Saul Shiffman

Saul Shiffman
University of Pittsburgh | Pitt · Psychology

Ph.D.

About

380
Publications
73,481
Reads
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28,993
Citations
Additional affiliations
June 1993 - present
Pinney Associates
Position
  • Senior Scienmtific Advisor
August 1984 - present
University of Pittsburgh
Position
  • Professor (Full)

Publications

Publications (380)
Preprint
Background : Electronic nicotine delivery systems (ENDS) have the potential to benefit public health if smokers completely switch from cigarettes to ENDS. Methods : A cohort of adult smokers (age≥21) who purchased a JUUL Starter Kit was followed for 12 months after the initial purchase. We examined factors associated with achievement and maintenanc...
Article
Full-text available
Rationale Electronic nicotine delivery systems and heated tobacco products are noncombustible alternatives for adult smokers. Evidence suggests sufficient nicotine delivery and satisfying effects are necessary to facilitate switching away from smoking; nicotine delivery varies across electronic nicotine delivery systems within limited nicotine conc...
Preprint
Background: Smokers who switch completely to electronic nicotine delivery systems (ENDS) may experience reductions in respiratory symptoms (e.g., cough, wheezing). Assessing such symptoms among smokers without respiratory disease using existing respiratory symptom questionnaires is challenging, as these questionnaires are intended for patient popul...
Article
OBJECTIVES Studies have assessed switching away from cigarettes among adult smokers who use electronic nicotine delivery systems (ENDS), but there is little data assessing differences in likelihood of switching or ENDS use characteristics by menthol smoking METHODS Adult (age≥21) established smokers who purchased a JUUL Starter Kit (N=15,036) comp...
Article
Background Self-efficacy, or the perceived capability to engage in a behavior, has been shown to play an important role in adhering to weight loss treatment. Given that adherence is extremely important for successful weight loss outcomes and that sleep and self-efficacy are modifiable factors in this relationship, we examined the association betwee...
Article
Full-text available
Introduction Evidence suggests that cigarette smokers who switch to electronic nicotine delivery systems (ENDS) reduce their exposure to harmful toxicants and carcinogens. It is unclear if dual use is associated with decreases in exposure to toxicants. Methods This parallel-group confinement study assessed changes in biomarkers of exposure (BOEs)...
Article
Full-text available
Introduction Electronic nicotine delivery systems (ENDS) may improve public health if they facilitate smokers switching away from cigarettes. Conceptually, switching is facilitated when ENDS provide adequate nicotine delivery. Switching rates among smokers who purchased the JUUL System (“JUUL”) were compared in the United Kingdom (UK), where regula...
Article
Objectives: In this study, we assessed changes in dependence as smokers transitioned from cigarette smoking to exclusive use of the JUUL System ("JUUL"), contrasting users of 5.0% versus 3.0% nicotine concentration pods. Methods: Overall, 5246 adult (age ≥ 21) established smokers (> 100 cigarettes lifetime) who purchased a JUUL device completed onl...
Article
Objectives: We assessed adult never smokers' trajectories of smoking over 12 months after a first-time JUUL Starter Kit (JSK) purchase. Methods: Adult (≥ 21) never smokers (N = 3853) who purchased a JSK were recruited into an observational naturalistic study. Analyses distinguished those who had previously used ENDS (NS+E, N = 2848) from those who...
Article
Objectives: In this study, we prospectively assessed changes in smoking a year after US adults' first-time purchase of a JUUL Starter Kit (JSK). Methods: Descriptive analyses assessed transitions in smoking status at 12 months among adult (age ≥21) JSK purchasers providing baseline and 12-month follow-up data (N = 27,164 [49.0% of baseline]), strat...
Article
This special issue addresses key topics relating to the public health impact of the use of electronic nicotine delivery devices (ENDS), particularly JUUL-brand ENDS. Smokers smoke for nicotine, but are harmed by the byproducts of combustion. ENDS can play a role in tobacco harm reduction offering a noncombustible alternative source of nicotine for...
Article
Objectives: Those underage should not use tobacco products, including electronic nicotine delivery systems. A technologically-based solution developed by Juul Labs Inc to restrict underage access seeks to automate transactions, structurally mandate age-verification, and limit the quantity of JUUL products purchased per transaction. A pilot of this...
Article
Full-text available
Objectives: In this study, we examined complete switching away from cigarettes across various medico-socio-demographic subpopulations of adult smokers who purchased a JUUL Starter Kit (JSK) electronic nicotine delivery system. Methods: We analyzed trajectories of smoking over 12 months in 17,986 adult smokers who purchased a JSK. Populations of spe...
Article
Objective: In this study, we assessed cigarette smoking over 12 months among adult former smokers who newly purchased a JUUL Starter Kit (JSK). Methods: Prevalence of past 30-day smoking and factors associated with smoking were assessed among adult (age ≥ 21) former established smokers, stratified as recent (quitting ≤ 12 months) and long-term quit...
Article
Objectives: Many smokers who start using ENDS engage in dual use of cigarettes and ENDS. This paper examines time trends in dual use after a JUUL Starter Kit purchase, and changes in cigarette consumption among those remaining dual users. Methods: In the ADJUSST study, a cohort of adult smokers who purchased a JUUL Starter Kit were followed natural...
Article
Objectives: In this study, we assessed complete switching away from cigarette smoking among adult smokers who purchased a JUUL Starter Kit (JSK). Methods: Adult (age ≥ 21) established smokers (smoked ≥ 100 lifetime cigarettes) who purchased a JSK in 2018 were invited to complete online surveys 1, 2, 3, 6, 9 and 12 months after initial JSK purchase....
Article
Objectives: The Adult JUUL System User Switching and Smoking Trajectories (ADJUSST) study assessed the smoking and JUUL use trajectories of adults who purchased JUUL. In this paper, we describe study methods, characterize the sample, and assesses potential for bias due to loss to follow-up. Methods: We entered 55,414 US adults (≥ age 21) who purcha...
Article
Objectives: In this paper, we estimate the prevalence of electronic nicotine delivery systems (ENDS) and JUUL brand ENDS use among adults in the US, overall and by smoking history. Methods: We obtained 2019 cross-sectional online surveys assessing smoking, use of any ENDS, and JUUL specifically, in a national probability sample of 11,833 US adults....
Article
Ecological momentary assessment (EMA) studies investigate intensive repeated observations of the current behavior and experiences of subjects in real time. In particular, such studies aim to minimize recall bias and maximize ecological validity, thereby strengthening the investigation and inference of microprocesses that influence behavior in real-...
Article
Full-text available
RationaleLittle is known about relapse among non-daily, intermittent smokers (ITS), who have difficulty quitting, despite a lack of dependence.Objectives To analyze situations associated with temptations to smoke and smoking lapses among ITS trying to maintain abstinence.Methods Participants were 130 initially abstinent ITS in the placebo arm of a...
Article
Background and aims Non‐daily smokers (NDS) comprise a large fraction of US smokers. Despite little or no dependence, as typically assessed, ITS have difficulty quitting smoking. A randomized clinical trial comparing the effect of nicotine gum with placebo on quitting smoking in non‐daily smokers did not find an effect on overall abstinence. We und...
Article
Full-text available
Background and Aims Cigarette smoking often results in nicotine dependence. With use of electronic cigarettes as an alternative source of nicotine, it is important to assess dependence associated with e‐cigarette use. This study assesses dependence among current and former adult e‐cigarette users on cigarettes and e‐cigarettes, compared with depend...
Article
Introduction: Non-daily intermittent smokers (ITS) comprise 30% of US adult smokers. ITS smoke for nicotine and have trouble quitting, but tend to smoke in particular situations. This study tested the effect of nicotine gum, used to prevent or react to situational temptations, for helping ITS quit. Methods: ITS (smoking 4-27 days/month) seeking...
Article
Full-text available
Introduction Snus, a low nitrosamine smokeless tobacco product, presents less risks to health than cigarettes. Effectively communicating such risk information could facilitate smokers switching completely to snus, thereby benefiting public health. Methods This study assessed comprehension and perceptions of modified-risk information regarding snus...
Article
Full-text available
Background: There is a well-established social gradient in smoking, but little is known about the underlying behavioral mechanisms. Here, we take a social-ecological perspective by examining daily stress experience as a process linking social disadvantage to smoking behavior. Method: A sample of 194 daily smokers, who were not attempting to quit...
Article
Background: Alcohol consumption promotes lapses to smoking among smokers trying to quit, perhaps particularly among smokers with lower dependence. We assessed how the role of alcohol in lapses varies over time. Methods: This is a secondary analysis of ecological momentary assessment data collected from 159 daily smokers (mean age = 43.90 (SD = 1...
Article
This study examines how well exposure in topography sessions correlates with exposure when smoking ad libitum in the field, by measuring material deposited on the filters of cigarettes smoked in the lab and in the field. The data were collected in a study of the effect of very low-nicotine-content versus normal-nicotine-content cigarettes in nondai...
Article
Full-text available
Introduction: Switching from cigarettes to snus by smokers unlikely to quit would be expected to benefit overall population health, with any potential benefit needing to be weighed against potential harms from snus use by tobacco non-users and smokers likely to quit. This study evaluates likelihood of snus use among tobacco users and non-users pro...
Article
Background The US Food and Drug Administration is considering reductions in the nicotine content of cigarettes to reduce smoking and tobacco dependence. A randomized study showed that even non-daily, intermittent smokers (ITS) reduced their cigarette consumption when switched to very-low-nicotine-content cigarettes (VLNCCs). This paper assesses whe...
Article
Temporal patterns of acetaminophen use exceeding the recommended daily maximum 4‐gram dose over a 5‐year period (4/1/2011‐3/31/2016) were evaluated in an online 1‐week diary study of 14,434 adult acetaminophen users who also reported acetaminophen use in the previous month. Specific medications taken were identified by list‐based prompting; respond...
Article
Full-text available
Researchers are sometimes interested in predicting a distal or external outcome (such as smoking cessation at follow-up) from the trajectory of an intensively recorded longitudinal variable (such as urge to smoke). This can be done in a semiparametric way via scalar-on-function regression. However, the resulting fitted coefficient regression functi...
Article
Full-text available
Rationale The Food and Drug Administration is considering severely restricting the nicotine in cigarettes, to reduce smoking. A study showed that non-daily, intermittent smokers (ITS) randomized to very-low-nicotine-content cigarettes (VLNCCs) reduced their cigarette consumption. Objectives To assess whether increased smoking intensity of VLNCCs c...
Presentation
Understanding social disadvantage and smoking through the experience of daily stress
Article
Objective Studies on situation and Person × Situation interaction effects often use only one method of measurement, so that the extent to which the effects may be method‐specific cannot be determined. We introduce a new multimethod latent state–trait model for random and fixed situations (MM‐LST‐RF), which allows examining person, situation, and Pe...
Article
Full-text available
Purpose/objective: The purpose of this report is to provide rehabilitation researchers with an explanation of multilevel item response theory (MLIRT), specifically applied to data collected using ecological momentary assessment (EMA) methods. Design: This is a didactic brief report of a statistical method. The advantages of the method are illust...
Article
Objectives We assessed the psychometric properties of the Relapse Situation Efficacy Questionnaire - Weight (RSEQ-W) including internal consistency reliability, criterion-related validity (concurrent and predictive validity) and construct validity (convergent validity and factor analysis). Methods We administered the RSEQ-W at baseline, and at 6 an...
Article
Objectives: To assess whether there are differences in the likelihood of exceeding the daily limit of 4 grams of acetaminophen when using different formulations (325 mg, 500 mg, 650 mg) of OTC single-ingredient (SI) acetaminophen medications. Design and setting: Multiyear observational study of acetaminophen use via daily online acetaminophen-us...
Article
Objectives: Users should know the active ingredients and dosing directions to optimize the safe use of acetaminophen-containing medications. The aim of this work was to examine knowledge of acetaminophen-containing medication directions among current users. Design, setting, and participants: An Internet panel diary study (2012-2016) of 1-week us...
Article
Importance The US Food and Drug Administration is considering limiting cigarettes to very low nicotine levels. Cigarette consumption of nondaily intermittent smokers (ITS), who compose one-third of US adult smokers, could feasibly increase or could be unaffected if their smoking is not motivated by nicotine seeking. Objective To compare cigarette...
Article
Ethnic differences in smoking patterns and dependence have been observed between Caucasian and African American smokers: African Americans who smoke are more likely to be intermittent smokers (ITS), and daily smokers (DS) consume fewer cigarettes yet report more dependence. Participants’ (N = 482, 67% Caucasian, 54% ITS) dependence was assessed by...
Article
Aims: To estimate prevalence of excess intake of acetaminophen, and investigate seasonal variations therein. Methods: Between 2011 and 2016, 14,481 US adults who used acetaminophen in the preceding 30 days were sampled from national online panels and completed a detailed online daily diary of acetaminophen medication use for 7 days. Respondents...
Presentation
Introduction: Smoking often occurs in and is influenced by particular situations and social contexts. Ecological momentary assessment methods (EMA) can be used to gather reliable and ecological valid data on individual’s daily lives. As such, EMA methods can be utilized to gain a greater understanding of temporal variations in social norms and to e...
Article
Purpose: Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective and very commonly used, but also have side effects. We determined prevalence of NSAID dosing exceeding the daily limit (EDL) and identified related user characteristics and dosing patterns among current ibuprofen users. Methods: Online 1-week diary study of 1326 ibuprofen users...
Article
Quantifying cigarette consumption is fundamental to smoking research. We examine the correspondence among 3 methods of capturing cigarette consumption in nondaily smokers. In the study, 232 nondaily smokers recorded cigarette consumption over 2 weeks of ad libitum smoking (total = 3,303 days) using 3 methods: (a) interactive voice response (IVR; ca...
Article
Full-text available
Introduction: Nicotine replacement medications are moderately effective in increasing quit rates. However, some smokers reject such aids, suggesting the value of considering alternative options. Snus, a smokeless tobacco product with low nitrosamine content, could offer an alternative. This study compared smoking cessation rates for snus, with and...
Article
Introduction: Individuals may compensate for workplace smoking bans by smoking more before or after work, or escaping bans to smoke, but no studies have conducted a detailed, quantitative analysis of such compensatory behaviors using real-time data. Methods: 124 daily smokers documented smoking occasions over 3weeks using ecological momentary as...
Article
We propose a copula-based joint modeling framework for mixed longitudinal responses. Our approach permits all model parameters to vary with time, and thus will enable researchers to reveal dynamic response-predictor relationships and response-response associations. We call the new class of models timecop because we model dependence using a time-var...
Article
Full-text available
There is a well-established socioeconomic gradient in smoking behavior: those with lower socioeconomic status smoke more. However, much less is known about the mechanisms explaining how SES is linked to smoking. This study takes a social-ecological perspective by examining whether socioeconomic status affects smoking behavior by differential exposu...
Article
Full-text available
Rationale: One third of US smokers are intermittent smokers (ITS) who do not smoke daily. Unlike daily smokers (DS), whose smoking is negatively reinforced by withdrawal relief, ITS may be motivated by immediate positive reinforcement. In contrast, incentive salience theory posits hypothesis that "liking" of drug effects fades in established users...
Article
Introduction: Studies testing novel tobacco products often provide participants with free product and assess consumption. Some, but not all, studies find that providing fee cigarettes increases smoking. We tested changes in smoking when free cigarettes were provided to non-daily, intermittent smokers (ITS), who constitute one third of US adult smo...
Article
Self-reported daily cigarette counts typically exhibit a preponderance of round numbers, a phenomenon known as heaping or digit preference. Heaping can be a substantial nuisance, as scientific interest lies in the distribution of the underlying true values rather than that of the heaped data. In principle, we can estimate parameters of the underlyi...
Article
Full-text available
Background: Ecological momentary assessment (EMA) assesses individuals' current experiences, behaviors, and moods as they occur in real time and in their natural environment. EMA studies, particularly those of longer duration, are complex and require an infrastructure to support the data flow and monitoring of EMA completion. Objective: Our obje...
Poster
Introduction: There is a well-established socioeconomic gradient in smoking behaviour with those from lower socioeconomic backgrounds engaging in higher rates of smoking. However, much less is known about the underlying pathways. This study takes a social-ecological perspective by examining whether socioeconomic status affects smoking behaviour by...
Article
Background: Ecological momentary assessment (EMA) assesses individuals’ current experiences, location and social context in which behaviors occur. During a 12-mo behavioral weight loss intervention and using an EMA app, we asked participants to report any instances of temptations or a lapse from their weight management diet. Objective: Estimate the...
Article
Background and aims: Nicotine addiction theory predicts small day to day variability in cigarettes/day (CPD) whereas social learning theory predicts large variability. A description of the variability in CPD over multiple days is not available. Methods: We conducted secondary analyses of two natural history studies with daily smokers - one of sm...
Article
Full-text available
Ecological momentary assessment (EMA) methods collect real-time data in real-world environments, which allow physical medicine and rehabilitation researchers to examine objective outcome data and reduces bias from retrospective recall. The statistical analysis of EMA data is directly related to the research question and the temporal design of the s...
Article
Full-text available
Background and aims: Quitting smoking is the most potent way to reduce the health risks associated with smoking cigarettes, and public health objectives in the United States include dramatic increases in the proportion of smokers making a serious quit attempt each year. The US Centers for Disease Control and Prevention (CDC) has, since 2000, set a...
Article
Previous laboratory studies have investigated associations between attentional bias and craving, but ecological momentary assessment (EMA) may provide ecologically-valid data. This study examines whether clinic-measured attentional bias is associated with noticing smoking cues, attention to smoking, and craving assessed by EMA and whether EMA-asses...
Article
Full-text available
Background and objective: Smoking is the largest preventable cause of death and diseases in the developed world, and advances in modern electronics and machine learning can help us deliver real-time intervention to smokers in novel ways. In this paper, we examine different machine learning approaches to use situational features associated with hav...
Article
Full-text available
PurposeOverview of geographically explicit momentary assessment research, applied to the study of mental health and well-being, which allows for cross-validation, extension, and enrichment of research on place and health. Methods Building on the historical foundations of both ecological momentary assessment and geographic momentary assessment resea...
Article
Introduction: Both withdrawal severity and smoking cues can trigger lapses. However, the temporal relationship between these two sets of triggers is unknown. Aims: To explore the time course of lapse triggers during a quit attempt. Methods: Across two cessation studies, 186 lapsers monitored their smoking in real-time for up to 7 weeks over the cou...
Article
Attention-deficit/hyperactivity disorder (ADHD) is associated with health risks in adolescence which includes the potential for smoking cigarettes, early smoking initiation, and rapid progression to daily smoking. Much less is known, however, about prognostically relevant smoking behaviors among individuals with childhood ADHD. Further research in...
Article
Objectives: To assess the effect of adding an acetaminophen ingredient icon to acetaminophen medication labels on consumer decision making about concomitant use of acetaminophen medications to avoid overdose, which is associated with liver injury. Design: Parallel-group randomized study. Setting: Consumer research facilities in Indianapolis, B...
Article
Background: Person-centered approaches to the study of behavior change, such as repeated measures latent class analysis (RMLCA), can be used to identify patterns of change and link these to later behavior change outcomes. Methods: Daily smoking status data from three smoking cessation studies (N=287, N=334, and N=403) were submitted to RMLCA to...
Article
Objectives: To estimate the costs and benefits of over-the-counter (OTC) statins under the 2013 American College of Cardiology/American Heart Association guidelines. Study design: A 10-year cost-effectiveness model using a health system perspective was developed to analyze the impact of making an OTC statin drug available. Methods: We calibrat...
Article
Introduction: Ecological momentary assessment (EMA) assesses individuals’ behaviors and moods as they occur in their natural environment. We examined self-reported triggers of temptations/urges to eat and compared percent of times each trigger was reported as the top trigger in the 1st 6 mos. vs. the 2nd 6 mos. of a standard behavioral weight loss...
Article
Full-text available
Adding icons on labels of acetaminophen-containing medicines could help users identify the active ingredient and avoid concomitant use of multiple medicines containing acetaminophen. We evaluated five icons for communication effectiveness. Adults (n = 300) were randomized to view a prescription container label or over-the-counter labels with either...
Article
It is well established that environmental stimuli influence smoking in light, and to a lesser degree, heavy smokers. A 2-factor model of dependence suggests that the influence of stimulus control is masked among heavier smokers who primarily smoke for nicotine maintenance. The current study aimed to assess the influence of stimulus control across a...
Article
Objective: This article presents an experimental design, the microrandomized trial, developed to support optimization of just-in-time adaptive interventions (JITAIs). JITAIs are mHealth technologies that aim to deliver the right intervention components at the right times and locations to optimally support individuals' health behaviors. Microrandom...