Enabling tobacco treatment for gastroenterology patients via a novel low-burden point-of-care model.

BACKGROUND & AIM: Smoking is a major risk factor for multiple gastrointestinal cancers, and adversely affects peptic ulcer disease, gastroesophageal reflux, pancreatitis and Crohn's disease. Despite key recommendations for diagnosing and treating tobacco use disorder in healthcare settings, the degree to which this is implemented in Gastroenterology (GI) clinics is unknown. We aimed to assess our providers' practices, identify barriers for implementing evidence-based smoking cessation treatments, and address these barriers by implementing a novel low-burden point of care Electronic health record-enabled evidence-based tobacco treatment (ELEVATE), in GI clinics. METHODS: An online survey was distributed to clinic gastroenterologists. ELEVATE module training was implemented in 1/2021. Data were evaluated during pre (7/2020-12/2020) and post (1/2021-12/2021) implementation periods to evaluate the reach and effectiveness of ELEVATE. Generalized estimating equations (GEE) were used to generate rate ratios (RR) to evaluate the intervention. RESULTS: 91% (20/22) of GI physicians responded to our survey, and only 20% often assisted patients who smoke with counseling. Lack of a systematic program to offer help to patients was reported by 80% of providers as an extremely/very important barrier limiting their smoking cessation practices. The proportion of current patients who smoke receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (14.36-27.47%, RR = 1.90, 95% CI 1.60-2.26, p < .001). Post-ELEVATE, 14.4% (38/264) of patients with treatment quit smoking, compared to 7.9% (55/697) of patients without treatment (RR = 1.89, 95% CI 1.26-2.82, p = .0021). CONCLUSION: Smoking practices are frequently assessed in GI clinics but barriers limiting cessation treatment exist. The use of a low burden point of care EHR enabled smoking cessation treatment module has led to a significant improvement in the treatment of smoking and subsequent cessation in our clinics. This study sheds light on an often under-recognized source of morbidity in GI patients and identifies an efficient, effective, and scalable strategy to combat tobacco use and improve clinical outcomes in our patients.

Experimental Test of High-Dimensional Quantum Contextuality Based on Contextuality Concentration.

Contextuality is a distinctive feature of quantum theory and a fundamental resource for quantum computation. However, existing examples of contextuality in high-dimensional systems lack the necessary robustness required in experiments. Here, we address this problem by identifying a family of noncontextuality inequalities whose maximum quantum violation grows with the dimension of the system. At first glance, this contextuality is the single-system version of multipartite Bell nonlocality taken to an extreme form. What is interesting is that the single-system version achieves the same degree of contextuality but uses a Hilbert space of lower dimension. That is, contextuality "concentrates" as the degree of contextuality per dimension increases. We show the practicality of this result by presenting an experimental test of contextuality in a seven-dimensional system. By simulating sequences of quantum ideal measurements with destructive measurements and repreparation in an all-optical setup, we report a violation of 68.7 standard deviations of the simplest case of the noncontextuality inequalities identified. Our results advance the investigation of high-dimensional contextuality, its connection to the Clifford algebra, and its role in quantum computation.

Assessment of formal tobacco treatment and smoking cessation in dual users of cigarettes and e-cigarettes.

BACKGROUND: The utility of electronic cigarettes ('e-cigarettes') as a smoking cessation adjunct remains unclear. Similarly, it is unclear if formal tobacco treatment (pharmacotherapy and/or behavioural support) augments smoking cessation in individuals who use both cigarettes and e-cigarettes. METHODS: We performed a longitudinal cohort study of adult outpatients evaluated in our tertiary care medical centre (6/2018-6/2020). E-cigarette use, smoking status and formal tobacco treatment (deterrent pharmacotherapy and/or behavioural support) were assessed in 6-month blocks (eg, cohort 1 (C1)=6/2018-12/2018, C2=1/2019-6/2019 and so on) using our electronic health record. We assessed the relationship between e-cigarette use (either with or without formal tobacco treatment) and point prevalence of smoking cessation at 6 and 12 months. RESULTS: 111 823 unique patients were included in the study. The prevalence of dual use of cigarettes and e-cigarettes increased significantly over the study period (C1=0.8%; C2=1.1%; C3=1.8%; C4=2.3%; p<0.001). The prevalence of smoking cessation at 12 months was higher among e-cigarette users (20.8%) compared with non-users (16.8%) (risk difference, 4.0% (95% CI 2.5% to 5.5%); adjusted relative risk (aRR) 1.354, 95% CI 1.252 to 1.464, p<0.0001). Further, among dual users of cigarettes and e-cigarettes, the prevalence of smoking cessation at 12 months was higher among individuals who received tobacco treatment (29.1%) compared with individuals who did not receive tobacco treatment (19.6%) (risk difference, 9.5% (95% CI, 4.6% to 14.4%); aRR 1.238, 95% CI 1.071 to 1.432, p=0.004). INTERPRETATION: These results suggest that dual users of cigarettes and e-cigarettes benefit from formal tobacco treatment. Clinicians should consider offering formal tobacco treatment to such patients, though future trials are needed.

Increased Reach and Effectiveness With a Low-Burden Point-of-Care Tobacco Treatment Program in Cancer Clinics.

BACKGROUND: Tobacco cessation after a cancer diagnosis can extend patient survival by improving outcomes for primary cancer and preventing secondary cancers. However, smoking is often unaddressed in cancer care, highlighting the need for strategies to increase treatment reach and cessation. This study examined a low-burden, point-of-care tobacco treatment program (ELEVATE) featuring an electronic health record-enabled smoking module and decision support tools to increase the reach and effectiveness of evidence-based smoking cessation treatment. METHODS: This study included adult outpatient tobacco smokers (n=13,651) in medical oncology, internal medicine, and surgical oncology clinics from a large midwestern healthcare system. We examined reach and effectiveness of ELEVATE with 2 comparisons: (1) preimplementation versus postimplementation of ELEVATE and (2) ELEVATE versus usual care. Data were evaluated during 2 time periods: preimplementation (January through May 2018) and postimplementation (June through December 2018), with smoking cessation assessed at the last follow-up outpatient encounter during the 6 months after these periods. RESULTS: The proportion of current tobacco smokers receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (1.6%-27.9%; difference, 26.3%; relative risk, 16.9 [95% CI, 9.8-29.2]; P<.001). Compared with 27.9% treatment reach with ELEVATE in the postimplementation time period, reach within usual care clinics ranged from 11.8% to 12.0% during this same period. The proportion of tobacco smokers who subsequently achieved cessation increased significantly from pre-ELEVATE to post-ELEVATE (12.0% vs 17.2%; difference, 5.2%; relative risk, 1.3 [95% CI, 1.1-1.5]; P=.002). Compared with 17.2% smoking cessation with ELEVATE in the postimplementation time period, achievement of cessation within usual care clinics ranged from 8.2% to 9.9% during this same period. CONCLUSIONS: A low-burden, point-of-care tobacco treatment strategy increased tobacco treatment and cessation, thereby improving access to and the impact of evidence-based cessation treatment. Using implementation strategies to embed tobacco treatment in every healthcare encounter promises to engage more smokers in evidence-based treatment and facilitate smoking cessation, thereby improving care cancer for patients who smoke.

Activation of Carbonyl Oxygen Sites in ß-Ketoenamine-Linked Covalent Organic Frameworks via Cyano Conjugation for Efficient Photocatalytic Hydrogen Evolution.

2D covalent organic frameworks (COFs) are drawing intense attention in heterogenous photocatalysis due to their porous, crystalline, and tailor-made structures. For highly efficient solar-to-chemical energy conversion, revealing and modulating active centers in the skeletons of COFs are of great importance but encounter severe challenges. Herein, it is demonstrated that cyano conjugation on a typical ß-ketoenamine-linked COF via aldehyde-imine Schiff-base condensation contributes to an enhanced stable photocatalytic H2 -evolution rate of 1.8 mmol h-1 g-1 (λ > 420 nm) with a superior apparent quantum yield of 2.12% at 420 nm, compared to pristine COFs. Both experimental results and density functional theory calculations disclose that the cyano conjugation can efficiently improve photoinduced charge separation and effectively decrease the energy barrier for H-intermediate generation on the carbonyl oxygen sites of the functionalized COFs. These findings present a precise organic functionalization strategy to optimize active centers on COF-based photocatalysts for the practical applications.

Photonic Implementation of Quantum Information Masking.

Masking of quantum information spreads it over nonlocal correlations and hides it from the subsystems. It is known that no operation can simultaneously mask all pure states [Phys. Rev. Lett. 120, 230501 (2018)PRLTAO0031-900710.1103/PhysRevLett.120.230501], so in what sense is quantum information masking useful? Here, we extend the definition of quantum information masking to general mixed states, and show that the resource of maskable quantum states is far more abundant than the no-go theorem seemingly suggests. Geometrically, the simultaneously maskable states lays on hyperdisks in the state hypersphere, and strictly contains the broadcastable states. We devise a photonic quantum information masking machine using time-correlated photons to experimentally investigate the properties of qubit masking, and demonstrate the transfer of quantum information into bipartite correlations and its faithful retrieval. The versatile masking machine has decent extensibility, and may be applicable to quantum secret sharing and fault-tolerant quantum communication. Our results provide some insights on the comprehension and potential application of quantum information masking.

Proof of the Peres Conjecture for Contextuality.

A central result in the foundations of quantum mechanics is the Kochen-Specker theorem. In short, it states that quantum mechanics cannot be reconciled with classical models that are noncontextual for ideal measurements. The first explicit derivation by Kochen and Specker was rather complex, but considerable simplifications have been achieved thereafter. We propose a systematic approach to find minimal Hardy-type and Greenberger-Horne-Zeilinger-type (GHZ-type) proofs of the Kochen-Specker theorem, these are characterized by the fact that the predictions of classical models are opposite to the predictions of quantum mechanics. Based on our results, we show that the Kochen-Specker set with 18 vectors from Cabello et al. [Phys. Lett. A 212, 183 (1996)PYLAAG0375-960110.1016/0375-9601(96)00134-X] is the minimal set for any dimension, verifying a longstanding conjecture by Peres. Our results allow to identify minimal contextuality scenarios and to study their usefulness for information processing.

Activation of M3 Muscarinic Acetylcholine Receptors Delayed Cardiac Aging by Inhibiting the Caspase-1/IL-1ß Signaling Pathway.

BACKGROUND/AIMS: Because the prevalence of age-related cardiac impairment increases as the human lifespan increases, it is important to combat the effects of aging. Recently, the cardiac M3 muscarinic acetylcholine receptor (M3-mAChR) has been demonstrated to play important roles in cardiac development and in the pathogenesis of cardiac diseases. However, the role of M3-mAChR in aging remains largely unknown. Therefore, the aim of this study was to investigate the involvement of M3-mAChR in the progression of cardiac aging. METHODS: We established a cardiac aging model in mice through subcutaneous injection with D-galactose at a dose of 100 mg/kg/day for 6 weeks. D-galactose was also used to induce aging in primary cultured neonatal mouse cardiomyocytes. The myocardium from mice was stained with hematoxylin and eosin for histological analysis. The protein expression levels of p53 and p21 were determined using western blotting. The mRNA and protein expression levels of M3-mAChR, caspase-1, and interleukin (IL)-1ß were determined using real-time PCR, immunohistochemical staining, and western blotting. RESULTS: The expression of M3-mAChR was down-regulated in the myocardium from aged mice and D-galactose-treated mice, while the expression levels of caspase-1 and its downstream molecule IL-1ß were significantly increased. The M3-mAChR agonist choline reduced the increase in caspase-1 in cardiomyocytes induced by D-galactose, which was reversed by the M3-mAChR antagonist 4-DAMP. Moreover, 4-DAMP promoted D-galactose-induced cardiomyocyte aging, which was attenuated by a caspase-1 inhibitor. CONCLUSION: Activation of M3-mAChR delayed cardiac aging by inhibiting the caspase-1/IL-1ß signaling pathway.

Experimental observation of quantum state-independent contextuality under no-signaling conditions.

Contextuality, the impossibility of assigning context-independent measurement outcomes, is a critical resource for quantum computation and communication. No-signaling between successive measurements is an essential requirement that should be accomplished in any test of quantum contextuality and that is difficult to achieve in practice. Here, we introduce an optimal quantum state-independent contextuality inequality in which the deviation from the classical bound is maximal. We then experimentally test it using single photons generated from a defect in a bulk silicon carbide, while satisfying the requirement of no-signaling within the experimental error. Our results shed new light on the study of quantum contextuality under no-signaling conditions.

Generalized Hardy's Paradox.

Here, we present the most general framework for n-particle Hardy's paradoxes, which include Hardy's original one and Cereceda's extension as special cases. Remarkably, for any n≥3, we demonstrate that there always exist generalized paradoxes (with the success probability as high as 1/2^{n-1}) that are stronger than the previous ones in showing the conflict of quantum mechanics with local realism. An experimental proposal to observe the stronger paradox is also presented for the case of three qubits. Furthermore, from these paradoxes we can construct the most general Hardy's inequalities, which enable us to detect Bell's nonlocality for more quantum states.

Isolation of ellagic acid from pomegranate peel extract by hydrophobic interaction chromatography using graphene oxide grafted cotton fiber adsorbent.

Ellagic acid, a natural polyphenol, was isolated from pomegranate peel extract by hydrophobic interaction using graphene oxide grafted cotton fiber as a stationary adsorbent. The grafted graphene oxide moieties served as hydrophobic interaction-binding sites for ellagic acid adsorption. The graphene oxide grafted cotton fiber was made into a membrane-like sheet in order to complete ellagic acid purification by using a binding-elution mode. The effects of operational parameters, such as the composition of the binding buffer/elution buffer, buffer pH, and buffer concentration, on the isolation process were investigated. It was found that 5 mmol/L sodium carbonate aqueous solution is a proper-binding buffer, and sodium hydroxide aqueous solution ranging from 0.04 to 0.06 mol/L is a suitable elution solution for ellagic acid purification. Under the optimized condition, the purity of ellagic acid increased significantly from 7.5% in the crude extract to 75.0-80.0%. The pH value was found to be a key parameter that determines the adsorption and desorption of ellagic acid. No organic solvent is involved in the entire purification process. Thus, a simple and environmentally friendly method is established for ellagic acid purification using a graphene oxide-modified biodegradable and bio-sourced fibrous adsorbent.

Experimental Quantification of Asymmetric Einstein-Podolsky-Rosen Steering.

Einstein-Podolsky-Rosen (EPR) steering describes the ability of one observer to nonlocally "steer" the other observer's state through local measurements. EPR steering exhibits a unique asymmetric property; i.e., the steerability can differ between observers, which can lead to one-way EPR steering in which only one observer obtains steerability in the steering process. This property is inherently different from the symmetric concepts of entanglement and Bell nonlocality, and it has attracted increasing interest. Here, we experimentally demonstrate asymmetric EPR steering for a class of two-qubit states in the case of two measurement settings. We propose a practical method to quantify the steerability. We then provide a necessary and sufficient condition for EPR steering and clearly demonstrate one-way EPR steering. Our work provides new insight into the fundamental asymmetry of quantum nonlocality and has potential applications in asymmetric quantum information processing.

Experimental demonstration of the Einstein-Podolsky-Rosen steering game based on the all-versus-nothing proof.

Einstein-Podolsky-Rosen (EPR) steering, a generalization of the original concept of "steering" proposed by Schrödinger, describes the ability of one system to nonlocally affect another system's states through local measurements. Some experimental efforts to test EPR steering in terms of inequalities have been made, which usually require many measurement settings. Analogy to the "all-versus-nothing" (AVN) proof of Bell's theorem without inequalities, testing steerability without inequalities would be more strong and require less resources. Moreover, the practical meaning of steering implies that it should also be possible to store the state information on the side to be steered, a result that has not yet been experimentally demonstrated. Using a recent AVN criterion for two-qubit entangled states, we experimentally implement a practical steering game using quantum memory. Furthermore, we develop a theoretical method to deal with the noise and finite measurement statistics within the AVN framework and apply it to analyze the experimental data. Our results clearly show the facilitation of the AVN criterion for testing steerability and provide a particularly strong perspective for understanding EPR steering.

Cannabis, Tobacco Use, and COVID-19 Outcomes.

Importance: It is unclear whether cannabis use is associated with adverse health outcomes in patients with COVID-19 when accounting for known risk factors, including tobacco use. Objective: To examine whether cannabis and tobacco use are associated with adverse health outcomes from COVID-19 in the context of other known risk factors. Design, Setting, and Participants: This retrospective cohort study used electronic health record data from February 1, 2020, to January 31, 2022. This study included patients who were identified as having COVID-19 during at least 1 medical visit at a large academic medical center in the Midwest US. Exposures: Current cannabis use and tobacco smoking, as documented in the medical encounter. Main Outcomes and Measures: Health outcomes of hospitalization, intensive care unit (ICU) admission, and all-cause mortality following COVID-19 infection. The association between substance use (cannabis and tobacco) and these COVID-19 outcomes was assessed using multivariable modeling. Results: A total of 72 501 patients with COVID-19 were included (mean [SD] age, 48.9 [19.3] years; 43 315 [59.7%] female; 9710 [13.4%] had current smoking; 17 654 [24.4%] had former smoking; and 7060 [9.7%] had current use of cannabis). Current tobacco smoking was significantly associated with increased risk of hospitalization (odds ratio [OR], 1.72; 95% CI, 1.62-1.82; P < .001), ICU admission (OR, 1.22; 95% CI, 1.10-1.34; P < .001), and all-cause mortality (OR, 1.37, 95% CI, 1.20-1.57; P < .001) after adjusting for other factors. Cannabis use was significantly associated with increased risk of hospitalization (OR, 1.80; 95% CI, 1.68-1.93; P < .001) and ICU admission (OR, 1.27; 95% CI, 1.14-1.41; P < .001) but not with all-cause mortality (OR, 0.97; 95% CI, 0.82-1.14, P = .69) after adjusting for tobacco smoking, vaccination, comorbidity, diagnosis date, and demographic factors. Conclusions and Relevance: The findings of this cohort study suggest that cannabis use may be an independent risk factor for COVID-19-related complications, even after considering cigarette smoking, vaccination status, comorbidities, and other risk factors.

Experimental demonstration of separating the wave‒particle duality of a single photon with the quantum Cheshire cat.

As a fundamental characteristic of physical entities, wave‒particle duality describes whether a microscopic entity exhibits wave or particle attributes depending on the specific experimental setup. This assumption is premised on the notion that physical properties are inseparable from the objective carrier. However, after the concept of the quantum Cheshire cats was proposed, which makes the separation of physical attributes from the entity possible, the premise no longer holds. Furthermore, an experimental demonstration of the separation of the wave and particle attributes inspired by this scenario remains scarce. In this work, we experimentally separated the wave and particle attributes of a single photon by exploiting the quantum Cheshire cat concept for the first time. By applying a weak disturbance to the evolution of the system, we achieve an effect similar to the quantum Cheshire cat and demonstrated the separation of the wave and particle attributes via the extraction of weak values. Our work provides a new perspective for the in-depth understanding of wave‒particle duality and promotes the application of weak measurements in fundamentals of quantum mechanics.

Blindly verifying partially unknown entanglement.

Quantum entanglement has shown distinguished features beyond any classical state. Many methods have been presented to verify unknown entanglement with the complete information about the density matrices by quantum state tomography. In this work, we aim to identify unknown entanglement with only partial information of the state space. The witness consists of a generalized Greenberger-Horne-Zeilinger-like paradox expressed by Pauli observables, and a nonlinear entanglement witness expressed by density matrix elements. First, we verify unknown bipartite entanglement and study the robustness of entanglement witnesses against the white noise. Second, we generalize such verification to partially unknown multipartite entangled states, including the Greenberger-Horne-Zeilinger-type and W-type states. Third, we give a quantum-information application related to the quantum zero-knowledge proof. It further provides a useful method in blindly verifying universal quantum computation resources. These results may be interesting in entanglement theories, quantum communication, and quantum networks.

Triptycene incorporated carbon nitride based donor-acceptor conjugated polymers with superior visible-light photocatalytic activities.

Polymeric carbon nitride (CN) has evoked considerable attention in photocatalysis, however, its π-deficiency conjugated frameworks engendering weak visible-light absorption and rapid charge recombination hinder the practical utilizations. Herein, a novel donor-acceptor (D-A) conjugated polymer based on triptycene incorporated carbon nitride (T-CN) has been facilely prepared by thermal copolymerization of melamine and 2,6,14-triaminotriptycene. Combined with the density functional theory (DFT) calculations, it is found that the formation of intramolecular charge transfer and the extended π-conjugative effect in the D-A structure contribute to a broadened light-harvesting spectral range, a higher charge separation/transfer efficiency and more active sites of T-CN for photoredox reactions. The T-CN catalyst accomplished superior visible-light photocatalytic performance in both hydrogen evolving and carbon dioxide reduction. The optimal T-CN catalyst exhibited the highest hydrogen evolution rate of 80.9 ± 1.3 µmol·h-1 and carbon monoxide production rate of 8.1 ± 0.2 µmol·h-1, which are ca. 8-fold and 20-fold of bulk CN, respectively. The convenient strategy of constructing D-A conjugated structure opens up a new intriguing avenue toward the rational creation of efficient polymeric nanomaterials for versatile applications of solar fuel production.

Point of care tobacco treatment sustains during COVID-19, a global pandemic.

BACKGROUND: Tobacco cessation treatment for cancer patients is essential to providing comprehensive oncologic care. We have implemented a point of care tobacco treatment care model enabled by electronic health record (EHR) modifications in a comprehensive cancer center. Data are needed on the sustainability of both reach of treatment and effectiveness over time, including the COVID-19 pandemic. METHODS: Using EHR data from the pre-implementation (P: 5 months) and post-implementation periods (6 month-blocks, T1-T5 for a total of 30 months), we compared two primary outcomes: 1) reach of treatment among those smoking and 2) effectiveness assessed by smoking cessation among those smoking in the subsequent 6 month period. We analyzed the data using generalized estimation equation regression models. RESULTS: With the point of care tobacco treatment care model, reach of treatment increased from pre to post T5 (3.2 % vs. 48.4 %, RR 15.50, 95 % CI 10.56-22.74, p < 0.0001). Reach of treatment in all post periods (T1-T5 including the COVID-19 pandemic time) remained significantly higher than the pre period. Effectiveness, defined by smoking cessation among those smoking, increased from pre to post T2 before the pandemic (12.4 % vs. 21.4 %, RR 1.57, 95 % CI 1.31-1.87, p < 0.0001). However, effectiveness, while higher in later post periods (T3, T4), was no longer significantly increased compared with the pre period. CONCLUSION: A point of care EHR-enabled tobacco treatment care model demonstrates sustained reach up to 30 months following implementation, even during the COVID-19 pandemic and changes in healthcare prioritization. Effectiveness was sustained for 12 months, but did not sustain through the subsequent 12 months.

Underutilization of guideline-concordant smoking cessation treatments in surgical patients: Lessons from a learning health system.

While smoking is a well-established risk factor for surgical complications, it is unclear how frequently guideline-concordant tobacco treatments are prescribed to surgical patients. In this cross-sectional study including 164673 unique patients evaluated in outpatient surgery clinics at a single institution in 2020, despite a relatively high smoking prevalence (14.7%), guideline-concordant treatment rates were very low, with only 12.7% of patients receiving pharmacotherapy and 31.7% receiving any treatment. Addressing disparities in smoking cessation treatments are critical given the disproportionate impact of smoking on surgical outcomes.

Racial disparities in intensity of smoke exposure and nicotine intake among low-dependence smokers.

BACKGROUND: Compared to white smokers, Black smokers are at disproportionately higher risk for smoking-related disease, despite consuming fewer cigarettes per day (CPD). To examine racial disparities in biobehavioral influences on smoking and disease risk, we analyzed the relationship between self-reported tobacco dependence and intensity of tobacco smoke exposure per cigarette, on the one hand, and intensity of nicotine intake per cigarette, on the other. METHODS: In 270 Black and 516 white smokers, smoke exposure was measured by expired carbon monoxide (CO), and nicotine intake was measured by plasma cotinine (COT) and cotinine+3'-hydroxycotinine ([COT + 3HC]). Using linear regression analyses, we analyzed how the Fagerström Test for Cigarette Dependence (FTCD) predicted intensity of smoke exposure per cigarette (CO/CPD) and intensity of nicotine intake per cigarette (COT/CPD; [COT + 3HC]/CPD), and how race moderated these relations. RESULTS: Overall, Black smokers consumed fewer CPD than white smokers and had higher levels of CO/CPD, COT/CPD, and [COT + 3HC]/CPD. These elevations were most pronounced at lower levels of dependence: amongst Black smokers, FTCD negatively predicted intensity of smoke exposure as measured by CO/CPD (B = -0.12, 95% CI = -0.18, -0.05, p = 0.0003) and intensity of nicotine intake as measured by [COT + 3HC]/CPD (B = -1.31, 95% CI = -2.15, -0.46, p = 0.002). CONCLUSIONS: Low-dependence Black smokers had higher intensities of both smoke exposure and nicotine intake per cigarette compared to similarly dependent white smokers, suggesting that measures of dependence, exposure, and intake underestimate incremental risk of each cigarette to Black smokers.