Independent and interactive effects of real-time risk factors on later temptations and lapses among smokers trying to quit

•Modeled within-person risk factors for temptations and lapses in adult smokers.•Used time-lagged hierarchical linear modeling to identify risk prior to outcome.•Independent and interactive effects of urge, affect, impulsiveness, and context.•Antecedents of temptations and lapses differ, suggesting separate interventions.

PurposeThe current study sought to expand our understanding of relapse mechanisms by identifying the independent and interactive effects of real-time risk factors on temptations and the ability to resist temptations in smokers during a quit attempt.ProceduresThis study was a secondary analysis of data from 109 adult, treatment-seeking daily smokers. Ecological momentary assessment data was collected 4 times a day for 21 days following a quit attempt and was used to assess affect, urge, impulsiveness, recent cigarette exposure, and alcohol use as predictors of temptations to smoke and smoking up to 8 h later. All smokers received nicotine replacement therapy and smoking cessation counseling.FindingsIn multinomial hierarchical linear models, there were significant main (agitation odds ratio (OR) = 1.22, 95% CI = 1.02–1.48; urge OR = 1.60, 95% CI = 1.35–1.92; nicotine dependence measured by WISDM OR = 1.04, 95% CI = 1.01–1.08) and interactive effects (agitation × urge OR = 1.12, 95% CI = 1.01–1.27; urge × cigarette exposure OR = 1.38, 95% CI = 1.10–1.76; positive affect × impulsiveness OR = 2.44, 95% CI = 1.02–5.86) on the odds of temptations occurring, relative to abstinence without temptation. In contrast, prior smoking (OR = 3.46, 95% CI = 2.58–4.63), higher distress (OR = 1.30, 95% CI = 1.06–1.60), and recent alcohol use (OR = 3.71, 95% CI = 1.40–9.89) predicted smoking versus resisting temptation, and momentary impulsiveness was related to smoking for individuals with higher baseline impulsiveness (OR = 1.12, 95% CI = 1.04–1.22).ConclusionsThe risk factors and combinations of factors associated with temptations and smoking lapses differ, suggesting a need for separate models of temptation and lapse.