BACKGROUND: Previous studies suggested that a higher craving level among smokers is associated with failure of attempting to quit smoking. However, integration with anxiety and craving has not been established, with reagents from specific instruments that are capable of generating an efficient model that determines the main predictors of failure in the cessation attempt. The aim of this study is to evaluate a structural equation model (SEM) in which anxiety and craving are predictors of abstinence failure in an online cessation program in Mexico.
METHODS: A prospective cohort in a smoking cessation treatment center in Mexico (n=256). All patients with at least 80% of attendance to the sessions were included in the analysis. Abstinence was self-reported. We used a SEM to evaluate our hypothesis that craving and anxiety symptoms predict abstinence failure with a diagonally weighted least squares estimator. The anxiety construct was measured using three items from the Beck Anxiety Inventory: feeling of choking, shakiness/unsteadiness, and fear of dying. The craving construct was assessed with three items from the Nicotine Craving Questionnaire: 'I had many urges to light a cigarette,' 'My desires to smoke were constant,' and 'The smoking desire was intense.' Items were selected according to polychoric correlation values. A third latent variable was proposed as a mediator between anxiety, craving, and abstinence failure.
RESULTS: A total of 256 patients were included; mean age was 49 (+-13) years and 56% (n=145) were female. Abstinence was reported by 88.9% (n=207) and 19.1% (n=49) failed abstinence. The model showed good fit, χ2(12) = 3.12, CFI = 1.00, RMSEA = 0.00, SRMR=0.035.
CONCLUSIONS: The model may be a useful and efficient clinical tool for assessing short-term abstinence failure risk, thus, could serve to enhance the effectiveness of smoking cessation efforts.