Strategic Directions in Preventive Intervention Research to Advance Health Equity.

As commissioned by the Society for Prevention Research, this paper describes and illustrates strategic approaches for reducing health inequities and advancing health equity when adopting an equity-focused approach for applying prevention science evidence-based theory, methodologies, and practices. We introduce an ecosystemic framework as a guide for analyzing, designing, and planning innovative equity-focused evidence-based preventive interventions designed to attain intended health equity outcomes. To advance this process, we introduce a health equity statement for conducting integrative analyses of ecosystemic framework pathways, by describing the role of social determinants, mechanisms, and interventions as factors directly linked to specific health equity outcomes. As background, we present health equity constructs, theories, and research evidence which can inform the design and development of equity-focused intervention approaches. We also describe multi-level interventions that when coordinated can produce synergistic intervention effects across macro, meso, and micro ecological levels. Under this approach, we encourage prevention and implementation scientists to apply and extend these strategic directions in future research to increase our evidence-based knowledge and theory building. A general goal is to apply prevention science knowledge to design, widely disseminate, and implement culturally grounded interventions that incrementally attain specific HE outcomes and an intended HE goal. We conclude with recommendations for conducting equity-focused prevention science research, interventions, and training.

Chronic stress, autonomic dysregulation and prospective drug use among African American emerging adults.

OBJECTIVE: Chronic stress is associated with increased vulnerability to drug use and may contribute to drug-related health disparities in the African American community. The underlying physiological mechanisms by which chronic stress confers this increased risk remain unclear. The present study aimed to characterize the impact of chronic and race-related stress exposure on regulatory mechanisms of the autonomic nervous system (ANS) in response to acute stress, to examine John Henryism as potential moderator of this relationship, and to investigate the association between ANS reactivity and subsequent drug use among a sample of African American emerging adults (18-25 years old) in the Southern United States (U.S.). METHOD: Participants (N = 276) completed self-report measures of chronic and race-related stress and John Henryism and underwent a laboratory-based stressor. ANS reactivity was assessed via heart rate variability (HRV) and skin conductance levels (SCL). At 90-day follow-up, retrospective reports of drug use were provided. RESULTS: Race-related stress was associated with greater SCL reactivity. John Henryism moderated the relationship between chronic stress exposure and HRV reactivity. SCL reactivity was associated with higher rates of alcohol and marijuana use at 90-day follow-up. HRV reactivity was associated with tobacco use at 90-day follow-up. CONCLUSIONS: Chronic stress exposure and active coping may interact to affect regulatory mechanisms of the ANS. ANS (dys)regulation may be an important endophenotype for increasing drug use vulnerability among African American emerging adults. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Moderating Role of Coping Style on Chronic Stress Exposure and Cardiovascular Reactivity Among African American Emerging Adults.

Chronic stress exposure may contribute to dysregulation of cardiovascular functions and increase CVD risk among African Americans. This study investigated the direct and interactive effects of chronic stress exposure and coping styles on cardiovascular reactivity to acute stress. A sample of African American emerging adults (n = 277) completed a battery of self-report assessments and underwent the Trier Social Stress Test (TSST) across two time points. Prior chronic stress exposure was negatively associated with heart rate (HR) reactivity among females at 1-month follow-up. Task-oriented coping was positively associated with HR reactivity, while avoidance-oriented coping showed a negative association. Higher use of emotion-oriented coping moderated the relationship between chronic stress exposure and HR reactivity, resulting in more robust reactivity. Among females, but not males, lower use of avoidance-oriented coping moderated the relationship between prior chronic stress exposure and HR reactivity, also resulting in more robust reactivity. Prior chronic stress exposure and the use of maladaptive coping strategies may confer negative impacts on cardiovascular reactivity, particularly among African American females. Using adaptive coping styles may mitigate these effects and improve cardiovascular reactivity. These findings provide preliminary support for psychosocial determinants of health within a controlled laboratory experiment and highlight important gender differences to consider in prevention efforts for African American cardiovascular health disparities.

The cost of minority stress: Risky alcohol use and coping-motivated drinking behavior in African American college students.

A motivational drinking framework is utilized to understand the relationship between minority stressors (e.g., race-related stress and acculturative stress) and alcohol use behaviors (risky alcohol use and coping-motivated drinking) among a large sample of Black American college students. Six hundred forty-nine Black college students from 8 colleges and universities in the United States were recruited as part of a large, multiwave, cross-sectional study investigating the stress and coping experiences of Black emerging adults. Results from the current investigation provide support for the independent contributions of acculturative stress and race-related stress to the risky alcohol use behavior of Black college students, while acculturative stress significantly predicted coping-motivated drinking behaviors in the sample. Findings underscore the need to better understand the unique relationships between minority stress and risky alcohol use behaviors of Black college students, namely, relationships not shared by their nonminority peers that increase their risk of problem drinking.

The Association of Lesbian, Gay, and Bisexual Identity Facets With Smoking Dependence Motives.

Introduction: Lesbian, gay, and bisexual (LGB) adults have higher rates of smoking than heterosexual adults. LGB individuals face unique stressors, including challenges associated with having a LGB identity. The extent to which these unique stressors are related to dependence motives in LGB adult smokers, however, has not been previously explored. The current study was conducted to redress these gaps. Methods: Participants (N = 52; Mage = 42.8; 55.8% Black/African American) were recruited from the local community. Identity facets were measured by the Lesbian, Gay, and Bisexual Identity Scale (LGBIS). Dependence motives were measured by the Brief Wisconsin Inventory of Smoking Dependence Motives. Linear multiple regressions were calculated with the predictors of seven LGBIS subscales for primary and secondary dependence motives, respectively. Results: Primary dependence motives (core nicotine dependence features) were predicted by affirmation of LGB identity (ß = 0.44). Secondary dependence motives (eg, taste, cognitive/affective enhancement) were predicted by uncertainty of LGB identity (ß = 0.43). Conclusions: LGB identity affirmation was associated with primary dependence motives, suggesting that a positive view of one's sexual orientation is a risk factor for dependence. It may be that identity affirmation is related to stronger involvement with the LGB community, which has smoking-friendly norms. Identity uncertainty was associated with secondary dependence motives; this unique identity challenge may represent a stressor contributing to smoking dependence. Findings can help explain the higher rate of smoking in LGB populations and offer avenues to better tailor smoking cessation interventions. Implications: The current study is the first to examine multidimensional aspects of LGB identity in explaining smoking dependence motives among LGB adults. Results reveal that LGB identity challenges are associated with dependence motives, suggesting that interventions targeting these challenges may be help reduce LGB smoking disparities. Specifically, reducing identity uncertainty may help reduce smoking dependence. Though identity affirmation was a smoking dependence correlate, it is counterproductive to reduce affirmation, given its association with other positive health outcomes. Rather, interventions to change LGB community norms around smoking appear warranted, given the documented high overlap between affirmation and community affiliation.

Positive parenting predicts cortisol functioning six years later in young adults.

Research which indicates that adverse experiences influence hypothalamic-pituitary-adrenal (HPA) axis functioning illustrates the social environment 'getting under the skin'. The present study extended this literature by examining whether positive social forces within the caregiving environment can also impact cortisol functioning. We conducted a prospective investigation of over 300 youth, half of whom were White and half were Black. Attachment, bonding and parental rewards for positive behaviors were observed or reported by the youth as an 8th grader. Twelve repeated measures of salivary cortisol were examined six years later when youth were young adults (mean age 20). Race differences were explored. Stronger attachment, bonding and teen-reported positive parenting were predictive of high waking cortisol and steeper diurnal slopes six years later. This effect was nonlinear and additive, such that youth whose social contexts were characterized by the strongest attachment, bonding and rewarding parental relationships had the highest waking cortisol. When effects were moderated by race, findings were such that links of positive parenting with HPA functioning were more consistent for White than Black youth. Findings suggest that positive aspects of the caregiving environment can also 'get under the skin' and these effects are additive across a range of caregiving indices. These findings dovetail with an emerging literature on the powerful role of social support for shaping the body's stress response system and are interpreted as consistent with the Adaptive Calibration Model which suggests that cortisol regulation can have adaptive significance. A video abstract of this article can be viewed at: https://youtu.be/8evHXpt_TXM.

Hypothalamic-Pituitary-Adrenal Reactivity to Acute Stress: an Investigation into the Roles of Perceived Stress and Family Resources.

Rurally situated African Americans suffer from chronic exposure to stress that may have a deleterious effect on health outcomes. Unfortunately, research on potential mechanisms that underlie health disparities affecting the African American community has received limited focus in the scientific literature. This study investigated the relationship between perceived stress, family resources, and cortisol reactivity to acute stress. A rural sample of African American emerging adults (N = 60) completed a battery of assessments, the Trier Social Stress Test (TSST), and provided four samples of salivary cortisol: prior to receiving TSST instructions, prior to conducting the speech task, immediately following the TSST, and 15-20 min following the TSST. As predicted, cortisol levels increased in response to a controlled laboratory inducement of acute stress. Moreover, diminished levels of family resources were associated with blunted cortisol reactivity to acute stress. Of note, higher levels of perceived stress over the past month and being male were independently associated with lower levels of cortisol at baseline. Lack of family resources had a blunting relationship on the hypothalamic-pituitary-adrenal axis reactivity. These findings provide biomarker support for the relationship between family resources-an indicator associated with social determinants of health-and stress physiology within a controlled laboratory experiment. Identifying mechanisms that work toward explanation of within-group differences in African American health disparities is both needed and informative for culturally informed prevention and intervention efforts.

Interactive Effects of Anxiety Sensitivity and Subjective Social Status on Psychological Symptomatology in Black Adults.

Anxiety sensitivity is the fear of anxiety-related sensations and subjective social status is a self-perception of social standing relative to others: both constructs have been linked to psychological symptomatology. This study investigated the interactive effects of anxiety sensitivity and social status in relation to anxiety and depressive symptomatology expression among 124 black adults. Participants provided sociodemographics and completed self-report questionnaires. The interactive associations between anxiety sensitivity and social status on anxiety symptomatology and depressive symptomatology were examined with hierarchical linear regressions adjusted for sociodemographics and negative affectivity. Significant interactions between anxiety sensitivity and social status were evident only for anxiety symptoms: specifically, the association between anxiety sensitivity and anxiety symptoms was much stronger for individuals with lower (versus higher) subjective social status. Black adults with this higher anxiety sensitivity/lower social status phenotype may be at heightened risk for the expression of anxiety symptomatology, and may benefit from interventions to reduce anxiety sensitivity.

The role of minority stress in second-generation Black emerging adult college students' high-risk drinking behaviors.

OBJECTIVE: This study used a minority stress framework to investigate the relationships between multiple stressors (e.g., general life stress, race related stress, and acculturative stress) and high-risk drinking behaviors in a sample of second-generation Black emerging adult college students across the United States. METHOD: Participants (n = 148) were recruited from U.S. colleges and universities as part of a large, multiwave cross-sectional study. RESULTS: Findings from this study mirrored those in the extant literature: the positive relationship between race-related stress and high-risk drinking behaviors found in other marginalized groups. However, when all stressors were entered into the model, acculturative stress accounted for significant variance in high-risk drinking behaviors above and beyond general life and race-related stressors in second generation Black emerging adult college students. CONCLUSION: Findings underscore the need to better understand the influence of acculturative stress on high-risk drinking behaviors among second-generation Black emerging adult college students: an understudied population in both the acculturation and alcohol use literatures. Implications for future research and clinical practice are discussed. (PsycINFO Database Record

Maternal depression, stress and feeding styles: towards a framework for theory and research in child obesity.

Against the background of rising rates of obesity in children and adults in the USA, and modest effect sizes for obesity interventions, the aim of the present narrative review paper is to extend the UNICEF care model to focus on childhood obesity and its associated risks with an emphasis on the emotional climate of the parent-child relationship within the family. Specifically, we extended the UNICEF model by applying the systems approach to childhood obesity and by combining previously unintegrated sets of literature across multiple disciplines including developmental psychology, clinical psychology and nutrition. Specifically, we modified the extended care model by explicitly integrating new linkages (i.e. parental feeding styles, stress, depression and mother's own eating behaviour) that have been found to be associated with the development of children's eating behaviours and risk of childhood obesity. These new linkages are based on studies that were not incorporated into the original UNICEF model, but suggest important implications for childhood obesity. In all, this narrative review offers important advancements to the scientific understanding of familial influences on children's eating behaviours and childhood obesity.

The moderating role of implicit alcohol-related cognitions in hazardous alcohol use.

The present study applied the Go/No-Go Association Test (GNAT; Nosek & Banaji, 2001) to measure alcohol-related implicit cognitions. Additionally, it assessed the role of implicit cognitions as a potential moderator in the relationship between explicit predictors of alcohol use and hazardous drinking behavior. University undergraduate students (N = 214) completed self-report questionnaires assessing reasons for drinking and reported alcohol use. Participants also completed two GNATs assessing implicit-alcohol-related cognitions associated with attitude (good-bad) and perceived safety (safe-dangerous). As expected, participants held implicit appraisals of alcohol as ''bad'' and ''dangerous'' in the context of nonalcoholic drinks, and as ''good'' and ''safe'' in the context of licit and illicit drugs. Implicit alcohol-related cognitions moderated the relationship between drinking to cope with negative affect and hazardous drinking and drinking due to cues or craving and hazardous drinking. These findings highlight the multidimensional nature of implicit cognitions and the role of negative implicit alcohol-related associations in moderating relationships between explicit processes and subsequent alcohol use behaviors.

Anxiety Sensitivity and Distress Tolerance in Relation to Smoking Abstinence Expectancies Among Black Individuals Who Smoke.

OBJECTIVE: Black individuals who smoke in the United States experience significant tobacco-related disparities. Although prior work has established that smoking abstinence expectancies play an important role in smoking-related outcomes, few studies have examined potential individual difference factors that may be relevant to smoking abstinence expectancies among Black individuals who smoke. The present study investigated anxiety sensitivity and distress tolerance in relation to smoking abstinence expectancies among a sample of Black individuals who smoke. METHOD: Participants were 86 Black adults who smoke cigarettes daily (M age = 46.07 years, SD = 10.37; 26.7% female). Four separate linear regression analyses were conducted to evaluate the relation between anxiety sensitivity, distress tolerance, and their interaction with each of the four smoking abstinence expectancies (i.e., somatic symptoms, positive consequences, harmful consequences, and negative mood). RESULTS: Results indicated that higher anxiety sensitivity was related to higher somatic symptoms, harmful consequences, and negative mood abstinence expectancies, whereas distress tolerance was related to higher positive consequences. Further, anxiety sensitivity and distress tolerance interacted to confer greater expectancies for the positive consequences of quitting. CONCLUSIONS: The current findings are among the first to document that anxiety sensitivity and distress tolerance are clinically relevant factors to consider when tailoring smoking cessation treatments for Black individuals who smoke. Future research is needed to examine distress tolerance and anxiety sensitivity as longitudinal predictors of smoking abstinence expectancies among Black individuals who smoke.

Mobile Intervention to Address Cannabis Use Disorder Among Black Adults: Protocol for a Randomized Controlled Trial.

BACKGROUND: African American or Black (hereafter referred to as Black) adults who use cannabis use it more frequently and are more likely to meet criteria for cannabis use disorder (CUD) than both White and Hispanic or Latin individuals. Black adults may be more apt to use cannabis to cope with distress, which constitutes a false safety behavior (FSB; a behavior designed to reduce psychological distress in the short term). Although FSB engagement can perpetuate the cycle of high rates of CUD among Black individuals, limited work has applied an FSB elimination treatment approach to Black adults with CUD, and no previous work has evaluated FSB reduction or elimination in the context of a culturally tailored and highly accessible treatment developed for Black individuals. OBJECTIVE: This study aims to develop and pilot-test a culturally tailored adaptive intervention that integrates FSB reduction or elimination skills for cannabis reduction or cessation among Black adults with probable CUD (Culturally Tailored-Mobile Integrated Cannabis and Anxiety Reduction Treatment [CT-MICART]). METHODS: Black adults with probable CUD (N=50) will complete a web-based screener, enrollment call, baseline assessment, 3 daily ecological momentary assessments (EMAs) for 6 weeks, and a follow-up self-report assessment and qualitative interview at 6 weeks after randomization. Participants will be randomized into 1 out of the 2 conditions after baseline assessment: (1) CT-MICART+EMAs for 6 weeks or (2) EMAs only for 6 weeks. RESULTS: The enrollment started in June 2023 and ended in November 2023. Data analysis will be completed in March 2024. CONCLUSIONS: No culturally tailored, evidence-based treatment currently caters to the specific needs of Black individuals with CUD. This study will lay the foundation for a new approach to CUD treatment among Black adults that is easily accessible and has the potential to overcome barriers to treatment and reduce practitioner burden in order to support Black individuals who use cannabis with probable CUD. TRIAL REGISTRATION: ClinicalTrials.gov NCT05566730; https://clinicaltrials.gov/study/NCT05566730. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52776.

Exploring COVID-19 Vaccine Attitudes among Racially and Ethnically Minoritized Communities: Community Partners' and Residents' Perspectives.

COVID-19 has disproportionately affected Black, Indigenous, and People of Color (BIPOC) communities, yet rates of COVID-19 vaccination remain low among these groups. A qualitative study was undertaken to better understand the factors contributing to low vaccine acceptance among these communities. Seventeen focus groups were conducted in English and Spanish from 8/21 to 9/22, with representatives from five critical community sectors: (1) public health departments (n = 1); (2) Federally Qualified Health Centers (n = 2); (3) community-based organizations (n = 1); (4) faith-based organizations (n = 2); and (5) BIPOC residents in six high-risk, underserved communities in metropolitan Houston (n = 11), for a total of 79 participants, comprising 22 community partners and 57 community residents. A social-ecological model and anti-racism framework were adopted to guide data analysis using thematic analysis and constant comparison, which yielded five key themes: (1) legacy of structural racism: distrust and threat; (2) media misinformation: mass and social; (3) listening and adapting to community needs; (4) evolving attitudes towards vaccination; and (5) understanding alternative health belief systems. Although structural racism was a key driver of vaccine uptake, a notable finding indicated community residents' vaccine attitudes can be changed once they are confident of the protective benefits of vaccination. Study recommendations include adopting an explicitly anti-racist lens to: (1) listen to community members' needs and concerns, acknowledge their justified institutional distrust concerning vaccines, and learn community members' healthcare priorities to inform initiatives built on local data; (2) address misinformation via culturally informed, consistent messaging tailored to communal concerns and delivered by trusted local leaders through multimodal community forums; (3) take vaccines to where people live through pop-up clinics, churches, and community centers for distribution via trusted community members, with educational campaigns tailored to the needs of distinct communities; (4) establish vaccine equity task forces to continue developing sustainable policies, structures, programs and practices to address the structural issues driving vaccine and health inequities within BIPOC communities; and (5) continue investing in an effective infrastructure for healthcare education and delivery, essential for competently responding to the ongoing healthcare and other emergency crises that impact BIPOC communities to achieve racial justice and health equity in the US. Findings underscore the crucial need to provide culturally tailored health education and vaccination initiatives, focused on cultural humility, bidirectionality, and mutual respect to support vaccine re-evaluation.

Engaging the Houston Community in Research: An Early Case Study of a Community Engagement Core in the University of Houston's HEALTH Center for Addictions Research and Cancer Prevention.

Objective: The National Institute on Minority Health and Health Disparities-funded U54 Research Center at the University of Houston addresses disparate racial/ethnic health outcomes related to cancer and substance abuse. Of its 4 cores, the Community Engagement Core involves the impacted community in affiliated research. Strategies include implementing community advisory boards, assisting with study design and execution, maintaining a social media presence, and publishing health-related videos for the community. We examine the early effectiveness of these strategies. Methods: Data collection included surveying investigators and community advisory board members and monitoring traffic to videos and social media posts. Results: On a Likert scale survey of investigators (4 = "agree" and 5 = "strongly agree"), the mean rating for a prompt expressing satisfaction with services received was 4.67 (SD = 0.52; N = 6). On a Likert scale survey of community advisory board members, the mean rating for a prompt expressing belief that feedback was taken seriously was 5.00 (SD = 0.00; N = 9). Conclusions: The Community Engagement Core is building trusting relationships between researchers and community members. We discuss lessons learned that may inform both our growth and others' efforts to implement community-engaged research.

Exploring the provider and organization level barriers to medication for opioid use disorder treatment for Black Americans: A study protocol.

Objectives: This study seeks to examine the provider and organizational factors that could be limiting the treatment of Opioid Use Disorder (OUD) for Black Americans in Texas. Formative research at the provider and organizational level will assist in understanding the current facilitators, potential barriers, and capacity for OUD treatment for Black Americans. Study design: Using the exploration phase of the Explore, Preparation, Implementation, Sustainment (EPIS) framework, the project will be a formative assessment of local factors that influence Medication for OUD (MOUD) treatment availability for Black Americans to guide the design of a culturally and locally relevant multi-level intervention strategy. Methods: and analysis: This project will utilize emergent mixed methods to identify and clarify the problems that are obstructing treatment for Black patients with OUD. First, the perspectives of individual providers in their openness and willingness to provide MOUD treatment to Black Americans diagnosed with OUD will be explored through in-depth interviews. The organizational capacity factors associated with increased availability to treatment for Black American OUD patients will be examined with the organizational leaders using an exploratory sequential mixed-methods design. Leader and program managers of organizations that provide MOUD will be invited to participate in an online survey, with the option to participate in a follow-up in-depth interview. All qualitative data from the provider and organization staff interviews will be analyzed with a thematic analysis approach. The analysis of the two different types of qualitative data will be analyzed together, as a form of triangulation. Conclusions: This project will assess the understandings of individual providers as well as the organizational-level awareness of the cultural contexts of MOUD intervention for Black Americans. This formative research seeks to highlight the current status of the opioid crisis in the Black community, and what additional supports are needed.

Perceived Disease Risk of Smoking, Barriers to Quitting, and Cessation Intervention Preferences by Sex Amongst Homeless Adult Concurrent Tobacco Product Users and Conventional Cigarette-Only Users.

Adults experiencing homelessness smoke conventional cigarettes and engage in concurrent tobacco product use at very high rates; however, little is known about how use patterns, perceived disease risk, barriers to quitting smoking, and smoking cessation intervention preferences differ by sex in this group. Participants comprised a convenience sample of 626 adult conventional cigarette smokers experiencing homelessness. Participants self-reported their sex, smoking history, mental health and substance use diagnosis history, other concurrent tobacco product use (CU), disease risk perceptions, perceived barriers to quitting smoking, and preferences regarding tobacco cessation interventions via a computer-administered survey. CU rates were 58.1% amongst men and 45.3% amongst women smokers. In both sexes, CUs started smoking earlier (p-values < 0.001) and were more likely to have been diagnosed with a non-nicotine substance use disorder (p-values < 0.014) relative to cigarette-only users. Among men only, CUs were younger, smoked more cigarettes per day and were more likely to identify as non-Hispanic White (p-values < 0.003) than cigarette-only users. Additionally, male CUs reported a greater risk of developing ≥1 smoking-related disease if they did not quit for good; were more likely to endorse craving cigarettes, being around other smokers, habit, stress/mood swings, and coping with life stress as barriers for quitting smoking; and were less likely to prefer medications to quit smoking relative to male cigarette-only users (p-values < 0.04). On the other hand, female CUs reported a greater risk of developing ≥1 smoking-related disease even if they quit for good; were more likely to endorse stress/mood swings and coping with life stress as barriers for quitting smoking relative to female cigarette-only users (p-values < 0.05); and did not differentially prefer one cessation medication over another. Overall, findings confirm high rates of CU among both sexes, characterize those who may be more likely to be CUs, and reveal opportunities to educate men and women experiencing homeless on the benefits of evidence-based interventions for smoking cessation.

Collaborative Learning: A Qualitative Study Exploring Factors Contributing to a Successful Tobacco Cessation Train-the-Trainer Program as a Community of Practice.

Individuals with behavioral health conditions account for 50% of annual smoking-related deaths, yet rarely receive tobacco dependence treatment within local mental health authorities (LMHAs). As lack of training and knowledge are key barriers to providing tobacco dependence treatment, Taking Texas Tobacco-Free (TTTF) developed an iterative, 4-6-months train-the-trainer program to embed expertise and delivery of sustained education on tobacco-free workplace policies and practices in participating centers. We explore the employee "champions'" train-the-trainer program experiences using a community of practice (CoP) model to identify key contributors to successful program implementation. Across 3 different LMHAs, we conducted semi-structured individual and group interviews online at 2 time points. We interviewed each champion twice (except for 1 champion who dropped out between measurements); pre-implementation (3 group interviews; N = 4 + 4 + 3 = 11 champions); post-implementation (7 individual interviews and 1 group interview; 7 + 3 = 10 champions). Therefore, 11 champions participated in pre- and post-implementation interviews from July 2020-May 2021. Guided by an iterative, thematic analysis and constant comparison process, we inductively coded and summarized data into themes. Five factors contributed to successful program implementation: value of peer support/feedback; building knowledge, champion confidence, and program ownership; informative curriculum, adaptable to targeted populations; staying abreast of current tobacco/nicotine research and products; and TTTF team responsiveness and practical coaching/assistance. Champions reported the TTTF train-the-trainer program was successful and identified attitudes and CoP processes that effectively built organizational capacity and expertise to sustainably address tobacco dependence. Study findings can guide other agencies in implementing sustainable tobacco-free training programs.

An epidemic and a pandemic collide: Assessing the feasibility of tobacco treatment among vulnerable groups at COVID-19 protective lodging.

INTRODUCTION: Individuals experiencing homelessness have elevated smoking rates in addition to chronic and acute physical and mental health conditions, which may increase chances for complications associated with COVID-19 recovery. Unfortunately, there is underuse of tobacco cessation services in many agencies (e.g., substance use treatment centers, mental health treatment centers) providing care to these individuals. The purpose of the current study was to evaluate the feasibility of providing tobacco cessation treatment alongside local COVID-19 emergency response efforts. METHOD: Taking Texas Tobacco Free (TTTF) partnered with relevant emergency response teams at 5 isolation centers (repurposed hotels) in Austin, Texas, to address tobacco use among presumed or confirmed COVID-19 positive individuals who had nowhere else to seek care and shelter. TTTF trained staff on tobacco cessation treatment; specifically, the 5A's and use of nicotine replacement therapy. RESULTS: Over 5 months in 2020; 170 of 379 (44.9%) isolation center residents were reached and assessed for cigarette or vape use. Smoking/vaping prevalence was 70.6%, and 41.7% of tobacco users accepted cessation treatment. DISCUSSION: Results suggest the feasibility and potential acceptability of providing tobacco treatment services in similar care settings during local emergency response efforts, including but potentially not limited to the COVID-19 pandemic. Further, this initiates a call to action for health care providers to deliver tobacco use cessation services for typically hard-to-reach groups (e.g., individuals/families experiencing homelessness) who may have increased contact with service agencies and health providers during times of crisis. Limitations and suggestions for future implementation are also provided. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Did School Meal Programs and SNAP Participation Improve Diet Quality of US Children from Low-Income Households: Evidence from NHANES 2013-2014?

Nutrition assistance programs such as school meals and the Supplemental Nutrition Assistance Program (SNAP) are designed to provide a safety net for the dietary intake of children from low-income families. However, compared with eligible non-participants, the relationship of diet quality with school meals only and school meals + SNAP is not well understood. The objectives of the study include: (1) To explore whether and to what extent nutrition assistance program participation (school meals only and school meals + SNAP) is related to diet quality; and (2) to examine the differences of diet quality between participating in school meals only, school meals + SNAP, or non-participation among American children. Children aged 5 to 18 years old from income eligible households who participated in the 2013-2014 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study (n = 1425). Diet quality was measured using the Healthy Eating Index (HEI)-2015 and its 13 subcomponents. A Rao-Scott Chi-square test, propensity scores approach, and Analysis of Covariance were performed. Covariates included age, sex, race/ethnicity, weight status, and family monthly poverty index. SAS survey procedures were used to incorporate the appropriate sample design weights. Participation in school meals + SNAP was not associated with higher diet quality compared to eligible non-participants or school meals-only participants. Participation in school meals + SNAP improved the intake of total dairy, but not added sugars or total vegetables compared to school meals only. Overall, school meal + SNAP participation did not significantly improve the overall diet quality of children in low-income households relative to comparable non-participants.