Associate Professor of Social and Behavioral Sciences
Dr. Thomas Kirchner is a clinical-health psychologist and methodologist interested in the analysis and graphical representation of longitudinal and geographic data, including methodologies that link individual behavior to the real-time context in which it occurs. Dr. Kirchner’s research targets momentary influences on the maintenance of health-related behavior utilizing both field-based (ecological momentary assessment) and laboratory-based paradigms. These geographic information systems and analytical methods can then inform public health, research, and policy.
As the Director and Principal Investigator of the mHealth (mobile health) Lab, Dr. Kirchner uses GIS to understand health-related behavior and decision-making in real time (e.g., how people make decisions about what they eat and drink, the places they go to exercise in their neighborhoods, the amount of time they spend outdoors, and whether they smoke cigarettes and/or marijuana). In the Lab, students apply mHealth tools to explore geospatial systems, technology, research, and community advocacy. Students learn how to leverage the power of their cell phones to collect data about neighborhoods and experiences.
MS, Clinical and Biological/Health Psychology, University of Pittsburgh, Pittsburgh, PAPhD, Clinical and Biological/Health Psychology, University of Pittsburgh, Pittsburgh, PA
Behavioral Determinants of HealthGeographic Information Science (GIS)Geographically-explicit EMALongitudinal Data AnalysisSocial BehaviorsUrban InformaticsUrban Science
Analyzing Trajectories of Acute Cigarette Reduction Post-Introduction of an E-Cigarette Using Ecological Momentary Assessment DataGuttentag, A., Tseng, T. Y., Shelley, D., & Kirchner, T. (n.d.).
Journal titleInternational journal of environmental research and public health
Issue12AbstractElectronic cigarettes (ECs) may hold great potential for helping smokers transition off combustible cigarettes (CCs); however, little is known about the patterns that smokers follow when using an EC as a CC-substitute in order to ultimately reduce and quit smoking. Our primary aim in this study was to evaluate whether common patterns of CC use exist amongst individuals asked to substitute an EC for at least half of the CCs they would normally smoke. These patterns may eluci-date the immediate switching and reduction behaviors of individuals using ECs as a reduction/ces-sation tool. This analysis uses data from a randomized controlled trial of 84 adult smokers assigned to receive either 4.5% nicotine or placebo (0% nicotine) EC. Participants were advised to use the EC to help them reach a 50% reduction in cigarettes-per-day (CPD) within 3 weeks. Longitudinal trajectory analysis was used to identify CPD reduction classes amongst the sample; participants clus-tered into four distinct, linear trajectories based on daily CC use during the 3-week intervention. Higher readiness to quit smoking, prior successful quit attempts, and lower baseline CC consumption were associated with assignment into “more successful” CC reduction classes. ECs may be a useful mechanism to promote CC reduction. This study demonstrates that a fine-grained trajectory approach can be applied to examine switching patterns in the critical first weeks of an attempt.
Electronic cigarettes as a harm reduction strategy among patients with COPD: protocol for an open-label two arm randomized controlled pilot trialStevens, E. R., Lei, L., Cleland, C. M., Vojjala, M., El-Shahawy, O., Berger, K. I., Kirchner, T. R., & Sherman, S. E. (n.d.).
Journal titleAddiction Science and Clinical Practice
Issue1AbstractBackground: Smoking cessation is the most effective means of slowing the decline of lung function associated with chronic obstructive pulmonary disease (COPD). While effective smoking cessation treatments are available, they are underutilized and nearly half of people with COPD continue to smoke. By addressing both nicotine and behavioral dependence, electronic cigarettes (EC) could help people with COPD reduce the harm of combustible cigarettes (CC) through reductions in number of Cigarettes per Day (CPD) or quitting CC completely. The purpose of this pilot study is to identify barriers and facilitators to the use of and assess the preliminary effectiveness of EC as a harm reduction strategy among people with COPD. Methods: In an open-label two-arm randomized controlled trial pilot study, 60 patients identified as smokers with a COPD diagnosis via electronic health records from a large urban health center are randomized in a 1:1 ratio to either standard care [counseling + nicotine replacement therapy (NRT)] or counseling + EC. The NRT arm will receive nicotine patches and nicotine lozenges for 12 weeks. The EC arm will receive EC for 12 weeks. Both cohorts will receive counseling from a licensed mental health counselor. Using ecological momentary assessment, participants will report their use of CC in both arms and EC use in the EC arm daily via text message. Primary outcomes will be feasibility and acceptability of intervention, and secondary outcomes will be reduction in CPD and change in COPD symptoms as measured by COPD Assessment Tool (CAT) score at 12-weeks. EC displacement of CC. To explore attitudes towards the use of EC as a harm-reduction strategy for patients with COPD, interviews will be performed with a sample of participants from both study arms. Discussion: Despite decades of availability of smoking cessation medications, nearly half of people with COPD still smoke. This study aims to address the unmet need for feasible and effective strategies for reducing CC use among those with COPD, which has the potential to significantly improve the health of people with COPD who smoke. Trial Registration ClinicalTrials.gov Identifier: NCT04465318.
Momentary measurements and chronic conditionsKirchner, T. R., & Gao, H. (n.d.).
Journal titleHealth and Place
PhenX: Vector measures for tobacco regulatory researchRibisl, K. M., Chaloupka, F. J., Kirchner, T. R., Henriksen, L., Nettles, D. S., Geisler, R. C., Hendershot, T. P., & Swan, G. E. (n.d.).
Journal titleTobacco control
Page(s)S27-S34AbstractThe PhenX (Phenotypes and eXposures) Toolkit provides researchers with recommended standard consensus measures for use in epidemiological, biomedical, clinical and translational studies. To expand the depth and breadth of measures in the PhenX Toolkit, the National Institutes of Health and U.S. Food and Drug Administration have launched a project to identify ' Core' and ' Specialty' collections of measures recommended for human subjects studies in tobacco regulatory research (TRR). The current paper addresses the PhenX Toolkit TRR Vector specialty area and describes the 6-month process to identify high-priority, low-burden, scientifically supported consensus measures. Self-reported, interviewer-administered and observational measurements were considered, and input from the research community assisted in justifying the inclusion of 13 tobacco industry-relevant measures (mainly interviewer-administered or self-reported measures) in the PhenX Toolkit. Compared with measures of addiction or the use of tobacco products, assessments of many Vector factors are much newer and at an earlier stage of development. More work is needed to refine and validate measures of the spatial distribution of tobacco retailers, retail environment, price promotions and corporate social responsibility.
Reducing drinking among people experiencing homelessness: Protocol for the development and testing of a just-in-time adaptive interventionBusinelle, M. S., Walters, S. T., Mun, E. Y., Kirchner, T. R., Hébert, E. T., & Li, X. (n.d.).
Journal titleJMIR Research Protocols
Issue4AbstractBackground: Adults who are homeless are more likely to have alcohol use disorders (AUDs) compared with domiciled adults. Although AUD treatments are commonly available, many factors (eg, transportation limitations and inability to schedule appointments) contribute to low treatment completion rates and low success rates of these interventions among adults experiencing homelessness. Most adults who are homeless own mobile phones; however, no interventions have been developed that use mobile devices to deliver and support AUD interventions for this population. Mobile phone–based AUD interventions may reduce barriers that have limited the use and utility of traditional interventions. Objective: The aim of this study is to (1) identify variables (eg, affect, stress, geolocation, and cravings) that predict drinking among homeless adults (phase I), (2) develop a mobile intervention that utilizes an algorithm to identify moments of risk for drinking and deliver treatment messages that are tailored to the individual’s current needs in real time (phase II), and (3) pilot test the intervention app (phase III). Methods: In phase I, adults experiencing homelessness with an AUD (N=80) will complete baseline, equipment, 2-week, and 4-week follow-up visits in person. Participants will be prompted to complete five daily ecological momentary assessments on a study-provided smartphone for 28 days. The smartphone app will collect GPS coordinates every 5 min for the entire 28-day study period. Participants will wear a transdermal alcohol sensor that will objectively measure alcohol use. In phase II, we will use phase I data to develop an algorithm that identifies moments of heightened risk for drinking and develop treatment messages that address risk factors for drinking. Phase III will pilot test the intervention in 40 adults experiencing homelessness with AUD. Results: This project was funded in June 2018. IRB approval was obtained in October 2018, and data collection for phase I began in February 2019. Phase III data collection is expected to conclude in 2020. To date, 80 participants have consented to the study, and data analysis for phase I will begin in early 2020. Conclusions: This research will highlight intervention targets and develop a novel intervention for understudied and underserved adults experiencing homelessness with AUD.
Adolescent Marijuana Use, Marijuana-Related Perceptions, and Use of Other Substances Before and After Initiation of Retail Marijuana Sales in Colorado (2013–2015)Brooks-Russell, A., Ma, M., Levinson, A. H., Kattari, L., Kirchner, T., Anderson Goodell, E. M., & Johnson, R. M. (n.d.).
Journal titlePrevention Science
Page(s)185-193AbstractDue to the recentness of changes to marijuana policies in a number of states, the effect on adolescent use and perceptions is not yet well understood. This study examines change in adolescent marijuana use and related perceptions in Colorado, before and after the implementation of legal commercial sale of recreational marijuana for adults starting on January 1, 2014. The data are from a repeated cross-sectional survey of a representative sample of Colorado high school students, with separately drawn samples surveyed in fall 2013 (prior to implementation) and fall 2015 (18 months after implementation). We examined change in the prevalence of adolescent marijuana use, measured by lifetime use, past 30-day use, frequent use, and use on school property. To consider the possibility of heterogeneity in the change in marijuana use, we examined change in past 30-day marijuana use by demographic characteristics (sex, grade, race/ethnicity), school characteristics (poverty, percent minority), urbanicity of the school district, and whether the city or county permitted retail marijuana stores. There was an absence of significant effects for change in lifetime or past 30-day marijuana use. Among those reporting past 30-day use, frequent use and use on school property declined. There was a significant decline in the perceived harm associated with marijuana use, but we did not find a significant effect for perceived wrongfulness, perceived ease of access, or perceived parental disapproval. We did not find significant variability in past 30-day use by demographic characteristics or by school and community factors from 2013 to 2015. We did not find a significant effect associated with the introduction of legal sales of recreational marijuana to adults in Colorado on adolescent (illegal) use, but ongoing monitoring is warranted, including consideration of heterogeneity in the effects of marijuana policies.
An African-specific haplotype in MRGPRX4 is associated with menthol cigarette smokingKozlitina, J., Risso, D., Lansu, K., Olsen, R. H. J., Sainz, E., Luiselli, D., Barik, A., Frigerio-Domingues, C., Pagani, L., Wooding, S., Kirchner, T., Niaura, R., Roth, B., & Drayna, D. (n.d.).
Journal titlePLoS genetics
Issue2AbstractIn the U.S., more than 80% of African-American smokers use mentholated cigarettes, compared to less than 30% of Caucasian smokers. The reasons for these differences are not well understood. To determine if genetic variation contributes to mentholated cigarette smoking, we performed an exome-wide association analysis in a multiethnic population-based sample from Dallas, TX (N = 561). Findings were replicated in an independent cohort of African Americans from Washington, DC (N = 741). We identified a haplotype of MRGPRX4 (composed of rs7102322[G], encoding N245S, and rs61733596[G], T43T), that was associated with a 5-to-8 fold increase in the odds of menthol cigarette smoking. The variants are present solely in persons of African ancestry. Functional studies indicated that the variant G protein-coupled receptor encoded by MRGPRX4 displays reduced agonism in both arrestin-based and G protein-based assays, and alteration of agonism by menthol. These data indicate that genetic variation in MRGPRX4 contributes to inter-individual and inter-ethnic differences in the preference for mentholated cigarettes, and that the existence of genetic factors predisposing vulnerable populations to mentholated cigarette smoking can inform tobacco control and public health policies.
Crowdsourcing for food purchase receipt annotation via amazon mechanical turk: A feasibility studyLu, W., Guttentag, A., Elbel, B., Kiszko, K., Abrams, C., & Kirchner, T. R. (n.d.).
Journal titleJournal of medical Internet research
Issue4AbstractBackground: The decisions that individuals make about the food and beverage products they purchase and consume directly influence their energy intake and dietary quality and may lead to excess weight gain and obesity. However, gathering and interpreting data on food and beverage purchase patterns can be difficult. Leveraging novel sources of data on food and beverage purchase behavior can provide us with a more objective understanding of food consumption behaviors. Objective: Food and beverage purchase receipts often include time-stamped location information, which, when associated with product purchase details, can provide a useful behavioral measurement tool. The purpose of this study was to assess the feasibility, reliability, and validity of processing data from fast-food restaurant receipts using crowdsourcing via Amazon Mechanical Turk (MTurk). Methods: Between 2013 and 2014, receipts (N=12,165) from consumer purchases were collected at 60 different locations of five fast-food restaurant chains in New Jersey and New York City, USA (ie, Burger King, KFC, McDonald's, Subway, and Wendy's). Data containing the restaurant name, location, receipt ID, food items purchased, price, and other information were manually entered into an MS Access database and checked for accuracy by a second reviewer; this was considered the gold standard. To assess the feasibility of coding receipt data via MTurk, a prototype set of receipts (N=196) was selected. For each receipt, 5 turkers were asked to (1) identify the receipt identifier and the name of the restaurant and (2) indicate whether a beverage was listed in the receipt; if yes, they were to categorize the beverage as cold (eg, soda or energy drink) or hot (eg, coffee or tea). Interturker agreement for specific questions (eg, restaurant name and beverage inclusion) and agreement between turker consensus responses and the gold standard values in the manually entered dataset were calculated. Results: Among the 196 receipts completed by turkers, the interturker agreement was 100% (196/196) for restaurant names (eg, Burger King, McDonald's, and Subway), 98.5% (193/196) for beverage inclusion (ie, hot, cold, or none), 92.3% (181/196) for types of hot beverage (eg, hot coffee or hot tea), and 87.2% (171/196) for types of cold beverage (eg, Coke or bottled water). When compared with the gold standard data, the agreement level was 100% (196/196) for restaurant name, 99.5% (195/196) for beverage inclusion, and 99.5% (195/196) for beverage types. Conclusions: Our findings indicated high interrater agreement for questions across difficulty levels (eg, single- vs binary- vs multiple-choice items). Compared with traditional methods for coding receipt data, MTurk can produce excellent-quality data in a lower-cost, more time-efficient manner.
Ecological momentary assessment of various tobacco product use among young adultsBerg, C. J., Haardörfer, R., Payne, J. B., Getachew, B., Vu, M., Guttentag, A., & Kirchner, T. R. (n.d.).
Journal titleAddictive Behaviors
Page(s)38-46AbstractIntroduction: Young adults are at high risk for using traditional and novel tobacco products. However, little is known about daily/weekly use patterns or psychosocial triggers for using various tobacco products. Methods: This ecological momentary assessment (EMA) study examined timing, tobacco cravings, affect, social context, and other substance use (alcohol, marijuana) in relation to use of cigarettes, electronic nicotine delivery systems (ENDS), and any tobacco product (i.e., cigarettes, ENDS, cigars, hookah), respectively. We also examined interactions between these predictors, sex, and race/ethnicity. From a longitudinal study of 3418 18–25 year-olds from seven Georgia colleges/universities, we recruited 72 reporting current tobacco use to participate in the 21-day EMA study; 43 participated, of which 31 completed ≥66% assessments and were analyzed. Cravings, affect, social context, and substance use were assessed daily across four four-hour windows. Results: Of the 31 participants, average age was 21.10 years (SD = 1.95), 45.2% were female, and 71.0% non-Hispanic White; 71.0% used cigarettes, 58.1% ENDS, 38.7% cigars, and 25.8% hookah (25.6% used one product, 46.5% two, 27.9% ≥ three). Predictors of cigarette use included higher anxiety, greater odds of marijuana and alcohol use, and higher boredom levels among women. Predictors of ENDS use included being non-White and greater odds of marijuana use, as well as higher tobacco cravings among women and higher boredom among men. Predictors of any tobacco product use included being non-White, higher boredom levels, and greater odds of marijuana and alcohol use. Conclusions: Distinct interventions may be needed to address use of differing tobacco products among young adults.
Flavored cigar smoking among African American young adult dual users: An ecological momentary assessmentChen-Sankey, J. C., Choi, K., Kirchner, T. R., Feldman, R. H., Butler, J., & Mead, E. L. (n.d.).
Journal titleDrug and alcohol dependence
Page(s)79-85AbstractBackground: Flavored cigar sales have increased in recent years in the U.S. African American young adults (AAYAs) have high prevalence of smoking flavored cigars and dual use with cigarettes, but the predictors of use are unclear. We examined the predictors of flavored cigar smoking among AAYA dual users. Methods: We analyzed data from an Ecological Momentary Assessment (EMA) study that captured near real-time affect, smoking cues, and tobacco smoking from eight text-messaging surveys per day over two weeks. Sixty-three AAYA (ages 18–29) dual users of cigarettes and cigars recorded 1205 cigar smoking moments. Multivariable Generalized Estimating Equations were used to assess the predictors of smoking cigars with flavors and specific flavor types. Results: Half of the participants were women (49.2%) and aged between 18–24 (46.7%). Over the two-weeks, almost all (98.4%) participants smoked flavored cigars, and 64.2% of the cigars smoked were flavored. Alcohol (34.4%) was the most frequently smoked flavor type followed by sweet (23.4%) and mint (5.7%). Feeling stressed (AOR = 1.07) and bored (AOR = 1.10) predicted smoking alcohol flavors. Blunt smoking positively predicted smoking sweet flavors (AOR = 4.79), but negatively predicted smoking alcohol flavors (AOR = 0.40). Conclusions: Smoking flavored cigars, especially alcohol-flavored cigars, was prevalent among AAYA dual users in this study. This group might use specific flavors for different purposes including smoking blunts and boosting mood. Efforts to reduce cigar use need to tackle these risk factors and the increased marketing and low-cost pricing of cigars. A federal ban of cigar flavors might reduce the appeal of cigar products.
Individual Mobility and Uncertain Geographic Context: Real-time Versus Neighborhood Approximated Exposure to Retail Tobacco Outlets Across the USKirchner, T. R., Gao, H., Lewis, D. J., Anesetti-Rothermel, A., Carlos, H. A., & House, B. (n.d.).
Journal titleJournal of Healthcare Informatics Research
Page(s)70-85AbstractThere is growing interest in the way exposure to neighborhood risk and protective factors affects the health of residents. Although multiple approaches have been reported, empirical methods for contrasting the spatial uncertainty of exposure estimates are not well established. The objective of this paper was to contrast real-time versus neighborhood approximated exposure to the landscape of tobacco outlets across the contiguous US. A nationwide density surface of tobacco retail outlet locations was generated using kernel density estimation (KDE). This surface was linked to participants’ (Np = 363) inferred residential location, as well as to their real-time geographic locations, recorded every 10 min over 180 days. Real-time exposure was estimated as the hourly product of radius of gyration and average tobacco outlet density (Nhour = 304, 164 h). Ordinal logit modeling was used to assess the distribution of real-time exposure estimates as a function of each participant’s residential exposure. Overall, 61.3% of real-time, hourly exposures were of relatively low intensity, and after controlling for temporal and seasonal variation, 72.8% of the variance among these low-level exposures was accounted for by residence in one of the two lowest residential exposure quintiles. Most moderate to high intensity exposures (38.7% of all real-time, hourly exposures) were no more likely to have been contributed by subjects from any single residential exposure cluster than another. Altogether, 55.2% of the variance in real-time exposures was not explained by participants’ residential exposure cluster. Calculating hourly exposure estimates made it possible to directly contrast real-time observations with static residential exposure estimates. Results document the substantial degree that real-time exposures can be misclassified by residential approximations, especially in residential areas characterized by moderate to high retail density levels.
Youth Access to Tobacco Products in the United States: Findings from Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health StudyTanski, S., Emond, J., Stanton, C., Kirchner, T., Choi, K., Yang, L., Ryant, C., Robinson, J., & Hyland, A. (n.d.).
Journal titleNicotine and Tobacco Research
Page(s)1695-1699AbstractObjectives: Tobacco products in the US market are growing in diversity. Little is known about how youth access tobacco products given this current landscape. Methods: Data were drawn from 15- to 17-year-olds from the Wave 1 youth sample of the US nationally representative Population Assessment of Tobacco and Health (PATH) Study. Past 30-day tobacco users were asked about usual sources of access to 12 different tobacco products, and if they had been refused sale because of their age. Results: Among 15- to 17-year-olds, social sources ("someone offered" or "asked someone") were the predominant usual source of access for each tobacco product. "Bought by self" was the usual source of access for users of smokeless (excluding snus, 23.2%), cigarillos (21.0%), cigarettes (13.8%), hookah (12.0%), and electronic cigarettes (10.5%). Convenience stores and/or gas stations were the most often selected retail source for all products except hookah. Among youth who attempted purchase, 24.3% were refused sale of cigarettes, 23.9% cigarillos, and 13.8% smokeless tobacco. Conclusions: Most 15- to 17-year-old tobacco users obtain tobacco products through social sources; however, among those who purchased tobacco, the majority report not being refused sale because of age. At the time of survey, cigarette and cigar sales to under 18 years were prohibited in all 50 states, and electronic cigarettes sales in 47 states and two territories. 2014 Annual Synar Reports signaled increasing trends in retail violations of state and/or district laws prohibiting tobacco product sales to under 18 years. Monitoring illicit youth sales, conducting compliance check inspections, and penalizing violations remain important to reduce youth tobacco access at retail venues. Implications: Access to the spectrum of tobacco products by youth in the United States remains predominantly through social sources. However, of the minority of youth tobacco users in 2014 who purchased tobacco themselves, a few reported being refused sale: Convenience stores and/or gas stations were the most common retail source for tobacco products. The strategies of monitoring illicit youth sales, conducting compliance checks, and penalizing violations remain important to reduce youth tobacco access at retail venues. Limiting sources of youth tobacco access remains an important focus to reduce the burden of tobacco on the public health.
An ecological momentary assessment of cigarette and cigar dual use among African American Young AdultsMead, E. L., Chen, J. C., Kirchner, T. R., Butler, J., & Feldman, R. H. (n.d.).
Journal titleNicotine and Tobacco Research
Page(s)S12-S21AbstractIntroduction The dual use of cigarettes and cigars among African American young adults is a significant public health issue. Patterns of and reasons for dual use are difficult to capture using traditional self-report methods. This study used ecological momentary assessment (EMA) to characterize patterns of dual smoking and examine the personal and environmental predictors of cigarette and cigar smoking among African American young adult dual users (ages 18-29) in real-time. Methods For 14 days, 64 participants smoked ad libitum and were prompted four times daily to record their smoking, craving, emotions, social smoking, and environment via text message on their mobile phones. The odds of single product and dual use were examined using adjusted generalized estimating equations. Results Participants smoked an average of 7.9 cigarettes and 4.2 cigars per day. Cigarettes and cigars were smoked as frequently during periods of dual use as they were during periods of single product use. Cigarette craving was positively associated with cigarette-only smoking (OR: 1.07), whereas cigar craving was positively associated with cigar-only smoking (OR: 1.43) and dual use (OR: 1.08). Cigars had the greatest odds of dual use when with others (OR: 4.69) and in others' homes (OR: 4.33). Cigarettes had the greatest odds of being smoked while alone (OR: 1.57). Conclusions EMA was useful for capturing variable smoking patterns and predictors. In this study population, cigarettes and cigars appeared to be smoked additively, and cigars smoked socially. These findings can inform future interventions addressing dual use in this high priority population. Implications This is the first study to use EMA to examine naturalistic patterns and predictors of multiple tobacco use in real-time. African American young adults smoked cigarettes and cigars during periods of dual use as frequently as during periods of single product use. This suggests that most use was additive (one product smoked in addition to another) and less often as substitution (one product smoked instead of another). Social smoking and craving were strongly associated with cigar smoking in single and dual use periods. This study suggests the need for cessation messaging specifically targeted to reduce dual use in this population.
Beyond blunts: reasons for cigarette and cigar use among African American young adult dual usersMead, E. L., Lindstrom Johnson, S., Siddiqui, J., Butler, J., Kirchner, T., & Feldman, R. H. (n.d.).
Journal titleAddiction Research and Theory
Page(s)349-360AbstractBackground: African American young adults are at high risk for dual use of cigarettes and cigars. Limited work has explored and characterized the reasons for use in this population and their relative importance for initiation and current smoking of these products. Method: Reasons for cigarette and cigar use were systematically explored and categorized using a mixed methods participatory approach called concept mapping. A series of in-person group sessions were held with 30 African American young adult (ages 18–29) current smokers of both cigarettes and cigars in Prince George’s County, MD and Washington, DC. Participants brainstormed, sorted, rated, and interpreted their reasons for initiation and past 30-day use of cigarettes and cigars. A cluster map was generated using multi-dimensional scaling, and t-tests were used to explore differences in ratings by background characteristics. Results: Participants generated 64 reasons for smoking cigarettes and cigars, and categorized these reasons into six groups: emotions, urges, access, product characteristics, lifestyle, and outside pressure. Emotions and urges were the most important motivations for initiation and current smoking of both products. Product characteristics were significantly more important for cigar initiation and smoking than for cigarettes, and outside pressure was more important for current smoking of cigars than cigarettes. Ratings differed by gender, socioeconomic status, and smoking characteristics. Conclusions: Cigarette and cigar smoking have several overlapping motivations, but key differences were also found, most notably for product characteristics. The FDA’s regulation of cigars and cigarettes should focus on addressing key characteristics appealing to young adults to curb dual use.
Initiation, continuation of use and cessation of alternative tobacco products among young adults: A qualitative studyVu, M., Getachew, B., Payne, J. B., Kirchner, T. R., & Berg, C. J. (n.d.).
Journal titleTobacco Prevention and Cessation
Volume4AbstractINTRODUCTION Diverse non-cigarette alternative tobacco products are increasingly popular in the United States. This study investigates the reasons why young adults initiate and continue the use of these products, as well as potential motivations and approaches for quitting. Products assessed include cigarettes, little cigars/cigarillos (LCCs), smokeless tobacco, e-cigarettes, and hookahs. METHODS We conducted 60 telephone interviews, of 30-minute duration, with tobacco users enrolled in colleges in Georgia. Qualitative analysis was used to identify themes emerging from the data. RESULTS Reasons for initiation, continued use, and (potential) cessation showed similarities and differences across products. Most commonly cited reasons for initiation included: peer influence (all products), flavors/tastes (all products except cigarettes), and easy environmental access and/or low costs (LCCs, smokeless tobacco, and e-cigarettes). Participants discussed several influences on continued use, such as peer influence (cigarettes, LCCs, and hookahs), stress management (all products except hookahs), and use with other substances (cigarettes, LCCs, and hookahs). Primary motivations for cessation mentioned by participants were family responsibilities (cigarettes, e-cigarettes, and hookahs) and health concerns (all products except e-cigarettes). Frequently used cessation strategies included avoidance of other tobacco users (cigarettes, LCCs, and hookahs) and a reduction of nicotine intake (cigarettes and e-cigarettes). CONCLUSIONS Our findings suggest that researchers should consider the differences in reasons for use and discontinued use of tobacco products in order to develop targeted messaging strategies, particularly noting the differential impact of interpersonal influences and health concerns.
Acceptability of ecological momentary assessment among young men who have sex with menDuncan, D. T., Kapadia, F., Kirchner, T. R., Goedel, W. C., Brady, W. J., & Halkitis, P. N. (n.d.).
Journal titleJournal of LGBT Youth
Page(s)436-444AbstractThe study evaluated the acceptability of text message– and voice-based ecological momentary assessment (EMA) methods among a sample (N = 74) of young men who have sex with men (MSM). We assessed the acceptability of text message– and voice-based EMA methods. Almost all participants (96%) reported that they would be willing to accept texts on their smartphone to answer questions about their current mood, surroundings, or feelings. A large majority (89%) also reported being willing to accept phone calls to answer these questions. This work suggests that different EMA methods are acceptable for use among young MSM.
Association of TAS2R38 haplotypes and menthol cigarette preference in an African American cohortRisso, D., Sainz, E., Gutierrez, J., Kirchner, T., Niaura, R., & Drayna, D. (n.d.). In Nicotine and Tobacco Research.
Indicators of dependence for different types of tobacco product users: Descriptive findings from Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health (PATH) studyStrong, D. R., Pearson, J., Ehlke, S., Kirchner, T., Abrams, D., Taylor, K., Compton, W. M., Conway, K. P., Lambert, E., Green, V. R., Hull, L. C., Evans, S. E., Cummings, K. M., Goniewicz, M., Hyland, A., & Niaura, R. (n.d.).
Journal titleDrug and alcohol dependence
Page(s)257-266AbstractBackground and aims With no established standard for assessing tobacco dependence (TD) across tobacco products in surveys, the Population Assessment of Tobacco and Health (PATH) Study provides a unique platform for examining the psychometric properties and validity of multiple indicators of tobacco dependence across a range of tobacco products. Participants A U.S. nationally representative sample from the 32,320 adult Wave 1 interviews with analyses focused on 14,287 respondents who were current established users of tobacco products. Findings This analysis confirms a single primary latent construct underlying responses to TD indicators for cigarettes, e-cigarettes, cigars, hookah, and smokeless tobacco products. Mutually exclusive past year tobacco-user groups included: cigarette only (n = 8689), e-cigarette only (n = 437), cigar only (traditional, cigarillo, or filtered) (n = 706), hookah only (n = 461), smokeless tobacco only (n = 971), cigarette plus e-cigarette (n = 709), and multiple tobacco product users (n = 2314). Differential Item Functioning (DIF) analyses supported use of 16 of the 24 examined TD indicators for comparisons across tobacco users. With cigarette users as a reference (mean = 0.0, SD = 1.0), we observed a range of TD with hookah (mean = −1.71) and cigar (mean = −1.92) only users being the lowest, and cigarette plus e-cigarette product users being the highest (mean = 0.35). Regression models including sociodemographic factors supported concurrent validity with increased product use frequency and TD among cigarette-only (p < 0.001), e-cigarette only (p < 0.002), cigar (p < 0.001), hookah only (p < 0.001), and smokeless tobacco users (p < 0.001). Conclusion The PATH Study Adult Wave 1 Questionnaire provided psychometrically valid measures of TD that enables future regulatory investigations of nicotine dependence across tobacco products.
Tobacco outlet density and converted versus native non-daily cigarette use in a national US sampleKirchner, T. R., Anesetti-Rothermel, A., Bennett, M., Gao, H., Carlos, H., Scheuermann, T. S., Reitzel, L. R., & Ahluwalia, J. S. (n.d.).
Journal titleTobacco control
Page(s)85-91AbstractObjective Investigate whether non-daily smokers’ (NDS) cigarette price and purchase preferences, recent cessation attempts, and current intentions to quit are associated with the density of the retail cigarette product landscape surrounding their residential address. Participants Cross-sectional assessment of N=904 converted NDS (CNDS). who previously smoked every day, and N=297 native NDS (NNDS) who only smoked non-daily, drawn from a national panel. Outcome measures Kernel density estimation was used to generate a nationwide probability surface of tobacco outlets linked to participants’ residential ZIP code. Hierarchically nested log-linear models were compared to evaluate associations between outlet density, non-daily use patterns, price sensitivity and quit intentions. Results Overall, NDS in ZIP codes with greater outlet density were less likely than NDS in ZIP codes with lower outlet density to hold 6-month quit intentions when they also reported that price affected use patterns (G2=66.1, p<0.001) and purchase locations (G2=85.2, p<0.001). CNDS were more likely than NNDS to reside in ZIP codes with higher outlet density (G2=322.0, p<0.001). Compared with CNDS in ZIP codes with lower outlet density, CNDS in high-density ZIP codes were more likely to report that price influenced the amount they smoke (G2=43.9, p<0.001), and were more likely to look for better prices (G2=59.3, p<0.001). NDS residing in high-density ZIP codes were not more likely to report that price affected their cigarette brand choice compared with those in ZIP codes with lower density. Conclusions This paper provides initial evidence that the point-of-sale cigarette environment may be differentially associated with the maintenance of CNDS versus NNDS patterns. Future research should investigate how tobacco control efforts can be optimised to both promote cessation and curb the rising tide of non-daily smoking in the USA.
A randomized trial comparing the effect of nicotine versus placebo electronic cigarettes on smoking reduction among young adult smokersTseng, T. Y., Ostroff, J. S., Campo, A., Gerard, M., Kirchner, T., Rotrosen, J., & Shelley, D. (n.d.).
Journal titleNicotine and Tobacco Research
Page(s)1937-1943AbstractIntroduction: Electronic cigarette (EC) use is growing dramatically with use highest among young adults and current smokers. One of the most common reasons for using ECs is interest in quitting or reducing cigarettes per day (CPD); however there are few randomized controlled trials (RCT) on the effect of ECs on smoking abstinence and reduction. Methods: We conducted a two-arm; double-blind RCT. Subjects were randomized to receive 3-weeks of either disposable 4.5% nicotine EC (intervention) or placebo EC. The primary outcome was self-reported reduction of at least 50% in the number of CPDs smoked at week 3 (end of treatment) compared to baseline. Study subjects (n = 99) were young adult (21-35), current smokers (smoked ≥ 10 CPDs) living in NYC. Results: Compared with baseline, a significant reduction in CPDs was observed at both study time periods (1 and 3 weeks) for intervention (P < .001) and placebo (P < .001) groups. Between-group analyses showed significantly fewer CPDs in the intervention group compared to the placebo group at week 3 (P = .03), but not at any other follow-up periods. The logistic regression analysis showed that using a greater number of ECs, treatment condition and higher baseline readiness to quit were significantly associated with achieving at least 50% reduction in CPDs at the end of treatment. Conclusion: A diverse young adult sample of current everyday smokers, who were not ready to quit, was able to reduce smoking with the help of ECs. Further study is needed to establish the role of both placebo and nicotine containing ECs in increasing both reduction and subsequent cessation. Implications: Despite the critical need for well-designed clinical trials on the effect of ECs on cessation and cigarette reduction, the majority of studies have been observational or noncomparative intervention designs. Only three RCTs studying ECs as a cessation or reduction intervention have been published, and none were conducted in the United States. The current study adds knowledge to current literature on the feasibility of using ECs to aid smoking reduction among young smokers in US urban populations.
American spirit pack descriptors and perceptions of harm: A crowdsourced comparison of modified packsPearson, J. L., Richardson, A., Feirman, S. P., Villanti, A. C., Cantrell, J., Cohn, A., Tacelosky, M., & Kirchner, T. R. (n.d.).
Journal titleNicotine and Tobacco Research
Page(s)1749-1756AbstractIntroduction: In 2015, the Food and Drug Administration issued warnings to three tobacco manufacturers who label their cigarettes as "additive-free" and/or "natural" on the grounds that they make unauthorized reduced risk claims. The goal of this study was to examine US adults' perceptions of three American Spirit (AS) pack descriptors ("Made with Organic Tobacco," "100% Additive-Free," and "100% US Grown Tobacco") to assess if they communicate reduced risk. Methods: In September 2012, three cross-sectional surveys were posted on Amazon Mechanical Turk. Adult participants evaluated the relative harm of a Marlboro Red pack versus three different AS packs with the descriptors "Made with Organic Tobacco," "100% Additive-Free," or "100% US Grown Tobacco" (Survey 1; n = 461); a Marlboro Red pack versus these AS packs modified to exclude descriptors (Survey 2; n = 857); and unmodified versus modified AS pack images (Survey 3; n = 1001). Results: The majority of Survey 1 participants rated the unmodified AS packs as less harmful than the Marlboro Red pack; 35.4%-58.8% of Survey 2 participants also rated the modified (no claims) packs as less harmful than Marlboro Red. In these surveys, prior use of AS cigarettes was associated with reduced perceptions of risk (adjusted odds ratio [AOR] 1.59-2.40). "Made with Organic Tobacco" and "100% Additive-Free" were associated with reduced perceptions of risk when comparing the modified versus the unmodified AS packs (Survey 3). Conclusions: Data suggest that these AS pack descriptors communicate reduced harm messages to consumers. Findings have implications for regulatory actions related to product labeling and packaging. Implications: These findings provide additional evidence that the "Made with Organic Tobacco," "100% Additive-Free," and "100% US Grown" descriptors, as well as other aspects of the AS pack design, communicate reduced harm to non-, current, and former smokers. Additionally, they provide support for the importance of FDA's 2015 warning to Santa Fe Natural Tobacco Company on "100% Additive Free" as an unauthorized modified risk claim.
Spatio-temporal determinants of mental health and well-being: advances in geographically-explicit ecological momentary assessment (GEMA)Kirchner, T. R., & Shiffman, S. (n.d.).
Journal titleSocial psychiatry and psychiatric epidemiology
Page(s)1211-1223AbstractPurpose: Overview of geographically explicit momentary assessment research, applied to the study of mental health and well-being, which allows for cross-validation, extension, and enrichment of research on place and health. Methods: Building on the historical foundations of both ecological momentary assessment and geographic momentary assessment research, this review explores their emerging synergy into a more generalized and powerful research framework. Results: Geographically explicit momentary assessment methods are rapidly advancing across a number of complimentary literatures that intersect but have not yet converged. Key contributions from these areas reveal tremendous potential for transdisciplinary and translational science. Conclusions: Mobile communication devices are revolutionizing research on mental health and well-being by physically linking momentary experience sampling to objective measures of socio-ecological context in time and place. Methodological standards are not well-established and will be required for transdisciplinary collaboration and scientific inference moving forward.
The Moment Study: Protocol for a mixed method observational cohort study of the Alternative Nicotine Delivery Systems (ANDS) initiation process among adult cigarette smokersPearson, J. L., Smiley, S. L., Rubin, L. F., Anesetti-Rothermel, A., Elmasry, H., Davis, M., De Atley, T., Harvey, E., Kirchner, T., & Abrams, D. B. (n.d.).
Journal titleBMJ open
Issue4AbstractIntroduction: Alternative Nicotine Delivery Systems (ANDS) such as e-cigarettes are battery-powered devices that aerosolize nicotine and other substances to simulate smoking without using tobacco. Little is known about the ANDS initiation process among adult smokers. The aims of this research are threefold to: (1) examine how ANDS use affects cigarette use; (2) examine how the immediate environmental and psychosocial contexts of cigarette and ANDS use vary within - and between - participants in general and by menthol preference and race; and, (3) examine participants' 'lived experience' of the subjective perceptions, meaning, influences and utility of cigarette and ANDS use. Methods and analyses: This study's mixed method, 6-week longitudinal design will produce a detailed description of the ANDS initiation process among adult smokers (N=100). Qualitative and quantitative data collection will include 3 weeks of: (1) ecological momentary assessment of patterns of cigarette/ANDS use, satisfaction, mood and craving; (2) geospatial assessment of participants' environment, including indoor and outdoor cigarette/ANDS norms and rules; (3) in-depth interviews about the meaning and utility o cigarette smoking and ANDS use; and, (4) saliva cotinine and exhaled carbon monoxide (CO) biomarkers. A diverse sample will be recruited with an equal number of menthol and non-menthol cigarette smokers. As the primary independent variable, we will investigate how ANDS use affects cigarette consumption. We will also examine how smoking related and ANDS-related rules and norms surrounding product use influence cigarette and ANDS product use, and how the subjective effects of ANDS use affect ANDS perceptions, beliefs and use. Ethics and dissemination: This study was funded by the National Institute on Drug Abuse of the US National Institutes of Health (1R21DA036472), registered at ClinicalTrials.gov (NCT02261363), and approved by the Chesapeake IRB (Pro00008526). Findings will be disseminated to the scientific and lay community through presentations, reports and scientific publications.
Tobacco retail outlet density and young adult tobacco initiationCantrell, J., Pearson, J. L., Anesetti-Rothermel, A., Xiao, H., Kirchner, T. R., & Vallone, D. (n.d.).
Journal titleNicotine and Tobacco Research
Page(s)130-137AbstractBackground: A growing body of evidence indicates that the density of tobacco retail outlets around the home residence may influence tobacco use among youth and adults. The purpose of this study was to examine the impact of neighborhood tobacco retail outlet density on young adult initiation of different tobacco product types. Methods: Cross-sectional data from a 2013 nationally representative sample of young adults aged 18-34 was examined in relation to a 2012 geocoded listing of all outlets likely to sell tobacco in the United States. Separate multivariable logistic regression analyses examined associations between neighborhood outlet density and past 6 months first use of cigarettes, non-cigarette combustible products, and noncombustible products among adults aged 18-24 and 25-34. Results: Outlet density was significantly associated with recent initiation of cigarettes and other combustibles, but this impact varied for younger and older groups. Increased density was significantly associated with a higher likelihood of initiating cigarette use among adults aged 25-34 (OR = 3.75, 95% CI = 1.18, 11.90), and of initiating non-cigarette combustible use among 18-24 year olds (OR = 3.16, 95% CI = 1.03, 9.74). There was no impact of outlet density on recent noncombustible product initiation among either group. Conclusion: This study is the first to examine the impact of tobacco outlet density on young adult initiation of cigarettes and other tobacco products. Findings demonstrate that residential neighborhood outlet density is associated with recent initiation of combustible products and this effect varies by product type and age. The tobacco outlet environment may be a critical factor in promoting young adult tobacco use initiation.
Cigarette price variation around high schools: Evidence from Washington DCCantrell, J., Ganz, O., Anesetti-Rothermel, A., Harrell, P., Kreslake, J. M., Xiao, H., Pearson, J. L., Vallone, D., & Kirchner, T. R. (n.d.).
Journal titleHealth and Place
Page(s)193-198AbstractThis study examines lowest cigarette prices in all tobacco retail outlets in Washington D.C. (. n=750) in relation to the type and number of high schools nearby, controlling for confounders. The lowest overall and Newport menthol prices were significantly lower at outlets near public non-charter and charter schools compared with outlets near private schools. Given higher smoking prevalence and more price-sensitive youth subgroups in U.S. public schools, exposure to low prices may contribute to tobacco-related health disparities in minority and low-income populations. Tobacco taxes combined with policies to minimize the increasing use of price as a marketing tool are critical.