Craving, Withdrawal, and Smoking Urges in Women on Days Immediately Prior to Smoking Relapse Sharon S. Allen, MD, PhD, Tracy Bade, MPH, Bruce A. Center, PhD,* Department of Family Medicine and Community Health Dorothy Hatsukami, PhD, Director of Tobacco Research Program, Department of Psychiatry University of Minnesota Medical School, Minneapolis, MN *Corresponding Author, Phone: 612-624-2077, E-mail: cente001@umn.edu 1. Background The effect of symptoms on smoking relapse is unclear. This is in spite of the fact that factors such as craving, withdrawal symptoms, and smoking urges (Intention to Quit, Negative Affect) are thought to be key contributors to relapse. It is unclear because: 1. Symptom scores are subjective and highly variable across people - People experience different levels of symptoms (true difference) - People interpret their symptoms differently on the Likert scales (measurement error) 2. People do not respond to a particular absolute symptom threshold. Rather they respond to their own relative subjective experience. It is known that symptom scores peak just after quitting, then gradually decline. 2. Hypothesis For Women who relapse, their symptoms will: 1. increase prior to relapse 2. peak at relapse 3. subside immediately subsequent to relapse 3. Methods 3.1 Participants: Data were analyzed from 137 female smokers, 18-40 years old, who completed 30 days of a protocol for a larger, longitudinal smoking cessation trial. Subjects were assigned a quit date and followed regardless of subsequent smoking status. At baseline and then beginning on their quit date, subjects completed 30 days of daily written measures of nicotine craving, withdrawal symptoms, and smoking urges.. 3.2 Analysis: Scores were standardized within subjects - a score of zero means she is at her average (mean) symptom level; - a score of -1.0 means she is one standard deviation below her mean level; - a score of 2.0 means that she is two standard deviations above her personal average. We shifted each series so they would line up at the point of relapse (always day zero). The series were averaged across women, where day is defined as number of days before or after relapse. Women who never relapsed (n=26) are represented on the left of zero and fall off before relapse. All other women who relapsed (n=111) enter the figures at different time points, depending on the number of days to relapse. There are a different number of women at each graphed data point. This does not effect our overall means; the mean of each and every women is zero, and their variability is the same (σ = 1.0). 4. Results 1. Symptoms rose during the 2-5 days prior to relapse. 2. Symptoms dropped precipitously over the two days subsequent to relapse. 3. The intensity of subjects’ craving, withdrawal, and smoking urges (Intention to smoke and Negative affect) peaked on the day of relapse by an average of 1.4, 1.1, 1.2, and 1.1 standard deviations, respectively. Hypotheses were confirmed. 5. Implications Escalation of withdrawal symptoms, craving, and smoking urges during a quit attempt contributes to smoking relapse. Frequent symptom monitoring might be clinically important for relapse prevention. Presented at the 35th Annual Meeting of the North American Primary Care Research Group, October 20-23, 2007, Vancouver, British Columbia 150