Robin Mermelstein

University of Illinois Chicago | UIC · Institute for Health Research and Policy

Aim To compare effects of three post‐relapse interventions on smoking abstinence. Design Sequential three‐phase multiple assignment randomized trial (SMART). Setting Eighteen Wisconsin, USA, primary care clinics. Participants A total of 1154 primary care patients (53.6% women, 81.2% White) interested in quitting smoking enrolled from 2015 to 201...

Affect regulation often is disrupted in depression. Understanding biomarkers of affect regulation in ecologically valid contexts is critical for identifying moments when interventions can be delivered to improve regulation and may have utility for identifying which individuals are vulnerable to psychopathology. Autonomic complexity, which includes...

Background: Co-use of cannabis and tobacco has become increasingly popular among young adults. Interactive voice response (IVR) based ecological momentary assessment (EMA) allows for measurement of behavior in or near real-time, but has limitations including non-compliance, missing data, and potential for reactivity (e.g., behavior change) from fr...

Importance SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID . Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infect...

Objective: Differences in the subjective effects of alcohol in different social contexts have been well documented, but little research examines affect during drinking in real-world social contexts. This study examined differences by social context in negative affect (NA) and positive affect (PA) during alcohol consumption. We hypothesized that NA...

The vision of the Central Society for Clinical and Translational Research (CSCTR) is to "promote a vibrant, supportive community of multidisciplinary, clinical, and translational medical research to benefit humanity." Together with the Midwestern Section of the American Federation for Medical Research, CSCTR hosts an Annual Midwest Clinical & Trans...

Background Little is known about the factors that bias event-based (i.e., self-initiated) reporting of health behaviors in ecological momentary assessment (EMA) due to the difficulty inherent to tracking failures to self-initiate reports. Purpose To introduce a real-time method for identifying the predictors of noncompliance with event-based repor...

Background: Cannabis use is rising globally, underscoring the importance of understanding contextual factors related to cannabis use. Although much work has retrospectively examined cannabis use patterns and effects, fewer studies have evaluated cannabis use in natural environments. Methods: The present study used ecological momentary assessment...

Introduction Available evidence is mixed concerning associations between smoking status and COVID-19 clinical outcomes. Effects of nicotine replacement therapy (NRT) and vaccination status on COVID-19 outcomes in smokers are unknown. Methods Electronic health record data from 104 590 COVID-19 patients hospitalized February 1, 2020 to September 30,...

Background: There is mixed evidence about the relations of current versus past cancer with severe COVID-19 outcomes and how they vary by patient and cancer characteristics. Methods: Electronic health record data of 104,590 adult hospitalized patients with COVID-19 were obtained from 21 United States health systems from February 2020 through Sept...

The prevalence of cigarette smoking in young adults is higher among those with socioeconomic disadvantage than those without. Low treatment-seeking among young adult smokers is compounded by few efficacious smoking cessation interventions for this group, particularly socioeconomically-disadvantaged young adults (SDYA) who smoke cigarettes. The goal...

BACKGROUND: As recreational cannabis use increases, it is important to document the context in which use occurs. Cannabis use contexts may relate to safety and daily functioning (e.g., if cannabis is used while driving or at work/school) as well as motives for use (e.g., if cannabis is used in social environments). The present study used ecological...

Objectives: Dual use of cigarettes and electronic nicotine delivery systems (ENDS) is increasingly common in adult smokers, who often report using ENDS to quit smoking. Elevated negative affect is an established predictor of increased difficulty quitting smoking combustible cigarettes but has not yet been examined in the context of cigarette cessat...

We address the issue of (non‐) responsivity of self‐initiated assessments in Ecological Momentary Assessment (EMA) or other mobile health (mHealth) studies, where subjects are instructed to self‐initiate reports when experiencing defined events, for example, smoking. Since such reports are self‐initiated, the frequency and determinants of nonrespon...

Introduction A large body of literature indicates that nicotine results in an acute mood “boost,” including increased positive affect and decreased negative affect. Young adults frequently engage in polysubstance use of cigarettes with cannabis and alcohol—a trend that is likely to accelerate with the expanding legalization of cannabis. However, li...

Background Longitudinal assessments of usage are often conducted for multiple substances (e.g., cigarettes, alcohol and marijuana) and research interests are often focused on the inter-substance association. We propose a multivariate longitudinal modeling approach for jointly analyzing the ordinal multivariate substance use data. Methods We descri...

Objectives This study examined how adult dual users of cigarettes and electronic nicotine delivery system (ENDS) flavor preference varied by demographics, tobacco history, motives, and expectancies for ENDS, and how ENDS flavor preference was associated with changes in cigarette and ENDS use over 12 months. Methods Data come from the baseline and...

The topic of e-cigarettes is controversial. Opponents focus on e-cigarettes’ risks for young people, while supporters emphasize the potential for e-cigarettes to assist smokers in quitting smoking. Most US health organizations, media coverage, and policymakers have focused primarily on risks to youths. Because of their messaging, much of the public...

Cannabis legalization has been welcomed by many U.S. states but its role in escalation from tobacco e-cigarette use to cannabis vaping is unclear. Meanwhile, cannabis vaping has been associated with new lung diseases and rising adolescent use. To understand the impact of cannabis legalization on escalation, we design an observational study to estim...

Cannabis legalization has been welcomed by many U.S. states but its role in escalation from tobacco e-cigarette use to cannabis vaping is unclear. Meanwhile, cannabis vaping has been associated with new lung diseases and rising adolescent use. To understand the impact of cannabis legalization on escalation, we design an observational study to estim...

Little is known about the pattern and course of recovery following acute COVID-19. Increasing numbers of reports describe persistent illness following infection with SARS-COV-2, also known as Post-Acute Sequelae of SARS-CoV-2 (PASC). This report describes the methods and results of a multi-pronged strategy to rapidly identify and enroll, over a one...

Introduction Maternal smoking is a well-known risk factor for youth smoking, yet whether this relationship is causal remains unresolved. This study utilizes propensity score methods for causal inference to robustly account for shared risk factors between maternal and offspring smoking. Methods An 8-year longitudinal cohort of 900 adolescents in th...

Introduction Maternal smoking is a risk factor for offspring smoking. Lifetime maternal smoking vs. prenatal tobacco exposure (PTE) appear to act through different mechanisms. This study tested the hypothesis that maternal smoking measures’ effects on offspring smoking could be attributable to hereditary mechanisms: personality traits (novelty-seek...

Introduction Alcohol, nicotine, and marijuana are the three most widely used substances among adolescents and young adults, with co-use of multiple substances being common. Few longitudinal studies have examined risk factors of alcohol, marijuana, and nicotine poly-substance use. We examined frequency of alcohol, marijuana, and cigarette poly-subst...

Aims: To assess the effectiveness of intervention components designed to increase quit attempts and promote abstinence in patients initially unwilling to quit smoking. Design: A 4-factor, randomized factorial experiment. Setting: 16 primary care clinics in southern Wisconsin. Participants: 577 adults who smoke (60% women, 80% White) recruite...

In their letter, Ebrahimi Kalan et al.¹ support the need to assess nicotine dependence (ND) separately for combustible cigarettes and electronic nicotine delivery systems (ENDS) among dual users of these products, as we concluded in our study² evaluating whether there was one common ND factor underlying the use of these two products. As Ebrahimi Ka...

Hidden Markov models (HMM) presents an attractive analytical framework for capturing the state-switching process for auto-correlated data. These models have been extended to longitudinal data setting where simultaneous multiple processes are observed by including subject specific random effects. However, application of HMMs for intensive longitudin...

Ecological Momentary Assessment (EMA) studies aim to explore the interaction between subjects’ psychological states and real environmental factors. During the EMA studies, participants can receive prompted assessments intensively across days and within each day, which results in three-level longitudinal data, e.g., subject-level (level-3), day-leve...

Introduction In a sample of dual users of cigarettes and electronic nicotine delivery systems (ENDS; e-cigarettes), we evaluated psychometric properties of ENDS versions of the Nicotine Dependence Syndrome Scale (NDSS), the brief Wisconsin Inventory of Smoking Dependence Motives (WISDM), and the Fagerstrom Test of Nicotine Dependence (FTND). Using...

Objective: The aim of this study was to examine dependence on combustible and e-cigarettes among users of both products (dual users), which may provide important insights into long-term use patterns. Method: Dual users (smoking daily for 3 months, using e-cigarettes at least once/week for the past month; N = 256; 45% women, 71% White, M age 39.0 y...

Despite support for the role of self-medication alcohol use in the etiology and maintenance of comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD), theoretical and empirical models of PTSD-AUD rarely account for the role of common comorbidities in risk processes, such as major depressive disorder (MDD). The current study ex...

Despite the need for sensitivity analysis to nonignorable missingness in intensive longitudinal data (ILD), such analysis is greatly hindered by novel ILD features, such as large data volume and complex nonmonotonic missing‐data patterns. Likelihood of alternative models permitting nonignorable missingness often involves very high‐dimensional integ...

Context Recent data suggest that the onset of cigarette smoking is now more likely during young adulthood than adolescence. Additionally, the landscape of delivering smoking-cessation interventions has changed in the past decade, with the emergence of mobile phone and web-based approaches. The objective of this study is to update a 2010 systematic...

Introduction Population studies highlight that alcohol and marijuana use are correlated with cigarette smoking and other tobacco use. The aim of our study was to describe the ways in which alcohol and drug use may affect cigarette smoking and cessation in socioeconomically-disadvantaged young adult (SDYA) smokers. Methods Thirty-six SDYA smokers a...

Introduction: Most people who smoke cigarettes are not willing (i.e., not ready) to make a quit attempt (QA) at any given time. Unfortunately, interventions intended to increase QAs and the success of QAs are only modestly effective. Identifying processes leading to QAs and quitting success could guide intervention development. Methods: This is...

Identifying as a smoker and urges to smoke are 2 predictors of persistent combustible cigarette smoking. We investigated the relationship between them. Specifically, grounded in PRIME Theory (West & Brown, 2013), we investigated whether a smoker identity and urges to smoke predict each other over time independent of their relationships with smoking...

Introduction: Cigars are a popular tobacco product of choice for youth and young adults. Despite growing interest in cigar research, there are gaps in the available literature limiting an ability to set evidence-based policies. Too small research samples, the heterogeneity of types of cigars when asking a single question about use, makes analyzing...

In this issue of JAMA Pediatrics, the article by Gray and colleagues¹ addresses a critical public health question: How can we help adolescents and young adults quit smoking before they incur its full human and economic costs? Adolescent and young adult smokers are a critical population, given the substantial benefits of quitting smoking in young ad...

Background: Rapid advances in the capability and affordability of digital technology have begun to allow for the intensive monitoring of psychological and physiological processes associated with affective disorders in daily life. This technology may enable researchers to overcome some limitations of traditional methods for studying risk in affecti...

Introduction: Nicotine dependence contributes to changes in tobacco use among young adults. However, research examining salient dependence motives in young adult users of electronic nicotine delivery systems (ENDS) is limited. This study examined the association of dependence motives with ENDS use or lifetime quit attempt, and tests sex moderation...

Background: Smoking reduction treatment is a promising approach to increase abstinence amongst smokers initially unwilling to quit. However, little is known about which reduction treatment elements increase quit attempts and the uptake of cessation treatment amongst such smokers. Methods: This study is a secondary analysis of a 4-factor randomiz...

Objectives: To examine differences in tobacco use and cessation between young adults (aged 18-24 years) and adults aged 25 years or older. Methods: We used data from the 2016 US National Health Interview Survey (n = 33 028) to identify 13 494 current and former cigarette smokers (562 aged 18-24 years; 12 932 aged 25 years or older). We analyzed...

In this paper, we address the problem of accounting for informative missing in the context of ecological momentary assessment studies (sometimes referred to as intensive longitudinal studies), where each study unit gets measured intensively over time and intermittent missing is usually present. We present a shared parameter modeling approach that l...

Latent trait shared‐parameter mixed models for ecological momentary assessment (EMA) data containing missing values are developed in which data are collected in an intermittent manner. In such studies, data are often missing due to unanswered prompts. Using item response theory models, a latent trait is used to represent the missing prompts and mod...

Background: Prenatal tobacco exposure (PTE) is associated with more frequent smoking among young, light smokers. Little is known about how nicotinic acetylcholine receptor (CHRN) genes may contribute to this relationship. Methods: Data were drawn from a longitudinal cohort of young light smokers of European ancestry (N = 511). Three single nucle...

This study describes cigarette smoking trajectories, the influence of social smoker self-identification (SSID), and correlates of these trajectories in two cohorts of U.S. young adults: a sample from the Chicago metropolitan area (Social Emotional Contexts of Adolescent and Young Adult Smoking Patterns [SECAP], n = 893) and a national sample (Truth...

As adolescents cross the threshold to young adulthood, they encounter more opportunities to engage in or accelerate previously discouraged or prohibited behaviors. Young adults, therefore, are more apt to initiate cigarette smoking and, more importantly, to accelerate their use if they tried and experimented as an adolescent. Preventing the escalat...

Background The effectiveness of smoking cessation treatment is limited in real-world use, perhaps because we have not selected the components of such treatments optimally nor have treatments typically been developed for and evaluated in real-world clinical settings. Purpose To validate an optimized smoking cessation treatment package that comprise...

Ecological momentary assessment studies usually produce intensively measured longitudinal data with large numbers of observations per unit, and research interest is often centered around understanding the changes in variation of people's thoughts, emotions and behaviors. Hedeker et al developed a 2-level mixed effects location scale model that allo...

Smokers unwilling to make a quit attempt can still benefit from smoking intervention. However, it is unclear what proportion of smokers will enter such a Motivation phase intervention, and whether such an intervention attracts different types of smokers than does abstinence oriented treatment. We conducted a study from June 2010 to October 2013 bas...

Background and aims: The implications of the rapid rise in electronic cigarette (e-cigarette) use remain unknown. We examined mutual associations between e-cigarette use, conventional cigarette use, and nicotine dependence over time to 1) test the association between e-cigarette use and later conventional smoking (both direct and via nicotine depe...

Introduction: E-cigarettes (Electronic Nicotine Delivery Systems, or ENDS) are an increasingly popular tobacco product among youth. Some evidence suggests that e-cigarettes may be effective for harm reduction and smoking cessation, although these claims remain controversial. Little is known about how nicotine dependence may contribute to e-cigaret...

Objective: The objective of this study was to examine associations between symptoms of alcohol hangover and depression, both cross-sectionally and prospectively. Method: Data were from a survey of young adults (N = 986, 60% female) initially recruited as part of an observational study of youth smoking. Participants reported past-year hangover sy...

The phenomenon of "social smoking" emerged in the past decade as an important area of research, largely due to its high prevalence in young adults. The purpose of this study was to identify classes of young adult ever smokers based on measures of social and contextual influences on tobacco use. Latent class models were developed using social smokin...

Background: Theory implies that individuals who use alcohol to cope with negative emotions experience the acute mood-altering effects they desire. However, no study to date has directly tested whether alcohol coping motives map onto alcohol-induced changes in mood in real-time or how co-occurring internalizing symptoms (i.e., depression and anxiet...

Factorial experiments have rarely been used in the development or evaluation of clinical interventions. However, factorial designs offer advantages over randomized controlled trial designs, the latter being much more frequently used in such research. Factorial designs are highly efficient (permitting evaluation of multiple intervention components w...

Background: Understanding how smoking cessation treatments exert their effects can inform treatment development and use. Factorial designs allow researchers to examine whether multiple intervention components affect hypothesized change mechanisms, and whether the affected mechanisms are related to cessation. Methods: This is a secondary data ana...

Background: The development of tobacco use treatments that are effective for all smokers is critical to improving clinical and public health. The Multiphase Optimization Strategy (MOST) uses highly efficient factorial experiments to evaluate multiple intervention components for possible inclusion in an optimized tobacco use treatment. Factorial ex...

In health studies, questionnaire items are often scored on an ordinal scale, for example on a Likert scale. For such questionnaires, item response theory (IRT) models provide a useful approach for obtaining summary scores for subjects (i.e., the model’s random subject effect) and characteristics of the items (e.g., item difficulty and discriminatio...

Introduction: Prior research suggests the CHRNA5A3B4 and CHRNB3A6 gene clusters have independent effects on smoking progression in young smokers. Here classification tree analysis uncovers conditional relations between these genes. Methods: Conditional classification tree and random forest analyses were employed to predict daily smoking at 6-year f...

There is often a need to assess the dependence of standard analyses on the strong untestable assumption of ignorable missingness. To tackle this problem, past research developed simple sensitivity index measures assuming a linear impact of nonignorability and missingness in outcomes only. These restrictions limit their applicability for studies wit...

Background: There is little research on how young adults or young adult subgroups utilize and engage with Web-based cessation interventions when trying to quit smoking. Addressing this knowledge gap is important to identify opportunities to optimize the effectiveness of online cessation programs across diverse young adult users. Objective: This stu...

Background: There is little research on how young adults or young adult subgroups utilize and engage with Web-based cessation interventions when trying to quit smoking. Addressing this knowledge gap is important to identify opportunities to optimize the effectiveness of online cessation programs across diverse young adult users. Objective: This stu...

A national survey of 591 community-based youth smoking cessation programs provided an opportunity to assess the sustainability of health promotion programming over a 3-year period. Initial survey questions were mapped to five sustainability domains (local ownership, organizational alignment, resources, demand, and standard operating procedures) and...

Novice and light adolescent smokers can develop symptoms of nicotine dependence, which predicts smoking behavior several years into the future. However, little is known about how the association between these early - emerging symptoms and later smoker behaviors may change across time from early adolescence into young adulthood. Data were drawn from...

Adolescents who smoke are more likely to escalate their smoking frequency if they believe smoking is self-defining. Knowing factors that are associated with development of a smoker identity among adolescents who smoke may help to identify who will become a regular smoker. We investigated whether smoker identity development is associated with intern...

Background: Despite the highly replicated relationship between symptoms associated with both alcohol and nicotine, little is known about this association across time and exposure to both drinking and smoking. In the present study, we evaluate if problems associated with alcohol use are related to emerging nicotine dependence symptoms and whether t...

Mood processes are theorized to play a role in the initiation and progression of smoking behavior. Available work using real-time assessments in samples of young smokers, including several reports from the Social and Emotional Contexts of Adolescent Smoking Patterns (SECASP) study, has indicated that smoking events acutely improve mood and that esc...

Background and aims: The neuropsychological correlates of simultaneous marijuana and tobacco use are largely unknown, which is surprising as both substances have similar neural substrates and have opposing influences on working memory (WM). This study examined the effects of marijuana alone, tobacco alone and simultaneous marijuana and tobacco use...

AimsTo identify promising intervention components that help smokers attain and maintain abstinence during a quit attempt. DesignA 2x2x2x2x2 randomized factorial experiment. SettingEleven primary care clinics in Wisconsin, USA. ParticipantsA total of 544 smokers (59% women, 86% white) recruited during primary care visits and motivated to quit. Inter...

Aim To identify promising intervention components intended to help smokers to attain and maintain abstinence in their quit smoking attempts. DesignA fully crossed, six-factor randomized fractional factorial experiment. SettingEleven primary care clinics in southern Wisconsin, USA. ParticipantsA total of 637 adult smokers (55% women, 88% white) moti...

AimsTo screen promising intervention components designed to reduce smoking and promote abstinence in smokers initially unwilling to quit. DesignA balanced, four-factor, randomized factorial experiment. SettingEleven primary care clinics in southern Wisconsin, USA. ParticipantsA total of 517 adult smokers (63.4% women, 91.1% white) recruited during...

Background and aims: A chronic care strategy could potentially enhance the reach and effectiveness of smoking treatment by providing effective interventions for all smokers, including those who are initially unwilling to quit. This paper describes the conceptual bases of a National Cancer Institute-funded research program designed to develop an op...

Introduction: In very novice smokers, CYP2A6 genotypes that reduce nicotine metabolism to an intermediate rate may increase smoking risk, relative to both normal and slow rates. The present study examined the hypothesis that intermediate metabolism variants are associated with greater pleasurable effects of the initial smoking attempt than either...

Exercise and sedentary behavior have different physiologic effects, which have yet to be fully explained. Time spent in sedentary behavior has been associated with glucose intolerance in adults at risk for type 2 diabetes, but these data have come largely from cross-sectional studies that have not explored this relationship in adults with diabetes....

Deficits in decision-making and episodic memory are often reported among heavy cannabis users, yet little is known on how they influence negative consequences from cannabis use. Individual differences in decision-making may explain, in part, why some individuals experience significant problems from their cannabis use whereas others do not. We hypot...

As prevalence of marijuana use increases, it is important that we better understand how factors like gender, cigarette use, and depression are related to marijuana use during adolescence and young adulthood. We examined longitudinal relationships among these variables in adolescents moving into young adulthood who were studied longitudinally for si...

Neuropsychological performance has historically been measured in laboratory settings using standardized assessments. However, these methods may be inherently limited in generalizability. This concern may be mitigated with paradigms such as ecological momentary assessment (EMA). We evaluated the initial feasibility and acceptability of administering...

Earlier initiation of cannabis use is associated with poorer neuropsychological functioning across several domains. Given well-documented sex differences in neuromaturation during adolescence, initiation of cannabis use during this time may affect neuropsychological functioning differently for males and females. In the current study, we examined se...

Young adults have the highest rates of alcohol, tobacco, and other drug use relative to any other age group. Few studies have examined the co-occurrence of substance use with new and emerging tobacco products in this vulnerable group, or the underlying personality factors that may explain these associations. To address this gap, this study examined...

The present study evaluated the predictive validity of individual early emerging nicotine dependence symptoms in adolescence on smoking behavior in young adulthood. A total of 492 adolescents who, at baseline, had not smoked more than 100 cigarettes in their lifetime and 123 adolescents who smoked more than 100 cigarettes lifetime, and who particip...