Cigarette-by-cigarette satisfaction during ad libitum smoking

Abstract

Smoking is thought to produce immediate reinforcement, and subjective satisfaction with smoking is thought to influence subsequent smoking. The authors used ecological momentary assessment (A. A. Stone & S. Shiffman, 1994) to assess cigarette-by-cigarette smoking satisfaction in 394 heavy smokers who subsequently attempted to quit. Across 14,882 cigarettes rated, satisfaction averaged 7.06 (0-10 scale), but with considerable variation across cigarettes and individuals. Women and African American smokers reported higher satisfaction. More satisfied smokers were more likely to lapse after quitting (HR = 1.1, p < .03), whereas less satisfied smokers derived greater benefit from patch treatment to help them achieve abstinence (HR = 1.23, p < .001). Cigarettes smoked in positive moods were more satisfying, correcting for mood at the time of rating. The best predictor of subsequent smoking satisfaction was the intensity of craving prior to smoking. Understanding subjective smoking satisfaction provides insight into sources of reinforcement for smoking.

Figure 1

Distribution of composite satisfaction ratings for individual cigarettes.

Figure 2

Satisfaction across the daily cigarette sequence. The solid line shows the trend (modeled from multi-level regression) for satisfaction to decrease over successive cigarettes (excluding the first cigarette of the day). The dashed line represents the extension of that predictive line to the first cigarette of the day. The hollow diamond represents the actual observed value of satisfaction for the first cigarette (with error bars indicating its 95% confidence interval), and the other symbols represent the observed values for subgroups that did or did not designate the first cigarette of the day as the one they would most hate to give up (confidence interval for these not shown, because they obscure the figure).

Figure 3

Kaplan-Meyer survival curves for time to lapse after initial abstinence was established, for subjects above and below the median of average satisfaction.

Figure 4

Association between satisfaction and positive affect (PA) and craving at the time of smoking (both on the 0-10 point X-axis). The figure shows the observed mean values, and the fitted line(s) from, multi-level regression models that partial out within-subject mean satisfaction.