An ecological momentary assessment study of outcome expectancies and smoking lapse in daily life

Objective: Outcome expectancies have been identified as key components of behavior change. Expectancies related to affect control are hypothesized to play an important role in smoking cessation, such that smokers may be more likely to lapse if they believe they can control their affect by smoking and less likely if they believe they can control their affect by means other than smoking. However, little is known about whether real-time, real-world changes in affect control expectancies influence smoking lapse during a quit attempt.

Methods: A diverse sample (N = 369) of adult smokers completed ecological momentary assessment of smoking expectancies and lapse for 28 days following a quit attempt. Multilevel logistic regression was used to examine whether the difference score of positive smoking outcome expectancies (the belief that smoking would improve mood) minus positive coping outcome expectancies (the belief that something other than smoking would improve mood) was related to smoking lapse in daily life.

Results: There was a significant within-person association between the expectancies difference score and lapse likelihood. When the difference score was 1 unit above a person's typical level, odds of lapse increased by 18.65 % (β = 0.174, SE = 0.024, p < .0001, OR = 1.189, 95 % CI [1.135, 1.247]).

Conclusion: Smokers undergoing a quit attempt were more likely to lapse in moments when the difference in the belief that smoking would improve their mood minus the belief that something other than smoking would improve their mood was larger. This work has relevance for tailoring interventions to both cultivate positive coping outcome expectancies and reduce smoking outcome expectancies, and informs theoretical models about the dynamic nature of outcome expectancies.