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A Descriptive Assessment of Smoking Using Ecological Momentary Assessment

Permanent Link: http://ufdc.ufl.edu/UFE0041321/00001

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Title: A Descriptive Assessment of Smoking Using Ecological Momentary Assessment
Physical Description: 1 online resource (37 p.)
Language: english
Creator: Rojewski, Alana
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2009

Subjects

Subjects / Keywords: assessment, cigarette, ema, smoking
Psychology -- Dissertations, Academic -- UF
Genre: Psychology thesis, M.S.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: Descriptive assessment measures can identify antecedent and consequent events that may maintain behavior, but few such measures have been utilized to assess smoking. The purpose of the current study was to employ a real-time, computer-based method, ecological momentary assessment (EMA), to identify individual differences in the events associated with smoking (e.g., direct drug effects, social reinforcers, presence of antecedent stimuli such as coffee, alcohol, etc.). Eight participants indicated the presence of various antecedent and consequent events on a PocketPC before and after each cigarette smoked. Frequency counts of reported items were obtained to assess the number of times each item was associated with an instance of smoking. Participants also completed assessments independent of smoking occasions to determine the frequency of the events when smoking did not occur. Individual differences in the events associated with smoking were apparent. Results suggest a descriptive assessment of smoking is feasible using the proposed methods.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Alana Rojewski.
Thesis: Thesis (M.S.)--University of Florida, 2009.
Local: Adviser: Dallery, Jesse.
Electronic Access: RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2011-12-31

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2009
System ID: UFE0041321:00001

Permanent Link: http://ufdc.ufl.edu/UFE0041321/00001

Material Information

Title: A Descriptive Assessment of Smoking Using Ecological Momentary Assessment
Physical Description: 1 online resource (37 p.)
Language: english
Creator: Rojewski, Alana
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2009

Subjects

Subjects / Keywords: assessment, cigarette, ema, smoking
Psychology -- Dissertations, Academic -- UF
Genre: Psychology thesis, M.S.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: Descriptive assessment measures can identify antecedent and consequent events that may maintain behavior, but few such measures have been utilized to assess smoking. The purpose of the current study was to employ a real-time, computer-based method, ecological momentary assessment (EMA), to identify individual differences in the events associated with smoking (e.g., direct drug effects, social reinforcers, presence of antecedent stimuli such as coffee, alcohol, etc.). Eight participants indicated the presence of various antecedent and consequent events on a PocketPC before and after each cigarette smoked. Frequency counts of reported items were obtained to assess the number of times each item was associated with an instance of smoking. Participants also completed assessments independent of smoking occasions to determine the frequency of the events when smoking did not occur. Individual differences in the events associated with smoking were apparent. Results suggest a descriptive assessment of smoking is feasible using the proposed methods.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Alana Rojewski.
Thesis: Thesis (M.S.)--University of Florida, 2009.
Local: Adviser: Dallery, Jesse.
Electronic Access: RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2011-12-31

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2009
System ID: UFE0041321:00001


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1 A DESCRIPTIVE ASSESSMENT OF SMOKING USING ECOLOGICAL MOMENTARY ASSESSMENT By ALANA M. ROJEWSKI A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE UNIVERSITY OF FLORIDA 2009

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2 2009 Alana M. Rojewski

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3 ACKNOWLEDGMENTS I thank my mentor, Jesse Dallery, for his guidance through this stage of my academic career the members of my supervisory committee for their helpful suggestions and my labmates and friends for their support. I also thank my parents and sister for their constant love and encouragement

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4 TABLE OF CONTENTS page ACKNOWLEDGMENTS ................................ ................................ ................................ ............... 3 LIST OF TABLES ................................ ................................ ................................ ........................... 5 LIST OF FIGURES ................................ ................................ ................................ ......................... 6 ABSTRACT ................................ ................................ ................................ ................................ ..... 7 INTRODUCTION ................................ ................................ ................................ ........................... 8 METHODS ................................ ................................ ................................ ................................ .... 12 Participants ................................ ................................ ................................ ............................. 12 Data Collection ................................ ................................ ................................ ....................... 13 Assessments ................................ ................................ ................................ ..................... 14 Assessment Follow up ................................ ................................ ................................ ..... 15 Data Analysis ................................ ................................ ................................ .......................... 15 RESULTS ................................ ................................ ................................ ................................ ...... 17 Environmental Events ................................ ................................ ................................ ............. 17 Internal States ................................ ................................ ................................ ......................... 18 Assessment Follow up ................................ ................................ ................................ ............ 19 DISCUSSION ................................ ................................ ................................ ................................ 29 LIST OF REFERENCES ................................ ................................ ................................ ............... 34 BIOGRAPHICAL SKETCH ................................ ................................ ................................ ......... 37

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5 LIST OF TABLES Table page 3 1 Participant demographics ................................ ................................ ................................ ... 2 1 3 2 Assessment items and abbreviations ................................ ................................ .................. 2 1 3 3 Assessment follow up ................................ ................................ ................................ ........ 2 2 3 4 Number of cigarettes or assessments ................................ ................................ ................. 2 2

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6 LIST OF FIGURES Figure page 3 1 Examples of assessment items on the PocketPC. ................................ .............................. 23 3 2 The proportions of observations for environmental events. ................................ .............. 24 3 3 Average and individual diff erence scores for internal states. ................................ ............ 26

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7 Abstract of Thesis Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Science A DESCRIPTIVE ASSESSMENT OF SMOKING USING ECOLOGICAL MOMENTARY ASSESSMENT By Alana M. Rojewski December 2009 Chair: Jesse Dallery Major: Psychology Descriptive assessment measures can identify antecedent and consequent events that may maintain behavior, but few such measures have been utilized to assess smoking. The purpose of the current study was to employ a real time, computer based method, ecologic al momentary assessment (EMA), to identify individual differences in the events associated wit h smoking (e.g., direct drug effects, social reinforcers, presence of antecedent stimuli such as coffee, alcohol, etc.) Eight participants indicated the presence of various antecedent and consequent events on a PocketPC before and after each cigarette smo ked. Frequency counts of reported items were obtained to assess the number of times each item was associated with an instance of smoking. Participants also completed assessments independent of smoking occasions to determine the frequency of the events when smoking did not occur. Individual differences in the events associated with smoking were apparent. Results suggest a descriptive assessment of smoking is feasible using the proposed methods.

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8 CHAPTER 1 INTRODUCTION Smoking poses a highly significant h ealth threat, yet only 4 to 7 percent of the 19 million adult American smokers that attempt to quit smoking each year are successful (Fiore et al., 2008). Researchers and clinicians attempt to improve smoking cessation rates through a variety of behaviora l and pharmacological methods yet success is only moderate and long term abstinence rates remain low (Jorenby et al., 2006 ; Kassel & Yates, 2002 ). One possible way to enhance treatment effects is to use assessment instruments to identify conditions that ma intain smoking for individual smokers. Based on assessment results, these conditions could be targeted more directly in treatment (Axelrod, 1991; Fiore, et al., 2008; Kassel & Yates, 2002). The purpose of the present study is to take a preliminary step tow ard assessing some of the events associated with smoking Smoking assessments are typically conducted using self report measures in the form of questionnaires or self monitoring procedures. Researchers or clinicians administer questionnaires prompting part icipants to recall variables that are associated with smoking (e.g., settings, events, activities, affect states, etc.). Unfortunately, long term recall can be in accurate rais ing questions about t he validity of the self report (Shiffman, et al., 1997 b ; Stone & Shiffman, 1994). An alternative is to incorporate self monitoring procedures ( e.g., Epstein & Collins, 1 977; Shiffman & Prange, 1988 ). For example, Epstein and Collins (19 7 7) asked participants to complete questionnaires about instances in which they smoke prior to a period of self monitoring. During self monitoring, participants were instructed to record the time of day and what they were doing when they smoked a cigarette (e.g., driving a car or watching TV). Only moderate correlations were repo rted between the self recorded and questionnaire data. Relationships between particular events and smoking were observed for a majority of participants and reliability of the data was

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9 assessed. Epstein and Collins concluded that data gathered from self mo nitoring provides more reliable information on smoking events than questionnaire data One innovative self monitoring method in behavior assessment is Ecological Momentary Assessment (EMA; Shiffman & Stone, 1998; Stone & Shiffman, 1994). Like other self monitoring methods, moment they occur in natural settings, thus maximizing ecological validity while avoiding characteristics of EMA are 1) assessment of phenomena at the moment they occur, 2) car eful timing of assessments, 3) many repeated obs ervations, and 4) measurement in the environments that the subjects typically inhabit (Stone & Shiffman, 1994). Participan ts are prompted to complete questionnaires or report on the frequency of occurrence of specific events in their natural environment using electronic diaries (EDs), such as palm top computers cell phones, or other hand held devices. Shiffman (1993a) sugges ted that EMA, as a form of self monitoring, allows for convenient recording of events associated with smoking. Researchers have utilized EMA to assess antecedent stimuli such as affect, situations (e.g., location, presence of friends, etc.), pharmacological stimuli (e.g., alcohol, coffee, etc.), other smoking related stimuli (e.g., cigarettes, a lighter, etc.), and the urg e to smoke ( Shapiro, Jamner, Davydov, & James, 2002; Shiffman et al., 2002; S hiffman et al., 1997a ). For example, Shiffman et al. (2002) assessed the association between antecedent stimuli and instances of smoking as participants engaged in normal smoking. They found that smoking was related to smoking urges, consumption of coffee and food, and the presence of other smokers. Research from applied behavior analysis highlights the importance of understanding environmental variables involved in the maintenance of behavior on an individual level ( Hanley,

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10 Iwata, & McCord, 2003; Iwata, K ahng, Wallace, & Lindberg 2000). Descriptive assessments involve direct observation of behavior under naturalistic conditions with no variable or environment manipulation (Herzinger & Campbell, 2007 ; Iwata et al., 2000 ). Hawkins (1979) suggests that these assessments can include self monitoring in the natural environment as a form of direct observation. Information provided by smokers about the events preceding and following smoking can be collected and used to make hypotheses about behavioral function (Iwata et al., 2000) For example, positive reinforcement could be associated with the direct pharmacological effects of nicotine, social reinforcement, or conditioned reinforcement (e.g., the cigarettes themselves; Pomerleau, 1979; Rose & Levin, 1991). N egative reinforcement could be related to escape from aversive activities (e.g., work) or escape from aversive emotional or physiological states ( e.g., urge; Tiffany, 1990 ). Further, antecedent events such as just having eaten food or being in the car may occasion or elicit smoking ( Niaura Rohsenow, Binkoff, Monti, Pedraza, & Abrams 1988; Tiffany, 1990 ). EMA sheds light on antecedents of smoking, but does not evaluate consequences Participants are typically instructed to report on events in their environ ment prior to smoking cigarettes (Shiffman et al., 2002 ). T he variables are exclusively evaluated as antecedents although they may be functioning as reinforcing consequences. For example, a participant may report that friends are present before they have a cigarette. The presence of friends could either occasion may deliver socially reinforcing consequences for smoking. The assessment of consequences is a vital aspect of understanding smoking behavior. Given the advantages of using EMA to assess antecedents of smoking, an integrated assessment of antecedent and consequent events across time may provide useful information about variables associated smoking on the individual level (Iwata et al., 2000). To this end, we

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11 developed a questionnaire encompassing both antecedents and consequences of smoking to be used in conjunction with EMA. The present study was conducted to assess the feasibility of assessing the variables associated with smoking at an indivi dual level by incorporating EMA with descriptive assessment methodology

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12 CHAPTER 2 METHODS Participants Participants were eight se lf reported smokers recruited via advertisement from the local community and paid $50 on completion of the study. Participants qualified for participation if they were between the ages of 18 and 60, smoked 5 or more cigarettes per day, had a n exhaled carbon monoxide (CO) reading greater than or equal to 7 ppm (if reported having smoked within the last 3 hours), and smoked for at least one year. Participant demographics and exhaled CO readings at intake are presented in Table 3 1. Screening Applicants were screened over the phone for age, years smoking, cigarettes smoked per day, and student or employment status. If they qualified, they were invited to the lab oratory for a 30 minute screening which included the informed consent process, a psychosocial history questionnaire, an exhaled CO reading, a drug test, a pregnancy test (if necessary), and the Fagerstrm test for nico tine dependence (FTND; Fagerstro m & Schneider 1989; Heatherton, Kozlowski, Frecker, & Fagerstr o m, 1991). The psychosocial history c ontained questions related to demographics, smoking history, and alcohol and marijuana use. The FTND is a six item questionnaire assessing nicotine dependence. Scores can range from zero to ten with a score of zero representing very low dependence and a sc ore of ten representing very high dependence. To prevent the possibility of theft of any loaned equipment, they also provide d a were a positive result on the drug (methamp hetamine, cocaine, morphine, benzodiazepines) and pregnancy tests, self reported medical conditions that would interfere with study procedures and self reported clinically diagnosed mental illness (e.g., schizophrenia).

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13 If they qualified for the study, pa rticipants were contacted to return to the University of Florida Smoking Lab and Clinic (UF SLC) and were issued a PocketPC (Dell Axim X51v or Pharos GPS 525). They were also asked to sign a property contract stating that they would return the PocketPC whe n asked. The participants were asked to use the Pockect PC to record each cigarette they smoked and answer brief questionnaires about the events preceding and following the cigarette for four days. Data Collection The researcher initiated the data collec tion program at the lab prior to loaning the device out. The program only allowed participants access to a main menu of options for their data collection. Access to all other features of the device was blocked. Participants were instructed to begin the 4 d ay data collection period the day after they picked up the PocketPC. Two days consisted of self reporting each cigarette smoked and completing the corresponding questionnaires (Pr e Post Cigarette Assessments). The other two days consisted of quasi random p rompts throughout the day to report on events not associated with smoking (No Cigarette Assessments). The Pre Post Cigarette (smoking) and No Cigarette Assessment (non smoking) days were alternated for each participant and the order was counterbalanced. On smoking days, the participants were asked to complete the Pre Cigarette Assessment immediately before smoking After finishing the cigarette, they were asked to complete the Post Cigarette Assessment. Initiating the assessments required only the selecti on of the corresponding button on the main menu. On non smoking days, participants were instructed to select a button on the main menu upon waking, which initiated a 14 hour locked data collection period of quasi random pr ompts to complete the corresponding questionnaires. The program was set such that a maximum of 30 quasi random prompts were issued during the data collection period The time between prompts was drawn from a

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14 distribution of 9 values derived from Fleschler and Hoffman (1962). The minimum and maximum inter assessment intervals were 15.3 0 and 58.89 minutes ( M = 34.81). A prompt began when the PocketPC beeped and asked the participant if they had smoked in the last 15 minutes. If they confirmed, a 15 minute tim e out was initiated and the participant was asked not to smoke. The participant was prompted on their smoking status until they reported not smoking in the last 15 minutes and the No Cigarette Assessment began. Completion of the first portion of the assess ment initiated a five minute countdown, mimicking the time elapsed during cigarette consumption. Participants were instructed not to smoke during this break. At the end of the break, p articipants were then prompted again to complete the second portion of t he No Cigarette Assessment. If a prompt was not immediately attended to, the device beeped once a minute until the participant initiated the assessment. Assessments The assessment items were developed by Dallery, Karlson, and Ivie ( 2007 ). Some of the items were derived from Axelrod (1991), and they were originally published in The Wellness Encyclopedia (Health Letter Associates, 1991). Additionally, experts in the field of smoking cessation and applied behavioral analysis and long term smokers were consulted during the construction of this q uestionnaire. The assessment items included in the present study are presented in Table 3 2 The smoking and non smoking questionnaires were identical except for the exclusion of cigarette related items on the non smoking questionnaire (i.e., the last 8 it ems in Table 3 2) Two example items as they would appear on the PocketPC are presented in Figure 3 1. Each item was presented one at a time and participants could not return to previous answers. For the environmental events, p articipants recorded whether or not specific stimuli were present in their environment of if they were engaged in specific activities. They were able to

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15 For internal states, p articipants rated affect adjectives and urge to smoke on a 10 po Assessment Follow u p Upon completion of the study, participants returned the device to the UF SLC and were compensated for t heir participation. They also complete d a questionnaire on their experience during the data collection period. Items included: 1. Please estimate the amount of the time the pre and post cigarette assessment items accounted for the instances in which you smoke. For example, you could give a percentage. 2. Are there any important instances in w hich you smoked that the assessments did not cover? 3. Do you think the assessment helped you understand some of the reasons you smoke? Please provide a rating as to how helpful the assessment was in helping you understand the reasons you smoke on a scale of 0 100, where 0 is not helpful at all and 100 is extremely helpful. 4. Is there anything else we should know about your experience completing the assessments? For example, instances in which you did not or cou ld not complete the assessments. A research assista nt provided the results of the assessment and resources and referrals for smoking cessation upon request. Data Analysis Frequency counts were obtained for the environmental variables to assess the number of times each item was associated with an instance of smoking. Because each participant smoked a different number of cigarettes each day, proportions were calculated based on the frequency counts and the total number of cigarettes smoked. Difference scores were calculated for affect and urge items on the Pre and Post Cigarette Assessments to assess any effect smoking a cigarette had on these items. These analyses were also conducted for the No Cigarette Assessments. A ssessments in which the participant completed both the Pre and Post Cigarette

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16 Assessment were con sidered acceptable assessments. A ssessments that did not include a Post Cigarette Assessment following initiation of the Pre Cigarette Assessment were considered unacceptable and dropped from the analysis. Similarly, assessments that did not include a Pre Cigarette Assessment prior to a Post Cigarette Assessment were dropped from the analysis.

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17 CHAPTER 3 RESU LTS All participants completed the four days of data for analysis. CD19 and KT07 completed one additional day because they acc identally initiated a locked No Cigarette Assessment during a smoking day which they had to complete in order to return to the mai n menu. SS01 took two days off in the middle of data collection due to scheduling conflicts, but asked to keep the device and completed al l four days. The mean number of smoking occasions per participant over the two days was 15.9 ( SD = 9.3 ) Of these, 12. 5 ( SD = 7.8 ) were acceptable smoking assessments The mean number of non smoking prompts completed per participant over the two days was 27.6 ( SD = 6.8). The estimated number of cigarettes smoked daily from the intake screening the total number of cigarettes reported on smoking days, and the total number of assessments completed on non smoking days are presented for each participant in Table 3 3. Environmental Events Proportions of observations for each item on the cigarette assessments w ere calculated for each of the conditions (smoking and non smoking days ). The number of instances in which the participant reported the item were totaled for both data collection days and divided by the total number of cigarettes smoked. Item abbreviations are presented in Table 3 2. The proportions of observations for each item on the cigarette assessments are shown in the left column of Figure 3 2 Individual differences in the events associated with instances of smoking are apparent. Some participants re ported a high frequency of the consequent events. For example, CL08 reported liking handling the cigarettes for all of the cigarettes she reported smoking. O thers reported a high frequency of the antecedent events. For example, all of the cigarettes AS05 r eported smoking were in the presence of non smokers and 0.8 0 occurred when he had nothing to do For other participants, both antecedent and consequent events were

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18 reported frequently. For example, EK10 reported the presence of non smokers and smokers and eating a meal for 0.67, 0.75, and 0.84 of the cigarettes reported (respectively). He also reported socializing with others for 0.75 of the cigarettes reported and liked handling the cigarettes, handling the lighter, watching the smoke on exhalation, and feeling the smoke in their mouth for all cigarettes reported. While some differentiati on in responses is apparent for most participants, than half of the cigarettes reported. Proportions of observations for each item on the non smoking assessments are shown in the right column of Figure 3 2. Few differences between smoking and non smoking days are apparent. In some instances, participants reported a greater frequency of one or two items. For example, BH09 reported being with smokers more often when smo king than when not. Overall, smoking days appear to be similar to non smoking days This may be due to the fewer number of observations on smoking days than non smoking days for most participants. Internal States Average and individual difference scores f or the affect items and urge on the Pre and Post Cigarette Assessments are shown in the left column of Figure 3 3. Item abbreviations are presented in Table 3 2 and the scale ranges from 10 to 10. Different patterns emerged in the average differences fro m before to after cigarette smoking. Three participants reported average changes near zero for most of the items. S light increases in feelings of relaxation, satisfaction, contentedness, and happiness and slight decreases in need for a lift were reported b y some participants. For BH09, these changes were generally near 2. For CL08, EK10, KT07, SS01, these changes range from 0 to 2. One notable deviation from these general patterns is the item participants, regardless o f the pattern of affect items,

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19 reported an average decrease greater than 2 for urge to smoke a cigarette. The eighth participant reported an average decrease of 1.4. Average and individual difference scores for the affect items and urge on the No Cigarette Assessments are shown in the right column of Figure 3 3 A malfunction in the program resulted in the item Cigarette Assessment days. The results are presented without this item. Different patterns from the ones observed on smoking days emerged in the average differ ences from before to after the five minute break. Only one participant, KT07, participant and SS01 were the only ones to show a similar pattern o n smoking and non smoking days for changes in affect items. AT02 showed slight average increases and decreases in affect items between smoking and non smoking days. The remainder of participants showed no average changes in affect from just experiencing th e passage of time. Assessment Follow u p Information gathered from the assessment follow up is presented in Table 3 4 Participants estimated that the assessments accounted for an average of 66% of the instances in which they smo ked. None of the participant s felt the assessments accounted for all of their smoking situations, yet only two participants provided additional information. EK10 suggested that he often smoked when bored and none of the items covered these instances. BH09 said that the items did not cover his habitual smoking or smoking as food replacement between meals. Participants reported an average helpfulness rating of 56 out of 100 in understanding their smoking patterns KT07 who gave a low rating for helpfulness reported doing so because sh e already knew why she smoked. When asked if we should know anything else about their experience with the device or data collection, about half of the participants provided additional information. KT07 reported

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20 that some of the P ost Cigarette Assessment items reflected something that happened while she was smoking and not the cigarette itself. No examples were provided, but a plausible situation would be having an argument while smoking and reporting feeling angrier on the Post Cigarette Assessment. AT02 BH09, CL08, and KT07 reported being in situations in which they could not attend to the No Cig arette prompts or could not hear them. AS05 reported forgetting to fill out Post Cig arette A ssessments because he was not prompted to do so, like with t he No Cig arette Assessments. KT07 also admitted not accurately reporting the n umber of cigarettes she smoked ; she had smoked many cigarettes one evening but on ly accounted for one because she was afraid of losing the device while drinking EK10 claim ed that his smo king increased from 0 to 5 cig arettes to 2 to 8 cig arettes a day from having to fill out the assessments This participant, however, never report ed more than four cigarettes on either of the cigarette assessment days, raising questions about the validity o f this statement.

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21 Table 3 1 Participant d emographics ID Sex Race Education Age Years s moking CO (ppm) FTND AS05 AT02 BH09 CD19 CL08 EK10 KT07 SS01 Male Female Male Male Female Male Female Male Latino Caucasian Caucasian Native American Caucasian Caucasian Caucasian Caucasian S ome college S ome college S ome college GED S ome college S ome college S ome college S ome college 22 26 22 45 36 21 19 19 6 9 5 25 13 2 2 2 10 17 29 65 13 13 16 14 3 4 5 5 3 0 5 4 Note. CO (carbon monoxide) refers to a measure of exhaled carbon monoxide in parts per million (ppm). FTND refers to the Fagerstrom Test for Nicotine Dependence. Table 3 2. Assessment i tems and a bbreviations Items Abbreviation I feel like I need a lift. I feel relaxed. I feel satisfied. I feel content. I feel happy. I feel angry. I feel frustrated. I feel sad or depressed. I feel anxious. I have an urge to smoke. I am with other people who are smoking. I am with other people who are NOT smoking. I just ate a meal or a snack. I am in my car. I am talking on the phone. I am waiting for someone or something. I have nothing to do. I am drinking a beer or other alcoholic beverage. I am drinking coffee. I am taking a break from work. I liked handling the cigarettes and cigarette container. I liked watching the smoke as I exhaled it. I liked handling the lighter or matches. I liked the feel of the smoke in my mouth and throat. I liked the way smoking made me feel around other people. I liked the way people looked at me when I smoked. I like d the way people interacted with me with I smoked. I socialized with other when I smoked. Lift Relaxed Satisfied Content Happy Angry Frustrated Depressed Anxious Urge With smokers With non smokers Meal Car Phone Waiting Nothing to do Alcohol Coffee Break Handling Cigarettes Watching smoke Handling lighter Feel of smoke Feel around others Looked at me Interacted with me Socialized with others

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22 Table 3 3. Number of cigarettes or assessments ID Intake Smoking Non smoking AS05 5 10 11 35 AT02 11 20 34 35 BH09 11 20 14 29 CD19 21 30 24 28 CL08 5 10 10 29 EK10 5 10 6 23 KT07 11 20 19 28 SS01 11 20 9 14 Table 3 4 Assessment f ollow u p ID % Accounted For Additional Items Helpfulness AS05 AT02 BH09 CD19 CL08 EK10 KT07 SS01 50 95 70 75 3 80 90 65 No No Habit/Food replacement No No Boredom No No 80 80 60 60 20 70 10 65

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23 I am with other people who are smoking. Yes No I feel like I need a lift. 1 2 3 4 5 6 7 8 9 10 Not at all Very much Figure 3 1. Examples of assessment items on the PocketPC. Next Next

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24 A B Figure 3 2 The proportions of observations for environmental events A) Smoking assessments. B) Non smoking assessments.

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25 A B Figure 3 2 Continued

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26 A B Figure 3 3. Average and individual difference scores for internal states. A) Smoking assessments. B) Non smoking assessments. Filled data points represent the first day of the assessment. Unfilled data points represent the second day of the assessment. Bars represent the two day average for the item.

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27 A B Figure 3 3. Continued

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28 A B Figure 3 3. Continued

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29 CHAPTER 4 DISCUSSION The results of this study suggest a descriptive assessment of smoking is feasible using the proposed methods. Individual differences in the events associated with smoking were observed, suggesting that our methods can effectively asses s smoking behavior at an individual level. The results also suggest that the inclusion of consequences may be useful in this assessment, as some participants reported these events as frequently occurring. Hypotheses about reinforcement contingencies and sp ecific maintaining variables can be derived from the data gathered by these assessments. For example, consequence of stimulation from handling the ci garettes maintains her smoking given that repo rt of this item occurs frequently with smoking. In general, this study is consistent with results from prior studies suggesting that assessment of situations associated with smoking is possible using this monitoring strategy in the natural environment ( Sha piro, et al., 2002; Shiffman et al., 2002 ). For example, Shapiro et al. (2002) reported that s moking occasions were positively associated with being in a car, outdoors, or on a work break; while waiting, being with friends, or being with others who are smo king; or after consumption of alcohol or food. Additionally, c ompared with control occasions, smoking was associated with an increased urge to smoke, feeling happy, and feeling stressed The results of the present study also suggest smoking was associated with these items; however, the frequency of the events varied markedly across participants. Assessing smoking at the individual level is possible and provides a more clear account of smoking events Furthermore, previous research ex clusively ev aluated smoking related events as antecedents ( Shapiro, et al., 2002; Shiffman et al., 2002; Shiffman, et al., 2007) The present study assessed antecedents prior to and consequences following cigarette consumption. Consequences were frequently reported,

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30 s uggest ing that they were relevant to smoking for so me participants and provide more information on smoking related events. The data gathered from non smoking days suggest few differences in the events reported when compared to smoking days. In other words, many of the antecedent events reported seem to occur frequently regardless of whether or not the participant is smoking. Unfortunately, the degree to which each item is associated with smoking cannot be determined (Epstein & Collins, 1977; Schwartz & Ston e, 1998). T he data from smoking days do not tell us how many times the stimulus was present in the environment and smoking did not take place. Further, large discrepancies were observed in the number of cigarettes reported on smoking days versus randomly p rompted assessments on non smoking days (Table 3 3) Comparisons between smoking and non smoking assessments may be misleading. For example, a report of being in the car for 2 of 6 assessments on smoking days versus 2 of 20 assessments on non smoking days may suggest that the car is more often associated with smoking (proportions of 0.3 3 and 0.1 0, respectively). T he comparisons between the two types of assessment s should be interpreted with caution ; however, the information gained from the smoking assessmen t independently may still be useful in that we have a depiction of smoking related events. Although descriptive assessment is feasible, interpretation may prove to be more difficult. Events reported less frequently than others does not preclude any of those events from playing a role in smoking. Even an item reported only twice out of 20 cigarettes may be functioning to maintain smoking for that individual. This may be the case for AT02, whose results seem to be undifferentiated. Additionally, these ite ms could be functioning as complex stimuli, with two or more items occurring simultaneously. For example, social reinforcement from friends combined with tactile stimulation from inhaling could occur simultaneously for each cigarette. Or perhaps a

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31 particip ant frequently reports drinking coffee before smoking, as well as liking the feeling of the smoke in their mouth. Does smoking make the effects of coffee more enjoyable, or is the coffee incidental to the reinforcing tactile stimulation of smoking? The res ults of this study were also congruent with other studies suggesting that subtle, if any, changes in affect are observed in the assessment of affect ( Shiffman et al., 2002). With our data, however, interpretation of these subjective measures is difficult g iven how the items are scored. Difference scores from before to after cigarette consumption were calculated to assess meaningful increase for maintaining smoking for one smoker but not others The concern could be raised that our measure is not sensitive to assessing these items ; however, the consistently reported average decreas the assessments were measuring some aspects of the smoking situation Some investigators may be concerned about the accuracy of self report. There are, however, many benefits to using se lf report data. Self reports are often used in human behavioral 1998, p 436). As previously discussed, this is certainly the case with attempting to assess events associated with smoking Someone reporting on their own behavior may even be at an advantage because they are subject to subtleties and special conditions affectin g the behavior that any other audience would not be privy to (Johnston & Pennypacker, 1980). Future research on the proposed methodology should include an attempt at increasing the validity and accuracy of self reports of smoking. This could be achieved by utilizing empirical validation strategies such as

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32 comparing self reports with different measures of the same referent behavior, seeking converging evidence from several types of self report, and calibrating self reports at times other than the main study (Critchfield et al., 1998). For example, calibrating self reports may involve providing participants with operational definitions of the assessment items and training responses in the laboratory. A possible limitation of this study, closely related to self report, is the possibility of reactivity. Reactivity refers to changes (increases or decreases) in the frequency of monitored behavior including self monitored behavior (Kazdin, 1979 ; Korotitsch & Nelson Gray 1999 ). For assessment purposes the behavior observed would not be considered natural if it were reactive (Epstein & Collins, 1977; Kazdin, 1979). In the present study, a comparison of reported number of cigarettes smoked daily prior to and during the study reveal discrepancies (Table 3 3) In gener al, participants smoked less during the study than what they reported prior to data collection. One participant reported that the data collection procedure increased the number of cigarettes smoked; however, as previously discussed, the data did not valida te his statement. Two situations could explain the discrepancies in cigarettes reported by participants: 1) over estimation of the number of cigarettes they smoked and 2) reactivity to self monitoring which resulted in a decrease in cigarettes smoked. Some participants reported not accurately reporting the cigarettes they smoked during the study because of situations in which they could not attend to the PocketPC, but none of the participants indicated deceptive reporting of cigarettes or any actual decreas es in their smoking. Reactivity in the present study is a possibility, but difficulty with the data collection device or overestimation of cigarettes smoked is a more likely explanation for any decreases in the number of cigarettes smoked during the study.

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33 EMA and descriptive assessment provide structured methodolog ies for assessing smoking behavior in the natural environment. The data gathered using these methods in conjunction may allow researchers and clinicians to make hypotheses about behavioral function. Additionally, the descriptive assessment could provide a bas is for a more rigorous functional assessment As the results of this study currently stand, however, we cannot move beyond correlates of smoking and hypotheses about behavioral function. Knowledge of behavioral function may be critical in developing effect ive treatment strategies for smoking cessation ( Axelrod, 1991; Kassel & Yates, 2002; Shiffman, 1993b). Without a delineation of causal variables, the results of the descriptive assessment may not be sufficient for making function based treatment recommenda tions (Hanley et al., 2003 ). This is the first of many steps in an attempt to understand individual maintaining variables of smoking and how researchers can use this information to aid smokers in their search for successful treatment strategies.

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34 LIST OF REFERENCES Critchfield, T. S., Tucker, J. A., & Vuchinich, R. E. ( 1998 ). Self report methods. In K. A. Lattal & M. Perone (Eds.), Handbook of research methods in human operant behavior. (pp. 435 470). NY: Plenum Press. Dallery, J., Karlson, C., & Ivie, J. L. ( 2007 ). A questionnaire based functional assessment of cigarette smoking. Unpublished manuscript. Epstein, L.H. & Collins, F.L. (1977). The measurement of situational influences of smoking. Addictive Behaviors, 2 47 53. Fiore, M. C., Jaen, C. R., Baker, T. B., Bailey, W. C., Ben owitz, N. L., Curry, S. J., et al. (2008). Treating tobacco use and dependence: 2008 update. Clinical practice guideline. Rockville, MD: US Department of Health and Human Services, Public Health Service. Fagerstrom, K. O. & Schneider, N.G. (1989). Measuring nicotine dependence: A review of the F agerstrom t olerance q uestionnaire. Journal of Behavioral Medicine, 12( 2), 159 182. Hanley, G. P., Iwata, B. A., & McCord, B. E. ( 2003 ). Functional analysis of problem behavior: A review. Journal of Applied Behavior Analysis, 36, 147 185. Hawkins, R. P. (1979). The functions of assessment: Implications for selection and development of devices for assessing repertoires in clinical, edu cational, and other settings. Journal of Applied Behavior Analysis, 12, 501 516. Health Letter Associates. (1991). The wellness encyclopedia Boston: Houghton Mifflin. Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & Fagerstrom, K. O. (1991). The Fagerstrom t est for n icotine d ependence: A revision of the Fagerstrom t olerance q uestionnaire. British Journal of Addiction 86, 1119 1127. Herzinger C. V. & Campbell, J. M. ( 2007 ). Comparing functional assessment methodologies: A quantitative synthesis. Journal of Autism Developmental Disorders, 37, 1430 1445. Iwata, B. A., Kahng, S. W., Wallace, M. D., & Lindberg, J. S. (2000). The functional analysis model of behavioral assessment. In J. Austin, & J.E. Carr (Eds.), Handbook of applied behavioral analysis (pp.61 89). Reno, NV: Context Press. Johnston, J. M. & Pennypacker, H. S. (1980). Strategies and tactics of human behavioral research. Hillsdale, NJ: Erlbaum. Jorenby, D. E., Hays, J. T., Rigotti, N. A., Azoulay, S., Watsky, E. J., Williams, K. E., et al. a gonist, vs placebo or sustained release buproprion for smoking cessation: A r andomized c ontrolled t rial. Journal of the American Medi cal Association, 296, 56 63.

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35 Kazdin, A. E. (1979). Unobtrusive measures in behavioral assessment. Journal of Applied Behavior Analysis, 12, 713 724. Korotitsch, W. J. & Nelson Gray, R. O. (1999). An overview of self monitoring research in assessment a nd treatment. Psychological Assessment, 11 415 425. Flesh l er, M., & Hoffman, H. S. (1962). A progression for generating variable interval schedules. Journal of the Experimental Analysis of Behavior, 5 529 530. Nelson, R. O. & Hayes, S. C. (1981). Theoretical explanations for reactivity in self monitoring. Behavior Modification, 5, 3 14. Niaura, R. S., Rohsenow, D. J., Binkoff, J. A., Monti, P. M., Pedraza, M., & Abrams, D. B. (1988). Relevance of cue reactivity to understanding alcohol and smoking relapse. J ournal of Abnormal Psychology, 97 133 152. Pomerleau, O. F. (1979). Behavioral f actors in the e stablishment, m aintenance, and c essation of s moking NIDA Research Monograph, 26, 47 67. Rose, J. E., & Levin, E D. (1991). Inter relationships between conditioned and primary reinforcement in the maintenance of cigarette smoking. British Journal of Addiction, 86 605 609. Shapiro, D., Jamner, L. D., Davydov, D. M., & James, P. (2002). Situations and moods associ ated with smoking in everyday life. Psychology of Addictive Behaviors, 16, 342 345. Shiffman, S. (1993a). Assessing smoking patterns and motives. Journal of Consulting and Clinical Psychology, 61 732 742. Shiffman, S. (1993b). Smoking cessation treatment: Any progress? Journal of Consulting and Clinical Psychology, 61 7 18 72 2. Shiffman, S., Balabanis, M. H., Gwaltney, C. J., Paty, J. A., Gnys, M., Kassel, J. D., Hickcox, M., & Paton, S. M. (2007). Predi ction of lapse from associations between smoking and situational antecedents assessed by ecological momentary assessment. Drug and Alcohol Dependence, 91 159 168. Shiffman, S., Engberg, J. B., Paty, J. A., Perz, W. G., Gnys, M., Kassel, J. D., Hickcox, M. (1997a). A day at a time: Predicting smoking lapse from daily urge. Journal of Abnormal Psychology 106, 104 116 Shiffman, S., Gwaltney, C. J., Balabanis, M. H. Liu, K. S ., Paty, J. A., Kassel, J. D., et al. (2002). Immediate antecedents of cigarette smoking: An analysis from ecological momentary assessment. Journal of Abnormal Psychology 111 531 545

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36 Shiffman, S., Hufford, M., Hickcox, M., Paty, J. A., Gnys, M., & Kassel, J. D. (1997 b ). Remember that? A comparison of real time versus retrospective recall of smoking lapses. Journal of Consulting and Clinical Psychology, 65, 292 300. Shiffman, S., & Paty, J. A. (2006). Smoking patterns and dependence: Co ntrasting chippers and heavy smokers. Journal of Abnormal Psychology, 115, 509 523. Shiffman, S. & Prange, M. (1 988 ). Self reported and self monitored smoking pattern s Addictive Behaviors, 13, 201 204. Shiffman, S., & Stone, A. A. (1998). Ecological momentary assessment: A new tool for behavioral medicine research. In D. Krantz & A. Baum (Eds.), Technology and methods in behavioral medicine (pp. 117 131). Mahwah, NJ: Erlbaum. Stone, A. A., & Shiffman, S. (1994). Ecological momentary assessment (EMA) in behavioral medicine. Annals of Behavioral Medicine, 16, 199 202. Sturmey, P. (1994). Assessing the functions of aberrant behaviors: A review of psychometric instruments. Journal of Autism and Developmental Disorders, 24, 293 304. Tiffany, S. T. (1990). A cognitive model of drug urges and drug use behavior: Role of automatic and nonautomatic processes. Psychological Review, 97 147 168.

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37 BIOGRAPHICAL SKETCH Alana M. Rojewski was born in Zanesvil le, Ohio. She graduated from Bishop Rosecrans High School in 2002 where she took an early interest in psychology. She was able to pursue this major at Denison University in Granville, Ohio, graduating magna cum laude with her B.A. in p sychology in 2006. F rom her early research experiences at Denison, she also developed an interest in drug abuse research. Alana matriculated in the b ehavior a nalysis program of the Psychology Department at the University of Florida under Dr. Jess e Dallery in the fall of 2006 She received her M.S. from the University of Florida in the fall of 2009 and is currently pursuing her Ph.D. Her current research interests include smoking and cessation methods.