Cancer prevention through neural and geospatial examination of tobacco marketing effects in smokers

项目摘要/摘要 在美国和整个发达国家，吸烟是可预防的死亡和疾病的主要原因。目前，烟草行业80%以上的营销预算集中在零售环境中。最近的研究表明，接触销售点烟草营销(Postm)、香烟渴望的增加和未能戒烟之间存在有害的联系。因此，了解个人在做出健康决定时如何受到自然环境的影响并对其做出反应对于癌症控制工作至关重要。我们建议使用一套创新的方法来测试重复的、真实的POSTM暴露是否会影响吸烟行为，以及这是否通过增强渴望和对POSTM的神经反应来调节。我们新颖的多方法通信研究方法包括基于手机的地理位置跟踪、生态瞬时评估(EMA)和功能磁共振成像(FMRI)。通过将观察场方法的生态有效性添加到神经成像的机械性洞察力中，以及来自实验设计的因果推断，我们的目标是显著推进对癌症控制中后遗症影响的可操作洞察力。利用地理空间位置跟踪和调查方法的研究表明，高水平的后期暴露可能会增加渴望；然而，相关研究排除了关于后期影响的机械性解释和因果推断。与之相关的是，实验室研究已经记录了神经和行为对标准化视觉吸烟线索的反应，例如香烟的照片，但大脑对自然主义后暴露的反应还没有被探索过。我们假设，暴露在POST中会增加大脑对吸烟暗示的反应以及主观渴望，从而导致吸烟行为的增加。为了测试这一点，我们将通过地理空间位置跟踪和EMA跟踪180名日常吸烟者，以评估真实世界后暴露的纵向波动是否与时刻渴望吸烟和吸烟行为有关(目标1)，以及这些过程是否与神经吸烟线索反应的差异有关(目标2)。最后，我们将进行一项实验，操纵自然主义的后遗症暴露，以测试这些影响是否是因果的(目标3)。在实验阶段，两组参与者将进入并在有或没有PostM显示屏的零售店购买少量商品(例如水)，为期4周，每周5次，而第三组参与者不会改变他们的习惯。我们将在实验操作前后测量所有组的神经反应和对后暴露的主观渴求。通过广泛的试点工作，已经确定了方案的可行性和剂量。吸烟行为、渴望和/或神经线索反应性的增加对事后暴露的反应将强烈暗示事后暴露的因果证据，这对于基于科学的政策制定非常必要，并可能为癌症控制工作提供信息。事后暴露的因果证据，对于基于科学的政策制定非常需要，并可能为癌症控制工作提供信息。

Project Summary / Abstract Cigarette smoking is the leading cause of preventable death and illness in the United States and throughout the developed world. Currently, the tobacco industry focuses over 80% of its marketing budget in the retail environment. Recent work suggests detrimental links between exposure to point-of-sale tobacco marketing (POSTM), increases in cigarette cravings, and the failure to quit smoking. Understanding how individuals are influenced by and react to their natural environments when making health decisions is thus critical to cancer control efforts. We propose to use an innovative set of methods to test whether repeated, real-world exposure to POSTM affects smoking behavior, and whether this is mediated by heightened craving and neural responses to POSTM. Our novel multi-method approach to communication research includes mobile-phone based geolocation tracking, ecological momentary assessment (EMA), and functional magnetic resonance imaging (fMRI). By adding the ecological validity of observational field methods to the mechanistic insight of neuroimaging, and causal inferences from an experimental design, we aim to significantly advance actionable insight about POSTM effects in cancer control. Research utilizing geospatial location tracking and survey methods suggests that high levels of POSTM exposure may increase craving; however, correlational studies preclude mechanistic explanations and causal inferences about POSTM effects. Relatedly, laboratory studies have documented neural and behavioral reactivity to standardized visual smoking cues, such as photographs of cigarettes, but the brain’s response to naturalistic POSTM exposure has not been explored. We hypothesize that exposure to POSTM increases brain responses to smoking cues as well as subjective craving, leading to increased smoking behavior. To test this, we will follow 180 daily smokers with geospatial location tracking and EMA to assess whether longitudinal fluctuations in real-world POSTM exposure are associated with moment-to-moment cigarette craving and smoking behavior (Aim 1), and whether these processes are related to differences in neural smoking cue reactivity (Aim 2). Finally, we will conduct an experiment that manipulates naturalistic exposure to POSTM to test whether these effects are causal (Aim 3). In the experimental phase, two groups of participants will enter and make a small purchase (e.g., water) at a retail outlet with or without POSTM displays 5 times per week for 4 weeks, while a third control group will not change their habits. We will measure neural responses and subjective cravings to POSTM exposure in all groups before and after the experimental manipulation. Protocol feasibility and dosage has been established through extensive pilot work. Increases in smoking behavior, craving, and/or neural cue reactivity in response to increased POSTM exposure would strongly implicate causal evidence for POSTM exposure, which is much needed for science-based policy making and could inform cancer control efforts.causal evidence for POSTM exposure, which is much needed for science-based policy making and could inform cancer control efforts.