Time-Varying Mediation of Pharmacological Smoking Cessation Treatments on Smoking Lapse via Craving, Cessation Fatigue, and Negative Mood.
Time-Varying Mediation of Pharmacological Smoking Cessation Treatments on Smoking Lapse via Craving, Cessation Fatigue, and Negative Mood.
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药物戒烟治疗通过渴望、戒烟疲劳和消极情绪对戒烟的时变调节。
DOI：
10.1093/ntr/ntac068
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Piper,MeganE
中科院分区：
文献类型：
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作者：
Chakraborti,Yajnaseni;Coffman,DonnaL;Piper,MeganE
尼古丁的成瘾特性使戒烟成为一个极具挑战性的过程。随着时间的延长，吸烟从积极的增强剂转变为消极的增强剂，因为吸烟被用来缓解令人厌恶的戒断症状。研究戒断症状的变化，特别是在戒烟尝试的第一周达到顶峰期间，可能有助于改善未来的戒烟治疗。时变中介模型有效地研究了戒断症状的改变是否在治疗和戒断之间起中介作用。目的与方法对3种药物治疗方案(尼古丁贴片、瓦伦尼克林和尼古丁贴片+迷你含片)的随机临床戒烟试验进行二次数据分析，分析目标戒烟后前4周的生态瞬时评估(EMA)数据。我们评估戒断症状(如消极情绪、戒断疲劳和渴求)是否在药物治疗和日常吸烟状态之间起中介作用，以及这种作用是否随着时间的推移而变化。结果我们发现伐伦克林通过渴求对吸烟状况具有显著的时变中介作用，这表明通过降低渴求来降低失败的风险。我们没有发现消极情绪和戒烟疲劳的显著时变中介效应。结论本研究支持渴望抑制在戒烟过程中的重要性。它还有助于识别戒烟症状增加的特定时间点，这些时间点可能受益于有针对性的戒烟干预策略。意义本研究旨在利用通过EMAS收集的密集纵向数据的一种新的分析方法，了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，并通过对时变中介效应的估计，为行为干预目标和干预时间提供了洞察力。
IntroductionThe 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.Aims and MethodsThis 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.ResultsWe 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.ConclusionsThis 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.ImplicationsThis 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.