scholarly journals Quit4hlth: a preliminary investigation of tobacco treatment with gain-framed and loss-framed text messages for quitline callers

2020 ◽  
Vol 15 (3) ◽  
pp. 143-148
Author(s):  
Alana M. Rojewski ◽  
Lindsay R. Duncan ◽  
Allison J. Carroll ◽  
Anthony Brown ◽  
Amy Latimer-Cheung ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Text Messaging ◽  
Preliminary Investigation ◽  
Relative Effectiveness ◽  
Text Messages ◽  
Message Content ◽  
Quit Attempt ◽  
Quit Smoking ◽  
Tobacco Treatment ◽  
Quit Attempts

AbstractIntroductionRecent evidence suggests that quitline text messaging is an effective treatment for smoking cessation, but little is known about the relative effectiveness of the message content.AimsA pilot study of the effects of gain-framed (GF; focused on the benefits of quitting) versus loss-framed (LF; focused on the costs of continued smoking) text messages among smokers contacting a quitline.MethodsParticipants were randomized to receive LF (N = 300) or GF (N = 300) text messages for 30 weeks. Self-reported 7-day point prevalence abstinence and number of 24 h quit attempts were assessed at week 30. Intent-to-treat (ITT) and responder analyses for smoking cessation were conducted using logistic regression.ResultsThe ITT analysis showed 17% of the GF group quit smoking compared to 15% in the LF group (P = 0.508). The responder analysis showed 44% of the GF group quit smoking compared to 35% in the LF group (P = 0.154). More participants in the GF group reported making a 24 h quit attempt compared to the LF group (98% vs. 93%, P = 0.046).ConclusionsAlthough there were no differences in abstinence rates between groups at the week 30 follow-up, participants in the GF group made more quit attempts than those in the LF group.

A Pilot Randomized Controlled Trial of Text Messaging to Increase Tobacco Treatment Reach in the Emergency Department

2021 ◽  
Author(s):  
Lorien C Abroms ◽  
Keng-Chieh Wu ◽  
Nandita Krishnan ◽  
Michael Long ◽  
Sarah Belay ◽  
...  
Keyword(s):  
Emergency Department ◽  
Smoking Cessation ◽  
Treatment Program ◽  
Low Income ◽  
Text Messaging ◽  
Controlled Trial ◽  
Text Messages ◽  
Program Text ◽  
Tobacco Treatment ◽  
The Impact

Abstract Background Automated text messaging programs have been studied as a treatment tool, but have not been studied as an outreach tool to increase the reach of smoking cessation treatment. Methods Two distinct text messaging programs were developed. One was aimed at connecting smokers to quitline phone counseling via text message (Text4Coach (T4C)) and the other was aimed at connecting smokers to a smoking cessation text messaging program (Text&Quit (T&Q)). Adult daily smokers with Medicaid insurance (N=80) were recruited from the Emergency Department at an urban hospital and randomized to T4C or T&Q. The primary outcome was program reach. Results Outreach text messages were found to have moderately high uptake, with the majority of participants (63.8%) opting into their assigned tobacco treatment program and younger and female participants more likely to opt in (p<.01). Receipt of the treatment portion of the program differed among the programs with 67.5% of T&Q receiving the treatment program and 27.5 % of T4C receiving the program (p<.001). Most participants across both groups replied to at least 1 message (71.3%) and very few unsubscribed from the service over the 3 week trial. The majority of participants reported overall satisfaction with their program (63.8%), found it helpful for quitting smoking (60.0%) and would recommend the program to a friend (62.5%). Overall, 11 (13.8 %) participants reported being abstinent from smoking for the past 7 days at follow-up, with no differences between groups. Conclusion Outreach text messages were found to have moderately high reach among Medicaid smokers. Larger trials are needed to evaluate the impact of such programs on helping low-income smokers quit.

scholarly journals Smoking-Related Stigma: A Public Health Tool or a Damaging Force?

2018 ◽  
Vol 22 (1) ◽  
pp. 96-103 ◽  
Author(s):  
Paula Lozano ◽  
James F Thrasher ◽  
Melinda Forthofer ◽  
James Hardin ◽  
Luz Myriam Reynales Shigematsu ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Tobacco Control ◽  
Smoking Behavior ◽  
Control Policy ◽  
Quit Attempt ◽  
Quit Smoking ◽  
Tobacco Control Policies ◽  
Quit Attempts ◽  
Lower Likelihood ◽  
Related Stigma

Abstract Background Tobacco control policies and other denormalization strategies may reduce tobacco use by stigmatizing smoking. This raises an important question: Does perceived smoking-related stigma contribute to a smoker’s decision to quit? The aim of this study was to evaluate if perceived smoking-related stigma was associated with smoking cessation outcomes among smokers in Mexico and Uruguay. Methods We analyzed prospective data from a panel of adult smokers who participated in the 2008–2012 administrations of the International Tobacco Control Policy Evaluation Surveys in Mexico and Uruguay. We defined two analytic samples of participants: the quit behavior sample (n = 3896 Mexico; n = 1525 Uruguay) and the relapse sample (n = 596 Mexico). Generalized estimating equations were used to evaluate if different aspects of perceived stigma (ie, discomfort, marginalization, and negative stereotype) at baseline were associated with smoking cessation outcomes at follow-up. Results We found that perceived smoking-related stigma was associated with a higher likelihood of making a quit attempt in Uruguay but with a lower likelihood of successful quitting in Mexico. Conclusions This study suggests that perceived smoking-related stigma may be associated with more quit attempts, but less successful quitting among smokers. It is possible that once stigma is internalized by smokers, it may function as a damaging force. Future studies should evaluate the influence of internalized stigma on smoking behavior. Implications Although perceived smoking-related stigma may prompt smokers to quit smoking, smoking stigma may also serve as a damaging force for some individuals, making quitting more difficult. This study found that perceived smoking-related stigma was associated with a higher likelihood of making a quit attempt in Uruguay but with a lower likelihood of successful quitting in Mexico.

scholarly journals Perceptions About Mindfulness and Text Messaging for Smoking Cessation in Vietnam: Results From a Qualitative Study

10.2196/17337 ◽  
2020 ◽  
Vol 8 (6) ◽  
pp. e17337
Author(s):  
Vuong Van Do ◽  
Claire Adams Spears ◽  
Hoang Van Minh ◽  
Jidong Huang ◽  
Pamela Buffington Redmon ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Focus Groups ◽  
Transtheoretical Model ◽  
Text Messaging ◽  
Developed Countries ◽  
Text Messages ◽  
Smoking Cessation Program ◽  
Intention To Quit ◽  
Message Content ◽  
Middle Income

Background With 15.6 million smokers, Vietnam is one of the top 10 largest cigarette-consuming countries in the world. Unfortunately, smoking cessation programs are still scarce in Vietnam. Mindfulness-based and text messaging–based interventions have been increasingly used in smoking cessation studies in developed countries, with promising results. Given the exponential growth of mobile phone usage in Vietnam in recent years, mobile health interventions could be a potential strategy to increase smoking cessation in Vietnam. However, substantial cultural adaptations are needed to optimize the effectiveness of these interventions among Vietnamese smokers. Objective This study aims to involve qualitative research to inform the development of a mindfulness-based text messaging smoking cessation intervention for Vietnamese smokers. Methods A total of 10 focus groups were conducted with 71 Vietnamese male smokers aged between 18 and 65 years (5-9 participants per focus group). Overall, 5 focus groups were conducted with smokers who had the intention to quit (ie, preparation stage of change in the transtheoretical model), and 5 focus groups were conducted with smokers who did not have the intention to quit (contemplation or precontemplation stage). The focus groups were audio recorded, transcribed verbatim, and analyzed using NVivo 12 software (QSR International). Results The major themes included smoking triggers, barriers and facilitators for quitting, the perceptions of text messaging and mindfulness approaches for smoking cessation, and suggestions for the development of a text messaging–based smoking cessation program. Common smoking triggers included stress, difficulties concentrating, and fatigue. Frequently encountering other people who were smoking was a common barrier to quitting. However, participants indicated that concerns about the harmful effects of smoking on themselves and their wives and children, and encouragement from family members could motivate them to quit. The participants preferred diverse message content, including information about the consequences of smoking, encouragement to quit, and tips to cope with cravings. They suggested that text messages be clear and concise and use familiar language. Most smokers perceived that mindfulness training could be useful for smoking cessation. However, some suggested that videos or in-person training may also be needed to supplement teaching mindfulness through text messages. Conclusions This study provides important insights to inform the development of a text messaging–based smoking cessation program that incorporates mindfulness for Vietnamese male smokers. The results could also be useful for informing similar programs in other low- and middle-income countries.

scholarly journals Perceptions About Mindfulness and Text Messaging for Smoking Cessation in Vietnam: Results From a Qualitative Study (Preprint)

2019 ◽  
Author(s):  
Vuong Van Do ◽  
Claire Adams Spears ◽  
Hoang Van Minh ◽  
Jidong Huang ◽  
Pamela Buffington Redmon ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Focus Groups ◽  
Transtheoretical Model ◽  
Text Messaging ◽  
Developed Countries ◽  
Text Messages ◽  
Smoking Cessation Program ◽  
Intention To Quit ◽  
Message Content ◽  
Middle Income

BACKGROUND With 15.6 million smokers, Vietnam is one of the top 10 largest cigarette-consuming countries in the world. Unfortunately, smoking cessation programs are still scarce in Vietnam. Mindfulness-based and text messaging–based interventions have been increasingly used in smoking cessation studies in developed countries, with promising results. Given the exponential growth of mobile phone usage in Vietnam in recent years, mobile health interventions could be a potential strategy to increase smoking cessation in Vietnam. However, substantial cultural adaptations are needed to optimize the effectiveness of these interventions among Vietnamese smokers. OBJECTIVE This study aims to involve qualitative research to inform the development of a mindfulness-based text messaging smoking cessation intervention for Vietnamese smokers. METHODS A total of 10 focus groups were conducted with 71 Vietnamese male smokers aged between 18 and 65 years (5-9 participants per focus group). Overall, 5 focus groups were conducted with smokers who had the intention to quit (ie, preparation stage of change in the transtheoretical model), and 5 focus groups were conducted with smokers who did not have the intention to quit (contemplation or precontemplation stage). The focus groups were audio recorded, transcribed verbatim, and analyzed using NVivo 12 software (QSR International). RESULTS The major themes included smoking triggers, barriers and facilitators for quitting, the perceptions of text messaging and mindfulness approaches for smoking cessation, and suggestions for the development of a text messaging–based smoking cessation program. Common smoking triggers included stress, difficulties concentrating, and fatigue. Frequently encountering other people who were smoking was a common barrier to quitting. However, participants indicated that concerns about the harmful effects of smoking on themselves and their wives and children, and encouragement from family members could motivate them to quit. The participants preferred diverse message content, including information about the consequences of smoking, encouragement to quit, and tips to cope with cravings. They suggested that text messages be clear and concise and use familiar language. Most smokers perceived that mindfulness training could be useful for smoking cessation. However, some suggested that videos or in-person training may also be needed to supplement teaching mindfulness through text messages. CONCLUSIONS This study provides important insights to inform the development of a text messaging–based smoking cessation program that incorporates mindfulness for Vietnamese male smokers. The results could also be useful for informing similar programs in other low- and middle-income countries.

scholarly journals Text Messaging Intervention for Young Smokers Experiencing Homelessness: Lessons Learned From a Randomized Controlled Trial

10.2196/23989 ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. e23989
Author(s):  
Sebastian Linnemayr ◽  
Rushil Zutshi ◽  
William Shadel ◽  
Eric Pedersen ◽  
Maria DeYoreo ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Text Messaging ◽  
Homeless Youth ◽  
Controlled Trial ◽  
Text Messages ◽  
Lessons Learned ◽  
Quit Attempt ◽  
Text Messaging Intervention ◽  
To Receive

Background Smoking rates are significantly higher among young people experiencing homelessness than in the general population. Despite a willingness to quit, homeless youth have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. Homeless youth generally enjoy the camaraderie and peer support that group-based programs offer, but continuous in-person support during a quit attempt can be prohibitively expensive. Objective This study aimed to assess the feasibility and acceptability of an automated text messaging intervention (TMI) as an adjunct to group-based cessation counseling and provision of nicotine patches to help homeless youth quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention. Methods Homeless youth smokers aged 18 to 25 years who were interested in quitting (n=77) were recruited from drop-in centers serving homeless youth in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches, with 52% (40/77) randomly assigned to receive 6 weeks of text messages to provide additional support for their quit attempt. Participants received text messages on their own phone rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow-up survey data as well as back-end data from the messaging platform to gauge the acceptability and feasibility of the TMI among the 40 participants who received it. Results Participants had widespread (smart)phone ownership—16.4% (36/219) were ineligible for study participation because they did not have a phone that could receive text messages. Participants experienced interruptions in their phone use (eg, 44% [16/36] changed phone numbers during the follow-up period) but reported being able to receive the majority of messages. These survey results were corroborated by back-end data (from the program used to administer the TMI) showing a message delivery rate of about 95%. Participant feedback points to the importance of carefully crafting text messages, which led to high (typically above 70%) approval of most text messaging components of the intervention. Qualitative feedback indicated that participants enjoyed the group counseling session that preceded the TMI and suggested including more such group elements into the intervention. Conclusions The TMI was well accepted and feasible to support smoking cessation among homeless youth. Given high rates of smartphone ownership, the next generation of phone-based smoking cessation interventions for this population should consider using approaches beyond text messages and focus on finding ways to develop effective approaches to include group interaction using remote implementation. Given overall resource constraints and in particular the exigencies of the currently ongoing COVID-19 epidemic, phone-based interventions are a promising approach to support homeless youth, a population urgently in need of effective smoking cessation interventions. Trial Registration ClinicalTrials.gov NCT03874585; https://clinicaltrials.gov/ct2/show/NCT03874585 International Registered Report Identifier (IRRID) RR2-10.1186/s13722-020-00187-6

scholarly journals Lessons Learned from a Text Messaging Intervention for Young Smokers Experiencing Homelessness (Preprint)

2020 ◽  
Author(s):  
Sebastian Linnemayr ◽  
Rushil Zutshi ◽  
William Shadel ◽  
Eric Pedersen ◽  
Maria DeYoreo ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Text Messaging ◽  
Controlled Trial ◽  
Text Messages ◽  
Lessons Learned ◽  
Randomized Controlled ◽  
Quit Attempt ◽  
Nicotine Patches ◽  
Text Messaging Intervention ◽  
To Receive

BACKGROUND Smoking rates are significantly higher among youth experiencing homelessness (YEH) than in the general population. Despite a willingness to quit, YEH have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. YEH generally enjoy the camaraderie and peer support that group-based programs offer, but continuous in-person support during a quit attempt can be prohibitively expensive. OBJECTIVE This study aimed to assess the feasibility and acceptability of an automated text messaging intervention (TMI), as an adjunct to group-based cessation counseling and provision of nicotine patches, to help YEH quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention. METHODS YEH smokers who were interested in quitting (n = 77) were recruited from drop-in centers serving YEH in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches; with n = 40 randomly assigned to receive six weeks of text messages to provide additional support for their quit attempt. Participants were sent the text messages to their own phone, rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow up survey data, as well as backend data from the messaging platform, to gauge the acceptability and feasibility of the TMI among the 40 participants who received it. RESULTS Participants had widespread (smart)phone ownership – only 14% were ineligible for study participation because they either did not have a phone that could receive text messages or did not want to receive messages. Participants experienced interruptions in their phone use but reported being able to receive the majority of messages. These survey results were corroborated by backend data (from the program used to administer the TMI) showing a message delivery rate of about 95%. Participant feedback points to the importance of carefully crafting text messages, which led to high (typically above 70%) approval of most text messaging components of the intervention. Participants reported enjoying the group counseling session that preceded the TMI, and suggested to include more such group elements into the intervention. CONCLUSIONS The TMI was well accepted and feasible to support smoking cessation among YEH. Given high rates of smartphone ownership, the next generation of phone-based smoking cessation interventions for this population should consider using approaches beyond text messages, and focus on finding ways to develop effective approaches to include group interaction using remote implementation. Given overall resource constraints and in particular the exigencies of the currently ongoing COVID-19 epidemic, phone-based interventions are a promising approach to support YEH, a population urgently in need of effective smoking cessation interventions. CLINICALTRIAL We report on implementation lessons, i.e. do not make use of the randomized controlled trial aspect of the underlying parent study that is registered with the ClinicalTrials.gov Identifier: NCT03874585

scholarly journals “Stages of change, smoking behavior and acceptability of a textmessaging intervention for tobacco cessation among cigarette, dokha and shishasmokers: A qualitative research study.”

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029144 ◽  
Author(s):  
Yusra Elhidaia Elobaid ◽  
Andrea Leinberger Jabari ◽  
Aisha Al Hamiz ◽  
Abdul Rizzak Al Kaddour ◽  
Sherif Bakir ◽  
...  
Keyword(s):  
Qualitative Research ◽  
Smoking Cessation ◽  
Focus Group ◽  
United Arab Emirates ◽  
Text Messaging ◽  
Tobacco Cessation ◽  
Text Messages ◽  
Controlled Study ◽  
Focus Group Discussions ◽  
Group Discussions

ObjectivesTo explore: (A) the underlying motivators and barriers to smoking cessation among young Arabic speaking smokers and (B) to examine the suitability and preferences for tobacco cessation interventions (specifically text messages) and study the possibility of enrollment methods for a randomised controlled study using text messages as an intervention for tobacco cessation.DesignQualitative research using focus group discussions and content analysis.Setting(s)Two universities, one of them is the first and foremost comprehensive national university in the United Arab Emirates (UAE). The third setting is the largest hospital in the UAE and the flagship institution for the public health system in the emirate of Abu Dhabi.ParticipantsSix focus group discussions with a total of 57 participants. Forty-seven men and 10 women. Fifty-three of them were current smokers.ResultsThe analysis of six focus groups was carried out. Main themes arose from the data included: preferences for tobacco cessation interventions and acceptability and feasibility of text messaging as tobacco cessation intervention. Different motives and barriers for quitting smoking including shisha and dokha were explored.ConclusionInterventions using text messaging for smoking cessation have not been used in the Middle East and they could potentially be effective; however, tailoring and closely examining the content and acceptability of text messages to be used is important before the conduction of trials involving their use. Social media is perceived to be more effective and influential, with a higher level of penetration into communities of young smokers.

Facebook Chat Application to Prompt and Assist Smoking Cessation Among Spanish-Speaking Young Adults in South Texas

2021 ◽  
pp. 152483992110262
Author(s):  
Patricia Chalela ◽  
Alfred L. McAlister ◽  
David Akopian ◽  
Edgar Munoz ◽  
Cliff Despres ◽  
...  
Keyword(s):  
Social Media ◽  
Smoking Cessation ◽  
Young Adults ◽  
South Texas ◽  
Spanish Speaking ◽  
Quit Attempt ◽  
Quit Attempts ◽  
Facebook Advertising

Given how smart phones, internet services, and social media have shown great potential for assisting smoking cessation, we constructed a Facebook chat application based on our previous work with SMS texting services. This report summarizes findings from 2,364 Spanish-speaking young adults recruited through Facebook advertising in South Texas during the 2020 New Year holiday season. Among these service users, 926 (39%) were ready to make a quit attempt, and 26 (3.1%) of those users reported that they were tobacco free 1 month later. There were no responses to a chat question survey 72 days after the dates selected for quitting. Although more research with longer follow up is needed, these findings show that social media chat applications may be helpful for at least prompting quit attempts and short-term cessation among young adult Spanish-speaking smokers. There is no evidence of an impact on long-term cessation, and more research is clearly needed.

scholarly journals Pathways to Smoking and Snus Use Cessation - Is Spontaneous Quitting Underrated?

2010 ◽  
Vol 3 (1) ◽  
pp. 20-23 ◽  
Author(s):  
Mats Toftgard ◽  
Hans Gilljam ◽  
Tanja Tomson
Keyword(s):  
Considerable Proportion ◽  
Men And Women ◽  
Quit Attempt ◽  
Quit Smoking ◽  
Quit Attempts

Aim: To investigate to what extent smokers and snus users in Sweden consider and plan their quit attempts in advance, and to assess if spontaneity is associated with success. Methods: A sample of 5999 Swedish men and women between 16 and 80 years were interviewed via telephone about current and former smoking and snus use and their latest quit attempts. Results: Among 2272 ex-smokers and current smokers who had ever made a serious quit attempt 48% reported to not having planned their latest attempt in advance. Furthermore, 40% reported to not even having considered giving up smoking before they actually made the attempt. Of 809 former and current snus users 48% did not plan, and 44% did not consider quitting in advance. Smokers and ex-smokers were more likely to remain smoke-free for at least six months if the attempt was unplanned (sex and age adjusted OR=2.6; 95% CI=1.7-3.8). When dividing the smoking quit attempts into considered versus not considered the advantage of the spontaneous attempts remained (adjusted OR=1.9; CI=1.3-2.9). The corresponding analyses of snus use quitting showed similar advantages for the unplanned and the not considered quit attempts. Conclusions: In Sweden, a considerable proportion of the attempts to quit smoking, as well as to quit using snus, are made without prior consideration or planning. Spontaneous quit attempts appear to have a greater chance of long-term success than those preceded by consideration or planning.

scholarly journals Affective and Situational Precipitants of Smoking Lapses Among Adolescents

2019 ◽  
Vol 22 (4) ◽  
pp. 492-497 ◽  
Author(s):  
Hayley Treloar Padovano ◽  
Jennifer E Merrill ◽  
Suzanne M Colby ◽  
Christopher W Kahler ◽  
Chad J Gwaltney
Keyword(s):  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Handheld Computers ◽  
Affective States ◽  
Ecological Data ◽  
High Arousal ◽  
Quit Attempt ◽  
Quit Smoking ◽  
Quit Attempts

Abstract Introduction Most adolescent smokers report a desire to quit, and many have made several unsuccessful quit attempts; however, when adolescents attempt to quit, they often resume smoking quickly. This ecological study aimed to (1) characterize affective and situational precipitants of smoking lapses among adolescents and (2) explore the moderating influence of nicotine dependence severity on lapse precipitants. Methods Adolescent daily smokers (n = 166; ages 14–18 years) completed electronic diaries of cigarettes smoked, craving and affective states, and situational variables on handheld computers in their natural environment for 2 weeks following an unassisted quit attempt. On average, adolescents were moderately nicotine dependent (Modified Fagerström Tolerance Questionnaire [mFTQ] score = 4.9; SD = 1.6). Results Craving was a significant episodic cue for lapse and stable influence on lapse, relating to 44% and 15% increased odds of lapse, respectively. High-arousal affective states—regardless of valence—were associated with 12%–13% increased odds of lapse. Low-arousal positive affective states were associated with 17% decreased odds of lapse. A 1-unit difference in a teen’s mFTQ score related to 27% increased odds of lapse, but dependence severity did not moderate proximal lapse influences. Conclusions This report provides some of the first ecological data characterizing adolescent smoking lapses following a quit attempt. As in prior work with teens, lapses were nearly universal and quickly followed the quit attempt. Specific situational and affective contexts of smoking lapses for adolescents were implicated, indicating the need for cessation interventions to address craving and high-arousal affective states as precipitators of lapse in this high-risk group. Implications This report provides some of the first ecological data characterizing smoking lapses among teens attempting to quit smoking on their own. Like adults, adolescents face many barriers when making quit attempts. The present work provides ecological data to suggest that the experience of heightened arousal in teens’ daily lives interferes with their efforts to quit smoking. Thus, this work highlights the importance of affective dysregulation, or amplitude of emotional feelings, for teen smoking lapses. Moment-to-moment fluctuation in craving was also implicated as a dynamic precipitator of smoking lapse in this high-risk group.

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