Increasing the reach of evidence-based interventions for weight management and diabetes prevention among Medicaid patients: study protocol for a pilot Sequential Multiple Assignment Randomised Trial.

INTRODUCTION: Over 40% of US adults meet criteria for obesity, a major risk factor for chronic disease. Obesity disproportionately impacts populations that have been historically marginalised (eg, low socioeconomic status, rural, some racial/ethnic minority groups). Evidence-based interventions (EBIs) for weight management exist but reach less than 3% of eligible individuals. The aims of this pilot randomised controlled trial are to evaluate feasibility and acceptability of dissemination strategies designed to increase reach of EBIs for weight management. METHODS AND ANALYSIS: This study is a two-phase, Sequential Multiple Assignment Randomized Trial, conducted with 200 Medicaid patients. In phase 1, patients will be individually randomised to single text message (TM1) or multiple text messages (TM+). Phase 2 is based on treatment response. Patients who enrol in the EBI within 12 weeks of exposure to phase 1 (ie, responders) receive no further interventions. Patients in TM1 who do not enrol in the EBI within 12 weeks of exposure (ie, TM1 non-responders) will be randomised to either TM1-Continued (ie, no further TM) or TM1 & MAPS (ie, no further TM, up to 2 Motivation And Problem Solving (MAPS) navigation calls) over the next 12 weeks. Patients in TM+ who do not enrol in the EBI (ie, TM+ non-responders) will be randomised to either TM+Continued (ie, monthly text messages) or TM+ & MAPS (ie, monthly text messages, plus up to 2 MAPS calls) over the next 12 weeks. Descriptive statistics will be used to characterise feasibility (eg, proportion of patients eligible, contacted and enrolled in the trial) and acceptability (eg, participant opt-out, participant engagement with dissemination strategies, EBI reach (ie, the proportion of participants who enrol in EBI), adherence, effectiveness). ETHICS AND DISSEMINATION: Study protocol was approved by the University of Utah Institutional Review Board (#00139694). Results will be disseminated through study partners and peer-reviewed publications. TRIAL REGISTRATION NUMBER: clinicaltrials.gov; NCT05666323.

Socio-economic status moderates within-person associations of risk factors and smoking lapse in daily life.

BACKGROUND AND AIMS: Individuals of lower socio-economic status (SES) display a higher prevalence of smoking and have more diffxiculty quitting than higher SES groups. The current study investigates whether the within-person associations of key risk (e.g. stress) and protective (self-efficacy) factors with smoking lapse varies by facets of SES. DESIGN AND SETTING: Observational study using ecological momentary assessment to collect data for a 28-day period following a smoking quit attempt. Multi-level mixed models (i.e. generalized linear mixed models) examined cross-level interactions between lapse risk and protective factors and indicators of SES on smoking lapse. PARTICIPANTS: A diverse sample of 330 adult US smokers who completed a larger study examining the effects of race/ethnicity and social/environmental influences on smoking cessation. MEASUREMENTS: Risk factors included momentary urge, negative affect, stress; protective factors included positive affect, motivation, abstinence self-efficacy; SES measures: baseline measures of income and financial strain; the primary outcome was self-reported lapse. FINDINGS: Participants provided 43 297 post-quit observations. Mixed models suggested that income and financial strain moderated the effect of some risk factors on smoking lapse. The within-person association of negative [odds ratio (OR) = 0.967, 95% CI= 0.945, 0.990, P < 0.01] and positive affect (OR = 1.023, 95% CI = 1.003, 1.044, P < 0.05) and abstinence self-efficacy (OR = 1.020, 95% CI = 1.003, 1.038, P < 0.05) on lapse varied with financial strain. The within-person association of negative affect (OR = 1.005, 95% CI = 1.002, 1.008, P < 0.01), motivation (OR = 0.995, 95% CI = 0.991, 0.999, P < 0.05) and abstinence self-efficacy (OR = 0.996, 95% CI = 0.993, 0.999, P < 0.01) on lapse varied by income. The positive association of negative affect with lapse was stronger among individuals with higher income and lower financial strain. The negative association between positive affect and abstinence self-efficacy with lapse was stronger among individuals with lower financial strain, and the negative association between motivation and abstinence self-efficacy with lapse was stronger among those with higher income. The data were insensitive to detect statistically significant moderating effects of income and financial strain on the association of urge or stress with lapse. CONCLUSION: Some risk factors (e.g. momentary negative affect) exert a weaker influence on smoking lapse among lower compared to higher socio-economic status groups.

An ecological momentary assessment study of outcome expectancies and smoking lapse in daily life.

OBJECTIVE: Outcome expectancies have been identified as key components of behavior change. Expectancies related to affect control are hypothesized to play an important role in smoking cessation, such that smokers may be more likely to lapse if they believe they can control their affect by smoking and less likely if they believe they can control their affect by means other than smoking. However, little is known about whether real-time, real-world changes in affect control expectancies influence smoking lapse during a quit attempt. METHODS: A diverse sample (N = 369) of adult smokers completed ecological momentary assessment of smoking expectancies and lapse for 28 days following a quit attempt. Multilevel logistic regression was used to examine whether the difference score of positive smoking outcome expectancies (the belief that smoking would improve mood) minus positive coping outcome expectancies (the belief that something other than smoking would improve mood) was related to smoking lapse in daily life. RESULTS: There was a significant within-person association between the expectancies difference score and lapse likelihood. When the difference score was 1 unit above a person's typical level, odds of lapse increased by 18.65 % (ß = 0.174, SE = 0.024, p < .0001, OR = 1.189, 95 % CI [1.135, 1.247]). CONCLUSION: Smokers undergoing a quit attempt were more likely to lapse in moments when the difference in the belief that smoking would improve their mood minus the belief that something other than smoking would improve their mood was larger. This work has relevance for tailoring interventions to both cultivate positive coping outcome expectancies and reduce smoking outcome expectancies, and informs theoretical models about the dynamic nature of outcome expectancies.

Trajectories of motivation and self-efficacy during a smoking quit attempt: An ecological momentary assessment study.

OBJECTIVE: Conceptual models of addiction highlight self-efficacy and motivation as key variables important during a smoking quit attempt; however, recent research has primarily focused on self-efficacy. Given the importance of motivation in these models, a clearer understanding of the effects of motivation during a smoking quit attempt is needed. METHOD: This study utilized ecological momentary assessment (EMA) to investigate the dynamic effects of motivation and self-efficacy early in a quit attempt. Participants were 356 smokers (45% male; 34% African American, 33% non-Hispanic White, 33% Latino). Participants completed EMAs of motivation, self-efficacy, and smoking for 4 days prequit through 1 week postquit, and returned for a follow-up assessment at 4 weeks postquit. Trajectory parameters of motivation and self-efficacy (mean, slope, and volatility) were analyzed in separate and combined regression models to predict smoking outcomes. RESULTS: Prequit results showed that parameters of motivation and self-efficacy were not associated with smoking on quit day. Postquit analyses revealed that participants with lower mean levels of motivation and self-efficacy were more likely to smoke at the end of Week 1. Moreover, individuals with decreasing levels of motivation over the first week of their quit attempt were more likely to be smoking at the end of Week 4. CONCLUSIONS: These findings highlight the need to incorporate dynamic measures of motivation in smoking research. Furthermore, the results underscore the value of utilizing EMA methods and trajectory parameters to gain a more nuanced understanding of the dynamic effects that key mechanisms have on smoking during a quit attempt. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mixed-methods economic evaluation of the implementation of tobacco treatment programs in National Cancer Institute-designated cancer centers.

BACKGROUND: The Cancer Center Cessation Initiative (C3I) was launched in 2017 as a part of the NCI Cancer Moonshot program to assist NCI-designated cancer centers in developing tobacco treatment programs for oncology patients. Participating centers have implemented varied evidence-based programs that fit their institutional resources and needs, offering a wide range of services including in-person and telephone-based counseling, point of care, interactive voice response systems, referral to the quitline, text- and web-based services, and medications. METHODS: We used a mixed methods comparative case study design to evaluate system-level implementation costs across 15 C3I-funded cancer centers that reported for at least one 6-month period between July 2018 and June 2020. We analyzed operating costs by resource category (e.g., personnel, medications) concurrently with transcripts from semi-structured key-informant interviews conducted during site visits. Personnel salary costs were estimated using Bureau of Labor Statistics wage data adjusted for area and occupation, and non-wage benefits. Qualitative findings provided additional information on intangible resources and contextual factors related to implementation costs. RESULTS: Median total monthly operating costs across funded centers were $11,045 (range: $5129-$20,751). The largest median operating cost category was personnel ($10,307; range: $4122-$19,794), with the highest personnel costs attributable to the provision of in-person program services. Monthly (non-zero) cost ranges for other categories were medications ($17-$573), materials ($6-$435), training ($96-$516), technology ($171-$2759), and equipment ($10-$620). Median cost-per-participant was $466 (range: $70-$2093) and cost-per-quit was $2688 (range: $330-$9628), with sites offering different combinations of program components, ranging from individually-delivered in-person counseling only to one program that offered all components. Site interviews provided context for understanding variations in program components and their cost implications. CONCLUSIONS: Among most centers that have progressed in tobacco treatment program implementation, cost-per-quit was modest relative to other prevention interventions. Although select centers have achieved similar average costs by offering program components of various levels of intensity, they have varied widely in program reach and effectiveness. Evaluating implementation costs of such programs alongside reach and effectiveness is necessary to provide decision makers in oncology settings with the important additional information needed to optimize resource allocation when establishing tobacco treatment programs.

Application of community - engaged dissemination and implementation science to improve health equity.

Community engagement is critical to accelerate and improve implementation of evidence-based interventions to reduce health inequities. Community-engaged dissemination and implementation research (CEDI) emphasizes engaging stakeholders (e.g., community members, practitioners, community organizations, etc.) with diverse perspectives, experience, and expertise to provide tacit community knowledge regarding the local context, priorities, needs, and assets. Importantly, CEDI can help improve health inequities through incorporating unique perspectives from communities experiencing health inequities that have historically been left out of the research process. The community-engagement process that exists in practice can be highly variable, and characteristics of the process are often underreported, making it difficult to discern how engagement of community partners was used to improve implementation. This paper describes the community-engagement process for a multilevel, pragmatic randomized trial to increase the reach and impact of evidence-based tobacco cessation treatment among Community Health Center patients; describes how engagement activities and the resulting partnership informed the development of implementation strategies and improved the research process; and presents lessons learned to inform future CEDI research.

Intersectionality and Smoking Cessation: Exploring Various Approaches for Understanding Health Inequities.

OBJECTIVE: Many marginalized groups smoke at higher rates and have greater difficulty quitting than less marginalized groups. Most research on smoking cessation inequities has focused on a single sociodemographic attribute (eg, race or socioeconomic status), yet individuals possess multiple attributes that may increase risk. The current study used an intersectionality framework to examine how the interplay between multiple marginalized attributes may impact smoking cessation outcomes. METHODS: A diverse sample of 344 adults enrolled in a smoking cessation program and reported on sociodemographic attributes (eg, race/ethnicity, gender, income) and continuous smoking abstinence on their quit date and at 1, 2, and 4 weeks postquit date. A Cox proportional hazard regression model was used to estimate whether intersectional links among race/ethnicity, gender, and income were related to smoking cessation outcomes. RESULTS: Lower household income may be related to higher risk of smoking cessation failure. There were no significant interactions among race/ethnicity, gender, and income in predicting relapse. Pairwise intersectional group differences suggested some groups may be at higher risk of relapse. Number of marginalized sociodemographic attributes did not predict relapse. CONCLUSIONS: Intersectionality may be a promising framework for addressing health inequities, and may help elucidate how to best design and target intervention efforts for individuals characterized by sociodemographic intersections that concur particularly high risk for poor tobacco cessation outcomes. IMPLICATIONS: Despite an overall decline in smoking rates, socioeconomic inequities in smoking prevalence and cancer mortality are widening. Efforts targeting tobacco cessation should incorporate new theory to capture the complex set of factors that may account for tobacco cessation inequities (eg, multiple aspects of identity that may influence access to tobacco cessation treatment and exposure to certain stressors that impede cessation efforts). Intersectionality may be a promising framework for addressing health inequities in tobacco use and cessation and may help elucidate how to best design and target intervention efforts for individuals that concur particularly high risk for poor tobacco cessation outcomes.

QuitSMART Utah: an implementation study protocol for a cluster-randomized, multi-level Sequential Multiple Assignment Randomized Trial to increase Reach and Impact of tobacco cessation treatment in Community Health Centers.

BACKGROUND: Tobacco use remains the leading cause of death and disability in the USA and is disproportionately concentrated among low socioeconomic status (SES) populations. Community Health Centers (CHCs) are a key venue for reaching low SES populations with evidence-based tobacco cessation treatment such as Quitlines. Electronic health record (EHR)-based interventions at the point-of-care, text messaging (TM), and phone counseling have the potential to increase Quitline reach and are feasible to implement within CHCs. However, there is a lack of data to inform how, when, and in what combination these strategies should be implemented. The aims of this cluster-randomized trial are to evaluate multi-level implementation strategies to increase the Reach (i.e., proportion of tobacco-using patients who enroll in the Quitline) and Impact (i.e., Reach × Efficacy [efficacy is defined as the proportion of tobacco-using patients who enroll in Quitline treatment that successfully quit]) and to evaluate characteristics of healthcare system, providers, and patients that may influence tobacco-use outcomes. METHODS: This study is a multilevel, three-phase, Sequential Multiple Assignment Randomized Trial (SMART), conducted in CHCs (N = 33 clinics; N = 6000 patients). In the first phase, clinics will be randomized to two different EHR conditions. The second and third phases are patient-level randomizations based on prior treatment response. Patients who enroll in the Quitline receive no further interventions. In phase two, patients who are non-responders (i.e., patients who do not enroll in Quitline) will be randomized to receive either TM or continued-EHR. In phase three, patients in the TM condition who are non-responders will be randomized to receive either continued-TM or TM + phone coaching. DISCUSSION: This project will evaluate scalable, multi-level interventions to directly address strategic national priorities for reducing tobacco use and related disparities by increasing the Reach and Impact of evidence-based tobacco cessation interventions in low SES populations. TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov (NCT03900767) on April 4th, 2019.

Socioeconomic Status, Social Context, and Smoking Lapse During a Quit Attempt: An Ecological Momentary Assessment Study.

BACKGROUND: Low socioeconomic status (SES) is linked to failure to quit smoking. Health inequity models suggest that low SES smokers experience barriers to quitting in part due to greater exposure to pro-smoking social contexts. PURPOSE: The current study examined longitudinal associations among socioeconomic status, pro-smoking social context factors (i.e., exposure to other smokers, places where smoking was allowed), cigarette availability, and smoking lapse during a quit attempt. METHODS: Ecological momentary assessments (EMA) were gathered from a multiethnic sample of 365 smokers engaged in a quit attempt. A multilevel structural equation model estimated a latent variable for SES indicated by income, education, health insurance, and employment, associations among EMAs for pro-smoking social contexts and cigarette availability, and indirect effects of SES through, pro-smoking social contexts and cigarette availability to subsequent smoking lapse. RESULTS: Lower SES scores were associated with a higher likelihood of smoking lapse. Decomposition of the path from SES to smoking lapse into indirect effects showed significant paths through exposure to places where smoking is allowed and cigarette availability. Additionally, significant serial indirect paths from SES through both exposure to other smokers and places where smoking was allowed, in turn, through cigarette availability, and, ultimately, to smoking lapse were noted. CONCLUSIONS: Consistent with models positing that SES influences health behaviors via contextual factors, the current study demonstrated that low SES smokers attempting to quit experienced greater pro-smoking social contexts that affected subsequent risk for lapse.

Socioeconomic indicators as predictors of smoking cessation among Spanish-Speaking Mexican Americans.

Objective: Smoking-related illnesses are the leading cause of death among Latinos, and within this ethnic group, Mexican Americans are the largest subgroup in the U.S. Understanding the factors associated with successful smoking cessation could inform interventions for this population. Although socioeconomic status (SES) is a powerful predictor of cessation outcomes in the general U.S. population, it has generally been a poor predictor of quitting smoking among Latinos. Within a sample of Spanish-speaking Mexican Americans (n = 199), this study examined a broad array of objective and subjective indicators of SES (i.e. income, education, employment, subjective social status, financial strain, insurance status) as predictors of smoking cessation. Design: Data for the current study came from a longitudinal cohort study examining the pathways linking the social determinants of health with smoking cessation. Generalized estimating equation modeling examined the association of each predictor variable with smoking abstinence across quit day, and the 3 and 26-weeks post-quit time points. Results: Results indicated that both low financial strain and insurance status predicted an increased likelihood of abstinence when controlling for covariates in the intention-to-treat analyses (p = .02 and p = .01, respectively). However, these models only approached significance in the multiple imputation analyses (all ps > .05). Other indicators of SES (i.e. income, education, employment) that have been predictive of cessation in other populations were not predictive of abstinence in this sample. Conclusions: These findings suggest that SES may indeed influence smoking cessation among Spanish-speaking Mexican Americans similarly to its influence in other populations, but that capturing the construct of SES may require assessing a broader range of SES indicators. Specifically, low financial strain and having insurance predicted a greater likelihood of achieving smoking abstinence, whereas other indicators of SES (i.e. income, education) were not predictive.

The use of ambulatory assessment in smoking cessation.

Ambulatory assessment of smoking behavior has greatly advanced our knowledge of the smoking cessation process. The current article first provides a brief overview of ecological momentary assessment for smoking cessation and highlights some of the primary advantages and scientific advancements made from this data collection method. Next, a discussion of how certain data collection tools (i.e., smoking topography and carbon monoxide detection) that have been traditionally used in lab-based settings are now being used to collect data in the real world. The second half of the paper focuses on the use of wearable wireless sensors to collect data during the smoking cessation process. Details regarding how these sensor-based technologies work, their application to newer tobacco products, and their potential to be used as intervention tools are discussed. Specific focus is placed on the opportunity to utilize novel intervention approaches, such as Just-In-Time Adaptive Interventions, to intervene upon smoking behavior. Finally, a discussion of some of the current challenges and limitations related to using sensor-based tools for smoking cessation are presented, along with suggestions for future research in this area.

The association of positive emotion and first smoking lapse: An ecological momentary assessment study.

OBJECTIVE: Individuals attempting to quit smoking typically have poor success rates, and the majority fail to maintain long-term abstinence. Although a large body of evidence documents the impact of negative affect on reducing abstinence, there is a much smaller body of research on positive emotions, which could be an important mechanism that is associated with successful cessation. As such, this study examined positive emotions in real-time via ecological momentary assessment (EMA) to determine whether discrete positive emotions were uniquely related to 2 cessation milestones: quit day lapse and first lapse. METHOD: Participants were 391 smokers who received tobacco cessation treatment. EMAs were completed pre- and postquit, and positive emotion was assessed with 3 items (enthusiastic, happy, and relaxed) rated on 5-point Likert scales. Analyses examined the associations of the means and slopes of each emotion on the current day with the likelihood of lapse on the following day. RESULTS: When controlling for relevant covariates, prequit positive emotions were not related to quit day lapse. However, postquit positive emotions were associated with first lapse. Specifically, high levels of happiness and relaxation, as well as increasing levels of enthusiasm, happiness, and relaxation were related to a lower likelihood of next day lapse. CONCLUSIONS: These are some of the first real-time, real-world data to demonstrate that distinct positive emotions are associated with a lower risk of lapse during the postquit period among smokers attempting to quit. (PsycINFO Database Record

Predicting quit attempts among homeless smokers seeking cessation treatment: an ecological momentary assessment study.

INTRODUCTION: Homeless adults are more likely to smoke tobacco and are less likely to successfully quit smoking than smokers in the general population, despite comparable numbers of cessation attempts and desire to quit. To date, studies that have examined smoking cessation in homeless samples have used traditional lab/clinic-based assessment methodologies. Real-time assessment of key variables may provide new insights into the process of quitting among homeless smokers. METHODS: The purpose of the current study was to identify predictors of a quit attempt using real-time assessment methodology during the 6 days prior to a scheduled quit attempt among homeless adults seeking care at a shelter-based smoking cessation clinic. Parameters for multiple variables (i.e., motivation for quitting, smoking expectancies, quit self-efficacy, smoking urges, negative affect, positive affect, restlessness, hostility, and stress) were calculated and were used as predictors of biochemically verified quit date abstinence (i.e., ≥13hr abstinent) using logistic regression analyses. RESULTS: Participants (n = 57) were predominantly male (59.6%), non-White (68.4%), and smoked an average of 18 cigarettes per day. A total of 1,132 ecological momentary assessments (83% completion rate) were collected at random times (i.e., up to 4 assessments/day) during the 6 days prior to a scheduled quit attempt. Results indicated that declining (negative slope) negative affect, restlessness, and stress predicted quit date abstinence. Additionally, increasing positive coping expectancies across the prequit week predicted quit date abstinence. CONCLUSIONS: Study findings highlight multiple variables that may be targeted during the precessation period to increase smoking cessation attempts in this difficult to treat population of smokers.

Mindfulness predicts lower affective volatility among African Americans during smoking cessation.

Recent research suggests that mindfulness benefits emotion regulation and smoking cessation. However, the mechanisms by which mindfulness affects emotional and behavioral functioning are unclear. One potential mechanism, lower affective volatility, has not been empirically tested during smoking cessation. This study examined longitudinal associations among mindfulness and emotional responding over the course of smoking cessation treatment among predominantly low-socioeconomic status (SES) African American smokers, who are at high risk for relapse to smoking and tobacco-related health disparities. Participants (N = 399, 51% female, mean age = 42, 48% with annual income <$10,000) completed a baseline measure of trait mindfulness. Negative affect, positive affect, and depressive symptoms were assessed at five time points during smoking cessation treatment (up to 31 days postquit). Volatility indices were calculated to quantify within-person instability of emotional symptoms over time. Over and above demographic characteristics, nicotine dependence, and abstinence status, greater baseline trait mindfulness predicted lower volatility of negative affect and depressive symptoms surrounding the quit attempt and up to 1 month postquit, ps < 0.05. Although volatility did not mediate the association between greater mindfulness and smoking cessation, these results are the first to show that mindfulness is linked to lower affective volatility (or greater stability) of negative emotions during the course of smoking cessation. The present study suggests that mindfulness is linked to greater emotional stability and augments the study of mindfulness in diverse populations. Future studies should examine the effects of mindfulness-based interventions on volatility and whether lower volatility explains effects of mindfulness-based treatments on smoking cessation.

Ecological momentary assessment of sleep, symptoms, and mood during chemotherapy for breast cancer.

OBJECTIVE: This study examined the association of sleep before and during a chemotherapy (CT) cycle for breast cancer with symptoms and mood during a CT cycle. METHODS: Twenty women undergoing CT for breast cancer completed the Pittsburgh Sleep Quality Index (PSQI) 1 h prior to a CT infusion. For 3 weeks following infusion, participants estimated sleep efficiency, minutes to sleep (sleep latency), number of nocturnal awakenings (sleep fragmentation (SF)), and sleep quality (SQ) each morning and rated symptoms (nausea, fatigue, numbness, and difficulty thinking) and mood three times daily (morning, afternoon, and evening) via ecological momentary assessments using automated handheld computers. RESULTS: The results showed that disturbed sleep (PSQI score > 5) prior to CT infusion was associated with greater fatigue, and more negative and anxious mood throughout the 3-week CT cycle, and good pre-CT infusion sleep (PSQI score < 5) buffered anxious mood in the first days following infusion. Time-lagged analyses controlling for mood/symptom ratings reported the previous evening revealed that longer sleep latency and greater SF were associated with greater daytime fatigue; poorer SQ and greater SF were antecedents of worse morning negative mood, and greater SF was associated with feeling more passive and drowsy. No evening symptom or mood ratings were related to subsequent SQ. CONCLUSIONS: These findings suggest that disturbed sleep before and after a CT infusion exacerbates fatigue, and negative, anxious, and drowsy mood during a CT cycle. Reducing sleep disturbance may be an important way to improve quality of life during CT.

The influence of discrimination on smoking cessation among Latinos.

BACKGROUND: Although studies have shown a cross-sectional link between discrimination and smoking, the prospective influence of discrimination on smoking cessation has yet to be evaluated. Thus, the purpose of the current study was to determine the influence of everyday and major discrimination on smoking cessation among Latinos making a quit attempt. METHODS: Participants were 190 Spanish speaking smokers of Mexican Heritage recruited from the Houston, TX metropolitan area who participated in the study between 2009 and 2012. Logistic regression analyses were conducted to evaluate the associations of everyday and major discrimination with smoking abstinence at 26 weeks post-quit. RESULTS: Most participants reported at least some everyday discrimination (64.4%), and at least one major discrimination event (56%) in their lifetimes. Race/ethnicity/nationality was the most commonly perceived reason for both everyday and major discrimination. Everyday discrimination was not associated with post-quit smoking status. However, experiencing a greater number of major discrimination events was associated with a reduced likelihood of achieving 7-day point prevalence smoking abstinence, OR=.51, p=.004, and continuous smoking abstinence, OR=.29, p=.018, at 26 weeks post-quit. CONCLUSIONS: Findings highlight the high frequency of exposure to discrimination among Latinos, and demonstrate the negative impact of major discrimination events on a smoking cessation attempt. Efforts are needed to attenuate the detrimental effects of major discrimination events on smoking cessation outcomes.