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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; Ten Hoor, Gill; Asare, Bernard Yeboah-Asiamah; ... Keller, Jan; + view all (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. 10.1111/add.16173. Green open access

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Abstract

BACKGROUND AND 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 synthesise 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 multilevel, 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 on psychological theory to inform EMA study designs. One of the included studies drew on 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.

Type: Article
Title: 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
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/add.16173
Publisher version: https://doi.org/10.1111/add.16173
Language: English
Additional information: © 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 (http://creativecommons.org/licenses/by/4.0/).
Keywords: Ecological Momentary Assessment, ambulatory assessment, meta-analysis, smoking cessation, smoking lapse, systematic review
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health
URI: https://discovery.ucl.ac.uk/id/eprint/10165704
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