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

项目总结/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，烟草行业将其80%以上的营销预算集中在零售环境中。最近的研究表明，暴露于销售点烟草营销（POSTM），增加对香烟的渴望和未能戒烟之间存在有害联系。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、真实世界的POSTM暴露是否会影响吸烟行为，以及这是否是由对POSTM的强烈渴望和神经反应介导的。我们新颖的多方法通信研究方法包括基于移动电话的地理定位跟踪，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见解和实验设计的因果推断中，我们的目标是显着推进关于POSTM在癌症控制中的作用的可操作见解。利用地理空间位置跟踪和调查方法的研究表明，高水平的POSTM暴露可能会增加渴望;然而，相关性研究排除了关于POSTM效应的机械解释和因果推断。与此相关的是，实验室研究已经记录了对标准化视觉吸烟线索（如香烟照片）的神经和行为反应，但大脑对自然POSTM暴露的反应尚未被探索。我们假设暴露于POSTM增加大脑对吸烟线索的反应以及主观渴望，导致吸烟行为增加。为了验证这一点，我们将跟踪180名每日吸烟者的地理空间位置跟踪和EMA，以评估现实世界POSTM暴露的纵向波动是否与即时的香烟渴望和吸烟行为相关（目标1），以及这些过程是否与神经吸烟线索反应性的差异相关（目标2）。最后，我们将进行一个实验，操纵自然暴露于POSTM，以测试这些影响是否是因果关系（目标3）。在实验阶段，两组参与者将进入并进行少量购买（例如，水）在有或没有POSTM显示器的零售店每周5次，持续4周，而第三个对照组将不改变他们的习惯。我们将在实验操作前后测量所有组对POSTM暴露的神经反应和主观渴望。通过广泛的试点工作，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POSTM暴露的反应将强烈暗示POSTM暴露的因果证据，这是基于科学的政策制定所急需的，可以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.