Exposure to tobacco retail was associated with increases in smoking and smoking craving in people who smoke cigarettes daily, according to research published Sept. 29 in JAMA Network Open.

In the multimodal, within-person cohort study, investigators Benjamin Muzekari, MA, et al., used GeoSmoking Study data from 273 participants (mean age, 43 years; 55% women; 64% White, 23% Black, 3% Asian) from three separate states (Pennsylvania, New Jersey and Delaware) who smoked at least five cigarettes per day over the previous six months (mean daily cigarettes, 13.5).

At four intervals throughout the day, participants reported their craving and cigarette use over the past hour. The momentary assessment data was combined with geolocation tracking and tobacco retail location records to assess possible connection between retail tobacco exposure and craving or smoking.

Results showed that participants reported significantly higher levels of craving (b=0.04; t_3,457=2.72; p=0.01) and smoked significantly more cigarettes (b=0.01; t_3,469=2.05; p=0.04) on days when they had higher exposure to tobacco retail. Participants were exposed to an average of 37 tobacco retail outlets per day.

Greater-than-average exposure to tobacco retail in the previous hour was associated with lower-than-average craving but greater-than-average smoking. Increased smoking in the previous hour was associated with lower-than-average craving (b= –10.17; t_13,851= –12.50; p<0.001). Both increased craving and smoking within the past hour was associated with subsequent increased tobacco retail exposure.

"There remains limited research that objectively quantifies naturalistic tobacco retail exposures and links those experiences with time-sensitive measures of craving and smoking, particularly in adults who smoke regularly and who are not trying to quit," write Muzekari and colleagues. "Investigating these dynamics is important for understanding everyday decisions about when and how much people smoke, which may ultimately contribute to the burden of smoking related disease."

In an accompanying editorial comment, Megan E. Piper, PhD, and Jennifer M. Betts, PhD, emphasized how data allowed investigators to explore the connection between exposure and craving at the hourly level, calling it "essential for understanding the processes that maintain tobacco dependence and act as barriers to cessation."

"Although ecological momentary assessment studies may not be able to control as many variables (e.g., the presence of other cues) and lack the same level of temporal precision or comparison control as cue-reactivity studies," they write, "such research allows investigators to ask important questions that could inform other researchers, clinicians, policymakers, and people who smoke about the situations that contribute to the risk of smoking and associated health outcomes."