Search

Background: Ensuring equitable access to smoking cessation services for cancer patients is necessary to avoid increasing disparities in tobacco use and cancer outcomes. In 2017, the Cancer Center Cessation Initiative (C3I) funded National Cancer Institute (NCI)-designated Cancer Centers to integrate evidence-based smoking cessation programs into cancer care. We describe the progress of C3I Cancer Centers in expanding the reach of cessation services across cancer populations. Methods: Cancer centers (n=17) reported on program characteristics and reach (the proportion of smokers receiving evidence-based cessation treatment) for two 6-month periods. Reach was calculated overall and by patient gender, race, ethnicity, and age. Results: Average reach increased from 18.5% to 25.6% over 1 year. Reach increased for all racial/ethnic groups, and in particular for American Indian/Alaska Native (6.6-24.7%), Asian/Native Hawaiian/Pacific Islander (7.3-19.4%), and black (18.8-25.9%) smokers. Smaller gains in reach were observed among Hispanic smokers (19.0-22.8%), but these were similar to gains among non-Hispanic smokers (18.9-23.9%). By age group, smokers aged 18-24 years (6.6-14.5%) and >65 years (16.1-24.5%) saw the greatest increases in reach. Conclusion: C3I Cancer Centers achieved gains in providing smoking cessation services to cancer patients who smoke, thereby reducing disparities that had existed across important subgroups. Taking a population-based approach to integrating tobacco treatment into cancer care has potential to increase reach equity. Implementation strategies including targeted and proactive outreach to patients and interventions to increase providers' adoption of evidence-based smoking cessation treatment may advance reach even further.

Objectives: This study investigated a) racial/ethnic differences in past-year discrimination experiences and b) associa­tions between discrimination and smoking abstinence. Design: Prospective, longitudinal analysis of smoking status. Perceived past-year discrimi­nation was assessed at baseline. ANCOVAs and intent-to-treat hierarchical logistic regressions were conducted. Setting: Dual-site (Tampa, FL and Miami, FL) randomized controlled trial testing the effects of a group cessation intervention plus pharmacotherapy. Participants: Treatment-seeking adult smokers (N=347; non-Hispanic White, non-Hispanic African American/Black, or Hispanic). Main Outcome Measures: Biochemically verified 7-day point prevalence abstinence (7-day ppa) was assessed immediately post-intervention and at 6-month follow-up. Results: After controlling for covari­ates, African Americans/Blacks reported greater perceived discrimination compared with non-Hispanic Whites (P=.02), and Hispanics (P=.06). Non-Hispanic Whites and Hispanics did not differ in perceived racial/ethnic discrimination experiences over the past year. Irrespective of race/ ethnicity, past-year perceived discrimina­tion was inversely associated with 7-day ppa, both post-intervention (AOR=.97, CI: .95-.99) and at 6-months (AOR=.98, CI: .96-.99). Among African Americans/Blacks, past-year perceived discrimination was inversely associated with 7-day ppa, both post-intervention (AOR=.95, CI: .92-.97) and at 6-months (AOR=.97, CI: .94-.99). Perceived discrimination was unrelated to 7-day ppa among Hispanics. Among non-Hispanic Whites, past-year perceived discrimination was inversely associated with post-intervention 7-day ppa (AOR=.95, CI: .91-.99), but not 6-months. Conclusions: Perceived racial/ethnic discrimination was greater among African American/Black smokers compared with non-Hispanic Whites. Perceived discrimina­tion was negatively associated with tobacco cessation in the full sample, and for African Americans at 6-months post-intervention. These data have implications for interven­tion delivery and health disparities. Ethn Dis. 2020;30(3):411-420; doi:10.18865/ed.30.3.411

Objective: The exclusion criteria of tobacco cessation randomized clinical trials (RCTs) may have unintended consequences on inclusion and cessation disparities. We examined racial/ethnic differences in: a) ex­clusion from a group-based cessation RCT; and b) reasons for exclusion.Design: Quasi-experimental. Inclusion criteria were self-identification as African American/Black, non-Hispanic White, or Hispanic (any race), adults, minimum five cigarettes/day or carbon monoxide reading of ≥ 8 parts per million (ppm), interest in quitting, and spoke/read English. Data were obtained from a parent trial, which is ongo­ing and will be completed in 2019. Analyses for our present study on participant screen­ing and enrollment were conducted in 2018.Main Outcome Measures: Study ineligi­bility, and reasons for exclusion (contra­indications for nicotine patch use, serious mental illness [SMI, eg, bipolar disorder or schizophrenia], alcohol dependence or illicit drug use, current tobacco treatment, attendance barriers [eg, transportation], and other concerns [eg, aggressive, intoxicated, disruptive, visibly ill]).Results: Of 1,206 individuals screened, 36% were ineligible. The most frequent reasons were SMI (28%), alcohol depen­dence or drug use (10%), and attendance barriers (7%). Ineligibility was greater among African Americans (42%) and Hispan­ics (37%), compared with Whites (24%; P

Tobacco smoking is responsible for one out of every five deaths in the US, according to the Centers for Disease Control and Prevention (CDC). Recent advances in treatment delivery include technology-based mobile health approaches, which seek to deliver real-time feedback to smokers to aid quit attempts and mitigate lapses. With regard to the measurement of smoking, clinical trials rely on participant self-report and/or biochemical verification of smoking status to evaluate outcomes. Wearable sensors have the potential to improve current approaches by providing personalized feedback and objective verification of smoking status ( Burns, 2000 ). In this paper, we describe the development of a novel smoking cessation system that combines motion detection and an Android software application to monitor smoking in real-time. In this system, a personalized smoking cessation plan will be created based on the goal of complete cessation or smoking reduction. Once the plan is created, the mobile system will monitor the users׳ smoking activity and provide feedback. An LSTM algorithm has been computed to train and test the motion data, which was collected from two armbands, to detect smoking and non-smoking motions. The internet message service will be used to remind users to stick to their plan when the sensor detects current smoking. Related video links are pushed and pulled to the users via Short Message Service (SMS) to support smoking cessation. Findings have implications for tobacco cessation treatment delivery and assessment of smoking status.

BACKGROUND Behavioral intervention studies in older breast cancer survivors, particularly older African American (AA) and socioeconomic status-disadvantaged breast cancer survivors, are lacking. To inform future studies, the authors examined recruitment strategies in older breast cancer survivors who participated in an exercise intervention study. METHODS IMPROVE is a randomized trial designed to evaluate a group-based exercise intervention versus a support group (ClinicalTrials.gov identifier, NCT02763228). Participants were aged ≥65 years who had survived stage I through III breast cancer and were within 5 years of treatment completion. Participants were recruited through multiple approaches, including peripheral, linguistic, and constituent-involving strategies that incorporated the identification of potentially eligible patients from 3 local hospitals and from State of Ohio registries and through direct clinician and community organization referrals. RESULTS Between October 2016 and November 2019, 7487 patients were screened, 4790 were potentially eligible, and 213 were randomized into the study. The eligible:randomization rates were 4.4% overall and 84%, 8%, and 2% for recruitment using direct referrals, hospital registries, and state registries, respectively. The median age of the randomized cohort was 70 years (range, 65-88 years) and included 44% AA and 44% socioeconomic status-disadvantaged breast cancer survivors. Compared with all registry-eligible patients, directly referred-eligible patients were more likely to be AA versus Non-Hispanic White (41% vs 19%; P = .006), to be contacted successfully (100% vs 33%; P < .0001), and to accept study participation (88% vs 16%; P < .0001). CONCLUSIONS Direct referrals appeared to be the most efficient strategy for recruiting AA survivors. Behavioral intervention studies seeking to target older AA and socioeconomic status-disadvantaged breast cancer survivors should include strategies that foster direct referrals to study participation.

Background African Americans (AA) and socioeconomic status (SES) disadvantaged older breast cancer survivors (BCS) are more likely to experience poor functional and health outcomes. However, few studies have evaluated the putative beneficial effects of exercise on these outcomes in older racial minority and SES-disadvantaged BCS. Methods This is a mixed-methods study that includes a randomized-controlled trial, “IMPROVE”, to evaluate a group-based exercise intervention compared to a support group program in older BCS, followed by post-intervention semi-structured interviews to evaluate the intervention. The trial aims to recruit 220 BCS with 55 in each of four strata defined by race (AA versus Non-Hispanic Whites) and SES (disadvantaged vs. non-disadvantaged). Participants are ≥65 years old and within five years of treatment completion for stage I-III breast cancer. Participants are randomized to a 52-week, three sessions/week, one-hour/session, moderate intensity aerobic and resistance group exercise intervention, (n = 110) or a 52-week, one hour/week, support group intervention [attention-control arm], (n = 110). The first 20 weeks of both programs are supervised and the last 32 week s , unsupervised. The primary outcome is the change in Short Physical Performance Battery (SPPB) Scores at 20 weeks from baseline, between the two arms. Secondary outcomes include change in SPPB scores at 52 weeks, change in body composition and biomarkers, at 20 and 52 weeks from baseline, between arms. Discussion Results of the trial may contribute to a better understanding of factors associated with recruitment, and acceptability, and will inform future exercise programs to optimally improve health outcomes for older BCS.

INTRODUCTION: Recruiting racial/ethnic minorities in smoking cessation trials is a priority. This study described lessons learned from recruiting a diverse sample of African American, White, and Hispanic/Latinx smokers in a smoking cessation trial. METHODS: We implemented a 42-month recruitment campaign utilizing reactive (e.g., word-of-mouth, newspaper, radio, online ads, flyers, community partnerships) and proactive (e.g., direct invitations) strategies. We included 821 participants in the analysis. We described our recruitment strategies’ implementation, their enrollment yield and rate (number enrolled/number screened) by race/ethnicity, and direct cost-per-participant (CPP: total cost/number of enrolled) for paid strategies. RESULTS: Enrollment yields were higher using reactive strategies than proactive strategies (94.3% vs. 5.7%). The top source of enrollment was word-of-mouth among African Americans (36%) and Whites (44%), and flyers among Hispanics/Latinxs (34%). Proactive recruitment, word-of-mouth, and flyers were more successful among African Americans than other groups. Newspaper and online ads were more successful among Hispanics/Latinxs than other groups (P

Introduction Research has shown that African Americans gain more than average weight after smoking cessation. However, African Americans have been underrepresented in post-cessation weight gain research. The current study examined 1) the pattern of weight gain and 2) the association between smoking status and weight gain in a sample of African Americans seeking smoking cessation treatment. Methods Data were drawn from a randomized controlled trial testing the efficacy of a 4-week culturally specific smoking cessation cognitive behavioral therapy (CBT) intervention among African American smokers (N = 342). Weight was measured and self-reported smoking status was biochemically verified at baseline, end of counseling, 3-, 6-, and 12-month follow-ups. Random effects multilevel modeling was used to examine weight gain over twelve months post CBT, and a fully unconditional model tested the pattern of weight gain over time. Smoking status was included as a time-varying factor to examine its effect on weight gain, controlling for potential confounding variables. Results Weight significantly increased among those who remained abstinent over 12 months post CBT [average gain of seven lbs. (three kg)]. Controlling for covariates, abstinence was predictive of the rate of weight gain for those with high weight concern. Conclusions Weight gain among African American abstainers was comparable to the average post-cessation weight gain observed among the general population. It is possible that exposure to CBT (culturally specific or standard) may have mitigated excessive weight gain. Future research should assess predictors of weight gain in African American smokers to inform future smoking cessation interventions and help elucidate factors that contribute to tobacco- and obesity-related health disparities.

Racial/ethnic disparities in tobacco cessation are such that U.S. minorities have greater difficulty quitting compared to White non-Hispanics. Group differences in distress (i.e., perceived stress and depressive symptoms) may contribute to cessation disparities. The allostasis model of health suggests that the toll of chronic stress experienced by racial/ethnic minorities may lead to dysregulation of the physiological stress system and drug use. Previous research suggests that group cognitive behavioral therapy (CBT) for tobacco cessation addresses distress as a modifiable mechanism and has the potential to reduce/eliminate disparities. The present study is a dualsite randomized controlled trial aimed at evaluating the efficacy of group CBT in eliminating racial/ethnic differences in smoking cessation and distress. The study utilizes a [2 (intervention: group CBT or group general health education [GHE]) × 3 (race/ethnicity: African American/Black, Hispanic, White)] factorial design by randomizing 225 adult smokers from the community. Both interventions provide eight counseling sessions and eight weeks of nicotine patch therapy. Assessments occur at the end-of-therapy, and at 3-, 6-, and 12-months. Generalized longitudinal mixed modeling will be used to test our primary abstinence outcome, biochemically-confirmed 7-day point prevalence abstinence at 12-months. We hypothesize that group CBT will reduce or eliminate racial/ethnic differences in perceived stress, depressive symptoms, and smoking cessation compared to group GHE. We also hypothesize that reductions in physiological distress, assessed by salivary cortisol, will mediate racial/ethnic group differences in smoking cessation, particularly among racial/ethnic minorities. This study has implications for eliminating disparities in psychosocial factors related to tobacco use and cessation. Trial registration: Clinicaltrials.gov NCT02511236 . Registered on July 27, 2015.

Tobacco cessation after cancer diagnosis leads to better patient outcomes. However, tobacco treatment services are frequently unavailable in cancer care settings, and multilevel implementation challenges can impede uptake of new programs. The National Cancer Institute (NCI) dedicated Cancer Moonshot funding through the Cancer Center Cessation Initiative (C3I) for NCI-Designated Cancer Centers to implement or enhance the implementation of tobacco treatment services. We examined a pragmatic application of the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate tobacco treatment programs implemented within Cancer Centers funded through C3I. Using three C3I-funded Centers as examples, we describe how each RE-AIM construct was operationalized to evaluate the implementation of a wide range of cessation services (e.g., tobacco use screening, counseling, Quitline referral, pharmacotherapy) in this heterogeneous group of cancer care settings. We discuss the practical challenges encountered in assessing RE-AIM constructs in real world situations, including using the electronic health record (EHR) to aid in assessment. Reach and effectiveness evaluation required that Centers define the setting(s) where cessation services were implemented (to determine the "denominator"), enumerate the patient population, report current patient tobacco use, patient engagement in tobacco treatment, and 6-month cessation outcomes. To reduce site heterogeneity, increase data accuracy, and reduce burden, reach was frequently captured via standardized EHR enhancements that improved the identification of current smokers and tobacco treatment referrals. Effectiveness was determined by cessation outcomes (30-day point prevalence abstinence at 6-months post-engagement) assessed through a variety of data collection approaches. Adoption was measured by the characteristics and proportion of targeted cancer care settings and clinicians engaged in cessation service delivery. Implementation was assessed by examining the delivery of tobacco screening assessments and intervention components across sites, and provider-level implementation consistency. Maintenance assessments identified whether tobacco treatment services continued in the setting after implementation and documented the sustainability plan and organizational commitment to continued delivery. In sum, this paper demonstrates a pragmatic approach to using RE-AIM as an evaluation framework that yields relevant outcomes on common implementation metrics across widely differing tobacco treatment approaches and settings.

Stress is robustly associated with tobacco smoking and relapse. African Americans experience greater difficulty quitting compared to whites, yet no studies have examined race differences in physiological stress biomarkers during a quit attempt. This pilot study compared cortisol levels among treatment-seeking African American and white smokers, and relapse rates. Adult smokers (N = 115, n = 72 African American, n = 43 White) received eight sessions of group cognitive behavioral therapy plus transdermal nicotine patches. Assessments included demographics, salivary cortisol (collected at session 1, the end-of-therapy [EOT], and one-month post-therapy), and carbon monoxide-verified smoking relapse. Overall, cortisol levels declined over the course of the day at baseline, the EOT, and the one-month follow-up. African Americans exhibited lower cortisol levels compared to Whites at baseline and the EOT, but not at the one-month follow-up. In addition, African American smokers exhibited flatter slopes compared to Whites at each time point. Relapse rates were greater among African Americans at the EOT and one-month follow-up. The attenuated cortisol pattern observed in African Americans may indicate hypothalamic-pituitary-adrenal axis (HPA) exhaustion and aid our understanding of tobacco-related disparities. There is a need to focus on stress mechanisms and specific intervention approaches in order to eliminate racial/ethnic differences.

Cigarette smoking is highly prevalent among persons living with the human immunodeficiency virus (HIV) (PLWH), with rates as high 50% as compared to 14% in the general U.S. population. Tobacco use causes morbidity and mortality in PLWH, and tobacco-related harm is substantially higher in PLWH than smokers in the general population, providing the scientific premise for developing effective tobacco cessation interventions in this population. To better address this issue, we conducted six focus group sessions with 45 African American smokers who are living with HIV to understand the barriers to smoking cessation and the strategies that would be helpful to overcome these barriers. We organized our findings by the Phase-Based Model of Smoking Treatment to understand the intervention components that are needed at each phase to help PLWH successfully quit smoking. Participants in our focus group sessions articulated key components for incorporation into tobacco cessation intervention for PLWH: a personalized plan for quitting, reminders about that plan, and a support system. Participants thought that their HIV and tobacco use were disassociated. Participants described barriers to the use of pharmacotherapy, including adverse side effects of the gum and patch and concerns about the negative health effects of some oral medications. Substance use was identified as a commonly co-occurring condition as well as a barrier to successfully ceasing to smoke tobacco products. In summary, these findings offer information on the components of a tobacco cessation intervention for PLWH, namely reminders, a support system, substance use treatment, and monitoring to prevent relapse.

Introduction Text-messaging programs for smoking cessation improve abstinence outcomes in the general population. However, little is known about engagement and abstinence outcomes among African Americans in text-messaging smoking cessation programs. The current study compares engagement and abstinence between Blacks and Whites in the National Cancer Institute’s SmokefreeTXT program. Method Data were from Blacks (n = 1333) and Whites (n = 7154) who enrolled in the 6-week SmokefreeTXT program between August 2017 and June 2018. We assessed the association between race and program initiation and completion; responses to weekly smoking cessation, mood, and craving assessments; and self-reported abstinence using multivariable logistic regression. Results Blacks and Whites initiated the program at a similar frequency, yet Blacks were more likely to complete the program (adjusted odds ratio [AOR] = 1.71, 95% confidence interval [CI] = 1.43 to 2.06). Blacks were less likely to respond to all seven abstinence, mood, and craving assessments (eg, AOR of quit day responses = 0.63, 95% CI = 0.51 to 0.77; 6-week AOR = 0.50, 95% CI = 0.34 to 0.72). Self-reported abstinence was lower among Blacks for all seven smoking assessments (eg, quit day abstinence AOR = 0.52, 95% CI = 0.41 to 0.68; 6-week abstinence AOR = 0.58, 95% CI = 0.38 to 0.89). Conclusion Although Blacks were more likely than Whites to complete the SmokefreeTXT program, they were less likely to engage with the program by responding to assessment questions and had lower abstinence rates. Qualitative research may reveal unique barriers to engagement among Blacks. Implications Black smokers enrolled in a nationwide mobile smoking cessation program at a rate comparable to White smokers. However, they were significantly less likely to engage with the program or quit smoking. This study highlights the need to examine barriers to cessation for Black smokers.

Cigarette smoking is the primary preventable cause of death and disease worldwide. Studies reveal that smoking is associated with psychiatric symptoms, sociodemographic characteristics, social stressors, and lack of social support. In general, smokers report poorer mental health and benefit from support to be able to quit smoking (Jorm et al., 1999). In this paper, a tailored smoking cessation system has been developed in which the counseling and support is delivered via video-messaging. The system engages users in adaptive motivating video access. Users can interact with the system and the system selects the best matching video for them by processing their messages using Natural Language Processing (NLP). We have tailored 77 videos for interactive contents that encompass important issues users might face during the process of smoking cessation. A novel application-based data driven approach has been taken for categorizing videos to push to participants. The approach is based on analyzing 750 messages of people in the cessation process. We observed that most of the messages’ contents were about smoking health effects, cravings, triggers, relapse, positive mood, low cessation self efficacy, medications, and culturally specific targeting inquiries. Considering these categories, videos are categorized to the corresponding groups by an intelligent approach. The information underlying the data driven categories allows for improving and facilitating smoking status assessment. The system has the potential for improving future smoking cessation decision-making adaptive interventions and health monitoring systems. The goal is to tailor the system to meet the needs of the users in real-time and maximize the potential impact.

e24052 Background: We conducted an exercise study to IMPROVE health outcomes in older breast cancer survivors (BCS) from diverse racial and socioeconomic backgrounds. Here, we report cohort recruitment strategies and baseline characteristics. Methods: ‘IMPROVE’ is a randomized trial, designed to evaluate a group-based exercise intervention compared to support group. Participants were ≥ 65 years, had stage I-III breast cancer and within five years of treatment completion. Enrollment target was 220 participants, 25% in each of four strata defined by race (AA versus Non-Hispanic Whites [NHW]) and SES (low vs. high). Participants were recruited through hospital-based tumor registries, the state tumor registry or direct referrals. Results: Between October 2016 and November 2019, 7487 patients were screened, 4790 were potentially eligible, 230 were consented and 213 randomized into the study. The Eligible-to-Randomization rates were 4.4% overall, and 84%, 8%, and 2% for recruitment utilizing direct referrals, hospital and state registries, respectively. Median age of the randomized cohort was 70 years (range: 65-88 years) and included 25% AA/Low SES, 20% AA/High SES, 19% NHW/Low SES and 36% NHW/High SES Older BCS. Compared with registry-eligible patients, directly referred patients were more likely to be AA vs. NHW (41% vs. 19%, p = 0.003) and to accept study participation (88% vs. 16%, p < 0.0001). Conclusions: Direct referrals resulted in the highest recruitment yield and was the most effective strategy for recruiting AA patients. Behavioral intervention studies seeking to target older BCS from racial minority and SES disadvantaged backgrounds should focus on strategies that foster direct referrals to study participation. Clinical trial information: NCT02763228 .

Introduction Previous research indicates that marijuana use may be interrelated with combustible tobacco use among U.S. adolescents and young adults. However, little is known about this relationship during older adulthood. The purpose of this study was: 1) examine the prevalence of past-month marijuana, cigarette and cigar use, and 2) assess the associations between demographic and tobaccouse variables with past-month marijuana use, among a nationally representative sample of U.S. adults 50 years and older. Material and Methods Data are from the public-use files of the 2013 National Survey on Drug Use and Health (NSDUH). The sample consisted of 6325 adults aged ≥50 years. Results Overall, 2.98% (N=216) of the sample reported past-month marijuana use; higher prevalence was noted for those who were past-month users of cigarettes (15.62%, N=1162) and lower prevalence was noted for those who were past-month users of cigars (2.68%, N=176). After accounting for covariables, past-month cigarette use was the strongest predictor of past-month marijuana use (adjusted odds ratio [AOR]=5.19, 95% CI, 3.51-7.66). Additionally, past-month cigar use showed a positive association with past-month marijuana use (AOR=2.41, 95% CI, 1.23-4.72). Conclusions Tobacco prevention, cessation, and control efforts that target older adults should be tailored effectively to address the use of marijuana and other combustible tobacco products.

Background African Americans suffer disproportionately from tobacco-related illness and have more difficulty quitting smoking than other racial/ethnic groups. Previous research indicates that African American treatment-seekers are high utilizers of tobacco quitlines, yet cessation rates via quitlines are lower relative to whites. The goal of the present study is to test the effectiveness of adding a culturally specific, video-based, adjunct to standard quitline care. It is hypothesized that the integration of an evidence-based intervention (Pathways to Freedom: Leading the Way to a Smoke-Free Community©; PTF) into quitline services will increase cessation and treatment engagement compared to control conditions, and that effects will be moderated by sociocultural factors (e.g., culturally specific intervention expectancies, acculturation, and ethnic identity). Methods This study is a 3-arm semi-pragmatic randomized controlled trial (RCT). Participants will be 1050 enrollees in the North Carolina State quitline (QuitlineNC) who self-identify as African American. Usual quitline care includes up to 4 proactive quit coaching calls, website access, and two-weeks of nicotine patch therapy. Eligible study participants will be randomized to receive (1) standard quitline services plus PTF (PTF); (2) quitline services plus a standard tobacco cessation DVD (attention control); or (3) quitline services alone (usual care). Assessments will be conducted at baseline, 3 and 6-months post-enrollment. The primary outcome will be biochemically verified 7 day ppa at 6-months. Generalized linear mixed models (GLMMs) and hierarchical logistic regression will be used to assess the effects of treatment group on cessation outcomes and to test potential moderators. Discussion This study will answer questions regarding the implementation and effectiveness of integrating a culturally specific video intervention into a real-world, population-level tobacco intervention. It will also aid our understanding of individual-difference variables that are associated with success. If an incremental benefit is found, this trial will have implications for increasing the responsiveness of tobacco quitlines for African Americans, reducing tobacco cessation disparities, and best practices for improving minority health. In addition, the PTF intervention has the potential for widespread disseminated through quitlines, which are available across the United States. Trial registration Clinicaltrials.gov NCT03064971 . Registered on February 22, 2017.

Objective: The urge to smoke is a predictor of smoking relapse. Little research has focused on the impact of acute urges during treatment among African Americans. This study examined the relationship between smoking urges and long-term abstinence among treatment seekers. Design: Longitudinal prospective investigation. Urges to smoke were assessed at the initial (session 1) and final (session 8) sessions among adult smokers (N=308) enrolled in a 4-week group intervention trial. Nicotine patch use was assessed over 30 days. Main Outcome Measures: Biochemically verified 7-day point prevalence abstinence (7-day ppa) was assessed immediately postintervention, and at 3-, 6-, and 12-month follow-ups. Hierarchical logistic regressions tested associations between session 1 and session 8 urges and 7-day ppa at each smoking status assessment. Results: There was a significant overall decrease in smoking urges (M=29, SD=15 at session 1; M=17, SD=11 at session 8). After controlling for covariates, urges to smoke at session 1 were unrelated to 7-day ppa at any of the assessment points. However, session 8 urges were inversely associated with 7-day ppa post-intervention (AOR=.94, CI:.92-.97), at 3-months (AOR=.93, CI: .89-.97), 6-months (AOR=.93, CI: .90-.97), and 12-months (AOR=.96, CI: .96-.99). Nicotine patch use was positively associated with 7-day ppa at each assessment. Conclusions: The most robust predictors of abstinence through 12-months postintervention were decreased urges over the 4-week, 8-session group intervention and the frequency of nicotine patch use. Interventions aimed at addressing the needs of African American smokers should address urges and encourage nicotine replacement adherence to increase abstinence rates.Ethn Dis. 2017;27(4):395-402; doi:10.18865/ ed.27.4.395.

Background and Aims Distress is a modifiable risk factor for smoking maintenance. This study aimed to assess racial/ethnic differences in distress pre- and post-cognitive–behavioral therapy (CBT) for smoking cessation, and relations with abstinence. Design Analyses of variance and logistic regressions were conducted. Setting University-based smoking cessation laboratory in South Florida, USA. Participants The sample comprised 234 treatment-seekers recruited from the community (18% white, 60% African American and 22% Hispanic). Intervention All participants received eight sessions of group CBT plus 8 weeks of transdermal nicotine patches (TNP). Measurements Demographics and smoking history [baseline], perceived stress and depressive symptoms [baseline and end of therapy (EOT)], carbon monoxide-verified 7-day point prevalence abstinence (p.p.a.) at EOT, 3 months post-CBT (primary outcome) and 6 months (self-report). Findings Compared with whites, African Americans reported greater baseline perceived stress (P = 0.03) and depressive symptoms (P = 0.06); no EOT differences were found. African Americans (P

Aims: Relapse rates among cigarette smokers are high. Few studies have examined time-to-relapse using survival analysis in racially/ethnically diverse smokers and initial abstinence criteria have been inconsistent or unspecified. This study compared survival curves using two common definitions of initial abstinence. We hypothesized greater relapse rates among participants abstinent for only 24 hours (h) at the end-of-therapy (EOT) compared with 7 days. Methods: Adult smokers (59% Black, 22% Hispanic and 17% White) received 8-sessions of group cognitive behavioural therapy (CBT) plus transdermal nicotine patches and were assessed monthly up to 12 months post-EOT. Participants reporting abstinence (7-day point prevalence abstinence [ppa] or 24-h ppa) at the EOT were included in Kaplan–Meier curves. Results: Of 301 participants, 120 (40%) reported 7-day ppa at the EOT and an additional 29 (10%) reported 24-h ppa only. Over the 12-month follow-up period, nearly 50% remained abstinent. Of those who res...

The purpose of this study was to systematically review recent empirical literature on smoking cessation in racial/ethnic minority groups. Specifically, we focused on smoking cessation intervention trials and investigations of factors associated with cessation. Studies published between 2010 and September 2014 were considered. Nine smoking cessation intervention trials and 16 studies examining correlates of smoking behavior were published in within the past 3 years. Results demonstrated promise for varenicline in facilitating cessation among African Americans and Hispanics, and culturally specific behavioral counseling appears to be efficacious among Asian Americans. In trans-group comparisons, racial/ethnic minorities reported greater quit attempts compared to Whites; yet success may be reduced due to factors such as menthol smoking, low pharmacotherapy use, and lower readiness to quit. Recommendations for evidence-based interventions and future research are offered.

Introduction Despite smoker interest in e-cigarettes as a harm reduction or cessation aid, many smokers prematurely discontinue vaping after trying a product. This study explored the role of early subjective sensory experiences in vaping persistence and desistance. Methods African American menthol cigarette smokers aged ≥18 years (N = 15; M = 54.1 years; SD = 8.2), motivated to quit smoking, and interested in trying e-cigarettes were recruited in Washington, DC. Participants were followed for 3 weeks and provided menthol cigalike e-cigarettes after Week 1. Participants completed three interviews about their vaping experiences. Thematic analysis of responses was designed to understand the sensory aspects of vaping. Results During the first 2 weeks of vaping, four participants reported a positive vaping experience while 11 reported decreased satisfaction. Salient sensory attributes of dissatisfaction included poor taste, insufficient throat hit, difficulty pulling, and a lack of "whole body" satisfaction compared to their preferred cigarette brand. Conclusions The sensory experiences with a specific cigalike e-cigarette were related to vaping persistence and desistence. Although this was a small volunteer sample of African American menthol smokers motivated to quit smoking, 27% (N = 4) of participants with a positive vaping experience continued using the product, while 73% (N = 11) of participants' vaping experience was unsatisfactory across several experiential categories. In future research of e-cigarettes' efficacy as a smoking cessation or reduction aid, both device characteristics and smokers' expectations for these devices should be considered, so vapers do not expect the same taste sensations, throat sensations, and "whole body" satisfaction as they experienced with their menthol cigarettes. Implications The subjective sensory experiences associated with initial e-cigarette product use are associated with use patterns. Subjective sensory experiences may also help understand the differences in the appeal, satisfaction, and harm-reduction potential of the rapidly evolving diverse types of products emerging in the marketplace. How products meet the sensory needs of smokers wanting to switch or quit smoking may influence adherence and success rates.

Cigarette smoking has been implicated in causing many cancers and cancer deaths. There is mounting evidence indicating that smoking negatively impacts cancer treatment efficacy and overall survival. The NCCN Guidelines for Smoking Cessation have been created to emphasize the importance of smoking cessation and establish an evidence-based standard of care in all patients with cancer. These guidelines provide recommendations to address smoking in patients and outlines behavioral and pharmacologic interventions for smoking cessation throughout the continuum of oncology care.

Background: While smoking rates in the United States have decreased, some population subgroups have smoking rates that exceed national and state averages. These higher rates often are associated with higher incidence rates of tobacco-associated cancers. Over time, a decrease in smoking rates leads to lower cancer incidence.Methods: Using spatial modelling techniques, we identified an underserved geographic locale in South Florida with higher than expected incidence rates of tobacco-associated cancers. We then used a community-based participatory research (CBPR) design to conduct focus groups in 2011 to elicit information about the acceptability of a smoking cessation intervention delivered by trained former smokers from within peer networks.Results: A variety of smoking cessation strategies was presented and discussed in separate, gender-stratified focus groups comprised of former and current smokers (n = 39). Focus group findings consistently indicated that support groups were the preferred cessation mechanism in this community. Based on this finding, we changed our initially proposed cessation approach to one which employed support groups as a quit method.Conclusions: Currently, we are collecting pilot data to test this intervention and to reach smokers who might not otherwise be directly targeted with cessation messaging from larger tobacco control initiatives. If successful, this strategy can be adapted to effect other important changes in health behaviours in at-risk populations.

The prevalence of e-cigarette use is increasing, yet few studies have focused on its use in racial/ethnic minority populations. We examined associations between race/ethnicity and e-cigarette use, plans to continue using e-cigarettes, and reasons for use among current/former smokers. Participants (285 in total; 29% non-Hispanic White, 42% African American/Black, and 29% Hispanic) were recruited between June and November 2014. Telephone-administered surveys assessed demographics, cigarette smoking, e-cigarette use, plans to continue using, and reasons for use. Analyses of covariance (ANCOVAs) and multivariable logistic regressions were conducted. African Americans/Blacks were significantly less likely to report ever-use compared to Whites and Hispanics (50% vs. 71% and 71%, respectively; p < 0.001). However, African American/Black ever users were more likely to report plans to continue using e-cigarettes compared to Whites and Hispanics (72% vs. 53% and 47%, respectively, p = 0.01). African American/Black participants were more likely to use e-cigarettes as a cessation aid compared to both Whites (p = 0.03) and Hispanics (p = 0.48). White participants were more likely to use e-cigarettes to save money compared to Hispanics (p = 0.02). In conclusion, racial/ethnic differences in e-cigarette use, intentions, and reasons for use emerged in our study. African American ever users may be particularly vulnerable to maintaining their use, particularly to try to quit smoking. These findings have implications for cigarette smoking and e-cigarette dual use, continued e-cigarette use, and potentially for smoking-related disparities.

OBJECTIVE Many treatment-seeking smokers have difficulty quitting and maintaining abstinence. Trait impulsivity versus self-control is relevant to this problem. However, impulsivity is a multifaceted construct, and different measures emphasize different parts of it. This study compared 2 self-report measures of self-control versus impulsiveness as predictors of smoking cessation. One measure taps a very specific tendency to respond impulsively when experiencing emotions. The other taps overall self-control without reference to emotional states. METHOD Adult smokers (N = 116) recruited from the community participated in a group-based smoking cessation intervention. The sample was racially/ethnically diverse, mostly male, middle aged, single, low income, and moderately nicotine dependent. Self-reports on scales titled Reflexive reaction to feelings and Self-control were completed at entry. Seven-day point prevalence abstinence (ppa) was assessed at end-of-therapy (EOT) and at 3- and 6-month follow-ups. A generalized estimating equation (GEE) tested overall relationships of the self-report scales with 7-day ppa across the assessments. RESULTS Bivariate analyses revealed inverse associations between Reflexive reaction to feelings and 7-day ppa; a positive association emerged between Self-control and 7-day ppa only at EOT. A GEE found that elevated scores on Reflexive reaction to feelings predicted failure in smoking cessation across the study period (adjusted odds ratio [AOR] = 0.69 [0.49-0.96], p = .03) and that Self-control scores did not do so significantly (AOR = 1.26 [0.80-1.99], p = .32). CONCLUSIONS Results add to a literature suggesting the importance of emotion-related impulsivity to behavioral problems by showing its relevance to smoking cessation in treatment-seekers. (PsycINFO Database Record

Introduction: Menthol cigarette smokers may find it harder to quit smoking than smokers of nonmenthol cigarettes. Methods: We conducted a systematic review of published studies examining the association between menthol cigarette smoking and cessation. Electronic databases and reference lists were searched to identify studies published through May 2010, and results were tabulated. Results: Ten studies were located that reported cessation outcomes for menthol and nonmenthol smokers. Half of the studies found evidence that menthol smoking is associated with lower odds of cessation, while the other half found no such effects. The pattern of results in these studies suggest that the association between smoking menthol cigarettes and difficulty quitting is stronger in (a) racial/ethnic minority populations, (b) younger smokers, and (c) studies carried out after1999. This pattern is consistent with an effect that relies on menthol to facilitate increased nicotine intake from fewer cigarettes where economic pressure restricts the number of cigarettes smokers can afford to purchase. Conclusions: There is growing evidence that certain subgroups of smokers find it harder to quit menthol versus non menthol cigarettes. There is a need for additional research, and particularly for studies including adequately powered and diverse samples of menthol and nonmenthol smokers, with reliable measurement of cigarette brands, socioeconomic status, and biomarkers of nicotine intake.

Few smoking cessation trials have focused on U.S. Hispanics. Consequently, little is known about culturally specific considerations for intervention delivery. The purpose of this study was to test the efficacy of a written smoking cessation intervention varying in cultural specificity and language. Participants (N = 222) were English-Spanish bilingual Hispanic smokers recruited from the community. A 2 (cultural specificity-culturally specific or standard) × 2 (receipt of preferred language materials-preferred or less preferred) between-subjects experiment was conducted. Participants were assessed at baseline and at a 2-week post intervention follow-up. Dependent variables measured intervention evaluations (intended utilization and content evaluation), cigarettes smoked per day, and smoking cessation (secondary outcome). We hypothesized independent effects of cultural specificity, receipt of preferred language materials, and an interaction effect. Results demonstrated that intended utilization was greater among participants who received the intervention in their preferred language, F(1, 213) = 9.772, p = .002, η2 = .044. No differences in content evaluations were observed. However, number of cigarettes smoked per day was lower, and self-reported cessation was significantly greater among participants who received a culturally specific intervention, F(1, 152) = 4.939, p = .028, partial η2 = .031, and materials in their preferred language, OR = 5.356, p = .037, 95% CI [1.106, 25.948], respectively. In conclusion, this study contributes to our understanding of dimensions influencing responses to smoking cessation interventions among Hispanics. Both cultural specificity and preferred language delivery appear to be causally related to the intended utilization of interventions and smoking behavior. (PsycINFO Database Record

Objectives: Electronic cigarette (e-cigarette) use is increasing in the U.S. Although marketed as a safer alternative for cigarettes, initial evidence suggests that e-cigarettes may pose a secondhand exposure risk. The current study explored the prevalence and correlates of support for e-cigarette bans. Methods: A sample of 265 current/former smokers completed a cross-sectional telephone survey from June–September 2014, 45% Black, 31% White, 21% Hispanic. Items assessed support for home and workplace bans for cigarettes and e-cigarettes and associated risk perceptions. Results: Most participants were aware of e-cigarettes (99%). Results demonstrated less support for complete e-cigarette bans in homes and workplaces compared to cigarettes. Support for complete e-cigarette bans was strongest among older, higher income, married respondents, and former smokers. Complete e-cigarette bans were most strongly endorsed when perceptions of addictiveness and health risks were high. While both e-cigarette lifetime and never-users strongly supported cigarette smoking bans, endorsement for e-cigarette bans varied by lifetime use and intentions to use e-cigarettes. Conclusions: Support for indoor e-cigarette bans is relatively low among individuals with a smoking history. Support for e-cigarette bans may change as evidence regarding their use emerges. These findings have implications for public health policy.

INTRODUCTION Previous research suggests that African American smokers may have improved outcomes if interventions are culturally specific. However, few interventions sufficiently address the unique needs of this population in a format with large reach potential. The purpose of this study was to test the efficacy of a newly developed digital video disc (DVD)-based cessation intervention targeting African Americans. METHODS In a 2-arm randomized trial, smokers (N = 140) were randomly assigned to view either the new Pathways to Freedom (PTF) DVD or a standard control DVD. Participants were assessed at baseline, immediately postviewing the DVD, and at a 1-month follow-up. The primary outcomes were feasibility and process variables, including intervention evaluations, readiness to quit, and risk perceptions, and smoking-related behavior changes were examined as secondary outcomes. RESULTS Findings demonstrated the hypothesized positive effects of the PTF DVD compared with the control DVD on content evaluations, risk perceptions, and readiness to quit at follow-up. CONCLUSIONS We found initial evidence for the efficacy of the PTF DVD as a stand-alone intervention. Future research will test the efficacy of the DVD for smoking cessation in a larger randomized trial. The ultimate goal of this research is to validate a new intervention for an underserved community of smokers that can be used in multiple settings, such as community health clinics, primary care, quitlines, cessation clinics, and seminars/workshops.

Research has documented tobacco-related health disparities by race and gender. Prior research, however, has not examined expectancies about the smoking cessation process (i.e., abstinence-related expectancies) as potential contributors to tobacco-related disparities in special populations. This cross-sectional study compared abstinence-related expectancies between American Indian (n = 87), African American (n = 151), and White (n = 185) smokers, and between women (n = 231) and men (n = 270) smokers. Abstinence-related expectancies also were examined as mediators of race and gender relationships with motivation to quit and abstinence self efficacy. Results indicated that American Indians and African Americans were less likely than Whites to expect withdrawal effects, and more likely to expect that quitting would be unproblematic. African Americans also were less likely than Whites to expect smoking cessation interventions to be effective. Compared with men, women were more likely to expect withdrawal effects and weight gain. These expectancy differences mediated race and gender relationships with motivation to quit and abstinence self-efficacy. Findings emphasize potential mechanisms underlying tobacco-related health disparities among American Indians, African Americans, and women and suggest a number of specific approaches for targeting tobacco dependence interventions to these populations.

Background African American smokers experience disproportionately higher rates of tobacco-related illnesses compared to Caucasians. It has been suggested that interventions targeted to specific racial/ethnic groups (i.e., culturally specific) are needed; however, the literature examining the efficacy of culturally specific interventions is equivocal. Moreover, there are few descriptions of methods used to create these interventions. The main aim of this study is to test the efficacy of a culturally specific smoking cessation intervention among African Americans. Methods/Design A 2-arm randomized controlled trial (RCT) will be conducted to assess the efficacy of a culturally specific group cognitive behavioral therapy (CBT), compared to standard group CBT among treatment-seeking smokers from the community. Participants in both conditions receive the transdermal nicotine patch (TNP) for 8-weeks. We intend to randomize at least 247 adult smokers who self-identify as African American into the trial. Enrolled participants are block randomized into one of two groups: Standard group CBT (control) or a culturally specific group CBT (CS-CBT). Groups are matched for time and attention, and consist of eight sessions. The primary outcome variable is 7-day point prevalence abstinence (7-day ppa). Smoking status is assessed at the end-of-counseling (EOC), and 3, 6, and 12-month follow-ups, with self-reported abstinence verified by saliva cotinine. We hypothesize that the CS-CBT condition will produce significantly greater smoking cessation rates compared to the control condition. We also expect that this effect will be moderated by acculturation and ethnic identity, such that the CS-CBT will show the greatest effect on cessation among participants who are less acculturated and have greater ethnic identity. Discussion Answering the fundamental question of whether culturally specific interventions lead to incremental efficacy over established, evidence-based approaches is of utmost importance. This study will have implications for the development and implementation of smoking cessation interventions among African Americans and other racial/ethnic minority groups. Trial registration NCT01811758

Objective Previous research has documented disparities in smoking cessation between African Americans and Caucasians. Many low-income African American smokers face a range of circumstances that may inhibit effective coping during quit attempts, yet previous research has not considered factors that influence coping in this population. This study examined (a) affect (positive and negative) and (b) perceived social support in association with coping strategies. Methods The baseline assessment of African American smokers ( N = 168) enrolled in a randomized controlled trial included the Positive and Negative Affect Schedule, the Multidimensional Scale of Perceived Social Support, and the Brief COPE. A factor analysis of the Brief COPE resulted in two factors, adaptive and maladaptive strategies. Results Participants were mostly single (64%), women (61%), with ≥ 12 years of education (68%), and low-income. They were middle aged ( M = 46.1, SD = 8.7), smoked 21.8 ( SD = 13.3) cigarettes/day for 24.3 ( SD = 11) years, and were moderately nicotine dependent. Results demonstrated that adaptive coping was positively correlated with positive affect and social support. Maladaptive coping was positively correlated with negative affect, and inversely related to positive affect and social support. Multivariate analyses revealed that positive affect and social support were independently associated with adaptive coping strategies. In contrast, maladaptive coping was independently associated with negative affect, but not social support. Conclusions Interventions that harness positive resources, such as social support and positive mood, may facilitate adaptive coping. Also, addressing negative affect among low-income African American smokers may be important to reduce maladaptive coping strategies.

Introduction This study tested the efficacy of group-based culturally specific cognitive behavioral therapy (CBT) for smoking cessation among low-income African Americans. Methods Participants (N = 342; 63.8% male; M = 49.5 years old; M cigarettes per day = 18) were randomly assigned to eight sessions of group-based culturally specific or standard CBT, plus 8 weeks of transdermal nicotine patches. Biochemically verified 7-day point prevalence abstinence (ppa) was assessed at the end-of-therapy (ie, CBT) (EOT), and 3-, 6-, and 12-month follow-ups. Primary outcomes were the longitudinal intervention effect over the 12-month follow-up period, and 7-day ppa at the 6-month follow-up. Secondary outcomes included 7-day ppa at the EOT and 12-month follow-up, and intervention ratings. Generalized linear mixed modeling tested the longitudinal effect and logistic regression tested effects at specific timepoints. Results Generalized linear mixed modeling demonstrated a longitudinal effect of intervention condition. Specifically, 7-day ppa was two times (P = .02) greater following culturally specific CBT versus standard CBT when tested across all timepoints. Analyses by timepoint found no significant difference at 6 or 12 months, yet culturally specific CBT was efficacious at the EOT (62.5% vs. 51.5% abstinence, P = .05) and the 3-month follow-up (36.4% vs. 22.9% abstinence, P = .007). Finally, intervention ratings in both conditions were high, with no significant differences. Conclusions Culturally specific CBT had a positive longitudinal effect on smoking cessation compared to a standard approach; however, the effects were driven by short-term successes. We recommend the use of group-based culturally specific CBT in this population when possible, and future research on methods to prevent long-term relapse. Implications Culturally specific interventions are one approach to address smoking-related health disparities; however, evidence for their efficacy in African Americans is equivocal. Moreover, the methodological limitations of the existing literature preclude an answer to this fundamental question. We found a positive longitudinal effect of culturally specific CBT versus standard CBT for smoking cessation across the follow-up period. Analyses by assessment point revealed that the overall effect was driven by early successes. Best practices for treating tobacco use in this population should attend to ethnocultural factors, but when this is not possible, standard CBT is an alternative approach for facilitating long-term abstinence.

African-Americans suffer disproportionately from tobacco-associated morbidity and mortality. Considering the relationship between cultural variables and cessation may be important for reducing disparities. This study aimed to examine acculturation as a predictor of smoking cessation following a standard group intervention. Treatment-seeking smokers (N = 140) participated in a group intervention for cessation plus transdermal nicotine patch therapy and completed the African American Acculturation Scale—Revised at baseline. The primary outcome was self-reported 7-day point prevalence abstinence at the end-of-counseling and 3 and 6 months postintervention. Adjusted logistic regression analyses found that acculturation predicted end-of-counseling and 3-month 7-day point prevalence abstinence; traditional African-Americans (i.e., less acculturated) were less likely to quit smoking. Cultural superstitions, religious beliefs and practices, and interracial attitudes were predictive of smoking cessation. Acculturation was associated with cessation following a group-based intervention. Culturally specific adaptations to established interventions might improve outcomes for traditional smokers.