Using ecological momentary assessment, geolocation tracking, and neuroimaging to assess effects of tobacco retail exposure on smoking behavior: Protocol for the GeoSmoking Study

Background: Cigarette smoking is one of the world’s main public health concerns, accounting for 1 in 5 deaths in the United States (U.S) per year. Exposure to tobacco retail has been linked to adverse smoking outcomes, but research utilizing naturalistic and causal approaches to quantify these effects in the real world remains relatively sparse. To address this, we used ecological momentary assessment, geolocation tracking, and neuroimaging to assess smoking outcomes in the real world, and conducted a randomized controlled trial focused on the effects of real-world exposure to tobacco retail.Objective: The GeoSmoking Study aimed to evaluate: (1) within-person associations between real-world tobacco retail exposure and cigarette craving and smoking; (2) causal effects of real-world tobacco retail exposure; and (3) neural cue reactivity as a mechanism for real-world tobacco retail effects.Methods: In a two-week baseline period, we used ecological momentary assessment to collect reports of craving and smoking multiple times per day. Simultaneously, we used geolocation tracking to quantify tobacco retail exposure, through creation of a tobacco retailer database across three U.S. states (Pennsylvania, New Jersey, Delaware). A four-week intervention period followed, in which participants were randomly assigned to enter either a non-tobacco retail store once per day (Non-tobacco retailer condition), a tobacco retail store once per day (Tobacco retailer condition), or follow their normal routines (Control condition). An optional functional magnetic resonance imaging (fMRI) session concluded the study. Individuals participated remotely, unless they opted in to the fMRI session, which was conducted at the University of Pennsylvania.Results: The GeoSmoking Study was approved by the Institutional Review Board at the University of Pennsylvania on February 3rd, 2022. Data collection started on May 25th, 2022 and ended on June 10th, 2024. In total, 310 participants were enrolled, 282 participants completed the baseline phase, 244 participants completed the intervention phase, and 24 participants completed the fMRI scan.Conclusions: This novel and innovative study protocol was successfully implemented. Findings from planned analyses may have significant implications for health behaviors, outcomes, and policy.Trial Registration: Cancer Prevention through Neural and Geospatial Examination of Tobacco Marketing Effects in Smokers: 1R01CA229305-01A1; ClinicalTrials.gov Identifier: NCT04279483