Department of Epidemiology and Biostatistics, Temple University, Philadelphia, PA, USA.
Department of Medicine, The University of Wisconsin, Madison, Madison, WI, USA.
Nicotine Tob Res. 2022 Oct 17;24(10):1548-1555. doi: 10.1093/ntr/ntac068.
The addictive nature of nicotine makes smoking cessation an extremely challenging process. With prolonged exposure, tobacco smoking transforms from being a positive reinforcer to a negative one, as smoking is used to mitigate aversive withdrawal symptoms. Studying the variations in withdrawal symptoms, especially during their peak in the first week of a quit attempt, could help improve cessation treatment for the future. The time-varying mediation model effectively studies whether altering withdrawal symptoms act as mediators in the pathway between treatment and cessation.
This secondary data analysis of a randomized clinical smoking cessation trial of three pharmacotherapy regimens (nicotine patch, varenicline, and nicotine patch + mini-lozenge) analyzes ecological momentary assessment (EMA) data from the first 4 weeks post-target quit day (TQD). We assess whether withdrawal symptoms (eg, negative mood, cessation fatigue, and craving) mediate the pathway between pharmacotherapy and daily smoking status and whether this effect varies over time.
We found a statistically significant time-varying mediation effect of varenicline on smoking status through craving, which shows decreasing risk of lapse via reduction in craving. We did not find significant time-varying mediation effects through negative mood and cessation fatigue.
This study supports the importance of craving suppression in the smoking cessation process. It also helped identify specific timepoints when withdrawal symptoms increased that would likely benefit from targeted cessation intervention strategies.
This study aimed to understand the underlying dynamic mechanisms of the smoking cessation process using a new analytical approach that capitalizes on the intensive longitudinal data collected via EMAs. The findings from this study further elucidate the smoking cessation process and provide insight into behavioral intervention targets and the timing of such interventions through the estimation of time-varying mediation effects.
尼古丁的成瘾性使得戒烟成为一个极具挑战性的过程。随着暴露时间的延长，吸烟从一种正强化物转变为负强化物，因为吸烟被用来减轻令人不快的戒断症状。研究戒断症状的变化，特别是在戒烟尝试的第一周达到高峰时，可能有助于为未来的戒烟治疗提供帮助。时变中介模型可以有效地研究改变戒断症状是否在治疗和戒烟之间的途径中起中介作用。
这是一项对三种药物治疗方案（尼古丁贴片、伐尼克兰和尼古丁贴片+迷你含片）的随机临床试验的二次数据分析，对戒烟目标日（TQD）后前 4 周的即时评估（EMA）数据进行分析。我们评估戒断症状（如负面情绪、戒烟疲劳和渴望）是否在药物治疗和每日吸烟状况之间的途径中起中介作用，以及这种效应是否随时间而变化。
我们发现伐尼克兰通过渴望对吸烟状况有统计学上显著的时变中介效应，这表明通过减少渴望来降低复吸的风险。我们没有发现通过负面情绪和戒烟疲劳的显著时变中介效应。
这项研究支持了在戒烟过程中抑制渴望的重要性。它还帮助确定了戒断症状增加的具体时间点，这些时间点可能需要针对戒烟干预策略。
本研究旨在使用一种新的分析方法，利用通过即时评估（EMA）收集的密集纵向数据，理解戒烟过程的潜在动态机制。这项研究的结果进一步阐明了戒烟过程，并通过估计时变中介效应，为行为干预目标和干预时间提供了见解。
