Studies of smoking relapse and temptation episodes have relied on retrospective recall and confounded between- and within-subject variability. Real-time data on temptations and lapses to smoke were gathered using palm-top computers. We made within-subject comparisons of the initial lapse, a temptation episode, and base rate data obtained through randomly scheduled assessments. Negative affect discriminated all three situations, with lapses worse than temptations, and temptations worse than random situations. Participants attributed lapses to negative mood and smoking cues, whereas temptations were more often attributed to behavioral transitions. Participants were 12 times more likely to report coping in temptations than in lapses. However, only cognitive (vs. behavioral) coping strategies were effective. Lapses (vs. the other situations) were more likely to occur when smoking was permitted, when cigarettes were easily available, and in the presence of other smokers. The results have clinical implications, and the computerized monitoring methods may be applicable to an array of clinical research problems.

Smokers who recently quit (N = 214) monitored smoking urges for up to 26 days after quitting. Computers administered 4-5 assessments daily at random times; participants rated urges on waking and when they experienced temptation episodes. Urge intensity after cessation did not generally exceed urges reported during baseline ad lib smoking. Urge intensity and temptation frequency consistently declined over the quit period. Controlling for urge intensity at baseline, all daily urge intensity measures predicted lapse the following day in proportional hazards survival analyses. Average duration of temptation episodes also predicted lapses; frequency of temptation did not. To isolate the effect of day-to-day variations in urges, participants' nicotine dependence and urge intensity on quit day were controlled for. Only urge intensity at waking still predicted lapse risk; this was not because of this measured being closer in time to the day's lapses. Among lapsers, urge intensity at waking and in temptations rose preceding a lapse.

The authors assessed the association between smoking and situational cues, including affect, in real-world contexts. Using ecological momentary assessment, 304 smokers monitored ad-lib smoking for 1 week, recording each cigarette on palm-top computers. Generalized estimating equations contrasted 10,084 smoking and 11,155 nonsmoking situations. After controlling for smoking restrictions, smoking was strongly related to smoking urges and modestly related to consumption of coffee and food, the presence of other smokers, and several activities. Smoking was unrelated to negative or positive affect or to arousal, although it was associated with restlessness. Thus, in daily life, affect appears to exert little influence over ad-lib smoking in heavy smoking adults.

Recent research suggests that retrospective coping assessments may not correspond well with day-to-day reports. The authors extended this work by examining the correspondence between short-term (within 48 hr) retrospective coping reports and momentary reports recorded via a palm-top computer close in time to when the stressor occurred. There was relatively poor correspondence between the 2 assessments. Some reports of momentary coping were not reported retrospectively, and some coping reported retrospectively was not reported at the time the stressor occurred. Cognitive coping was more likely to be underreported retrospectively; behavior coping was overreported. Participants were consistent in their discrepancies, but there was no correspondence between discrepancy rates and demographic or personality variables.

Most attempts to quit smoking end in failure, with many quitters relapsing in the first few days. Responses to smoking-related cues may precipitate relapse. A modified emotional Stroop taskwhich measures the extent to which smoking-related words disrupt performance on a reaction time (RT) task-was used to index the distracting effects of smoking-related cues. Smokers (N = 158) randomized to a high-dose nicotine patch (35 mg) or placebo patch completed the Stroop task on the 1st day of a quit attempt. Smokers using an active patch exhibited less attentional bias, making fewer errors on smoking-related words. Smokers who showed greater attentional bias (slowed RT on the first block of smoking words) were significantly more likely to lapse in the short-term, even when controlling for self-reported urges at the test session. Attentional bias measures may tap an important component of dependence.Keywords attentional bias; emotional Stroop; relapse; smoking cessation Most attempts to quit smoking end in failure. Less than 5% of smokers trying to quit on their own maintain abstinence for 12 months (Hughes et al., 1992;Ward, Klesges, Zbikowski, Bliss, & Garvey, 1997). In smoking-cessation clinics, typically only 20-25% of smokers are abstinent at 6 months, and fewer are abstinent at 12 months. Relapse to smoking is rapid as well as common, with many relapses occurring in the first few days (Garvey, Bliss, Hitchcock, Heinold, & Rosner, 1992;Hughes et al., 1992). Medications such as nicotine replacement and bupropion improve outcomes (Jorenby et al., 1999; Silagy, Mant, Fowler, & Lancaster, 2000), but even with treatment, the majority of cessation efforts end in failure. Therefore, it is important to understand the psychological processes that cause the rapid relapse to smoking in the first few days, so that more effective relapse-prevention interventions can be developed.It is unclear what psychological processes underlie early lapses to smoking. Nicotine withdrawal in acute abstinence has been suggested as a critical process enhancing motivation to smoke and lapses to smoking, but it has been hard to demonstrate a strong link between severity of withdrawal and outcome in smoking cessation (Hughes, Higgins, & Hatsukami, 1990;Patten & Martin 1996). Many theories of drug addiction assume that responses to drugrelated cues are critical in maintaining drug use (e.g., Niaura et al., 1988;Robinson & Berridge, 1993;Siegel, 1983;Stewart, de Wit, & Eikelbloom, 1984;Wikler, 1948). Research on the details of initial lapse episodes (e.g., Shiffman, Paty, Gnys, Kassel, & Hickcox, 1996) suggests that environmental stimuli and events play a substantial role in precipitating initial lapses, and when such a lapse occurs, complete relapse is nearly certain to follow: 85-90% of lapses lead NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript to relapse (e.g., Kenford et al., 1994). There have also been reports of associations between measures of cue reactivity and clinical outcome (Abrams, Monti, Carey, Pinto...