An experimental investigation of reactivity to ecological momentary assessment frequency among adults trying to quit smoking

Abstract

Aims Ecological Momentary Assessment (EMA) captures real-time reports in subjects’ natural environments. This experiment manipulated EMA frequency to estimate effects on abstinence and peri-cessation subjective experiences. Design In this randomized trial, subjects had an equal chance of being assigned to low-frequency (once) or high-frequency (6 times) daily EMA for 4 weeks (1 week pre- and 3 weeks post-cessation). Participants completed 6 office visits over 5 weeks and 6- and 12-week follow-up telephone interviews. Setting Community participants were recruited from central New Jersey, USA. Participants 110 adult daily smokers seeking to quit smoking were included in intent-to-treat analyses of tobacco abstinence; 94 were available for secondary analyses of peri-cessation subjective ratings. Measurements Primary outcomes were cessation (abstaining at least 24 hours within 2 weeks of attempting to quit) and prolonged abstinence (no relapse between weeks 2 and 12 post-quit). Secondary outcomes were mean levels and growth in ratings of cigarette craving, affect, and quitting motivation and self-efficacy. Findings EMA frequency was unrelated to cessation (Odds Ratio=1.37, 95% CI=0.60–3.10) or prolonged abstinence (Odds Ratio=1.04, 95% CI=0.45–2.39) in intent-to-treat analyses. High-frequency EMA was associated with lower craving (B=−.54, SE=.18, p=.004, anxiety (B=−.42, SE=.17, p=.015), anger (B=−.47, SE=.14, p=.001), hunger (B=−.39, SE=.17, p=0.25), and positive affect (B=−.43, SE=.20, p=.03). Conclusions In smokers trying to quit, more frequent ecological momentary assessment (EMA) self-monitoring results in lower craving, anxiety, anger, hunger, and positive affect. It is not clear whether this translates into higher rates of smoking abstinence.

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

“…The prompt signaled participants to answer several self-report items and complete a brief momentary impulsiveness assessment, described below. We chose to use random EMA assessment only rather than ask participants to prompt reports of events following temptations or smoking because, unlike prior studies that examined only the first lapse post-quit (e.g., Shiffman et al, 1996), we wanted to assess smoking and temptations occurring over several weeks post-quit and aimed to reduce participant burden and possible assessment reactivity over time (McCarthy et al, 2015). …”

Time-varying effects of a text-based smoking cessation intervention for urban adolescents

“…However, there are studies that have examined EMA reactivity within smoking cessation trials and have found minimal to no behavioral changes due to EMA (Shiffman et al, 2002; Rowan et al, 2007). In a recent study designed to test EMA reactivity within a smoking cessation trial using randomly assigned EMA frequency conditions, researchers found that EMA frequency was unrelated to cessation or prolonged abstinence (McCarthy et al, 2015). Given these findings, it is reasonable to assume that EMA is an appropriate measurement method, particularly for smoking cessation clinical trials.…”

Potential benefits of using ecological momentary assessment to study high-risk polydrug use

“…Taken together, findings from our study add to the ongoing discussion about assessment reactivity within EMA research (20,21,23). Participants from our study anticipated that repeated assessment of mood and behavior could change their drug-related behavior.…”

“…Some researchers pose that "assessment reactivity," or shifts in behavior over time as it is intensely monitored during EMA studies, may be a benefit of this methodology (5). However, the studies that have explored assessment reactivity within the field of EMA have produced mixed results (20)(21)(22)(23). For example, in the field of alcohol abuse research, Epstein et al showed that assessment of alcohol use, mental health and affect via EMA triggers reduction in drinking pre-treatment among alcohol-dependent women (20), but Hufford et al's study of alcohol-abusing college students did not show changes in drinking frequency during EMA recording, relative to pre-EMA levels (22).…”