Geospatial exposure to point-of-sale tobacco: real-time craving and smoking-cessation outcomes.
BACKGROUND
Little is known about the factors that drive the association between point-of-sale marketing and behavior, because methods that directly link individual-level use outcomes to real-world point-of-sale exposure are only now beginning to be developed.


OBJECTIVE
Daily outcomes during smoking cessation were examined as a function of both real-time geospatial exposure to point-of-sale tobacco (POST) and subjective craving to smoke.


METHODS
Continuous individual geospatial location data collected over the first month of a smoking-cessation attempt in 2010-2012 (N=475) were overlaid on a POST outlet geodatabase (N=1060). Participants' mobility data were used to quantify the number of times they came into contact with a POST outlet. Participants recorded real-time craving levels and smoking status via ecological momentary assessment (EMA) on cellular telephones.


RESULTS
The final data set spanned a total of 12,871 days of EMA and geospatial tracking. Lapsing was significantly more likely on days with any POST contact (OR=1.19, 95% CI=1.18, 1.20), and increasingly likely as the number of daily POST contacts increased (OR=1.07, 95% CI=1.06, 1.08). Overall, daily POST exposure was significantly associated with lapsing when craving was low (OR=1.22, 95% CI=1.20, 1.23); high levels of craving were more directly associated with lapse outcomes.


CONCLUSIONS
These data shed light on the way mobility patterns drive a dynamic interaction between individuals and the POST environment, demonstrating that quantification of individuals' exposure to POST marketing can be used to identify previously unrecognized patterns of association among individual mobility, the built environment, and behavioral outcomes.
Steven A. Schroeder National Institute for Tobacco Research and Policy Studies (Kirchner, Anesetti-Rothermel, Abrams), Georgetown University Medical Center, Washington, District of Columbia; Department of Oncology (Kirchner, Abrams), Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia; Department of Health, Behavior and Society (Kirchner, Cantrell, Vallone, Abrams), Johns Hopkins School of Public Health, Baltimore, Maryland. Electronic address: tkirchner@legacyforhealth.org.
Thomas R
TR
Kirchner
Jennifer
J
Cantrell
Andrew
A
Anesetti-Rothermel
Ollie
O
Ganz
Donna M
DM
Vallone
David B
DB
Abrams
D000328:Adult; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D040362:Geographic Information Systems; D006801:Humans; D008297:Male; D040541:Marketing / Q000706:statistics & numerical data*; D008875:Middle Aged; D012008:Recurrence; D016540:Smoking Cessation / Q000523:psychology*; D012959:Socioeconomic Factors; D014029:Tobacco Use Disorder / Q000523:psychology*; D014026:Nicotiana