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

Background: Cigarettes are a global public health concern, as cigarette smoking is the leading cause of death in the US and throughout most high-income countries. 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, the study used geolocation tracking, ecological momentary assessment, and neuroimaging to assess smoking outcomes in daily life, and conducted a randomized controlled trial focused on the effects of 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, the study collected reports of craving and smoking multiple times per day using ecological momentary assessment, in addition to other measures. Simultaneously, geolocation tracking was used to quantify tobacco retail exposure, through creation of a tobacco retail database across three U.S. states (Pennsylvania, New Jersey, Delaware). A four-week intervention period followed, in which participants were randomly assigned to make a purchase at either a non-tobacco retail store five days per week (non-tobacco retail condition), a tobacco retail store five days per week (tobacco retail 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 completed at the University of Pennsylvania.Results: The GeoSmoking Study was approved by the Institutional Review Board at the University of Pennsylvania. Data collection started on May 25, 2022 and ended on June 10, 2024. In total, 310 participants were enrolled, 282 participants completed the baseline phase, 244 participants completed the intervention phase, and 24 participants completed the optional fMRI scan.Conclusions: This study protocol was implemented successfully. Findings from planned analyses may have significant implications for our understanding of health behaviors and outcomes, as well as policy.Trial Registration: Cancer Prevention through Neural and Geospatial Examination of Tobacco Marketing Effects in Smokers: 1R01CA229305-01A1; ClinicalTrials.gov Identifier: NCT04279483