About

Dr. Tanya Schlam is an assistant professor in the Department of Kinesiology at the University of Wisconsin-Madison. She holds a B.A. from Yale University and a Ph.D. in clinical psychology from Rutgers University. Her research focuses on health behavior change, primarily smoking cessation, and she works on developing interventions, including mobile health interventions, to help individuals acquire behavioral and cognitive control skills to optimize health outcomes in the face of societal, environmental, interpersonal, and psychological challenges. She teaches courses related to health promotion and health equity.

Research topics

• Internal medicine
• Medicine
• Clinical psychology
• Psychiatry
• Psychology
• Social psychology

Selected publications

• Expanding the scope of the withdrawal syndrome: Anhedonia as a core nicotine withdrawal symptom.

  Journal of Psychopathology and Clinical Science · 2025-04-07 · 3 citations

  articleOpen access

  < .001) post-TQD. These effects remained even after controlling for other withdrawal symptoms and individual characteristics. Gold standard smoking pharmacotherapies had comparable statistical effects on anhedonia's trajectory and association with abstinence during treatment. The results replicate and extend previous research supporting anhedonia as a motivationally significant symptom of nicotine withdrawal. The results suggest anhedonia not only conforms to features of a tobacco withdrawal symptom but is associated with difficulty stopping smoking. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

  PublisherDOI

• Representativeness of Electronic Referral to Smoking Treatment Trials in Adult Primary Care

  Nicotine & Tobacco Research · 2025-02-22

  articleOpen access

  INTRODUCTION: Some populations are underrepresented in smoking treatment research. Electronic health record (EHR)-enabled referral of patients who smoke, which may enhance the representativeness of clinical trial samples. This study assessed the representativeness of smoking treatment trial electronic referral (e-referral), exclusion, enrollment, and engagement in primary care. AIMS AND METHODS: Eighteen adult primary care clinics in two healthcare systems offered patients who smoked e-referral to smoking reduction or cessation treatment trials. Extracted EHR data were analyzed to compare rates of e-referral and enrollment across patient groups defined by sex, age, race, ethnicity, and insurance status. Trial eligibility screening data were analyzed to identify differential exclusion of patient groups by sex, race, or neighborhood disadvantage. RESULTS: Overall, 23.3% of eligible patients were e-referred, with elevated e-referral rates among women, African American, Medicaid-eligible, and middle-aged patients. Among e-referred patients, 20.5% were excluded at trial eligibility screening, with exclusions elevated for women, minoritized individuals, and individuals from disadvantaged neighborhoods. Overall, 7.0% of patients who smoked enrolled in a smoking treatment trial, with enrollment rates elevated among women, those over age 44, and, in one health system, African American patients. Most enrollees (>87%) initiated counseling and enrollees completed 52.4-79.9% of counseling sessions, with older, college-educated, and lower-income enrollees attending more sessions. CONCLUSIONS: Proactive e-referral in primary care may improve the representation of certain groups (eg African American and Medicaid-eligible patients) in smoking treatment trials, but differential exclusion at eligibility screening may reduce sample representativeness. Relaxing nonessential eligibility criteria may enhance the inclusion of minoritized and disadvantaged populations in smoking treatment research. IMPLICATIONS: Electronic referral of adult primary care patients who smoke to smoking cessation and reduction trials may enhance referral of high-priority populations (eg African American patients and those eligible for Medicaid) to tobacco treatment trials. Relaxing treatment trial inclusion criteria may enhance representation of minoritized and disadvantaged patients in treatment trials.

  PublisherOA PDFDOI

• Associations Between Cigarette Smoking and Poor Sleep Among Adults With a Lifetime Cancer Diagnosis

  Cancer Reports · 2025-11-01

  articleOpen access

  BACKGROUND: Poor sleep is associated with cigarette smoking and cancer diagnosis, but little is known about the contribution of smoking to poor sleep following a cancer diagnosis. METHODS: Using the National Health and Nutrition Examination Survey (N = 6183), multivariable Poisson regression models estimated the associations between lifetime cancer diagnosis, cigarette smoking, and poor sleep, controlling for covariates and evaluating interactions between smoking and cancer diagnosis. RESULTS: Among adults, 11.6% reported a lifetime cancer diagnosis, and 13.3% of those reported current cigarette smoking. Adults with a cancer diagnosis who smoked had a higher prevalence of inappropriate sleep duration (Adjusted Prevalence Ratio, APR: 2.29, 95% CI: 1.03, 5.13) and snorting/stop breathing (APR: 1.63, 95% CI: 1.10, 2.41) than those without a cancer diagnosis who don't smoke. CONCLUSION: Smoking among adults with a lifetime cancer diagnosis is correlated with poor sleep, highlighting the need for targeted smoking cessation interventions to improve sleep health in this population.

  PublisherOA PDFDOI

• The Impact of Three Alternate Nicotine-Delivery Products on Combusted Cigarette Use: A Randomized Controlled Trial

  Nicotine & Tobacco Research · 2024-02-13 · 4 citations

  articleOpen access

  INTRODUCTION: Smoking cessation is a critical public health goal. This study examined the ability of e-cigarettes and very low nicotine cigarettes (VLNCs) to serve as cigarette substitutes and whether a substitution was supported by steady-state nicotine from a nicotine patch. AIMS AND METHODS: This mixed design experiment with study product (between-subjects) and patch (within-subjects) factors recruited adults smoking cigarettes daily and not motivated to quit (N = 160). Participants were randomized to 4 weeks of: (1) VLNCs; (2) e-cigarettes; or (3) no product. During two switch weeks, one with an active nicotine patch and one with a placebo patch (in a double-blind and counterbalanced fashion), participants were told to not smoke their usual cigarettes. RESULTS: During the switch weeks, participants in the VLNC (M = 2.88, SD = .65) and e-cigarette (M = 3.20, SD = .63) groups smoked fewer of their own cigarettes per day than did no product group participants who continued to smoke their own cigarettes (M = 5.48, SD = .63); the VLNC and e-cigarette groups did not differ. There was no main effect of patch on mean usual brand cigarettes smoked per day (P = .09), nor was there a product × patch interaction (P = .51). There was a product × age interaction (P = .03); smokers aged 60-74 smoked more of their own cigarettes if they were randomized to no product group. CONCLUSIONS: VLNCs and e-cigarettes appear to reduce usual brand cigarettes smoked per day to a similar degree, regardless of patch condition. Behavioral factors, in addition to nicotine dependence, play an important role in sustaining smoking behavior and need to be addressed in smoking cessation treatment. IMPLICATIONS: This study found that behavioral substitutes for cigarettes, whether or not they delivered nicotine, reduced the number of usual brand cigarettes smoked. Specifically, both e-cigarettes delivering nicotine and VLNCs equally reduce usual brand cigarettes smoked among adults who smoke daily and do not want to quit.

  PublisherOA PDFDOI

• What to do after smoking relapse? A sequential multiple assignment randomized trial of chronic care smoking treatments

  Addiction · 2024-01-28 · 7 citations

  articleOpen access1st authorCorresponding

  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 2019; 582 relapsed and were randomized to relapse recovery treatment. INTERVENTIONS: In phase 1, patients received cessation counseling and 8 weeks nicotine patch. Those who relapsed and agreed were randomized to a phase 2 relapse recovery group: (1) reduction counseling + nicotine mini-lozenges + encouragement to quit starting 1 month post-randomization (preparation); (2) repeated encouragement to quit starting immediately post-randomization (recycling); or (3) advice to call the tobacco quitline (control). The first two groups could opt into phase 3 new quit treatment [8 weeks nicotine patch + mini-lozenges plus randomization to two treatment factors (skill training and supportive counseling) in a 2 × 2 design]. Phase 2 and 3 interventions lasted ≤ 15 months. MEASUREMENTS: The study was powered to compare each active phase 2 treatment with the control on the primary outcome: biochemically confirmed 7-day point-prevalence abstinence 14 months post initiating phase 2 relapse recovery treatment. Exploratory analyses tested for phase 3 counseling factor effects. FINDINGS: Neither skill training nor supportive counseling (each on versus off) increased 14-month abstinence rates; skills on versus off 9.3% (14/151) versus 5.2% (8/153), P = 0.19; support on versus off 6.6% (10/152) versus 7.9% (12/152), P = 0.73. Phase 2 preparation did not produce higher 14-month abstinence rates than quitline referral; 3.6% (8/220) versus 2.1% [3/145; risk difference = 1.5%, 95% confidence interval (CI) = -1.8-5.0%, odds ratio (OR) = 1.8, 95% CI = 0.5-6.9]. Recycling, however, produced higher abstinence rates than quitline referral; 6.9% (15/217) versus 2.1% (three of 145; risk difference, 4.8%, 95% CI = 0.7-8.9%, OR = 3.5, 95% CI = 1.0-12.4). Recycling produced greater entry into new quit treatment than preparation: 83.4% (181/217) versus 55.9% (123/220), P < 0.0001. CONCLUSIONS: Among people interested in quitting smoking, immediate encouragement post-relapse to enter a new round of smoking cessation treatment ('recycling') produced higher probability of abstinence than tobacco quitline referral. Recycling produced higher rates of cessation treatment re-engagement than did preparation/cutting down using more intensive counseling and pharmacotherapy.

  PublisherOA PDFDOI

• Understanding what changes adults in a smoking cessation study believe they need to make to quit smoking: A qualitative analysis of pre- and post-quit perceptions.

  Psychology of Addictive Behaviors · 2022-06-23 · 3 citations

  articleOpen access

  OBJECTIVE: Most individuals who try to quit smoking will not succeed even if they use evidence-based treatment. Qualitative methods can help identify cessation treatments' limitations and suggest adaptations to increase treatment success. METHOD: Rapid qualitative analysis was conducted on data from 125 adults who smoked daily (48% female; 44% White) and participated in a smoking cessation trial and completed qualitative interviews 2 weeks prequit, reporting on changes they needed to make to quit, and 100 adults (50% female; 49% White) who completed a second interview 2 weeks postquit, reporting changes they had made. RESULTS: The anticipated changes reported prequit (in order of frequency) were as follows: identify smoking triggers (without a coping plan), focus on benefits of quitting, reduce exposure to others smoking, make other health changes, reduce exposure to nonsocial smoking cues, and reduce alcohol consumption. Many participants were unable to identify specific changes that would aid their cessation success. Changes reported postquit included the following: use the 4 D strategies (delay, drink water, deep breathing, distract), reduce exposure to nonsocial smoking cues, focus on benefits of quitting, change daily routine, make other health changes, reduce exposure to others smoking, and get support from loved ones. Most changes reported postquit were consistent with clinical practice guidelines; however, use of cessation medication was the least reported theme. CONCLUSION: Prior to quitting, over a third of participants were unable to identify changes to increase cessation success. Those who could focus on triggers and cues for smoking. Postquit, participants reported using cessation strategies encouraged during study cessation counseling. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

  PublisherDOI

• Evaluating four motivation‐phase intervention components for use with primary care patients unwilling to quit smoking: a randomized factorial experiment

  Addiction · 2021 · 10 citations

  • Medicine
  • Clinical psychology
  • Psychiatry

  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 four-factor, randomized factorial experiment. SETTING: Sixteen primary care clinics in southern Wisconsin. PARTICIPANTS: A total of 577 adults who smoke (60% women, 80% White) recruited during primary care visits who were currently willing to reduce their smoking but unwilling to try to quit. Interventions Four factors contrasted intervention components administered over a 1-year period: (i) nicotine mini-lozenge versus none; (ii) reduction counseling versus none; (iii) behavioral activation (BA) counseling versus none; and (iv) motivational 5Rs counseling versus none. Participants could request cessation treatment at any time. MEASUREMENTS: The primary outcome was 7-day point-prevalence abstinence at 52 weeks post enrollment; secondary outcomes were point-prevalence abstinence at 26 weeks and making a quit attempt by weeks 26 and 52. FINDINGS: No abstinence main effects were found but a mini-lozenge × reduction counseling × BA interaction was found at 52 weeks; P = 0.03. Unpacking this interaction showed that the mini-lozenge alone produced the highest abstinence rate (16.7%); combining it with reduction counseling produced an especially low abstinence rate (4.1%). Reduction counseling decreased the likelihood of making a quit attempt by 52 weeks relative to no reduction counseling (P = 0.01). CONCLUSIONS: Nicotine mini-lozenges may increase smoking abstinence in people initially unwilling to quit smoking, but their effectiveness declines when used with smoking reduction counseling or other behavioral interventions. Reduction counseling decreases the likelihood of making a quit attempt in people initially unwilling to quit smoking.

  PublisherOA PDFDOI

• Predictors of Smoking Cessation Attempts and Success Following Motivation-Phase Interventions Among People Initially Unwilling to Quit Smoking

  Nicotine & Tobacco Research · 2020 · 47 citations

  • Medicine
  • Clinical psychology
  • Psychology

  INTRODUCTION: Most people who smoke cigarettes are not willing (ie, 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. AIMS AND METHODS: This is a secondary analysis of a randomized factorial trial of 6 weeks of motivation-phase interventions among primary care patients (N = 517) who were initially unwilling to quit but were willing to reduce their smoking. Using logistic regression, we controlled for treatment condition and tested whether baseline or change in smoking-related constructs after 6 weeks of treatment predicted (1) making an at least 24 h QA between weeks 6 and 26 and (2) quitting success at week 26 (7-day point-prevalence abstinence among those who made a QA). Predictors included cigarettes/day, time to first cigarette, motivation to quit, quitting self-efficacy, anticipated urges to smoke if quit, positive affect, negative affect, and time spent around others who smoke. RESULTS: In multivariable models that included all smoking-related constructs, changes in the following variables predicted initiating a QA above and beyond other variables: greater baseline time to first cigarette (odds ratio [OR] = 1.60), increases in time to first cigarette (OR = 1.27), and increases in quitting self-efficacy (OR = 1.14). Increased motivation to quit predicted conversion of a QA into quitting success at 26 weeks (OR = 1.36). CONCLUSION: Predictors of making a QA differed from predictors of quitting success. Predictors of QAs and success could each serve as important treatment targets of motivation-phase interventions. IMPLICATIONS: Motivation-phase interventions for people initially unwilling to quit smoking cigarettes may be improved by striving to increase their (1) time to first cigarette and quitting self-efficacy to promote QAs and (2) motivation to quit to promote quit success. Future experimental tests of such interventions are needed to identify causal determinants of QAs and quitting success.

  PublisherOA PDFDOI

• Time‐varying effects of ‘optimized smoking treatment’ on craving, negative affect and anhedonia

  Addiction · 2020-08-24 · 7 citations

  articleOpen access

  AIMS: To identify when smoking cessation treatments affect craving, negative affect and anhedonia, and how these symptoms relate to abstinence, to help evaluate the effects of particular intervention components in multi-component treatments and accelerate treatment refinement. DESIGN: Secondary analysis of data from a two-arm randomized controlled trial. SETTING: Seven primary care clinics in Wisconsin, United States. PARTICIPANTS: Adult primary care patients who smoked daily (n = 574). INTERVENTION AND COMPARATOR: Intervention was abstinence-optimized treatment (A-OT, n = 276) comprising 3 weeks of nicotine mini-lozenges pre-target quit day (TQD), 26 weeks of combination nicotine patch and mini-lozenges post-TQD and extensive psychosocial support. The comparator was recommended usual care (RUC, n = 298), comprising brief counseling and 8 weeks of nicotine patch post-TQD. MEASUREMENTS: Time-varying effect models examined dynamic effects of A-OT (versus RUC) on the primary outcomes of nightly cigarette craving, negative affect and anhedonia from 1 week pre- to 2 weeks post-TQD. Exploratory models examined within-person relations between nicotine medication use and same-day symptom ratings. Secondary logistic regression analyses examined associations between post-TQD craving, negative affect and anhedonia and 1-month post-TQD abstinence. FINDINGS: A-OT significantly suppressed pre- and post-TQD craving (β = -0.27 to -0.46 across days) and post-TQD anhedonia (β = -0.24 to -0.38 across days), relative to RUC. Within individuals, using patches was associated with lower negative affect in RUC (β = -0.42 to -0.52), but not in A-OT. Using more mini-lozenges was associated with greater craving (β = 0.04-0.07) and negative affect (β = 0.03-0.05) early, and with lower anhedonia (β = -0.06 to -0.12) later. Greater post-TQD craving (OR = 0.68) and anhedonia (OR = 0.85) predicted lower odds of abstinence 1 month post-TQD. CONCLUSION: Time-varying effect models showed that a multi-component treatment intervention for smoking cessation suppressed significant withdrawal symptoms more effectively than recommended usual care among daily adult smokers motivated to quit. The intervention reduced craving pre- and post-target quit day (TQD) and anhedonia post-TQD.

  PublisherOA PDFDOI

• Electronically Monitored Nicotine Gum Use Before and After Smoking Lapses: Relationship With Lapse and Relapse

  Nicotine & Tobacco Research · 2020 · 8 citations

  1st authorCorresponding
  • Medicine
  • Internal medicine

  INTRODUCTION: Greater use of nicotine replacement therapy (NRT) is related to smoking cessation success, but the causal direction is unclear. This study characterized the relationship between NRT use and smoking lapse and relapse. METHODS: Participants (N = 416 smokers; 57% female, 85% White) were recruited from primary care for a smoking cessation factorial experiment and analyzed if abstaining ≥1 day in the first 2 weeks post-target quit day (TQD). Participants were randomized to counseling and 8 versus 26 weeks of nicotine patch plus nicotine gum post-TQD. Participants carried electronic dispensers that timestamped each gum use. Participants who lapsed (smoked after abstaining) within 6 weeks post-TQD were matched with nonlapsers (n = 146 pairs) on multiple variables. We compared lapsers' versus matched nonlapsers' gum use in the 5 days before and after the lapsers' first lapse. RESULTS: By week 6 post-TQD, 63% of participants lapsed. Compared with nonlapsers, lapsers used less gum 1 and 2 days pre-"lapse" and on the 5 days post-lapse. Lapsers used less gum during the 5 days post-lapse than the 5 days pre-lapse. Univariate survival analyses with lapsers showed greater gum use during both pre- and post-lapse periods predicted longer latency to relapse in the first 6 weeks. CONCLUSIONS: In a smoking cessation attempt using nicotine patch plus gum, lapsers versus matched nonlapsers used less gum immediately preceding and following their first lapse. Lower mean gum use before and after lapses predicted a more rapid escalation to relapse. Decreased nicotine gum use both precedes and follows returns to smoking during cessation attempts. IMPLICATIONS: This research examined electronically monitored nicotine gum use collected in real time and found that among smokers engaged in a quit attempt, lapsers (vs. matched nonlapsers) tended to decrease their gum use 1-2 days prior to lapsing and to further decrease their gum use from pre- to post-lapse. Decreased gum use pre-lapse may signal heightened lapse risk in 1-2 days, with lower level of gum use predicting a more precipitous course of relapse. These results encourage further exploration of objective measures of smoking medication use patterns to examine their signaling properties and to inform understanding of cessation failure. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT01120704.

  PublisherOA PDFDOI

Frequent coauthors

• Jessica W. Cook

  William S. Middleton Memorial Veterans Hospital

  44 shared

• Megan E. Piper

  43 shared

• Timothy B. Baker

  University of Wisconsin–Madison

  41 shared

• Stevens S. Smith

  University of Wisconsin–Madison

  28 shared

• Michael C. Fiore

  University of Wisconsin–Madison

  26 shared

• Douglas E. Jorenby

  University of Wisconsin–Madison

  20 shared

• Robin J. Mermelstein

  Vanderbilt University

  17 shared

• Linda M. Collins

  New York University

  17 shared