Influence of affective manipulations on cigarette craving: a meta-analysis

Retrospective self-report and observational studies have yielded inconsistent findings regarding the capacity of negative affect (NA) to increase smoking motivation among dependent samples. Controlled laboratory studies offer an alternative paradigm for testing the role of affective state upon smoking motivation. The aim of the current study was to quantify cue-provoked cravings produced by affective manipulations in the published literature, and to identify theoretical and methodological moderators.

We conducted a systematic literature search to identify experimental studies that manipulated NA or positive affect (PA), and assessed post-manipulation craving. Separate random-effects meta-analyses examined NA and PA cues as predictors of self-reported craving. Self-reported affect (NA and PA), nicotine deprivation, gender, nicotine dependence, order of cue presentation, single versus multi-item craving assessment and affect induction method were tested as moderators of affective cue-induced craving.

NA manipulations produced a medium effect [g = 0.47; confidence interval (CI) = 0.31-0.63] on craving, but no main effects were found for PA manipulations (g = 0.05; CI = -0.09 to 0.20) on craving. Self-reported NA moderated the extent to which NA and PA manipulations elicited craving (P < 0.02 for each). That is, more effective NA manipulations produced greater cravings, and PA manipulations reduced cravings when they reduced NA.

Laboratory studies indicate that negative, but not positive, affect is a situational determinant of cravings to smoke among dependent smokers. Adverse emotional states increase craving to smoke among dependent smokers, but positive emotional states do not consistently reduce craving to smoke.