About

Robert A. Schnoll, Ph.D., is a faculty member in the Department of Psychiatry at the University of Pennsylvania's Perelman School of Medicine. His educational background includes a B.A. and M.A. in Psychology from York University and Connecticut College, respectively, and a Ph.D. in Experimental Psychology from the University of Rhode Island. His research focuses on areas related to public health initiatives, nicotine addiction, and cancer research, as evidenced by his roles as Program Leader and Director at the Center for Interdisciplinary Research on Nicotine Addiction and his involvement with the Abramson Cancer Center. He also serves as a Senior Fellow at the Center for Public Health Initiatives and the Penn Implementation Science Center, contributing to community outreach, global initiatives, and patient care efforts at Penn Medicine.

Research topics

• Physical therapy
• Family medicine
• Internal medicine
• Medicine
• Psychiatry

Selected publications

• Text-Message Outreach to Connect Adolescents and Young Adults to Nicotine Treatment: A Pilot Study in Pediatric Primary Care

  Academic Pediatrics · 2026-04-10

  articleOpen access

  OBJECTIVE: Strategies are needed to increase adolescent and young adult (AYA) engagement in nicotine use treatment. We assessed feasibility, acceptability, and clinical impact of text-message outreach connecting AYA to nicotine use treatment across a large health network. METHODS: This quality improvement pilot study included 2 phases of text-message outreach following primary care visits. All patients aged 13 to 22 completed an in-visit confidential electronic health questionnaire assessing past 30-day nicotine use. Phase 1: patients selected whether to receive text outreach about quitting resources. Phase 2: all patients reporting nicotine use who provided a phone number on the electronic questionnaire received automatic text outreach. Treatment options included a text-messaging program (This is Quitting) and/or nicotine replacement therapy. Outcome measures included feasibility (phone number provision), acceptability (treatment interest), and clinical impact (treatment connection). RESULTS: Among 23,411 AYA screened from February to June 2024, 919 (3.9%) reported past 30-day nicotine use. For feasibility, 90% and 91% of AYA who reported nicotine use provided a phone number in each phase, respectively. Acceptability was higher in Phase 1 versus Phase 2 (11% vs 2%), but clinical impact was similar (2% vs 1%). Overall, 824 patients who reported nicotine use provided a phone number (90%), 59 expressed treatment interest (6%), and 16 connected to treatment (2%). CONCLUSIONS: Text-message outreach was feasible but achieved low acceptability and clinical impact. Barriers included a high rate of messages blocked as spam, limited interventions for AYA with infrequent nicotine use, and barriers to accessing NRT related to cost and confidentiality.

  PublisherOA PDFDOI

• Behavioral activation for smoking cessation may improve bodily pain in adults with lifetime major depressive disorder

  Journal of Affective Disorders · 2026-04-21

  articleOpen access
  PublisherOA PDFDOI

• Differences in Cognition and Smoking Abstinence Rates Among People With and Without HIV

  Drug and Alcohol Dependence · 2025-02-01

  article
  PublisherDOI

• A formative study to develop nudges informed by behavioral economics to increase engagement with tobacco treatment among people who smoke receiving care for HIV

  Drug and Alcohol Dependence Reports · 2025-06-25 · 1 citations

  articleOpen accessSenior authorCorresponding

  The rate of tobacco use among people with HIV (PWH) is >2 fold higher vs. the general population and accounts for more life years lost than the virus. Yet, evidence-based tobacco treatments are uncommonly offered by clinicians or used by PWH. Biases informed by behavioral economics concerning tobacco treatments may drive this practice gap. This formative study tested nudges in the form of messages that target four behavioral economic biases – status quo, availability, omission, and focusing effect – to determine which message would be most strongly associated with PWH willingness to use or clinician referral for tobacco treatment; 19 clinicians and 75 PWH assessed pair-wise comparisons of the four messages with instructions to select the message that, if sent via text or a patient portal, or via the electronic medical record (EMR) at a clinic visit, would increase willingness to use or provide a referral for tobacco treatment. There were significant differences in reported preference across the messages among PWH (χ 2 [3]=24.79, p <0.001) and clinicians ( χ 2 [3]=33.85 , p <0.001). The message that addressed focusing effect bias was most preferred for increasing use and referral for tobacco treatment among PWH (29%) and clinicians (38%). A message that addressed focusing effect bias was associated with greater interest in the use of or referral for tobacco treatment within HIV care. These results can help design a clinical trial to test the effectiveness of these messages within the clinical workflow for their effects on actual use of and referral for tobacco treatment for PWH. • Messages targeting focusing effect bias related to tobacco treatment in HIV care. • Behavioral economics can provide a framework for implementing tobacco treatment. • Results can guide subsequent implementation science studies of tobacco treatment.

  PublisherDOI

• Baseline predictors of smoking cessation among individuals with current or past major depressive disorder following treatment with varenicline and intensive behavioral treatment

  Drug and Alcohol Dependence · 2025-06-21

  article
  PublisherDOI

• Training a Smoking Status Probabilistic Model Using Cotinine Levels in a Large Claims Database

  Nicotine & Tobacco Research · 2025-10-30

  articleOpen access

  INTRODUCTION: Smoking status is an important confounder for many epidemiologic studies, yet it is not well documented in common sources of real-world data, including administrative claims. Probabilistic models can be used to create a proxy for smoking status, yet most published models have been trained using self-reported data. The objective of this study was to train a smoking status probabilistic model using cotinine values available in a large claims database. METHODS: Beneficiaries were included if they had at least one cotinine measurement and were categorized as a "current smoker" if their serum or plasma cotinine value was ≥5 ng/mL or urine cotinine value was ≥30 ng/mL. Predictors were collected across one year prior to the cotinine assessment date. The model was fit using logistic regression with stepwise forward selection. Model performance was assessed using discrimination and calibration. RESULTS: The final model yielded an area under the receiver operating characteristic curve of 0.77 (95%CI:0.75-0.78) and was well calibrated across most prediction deciles. The strongest predictors included diagnosis codes for smoking and drug abuse, and number of medications. The model was found to be highly specific, yet not sensitive at probability cutoffs ≥0.2. CONCLUSIONS: A smoking status model was developed and internally validated for application in claims data, using available cotinine values to define smoking status and found to have acceptable discrimination and calibration. The model is based on 26 predictors, fewer than other similar published smoking status models. External validation of the model should be a next step toward utilizing the model for epidemiological research. IMPLICATIONS: This study tests the utility of cotinine values to validate a smoking status probabilistic model, which has not been done in the literature to date. The results were robust to various cotinine levels used to define smoking status, per current guidance. The final model uses only 26 factors to predict smoking status, simplifying the application of the model in other claims databases.

  PublisherOA PDFDOI

• A multi-site study examining the tobacco withdrawal trajectory in people with tobacco and cannabis co-use

  Drug and Alcohol Dependence · 2025-07-03

  articleOpen access

  BACKGROUND: Approximately 30 % of people who use tobacco also use cannabis, and rates of co-use are rising. Relative to people who use tobacco alone (TO), individuals who co-use tobacco and cannabis (TC) experience greater difficulty with tobacco cessation, yet mechanisms underlying this phenomenon remain unexplored. Leveraging data from a multi-site, double-blind clinical trial for tobacco cessation, we compared the trajectory of tobacco withdrawal, a strong predictor of relapse, between TC and TO during 11-weeks of tobacco treatment. METHODS: People seeking treatment for tobacco were randomized to one of three arms (placebo, nicotine patch or varenicline) and followed for 11-weeks. Participants were parsed according to their cannabis use status determined by a cannabis-positive urine toxicology at screen (N = 1246). We selected participants with end-of-treatment biochemically verified 7-day point prevalence tobacco abstinence (N = 330; TC, n = 55 and TO, n = 275) and examined group differences in tobacco withdrawal severity using the Minnesota Nicotine Withdrawal Scale (MNWS) at baseline, week 1, 4, 8, and week 11 (end-of-treatment). RESULTS: Controlling for age, treatment arm, and site, we found a significant interaction (group x time) effect for withdrawal severity (p < 0.01). Bonferroni-corrected post-hoc comparisons revealed that relative to TO, TC had elevated withdrawal scores at week 1 (TC, M=9.3 ± 5.5; TO, M=7.1 ± 5.6; p < 0.01); no other timepoints showed between-group differences. CONCLUSIONS: People who co-use experience greater tobacco withdrawal severity one-week post abstinence compared to people who only use tobacco. Personalized interventions that target immediate tobacco withdrawal and/or cannabis use may help improve tobacco cessation rates for people who co-use both substances.

  PublisherDOI

• The role of alternative reinforcers in smoking outcomes among people with and without HIV.

  Psychology of Addictive Behaviors · 2025-06-05

  articleOpen access

  OBJECTIVE: People with HIV (PWH) smoke at higher rates than people without HIV (PWOH). Alternative reinforcers, or behaviors that replace (substitute reinforcers) or maintain (complementary reinforcers) smoking, are associated with smoking outcomes but have not been studied among PWH. This observational study assessed whether alternative reinforcers changed during a quit attempt among PWH and PWOH and whether the associations differed between groups. METHOD: The parent study included 274 participants (93 PWH and 181 PWOH) who sought treatment for smoking cessation in a 12-week program. The present analyses were limited to 173 (73 PWH and 100 PWOH) study completers. The primary outcomes were changes in substitute and complementary reinforcers at the end of treatment (EOT; week 12) measured using the Pleasant Events Schedule. We performed linear regressions in the overall sample and then stratified by HIV status for each alternative reinforcer. The time (baseline; week 0 vs. EOT) by smoking status at EOT (abstinent vs. nonabstinent) interaction was tested. RESULTS: = .04). CONCLUSIONS: Declines in complementary reinforcers were associated with smoking cessation outcomes among PWH. These findings partially support results from prior literature, suggesting that addressing complementary reinforcers during smoking cessation treatment may be crucial in improving quit rates among PWH. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

  PublisherDOI

• Building capacity and equity in implementation science: evaluation of a national mentored training program

  Implementation Science · 2025-08-01 · 1 citations

  articleOpen access

  BACKGROUND: As implementation science evolves, it is essential to expand training capacity to build intellectual capital continually. The demand for training in implementation science far outstrips the current supply. This paper presents the methods and findings from the Institute for Implementation Science Scholars (IS-2) national training program (2020-2024). METHODS: The IS-2 was a US-based, two-year training program that provided mentored training for early- and mid-career researchers interested in applying implementation science principles to reduce the burden of chronic disease disparities. Scholars attended two annual, 2.5-day intensive training sessions, received ongoing remote and in-person mentoring, and were supported by other activities (e.g., pilot funding, networking events, mock grant reviews). A quasi-experimental (pre/post) design evaluated IS-2 on skill building, mentoring, and networking. We used descriptive and inferential statistics to characterize the sample and analyzed primary outcomes and networks. RESULTS: A majority of the 59 scholars were female (86%), white (61%), and assistant professors (61%). Forty-three implementation science competencies were assessed; all skill categories increased from baseline to 10 months and from 10 to 22 months post-enrollment. The relative change was largest for advanced competencies. Scholars rated their assigned mentors as highly competent across all mentoring competencies. A vibrant mentoring network was established, with the highest number of network ties in 2023, facilitating manuscript publication and joint research. Under-represented scholars (n = 21) had similar skill gains relative to scholars not-under represented, yet were less likely to hold network ties in 2024. After accounting for other predictors, sharing a mentoring relationship within the previous two years was a strong positive predictor of forming collaboration ties between network members in 2024 (odds ratio = 9.66; 95% confidence interval = 6.34-14.74). IS-2 showed multiple impacts of practice and societal relevance (e.g., improving intervention reach, building cost data in patient decision aids). CONCLUSIONS: The approaches used in IS-2 effectively helped mentees gain skills in implementation science, experience mentorship for career development, and establish collaborative networks. The results demonstrate how the field can develop and utilize a mentoring program to reach diverse scholars, incorporate equity into curricula, and conduct high-quality mentoring to address critical implementation science topics.

  PublisherOA PDFDOI

• Use of organizational change strategies and personalized agency feedback improves addressing tobacco in behavioral health outpatient treatment settings

  Frontiers in Health Services · 2025-10-07

  articleOpen access

  Introduction Implementing evidence-based interventions for tobacco use disorder (TUD) in community mental health agencies is critical, given the low adoption rates of these interventions and the high rates of TUD among patients, contributing to the high morbidity and shortened lifespan of this population. Implementation efforts require enhancing organizational preparedness to integrate these evidence-based interventions. Purpose When the Addressing Tobacco Through Organizational Change (ATTOC) model was evaluated in a cluster-randomized trial (with 13 clinics, 610 clients, and 222 staff) and compared with an education-only intervention, ATTOC proved to be better at having more TUD treatment, policies, and staff skills. This paper presents a secondary analysis focusing only on the ATTOC sites, examining whether clinic-level preparedness is associated with increased implementation activities and estimating the combined direct and indirect impact on patient referrals to evidence-based TUD interventions. Methods Seven sites applied the ATTOC model over 9 months, with the ATTOC Environmental Scan (ES) conducted at baseline and 3, 6, and 9 months to assess the following: (1) the environment inside and outside the building, (2) staff training and personal tobacco use, (3) clinical TUD services and documentation, and (4) tobacco policies. Summary statistics are provided, and generalized linear mixed model analyses for repeated measures were used to assess time trends and relationships among composite preparedness, activities, and number of referrals. Results Over the 9-month period, significant improvements were observed in ES composite preparedness ( p &amp;lt; 0.001) and individual ES areas ( p &amp;lt; 0.001 for each). Eight out of 11 ATTOC Dashboard items showed significant changes, including increased number of patients treated ( p = 0.002); tobacco discussions ( p = 0.022); provision of educational brochures ( p = 0.034); referrals to a Nicotine Anonymous group ( p &amp;lt; 0.001), an in-house wellness or tobacco group ( p &amp;lt; 0.001), and state quitline ( p = 0.012); and documentation in treatment plans ( p = 0.008). Both composite preparedness ( p = 0.006) and composite activities ( p &amp;lt; 0.001) were significantly associated with the number of composite referrals. Conclusion Significant TUD intervention uptake was found over time through the ATTOC model organizational change intervention and tracking tools.

  PublisherOA PDFDOI

Recent grants

• NIH Grant R01DA025078

  NIH · $3.1M · 2015

• Testing Novel Pharmacogenetic and Adherence Optimization Treatments to Improve the Effectiveness of Smoking Cessation Treatments for Smokers with HIV

  NIH · $3.4M · 2019–2026

• NIH Grant R01CA126969

  NIH · $1.7M · 2013

• NIH Grant R01CA095678

  NIH · $2.8M · 2008

• NIH Grant R21DA026889

  NIH · $433k · 2011

Frequent coauthors

• Frank T. Leone

  University of Pennsylvania

  107 shared

• Rachel F. Tyndale

  Centre for Addiction and Mental Health

  70 shared

• Jamie S. Ostroff

  Memorial Sloan Kettering Cancer Center

  60 shared

• Linda Sarna

  American Academy of Nursing

  58 shared

• E. Paul Wileyto

  52 shared

• Lisa Sanderson Cox

  University of Kansas Medical Center

  50 shared

• Catherine M. Alfano

  49 shared

• Glen D. Morgan

  University of North Carolina at Chapel Hill

  49 shared

Labs

• Robert A. Schnoll LabPI