Within-person associations between psychological and contextual factors and lapse incidence in smokers attempting to stop: A systematic review and meta-analysis of Ecological Momentary Assessment studies

Background and Aims: When attempting to stop smoking, discrete smoking events (‘lapses’) are strongly associated with a return to regular smoking (‘relapse’). No study has yet pooled the psychological and contextual antecedents of lapse incidence, captured in Ecological Momentary Assessment (EMA) studies. This systematic review and meta-analysis aimed to synthesise within-person psychological and contextual predictor-lapse associations in smokers attempting to quit.Design: We searched Ovid MEDLINE, Embase, PsycINFO and Web of Science. A narrative synthesis and multilevel, random-effects meta-analyses were conducted.Setting: No restrictions on setting.Participants: Adult, non-clinical populations attempting to stop smoking.Measurements: Outcomes were the association between a psychological (e.g., stress, cravings) or contextual (e.g., cigarette availability) antecedent and smoking lapse incidence; definitions of ‘lapse’ and ‘relapse’; the theoretical underpinning of EMA study designs; and the proportion of studies with pre-registered study protocols/analysis plans and open data.Findings: We included 56 studies, with 18 studies contributing 1+ effect sizes to the meta-analyses. We found positive relationships between lapse incidence and ‘environmental and social cues’ (k = 12, OR = 4.19, 95% CI = 1.77, 9.91, p = 0.001) and ‘cravings’ (k = 10, OR = 1.73, 95% CI = 1.25, 2.40, p = 0.001). ‘Negative feeling states’ was not significantly associated with lapse incidence (k =15, OR = 1.10, 95% CI = 0.97, 1.24, p = 0.14). In the narrative synthesis, negative relationships with lapse incidence were found for ‘behavioural regulation’, ‘motivation not to smoke’, and ‘beliefs about capabilities’; positive relationships with lapse incidence were found for ‘positive feeling states’ and ‘positive outcome expectancies’. Although lapse definitions were comparable, relapse definitions varied widely across studies. Few studies explicitly drew on psychological theory to inform EMA study designs. None of the included studies drew on Open Science principles.Conclusions: In smokers attempting to stop, environmental and social cues and cravings appear to be key within-person antecedents of smoking lapse incidence.