) to smoking cessation were identified. Personal factors included addiction and non-addiction-related barriers. Addiction-related barriers included smoking history, cravings for a cigarette, smoking as part of a daily routine, and failed quit attempts. Non-addiction-related barriers included lack of knowledge about quit strategies, psychosocial stress, lack of the willpower to quit smoking, and the influence of peers. Structural barriers included ineffective health education programs, lack of extramural activities when on admission in hospital leading to a lot of spare time, lack of smoking cessation interventions, and access to cigarettes within and around the hospital environment. Patients expressed interest in smoking cessation and conveyed their frustration at the lack of appropriate support to do so.

CONCLUSIONS

The findings reiterate the need for smoking cessation intervention to be incorporated as an integral component of DR-TB management in South Africa. Many patients expressed an interest in pharmacological aids and psychological support to help them to quit smoking. Additionally, offering extramural activities and enforcing smoke-free policies in hospital facilities will help to reduce patients' access to cigarettes while at the hospital.

Quit interest influences smoking cue-reactivity

Interest in quitting smoking is important to model in cue-reactivity studies, because the craving elicited by cue exposure likely requires different self-regulation efforts for smokers who are interested in quitting compared to those without any quit interest. The objective of the current study was to evaluate the role of quit interest in how cigarette cue exposure influences self-control efforts. Smokers interested in quitting (n=37) and smokers with no interest in quitting (n=53) were randomly assigned to a cigarette or neutral cue exposure task. Following the cue exposure, all participants completed two self-control tasks, a measure of risky gambling (the Iowa Gambling Task) and a cold pressor tolerance task. Results indicated that smokers interested in quitting had worse performance on the gambling task when exposed to a cigarette cue compared to neutral cue exposure. We also found that people interested in quitting tolerated the cold pressor task for a shorter amount of time than people not interested in quitting. Finally, we found that for people interested in quitting, exposure to a cigarette cue was associated with increased motivation to take steps toward decreasing use. Overall these results suggest that including quit interest in studies of cue reactivity is valuable, as quit interest influenced smoking cue-reactivity responses.