Pilot randomised controlled trial of a culturally aligned smoking cessation app for American Indian persons.

OBJECTIVE: To pilot test QuitGuide for Natives, a culturally aligned version of the National Cancer Institute's QuitGuide smartphone app for smoking cessation. METHODS: This randomised controlled trial was conducted remotely during 2022-2023. American Indian adults who smoked and resided in the Midwest (n=115) were randomised to QuitGuide for Natives or the general audience QuitGuide smartphone-based intervention. Group differences in feasibility (times the app was initiated), usability, acceptability ('How likely would you be to recommend the app to a friend?'), fit of app with culture and preliminary efficacy (24-hour quit attempts, cotinine-confirmed self-reported 7-day abstinence) outcomes were examined. RESULTS: QuitGuide for Natives versus the general audience QuitGuide did not differ in the number of times the app was opened (adjusted incidence rate ratio 0.94 (95% CI 0.63 to 1.40); p=0.743) nor in usability score (adjusted mean difference (aMD) 0.73 (95% CI: -5.00 to 6.46); p=0.801) or likeliness of recommending the app to a friend (aMD 0.62 (95% CI -0.02 to 1.27); p=0.058). Differences were observed for all cultural fit outcomes such as 'The app fits my American Indian culture (aMD 0.75 (95% CI 0.35 to 1.16); p<0.001). QuitGuide for Natives versus the general audience QuitGuide resulted in an average of 6.6 vs 5.1 24-hour quit attempts (p=0.349) and cotinine-confirmed 7-day abstinence was achieved by 6.9% vs 3.5% (p=0.679). CONCLUSIONS: Acceptability, cultural fit and preliminary efficacy findings are encouraging and will inform future, larger-scale evaluation of culturally aligned digital smoking cessation resources for American Indian adults.

Impact of nicotine reduction in cigarettes on smoking behavior and exposure: Are there differences by race/ethnicity, educational attainment, or gender?

BACKGROUND: Lowering nicotine in cigarettes may reduce smoking prevalences; however, it is not known whether an immediate or gradual reduction in nicotine is the optimal approach for all population groups. OBJECTIVES: We examined whether the optimal approach to nicotine reduction depended on the education, gender, or race of people who smoke and whether the optimal approach differentially benefited people who smoke based on their education, gender, or race. METHODS: Secondary analysis was conducted on a randomized clinical trial (N = 1250) comparing (1) immediate reduction from 15.5 to 0.4 mg of nicotine per gram of tobacco(mg/g);(2) gradual reduction to 0.4 mg/g;(3) control group with normal nicotine cigarettes(15.5 mg/g). Outcomes included cigarettes per day(CPD), carbon monoxide(CO), total nicotine equivalents(TNE), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and its glucuronides(NNAL), phenanthrene tetraol(PheT), N-Acetyl-S-(2-cyanoethyl)-l-cysteine(CEMA). Data were analyzed as area under the curve(AUC). RESULTS: Results were presented by education (High school[HS] or less n = 505, more than HS n = 745), gender (males n = 701, females n = 549), and race (Black participants n = 373,White participants n = 758). Regardless of education, gender, and race, CPD, CO, TNE, NNAL, PheT, and CEMA were lower in immediate versus gradual nicotine reduction. Comparing immediate versus the control, outcomes were lower for all subgroups; however, the magnitude of the effect for TNE varied by race. Specifically, geometric mean of the AUC of TNE in immediate versus gradual was 49 % lower in Black participants and 61 % lower in White participants (p-value = 0.047). CONCLUSIONS: Immediately reducing nicotine in cigarettes has the potential to benefit people who smoke across lower and higher educational attainment, male and female gender, and Black and White race.

Brief Underage Alcohol Use Screener Scores Predict Health Risk Behaviors.

The aim of this study was to determine if adolescents' scores on a 2-item underage alcohol use screener predict risky consequences of past-year alcohol use and other health risk behaviors in a nonclinical, school-based sample of adolescents. A predominantly minority sample of 756 middle and high school students completed in-school tablet-based surveys on past-year underage alcohol use and a range of health risk behaviors. Higher scores for self alcohol risk and peer alcohol risk were associated with higher risk of past-year riding with a drunk driver and past 90-day measures of cigarette use, marijuana use, unplanned sex, and unprotected intercourse. The National Institute of Alcohol Abuse and Alcoholism Brief Alcohol Screener is a useful tool for school-based service providers, including school nurses, to identify and address the needs of adolescents at high risk of the development of alcohol use disorders, as well as a range of preventable health risk behaviors.

Preliminary Evaluation of the NIAAA/AAP Brief Alcohol Use Screener.

AIMS: To assess the concurrent validity of the two-item NIAAA/American Academy of Pediatrics Brief Alcohol Use Screener, a developmentally sensitive assessment instrument, in a school-based sample of adolescents. METHOD: The sample consisted of 756 adolescents (53% girls; Mage = 13.7 years; SD = 1.6 years) in the 6th (n = 192), 8th (n = 283), and the 10th (n = 281) grades from Miami-Dade County, FL and Prince George's County, MD. Adolescents completed the NIAAA/AAP Brief Alcohol Use Screener, which consists of two items asking about adolescents' alcohol use and about peers' alcohol use during the last year. Peer-Risk is categorized into 'No Peer-Risk' versus 'Heightened Concern'; Self-Risk is categorized into 'No-Risk,' 'Low-Risk,' 'Moderate-Risk' or 'High-Risk,' based on alcohol use patterns and age. Adolescents also completed measures of recent alcohol use and four previously validated screener instruments. RESULTS: Relative to the self-use 'No-Risk' category, adolescents classified into the 'Low-,' 'Moderate-' and 'High-Risk' categories reported progressively greater alcohol use and misuse during the last 90 days. Similar patterns were observed between the Peer-Risk categories. Combined, the two NIAAA/AAP screener items were positively related to recent alcohol use and outperformed the other screeners examined. CONCLUSIONS: Results from the present study support the concurrent validity of the single and combined items of the NIAAA/AAP Brief Alcohol Use Screener, as well as the measure's favorable concurrent validity compared to four previously validated screener instruments. SHORT SUMMARY: The current results support the concurrent validity of the single and combined items of the NIAAA/AAP Brief Alcohol Use Screener, as well as the measure's favorable concurrent validity compared to four previously validated screener instruments, in a school-based sample of adolescents.