Momentary predictors of tobacco lapse among African Americans during a quit attempt

Abstract

Background and aims: African American smokers are less likely to successfully quit and experience a greater burden of tobacco-related health outcomes than White individuals. There is a profound need to understand factors that impact tobacco cessation among African Americans who are undergoing a quit attempt. This study aimed to examine the within- and between-person associations of risk factors (motivation, self-efficacy, urge, positive affect, negative affect, smoking expectancies, and cigarette availability) with lapse.

Design and setting: Observational study in the Houston, TX area that used ecological momentary assessment (EMA) to collect data for 10 days following a smoking quit attempt. Multilevel modeling was used to test associations between risk factors and lapse.

Participants: N = 211 African American adults, 51 % female, and ages 18-74.

Measurements: EMA was used to assess risk factors (motivation, self-efficacy, urge, positive affect, negative affect, smoking expectancies, and cigarette availability) and lapse.

Findings: At the within-person level, moments characterized by greater urge, smoking expectancies, and cigarette availability were associated with greater risk of lapse in daily life. At the between-person level, those who had lower motivation and self-efficacy and greater urge, smoking expectancies, and cigarette availability were more likely to lapse in daily life.

Conclusions: The current study addresses important theoretical underpinnings regarding the dynamic nature of predictors of lapse. Although some predictors (urge, smoking expectancies, cigarette availability) did have a significant effect with lapse in expected directions, between person effects may be increasingly important in this population, and additional momentary predictors should be explored in future research.

Keywords: African American; Ecological momentary assessment; Health inequities; Lapse; Tobacco cessation; mHealth.