Within-day temporal patterns of smoking, withdrawal symptoms, and craving

Abstract

We examined the temporal relationships between smoking frequency and craving and withdrawal. 351 heavy smokers (≥15 cigarettes per day) used ecological momentary assessment and electronic diaries to track smoking, craving, negative affect, arousal, restlessness, and attention disturbance in real time over 16 days. The waking day was divided into 8 2-h "bins" during which cigarette counts and mean levels of craving and withdrawal were computed. Cross-sectional analyses showed no association between restlessness and smoking, and arousal and smoking, but craving (b=0.65, p<0.01) was positively associated, and negative affect (b=-0.20, p<0.01), and attention disturbance (b=-0.24, p<0.01) were inversely associated with smoking. In prospective lagged analyses, higher craving predicted more subsequent smoking and higher smoking predicted lower craving (p's<0.01). Higher restlessness also predicted more subsequent smoking and higher smoking predicted lower restlessness (p's<0.01). Higher negative affect did not predict later smoking, but more smoking preceded lower negative affect (p<0.01). Neither attention disturbance nor arousal predicted, or were predicted by variations in smoking. In short, smoking exhibits time-lagged, reciprocal relationships with craving and restlessness, and a one-way predictive relationship with negative affect. Temporal patterns of craving and restlessness may aid in the design of smoking cessation interventions.

Figure 1

Daily patterns of (a) smoking, (b) craving and restlessness, (c) negative affect and arousal, and (d) attention disturbance. Times on the X-axis represent approximate times for each of 8 2-hour bins.

Figure 2

Relationships between (a) craving and (b) restlessness and subsequent smoking, based on models described in the text. The range on the X-axis represents the 5^th to 95^th percentile of observed values.