Abstract
Aims
When attempting to stop smoking, discrete smoking events (‘lapses’) are strongly associated with a return to regular smoking (‘relapse’). No study has yet pooled the psychological and contextual antecedents of lapse incidence, captured in ecological momentary assessment (EMA) studies. This systematic review and meta-analysis aimed to synthesize within-person psychological and contextual predictor–lapse associations in smokers attempting to quit.
Methods
We searched Ovid MEDLINE, Embase, PsycINFO and Web of Science. A narrative synthesis and multi-level, random-effects meta-analyses were conducted, focusing on studies of adult, non-clinical populations attempting to stop smoking, with no restrictions on setting. Outcomes were the association between a psychological (e.g. stress, cravings) or contextual (e.g. cigarette availability) antecedent and smoking lapse incidence; definitions of ‘lapse’ and ‘relapse’; the theoretical underpinning of EMA study designs; and the proportion of studies with pre-registered study protocols/analysis plans and open data.
Results
We included 61 studies, with 19 studies contributing ≥ 1 effect size(s) to the meta-analyses. We found positive relationships between lapse incidence and ‘environmental and social cues’ [k = 12, odds ratio (OR) = 4.53, 95% confidence interval (CI) = 2.02, 10.16, P = 0.001] and ‘cravings’ (k = 10, OR = 1.71, 95% CI = 1.34, 2.18, P
Conclusions
In smokers attempting to stop, environmental and social cues and cravings appear to be key within-person antecedents of smoking lapse incidence. Due to low study quality, the confidence in these estimates is reduced.
When attempting to stop smoking, discrete smoking events (‘lapses’) are strongly associated with a return to regular smoking (‘relapse’). No study has yet pooled the psychological and contextual antecedents of lapse incidence, captured in ecological momentary assessment (EMA) studies. This systematic review and meta-analysis aimed to synthesize within-person psychological and contextual predictor–lapse associations in smokers attempting to quit.
Methods
We searched Ovid MEDLINE, Embase, PsycINFO and Web of Science. A narrative synthesis and multi-level, random-effects meta-analyses were conducted, focusing on studies of adult, non-clinical populations attempting to stop smoking, with no restrictions on setting. Outcomes were the association between a psychological (e.g. stress, cravings) or contextual (e.g. cigarette availability) antecedent and smoking lapse incidence; definitions of ‘lapse’ and ‘relapse’; the theoretical underpinning of EMA study designs; and the proportion of studies with pre-registered study protocols/analysis plans and open data.
Results
We included 61 studies, with 19 studies contributing ≥ 1 effect size(s) to the meta-analyses. We found positive relationships between lapse incidence and ‘environmental and social cues’ [k = 12, odds ratio (OR) = 4.53, 95% confidence interval (CI) = 2.02, 10.16, P = 0.001] and ‘cravings’ (k = 10, OR = 1.71, 95% CI = 1.34, 2.18, P
Conclusions
In smokers attempting to stop, environmental and social cues and cravings appear to be key within-person antecedents of smoking lapse incidence. Due to low study quality, the confidence in these estimates is reduced.
| Original language | English |
|---|---|
| Pages (from-to) | 1216-1231 |
| Number of pages | 16 |
| Journal | Addiction |
| Early online date | 20 Feb 2023 |
| DOIs | |
| Publication status | Published - Jul 2023 |
Bibliographical note
Acknowledgements: OP and DKa receives salary support from Cancer Research UK (PRCRPGNov21\100002). The authors would like to thank David Simons for his help with the R code.Data Availability Statement
The data and R code underpinning the analyses are available via GitHub (https://github.com/OlgaPerski/EMA_smoking_lapse_review).Keywords
- ambulatory assessment
- Ecological Momentary Assessment
- smoking cessation
- smoking lapse
- systematic review
- meta-analysis
Access to Document
- Perski_etal_A_Within_Person_Addiction_VOR
© 2023 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.