Smoking cessation remains the single most effective public health tool to improve the nation’s health and reduce the huge burden of preventable disease on our economy. While tobacco use among white and Latino Washington, DC residents declined between 1996 and 2007, the percentage of African American residents who use tobacco increased from 21.5 percent to 23.9 percent (CDC, 2008).  In DC, as is the case nationally, smoking rates are higher in neighborhoods with lower per capita incomes and higher rates of poverty (CDC, 2008).  Tobacco cessation telephone counseling lines (“quitlines”) have the potential to reach large numbers of underserved smokers with effective treatments, yet utilization remains low, and we know very little about how best to engage and retain contact with quitters.  This project represents a collaborative effort that utilizes web-enabled mobile devices to enhance the effectiveness of an established quitline program benefiting underserved communities in Washington, DC.  This translational work is unconventional and innovative in the way it leverages web-based real-world, real-time contact (“ecological momentary assessment” methodology) to literally close the loop between research and practice. Via a partnership between the DC Department of Health Tobacco Quitline and the Schroeder Institute for Tobacco Research and Policy Studies at the American Legacy Foundation, this project is uniquely positioned to deliver and evaluate smoking cessation support services to underserved communities characterized by the highest rates of smoking prevalence, providing both an immediate and potentially lasting benefit to these communities.

Principal Investigator:  Thomas R. Kirchner, PhD

SI/Legacy Collaborators: David Abrams, PhD, Amanda Graham, PhD, Nathan Cobb, MD

Collaborators at other institutions: Saul Shiffman, PhD (University of Pittsburgh)

Funding agency: National Institute on Drug Abuse (1RC1 DA028710)

Project Period:  9/2009 – 9/2012

The Schroeder Institute has partnered with the DC Department of Health to implement a powerful new community-based surveillance tool to understand and thereby combat point-of-sale tobacco marketing tactics. This DC “POST” (Point-of-Sale Tobacco) Project examines point-of-sale tobacco marketing practices at more than 1200 licensed tobacco retailers in DC, with an emphasis on both regulatory compliance and compensatory POST marketing tactics that remain unregulated. The DC POST project utilizes a comprehensive surveillance system that features Internet-based mobile data collection devices that capture voice (i.e., interactive voice response), survey, photo and global positioning system (GPS) coordinates in real-time.  An advanced geographic information system (GIS) enables systematic deployment of survey administrators to sets of retail outlets across Washington DC in cluster-randomized order, as well as GIS analyses incorporating an array of other community-level data, and server-based GIS web applications like a community dashboard.  Tobacco marketing assessments are conducted via cell-phone survey (usually IVR, requiring only yes/no or other nondiscript responses), including photographic documentation of store-front advertising and conditions of the surrounding community.  The potential impact of this work are hard to overstate, as the absence of information on marketing tactics being used by the tobacco industry to directly compensate for new point-of-sale restrictions leaves us in a classic "one-step forward, one-step back" circumstance.  Alternatively, point-of-sale surveillance systems make it possible to break this cycle by rapidly collecting and disseminating information on POST marketing practices and thereby empower communities and policy makers to take back control of the POST environment.   

Principal Investigator:  Thomas R. Kirchner, PhD

SI/Legacy Collaborators: Donna Vallone, PhD, Jennifer Cantrell, PhD, Jennifer Pearson, MPH

Collaborators at other institutions: Denise Grant (DC Department of Health)

Funding Agency: Centers for Disease Control and Prevention, Communities Putting Prevention to Work

Project Period:  3/2011 – 3/2012

In addition to point-of-sale marketing practices, an emerging target for surveillance research is tobacco product purchase patterns among current smokers.  The Legacy National Point-of-Sale Surveillance (POSSE) Project is designed to monitor tobacco product purchases as part of the upcoming 4th wave of the Legacy Longitudinal Smoker Cohort Survey.  For this project our team has developed a mobile-phone based ecological momentary assessment (EMA) system that is founded on a web-based framework that is mobile device and platform independent, meaning that the system works with any mobile phone.  A critical feature of any EMA system is the ability to flexibly design and implement random and/or fixed prompting regimen.  The SI EMA prompting system is sophisticated and multi-modal, in that it allows users to decide if they prefer to be prompted by SMS or IVR, specify their sleep/wake patterns, and utilize a “snooze” function to temporarily delay responding to a prompt that comes at an inopportune moment.  The SI EMA system also features complex branching and non-linear skip-patterns and thus minimizes response burden.  Participants in the Legacy Longitudinal Smoker Cohort will use their own phone to access the SI EMA system in order to track their tobacco product purchases over time, enabling us to improve our understanding of the behavioral and cognitive correlates of brand-switching, dual-use, novel product experimentation and cessation.

Principal Investigator:  Thomas R. Kirchner, PhD

SI/Legacy Collaborators: Donna Vallone, PhD, Amanda Richardson, PhD, Jennifer Cantrell, PhD, Jennifer Pearson, MPH

Funding agency: Legacy (internal)

Project Period:  ongoing

Approximately 6 million people are required to participate in community-based probation, parole or mandated drug/alcohol treatment each year.  Smoking prevalence in these populations hovers around 60-70%, 3-4 times the U.S. population average, yet while prisons are increasingly smoke-free, smoking is largely ignored upon transition into community corrections programs.  The objective of this project is to improve our understanding of issues related to smoking prevalence, prevention and cessation among community corrections populations. Community corrections programs require criminal justice supervision, but participants are not incarcerated and are therefore free to smoke without restriction.  Individuals under community correction supervision represent a large population of underserved smokers who have high smoking prevalence rates, high rates of existing health problems caused or exacerbated by smoking, poor access health care due to lack of insurance and other poverty issues, and who can be targeted for effective smoking cessation interventions via coordination with community corrections offices. 

Principal Investigator:  Thomas R. Kirchner, PhD

SI/Legacy Collaborators: Andrea Villanti, PhD

Collaborators at other institutions: Kenneth Robinson, EdD (Correctional Counseling, Inc.), Karen Cropsey, PhD (University of Alabama at Birmingham)

Project Period:  ongoing

This project seeks to develop a set of integrated, online tools for smokers to quit and stay quit, assisted by other individuals in their social environment. The system as envisioned will include a series of interlocking components: access to a social network for support and dissemination, text messaging for proactive content, and IVR and mobile applications for access at any time. This project is funded internally and supplemented with external funding.

Principal Investigator: Nathan K. Cobb, MD

SI/Legacy Collaborators: Amanda Graham, PhD, David Abrams, PhD, Tom Kirchner, PhD

Funding: Internal