Within-person associations between psychological and contextual factors and lapse incidence in smokers attempting to quit: A systematic review and meta-analysis of ecological momentary assessment studies

Perski, Olga, Kwasnicka, Dominika, Kale, Dimitra, Schneider, Verena, Szinay, Dorothy ORCID: https://orcid.org/0000-0003-2722-6758, ten Hoor, Gill, Asare, Bernard Yeboah-Asiamah, Verboon, Peter, Powell, Daniel, Naughton, Felix and Keller, Jan (2023) Within-person associations between psychological and contextual factors and lapse incidence in smokers attempting to quit: A systematic review and meta-analysis of ecological momentary assessment studies. Addiction, 118 (7). pp. 1216-1231. ISSN 0965-2140

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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 < 0.001). ‘Negative feeling states’ was not significantly associated with lapse incidence (k = 16, OR = 1.10, 95% CI = 0.98, 1.24, P = 0.12). In the narrative synthesis, negative relationships with lapse incidence were found for ‘behavioural regulation’, ‘motivation not to smoke’ and ‘beliefs about capabilities’; positive relationships with lapse incidence were found for ‘positive feeling states’ and ‘positive outcome expectancies’. Although lapse definitions were comparable, relapse definitions varied widely across studies. Few studies explicitly drew upon psychological theory to inform EMA study designs. One of the included studies drew upon Open Science principles. 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.

Item Type: Article
Additional Information: Funding Information: O.P. and D.Ka. receive salary support from Cancer Research UK (PRCRPG‐Nov21\100002).
Uncontrolled Keywords: ambulatory assessment,ecological momentary assessment,meta-analysis,smoking cessation,smoking lapse,systematic review,medicine (miscellaneous),psychiatry and mental health,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2701
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging
Faculty of Medicine and Health Sciences > Research Groups > Behavioural and Implementation Science
Faculty of Medicine and Health Sciences > Research Groups > Health Promotion
Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health
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Depositing User: LivePure Connector
Date Deposited: 05 May 2023 12:30
Last Modified: 19 Oct 2023 03:35
URI: https://ueaeprints.uea.ac.uk/id/eprint/91996
DOI: 10.1111/add.16173

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