Real-time Exposure to Point-of-Sale Tobacco and Longitudinal Patterns of Use

描述（由申请人提供）：有相当多的经验证据表明，销售点烟草（POST）营销影响烟草使用者的产品偏好以及开始或不使用烟草的决定。然而，人们对销售点营销与行为之间联系的机制知之甚少，因为将个人使用结果与现实世界的销售点暴露直接联系起来的方法现在才刚刚开始发展。迫切需要数据来填补这一研究空白，因为无法通过经验证明POST暴露与行为之间的直接联系是拟议的销售点法规经常无法承受行业法律挑战的主要原因之一。拟议的项目将为直接解决这一关键知识缺口提供数据。它扩展了一种创新方法的使用，该方法首次提供了关于个人在日常活动中接触到销售点营销的程度的客观、实时数据，以及随着时间的推移，接触到营销的方式对使用模式的影响。量化实时销售点烟草暴露（POSTE）需要一个多层次的系统，既有社区层面的综合销售点数据，也有个人层面的基于地点的暴露数据。因为不可能预测每个人每时每刻都会去哪里，所以描述他们的销售点体验必须从每个人直接环境中的营销综合数据开始。POSTE系统包括两个关键组成部分：1)由实地工作者收集的社区层面的数据和2)个人层面的地理定位数据。与其他方法不同，POSTE测量不需要参与者主动输入，因此不是主观的。与通过现场工作人员收集的社区级销售点数据完全分离，POSTE参与者同意持续的位置跟踪。数据无线同步到一个安全的服务器，其中先进的地理信息系统（GIS）基础设施将每个人实时连接到他们的销售点环境。因此，详细的POSTE数据准确量化，参与者负担非常低。拟议的项目将我们现有的销售点监测系统与当前哥伦比亚特区居民烟草使用者的连续（1分钟采样率）地理空间暴露数据结合起来。华盛顿特区市区为这一目的提供了一个理想的社区级实验室，因为1)华盛顿特区的特点是在一个小的地理区域内存在巨大的人口变化，这使得在华盛顿特区的每个烟草销售点快速、重复地评估POST营销的社会经济相关性成为可能；2)华盛顿特区是烟草业营销的“重点”城市；3)我们有一个现有的华盛顿特区居民吸烟者群体，可以很容易地参与和补充。参与者（N=1200）将是目前无意戒烟的吸烟者。所有参与者将有机会获得补偿，并通过在基线时携带地理位置跟踪设备两周，然后作为每个季度评估的一部分，进一步了解他们对烟草营销的暴露情况。这将在每个人和他们周围的POST营销环境之间建立一个物理联系。季度随访评估将评估整个研究期间主观感知的POSTE水平和烟草使用模式。拟议的项目代表了一种强有力的新方法，可以理解并因此与POST营销策略影响烟草使用模式的方式作斗争。该项目将提供数据和工具，用于实时分析POST营销法规和烟草使用情况，通过将政策和执法标准与旨在影响的行为结果直接联系起来，不断改进政策和执法标准。

DESCRIPTION (provided by applicant): There is a considerable body of empirical evidence suggesting that point-of-sale tobacco (POST) marketing influences tobacco users' product preferences as well as decisions to initiate or refrain from use. Yet little is known about the mechanisms that underlie the association between point-of-sale marketing and behavior, because methods that directly link individual use outcomes to real-world point-of-sale exposure are only now beginning to be developed. There is an urgent need for data to fill this research gap, as the inability to empirically document a direct link between POST exposure and behavior is among the primary reasons proposed point-of-sale regulations have often failed to withstand industry legal challenge. The proposed project will provide data to directly address this critical knowledge gap. It extends the use of an innovative methodology that has been the first to provide objective, real-time data on the degree to which individuals are exposed to point-of-sale marketing as they move through their daily activities, as well as the way accumulating exposure to marketing affects use patterns over time. Quantifying real-time point-of-sale tobacco exposure (POSTE) requires a multilevel system with both comprehensive point-of-sale data at the community level and location-based exposure data at the individual level. Because it is impossible to predict where each individual will travel from moment-to-moment, characterizing their point-of-sale experience must begin with comprehensive data on marketing in each person's immediate environment. The POSTE system includes two key components: 1) community-level data collection by fieldworkers, and 2) individual-level geo- location data. Unlike other approaches, POSTE measurement does not require active input from participants and thus is not subjective. Entirely separate from community-level point-of-sale data collected via fieldworkers, POSTE participants consent to continuous location tracking. Data are wirelessly synced to a secure server, where advanced geographic information system (GIS) infrastructure links each person to their point-of-sale environment in real-time. Thus, detailed POSTE data is accurately quantified with very low participant burden. The proposed project couples our existing point-of-sale surveillance system with continuous (1-min sampling rate) geo-spatial exposure data from current DC resident tobacco users. The Washington DC metropolitan area provides an ideal community-level laboratory for this purpose, because 1) DC is characterized by tremendous demographic variation over a small geographic area, making it possible to evaluate socio-economic correlates of POST marketing at every tobacco outlet in DC quickly and repeatedly, 2) DC is a "focus" city for tobacco industry marketing, and 3) we have an existing DC resident smoker cohort that can readily be engaged and replenished. Participants (N=1200) will be current cigarette smokers not currently interested in quitting. All participants will be offered the opportunity to be compensated and to learn more about their exposure to tobacco marketing by carrying a geolocation tracking device for two-weeks at baseline and then again as part of each quarterly assessment. This will create a physical link between each person and their surrounding POST marketing environment. Quarterly follow-up assessments will assess subjectively perceived levels of POSTE and tobacco-use patterns across the study period. The proposed project represents a powerful new approach to understand and thereby combat the way POST marketing tactics affect tobacco use patterns. The project will provide data and tools for real-time analysis of POST marketing regulations and tobacco use, iteratively improving both policy and enforcement standards by linking them directly to the behavioral outcomes they are designed to affect.