"Healthier health in more ways than one": Perspectives on a program for changing both smoking and obesity-related health behaviors.

INTRODUCTION: Individuals with obesity who smoke cigarettes have increased risk of morbidity and mortality. The goal of the current study was to inform the development of a multiple health behavior change intervention designed to facilitate smoking cessation while also targeting weight gain. METHODS: Four qualitative focus groups were conducted with individuals who smoked cigarettes and had overweight or obesity (n = 16) to explore the combined effects of smoking and obesity, past attempts to quit smoking or lose weight, and preferences for a combined health intervention. RESULTS: Focus groups converged on five themes including: the interactive effects of weight and smoking; lack of experience with evidence-based weight loss approaches; a desire and expectation to lose weight quickly; rapid weight gain during past attempts at smoking cessation; and interest in a multiple health behavior change intervention with weight management preceding smoking cessation and an emphasis on planning for the future and receiving encouragement and support. CONCLUSIONS: Groups provided insight into key topics to highlight in a combined intervention and key issues that have interfered with success in both domains.

Effects of mint, menthol, and tobacco-flavored e-cigarettes on tobacco withdrawal symptoms in adults who smoke menthol cigarettes: A laboratory pilot study.

BACKGROUND: Menthol cigarette smoking has remained stable or increased in certain groups, despite an overall decline in cigarette smoking rates in the U.S. Understanding whether e-cigarettes alter patterns of menthol cigarette use is critical to informing efforts for reducing the public health burden of menthol cigarette smoking. This 2019-2020 laboratory pilot study evaluated whether self-administration of mint-, menthol-, or tobacco-flavored e-cigarettes would differentially impact tobacco withdrawal symptoms in e-cigarette-naïve adults who smoke menthol cigarettes daily. METHODS: Participants (N=17; 35.3% Female; mean age=51.8) attended three laboratory sessions after 16-hours of tobacco abstinence. Participants self-administered a study-provided JUUL e-cigarette (0.7mL with 5% nicotine by weight) at each session in which flavor was manipulated (mint vs. menthol vs. tobacco; order randomized). Participants completed pre- and post-e-cigarette administration self-report assessments on smoking urges, nicotine withdrawal, and positive and negative affect states. Multilevel linear regression models tested differences between the three flavor conditions for individual study outcomes. RESULTS: Following overnight tobacco abstinence, vaping either a mint or menthol (vs. tobacco) flavored e-cigarette led to significantly greater reductions in smoking urges over time; menthol (vs. tobacco) flavored e-cigarettes also suppressed urges to smoke for pleasure. Notably, no differences in nicotine withdrawal, positive affect, or negative affect were observed. CONCLUSIONS: In this laboratory pilot study, mint and menthol (vs. tobacco) flavored e-cigarettes provided some negative reinforcement effects via acute reductions in smoking urges during tobacco abstinence, yet only menthol flavored e-cigarettes demonstrated suppressive effects on smoking urges for pleasure in adults who smoke menthol cigarettes daily.

Technical and relational process in MI sessions with a sample of Hispanic/Latinx adults who engage in heavy drinking: A latent growth mediation model.

The current study tests the Motivational Interviewing (MI) technical and relational hypotheses in a sample of Hispanic/Latinx adults (N = 276) who engage in heavy alcohol consumption. MI causal theory hypothesizes that therapist use of MI consistent skills (i.e., technical hypothesis) and embodiment of the MI Spirit (i.e., relational hypothesis) will elicit client change talk, which is a putative mechanism of positive client outcome after the session. We tested these associations in a rigorous parallel process latent growth curve mediation modeling framework. The data are from a completed randomized clinical trial of a culturally-adapted (CAMI) versus un-adapted MI targeting hazardous alcohol use and consequences. Results. The unconditional growth models for the mediator (i.e., proportion of change talk relative to sustain talk) and two study outcomes (i.e., percent of heavy drinking days; alcohol-related consequences) showed a linear effect over a 12-month period with a slower rate of growth at later timepoints. Contrary to expectations, the latent growth mediation models did not show relationships between MI-consistent skills (i.e., technical predictor) or latent MI Spirit (i.e., relational indicator) and the slope factor for proportion change talk. The slope factor for proportion change talk was also not associated with the slope factors for percent heavy drinking and consequences over follow-up. Conclusions. In this novel population for MI process analysis, the technical and relational hypotheses were not supported. Studies that are exploratory may be needed to further investigate the causal model in populations that are not often represented in MI process research.

Outcomes of a Brief Motivational Intervention for Heavy Alcohol Use in Racial or Ethnic Minority Compared to White Emerging Adults.

PURPOSE: This study used secondary data from a randomized controlled trial of a Brief Motivational Intervention (BMI) to examine whether Non-White participants had different treatment results compared to White participants. METHODS: The outcome variables of this study were divided into primary outcomes (heavy drinking and consequences associated with alcohol use) and secondary outcomes (cognitive variables such as motivation to change alcohol use, and behavioral variables, including protective behavioral strategies). Linear regression analyses were conducted with the PROCESS macro for SPSS, to test if race or ethnicity moderated the relationship between BMI and each treatment outcome. Data was collected at two time points, six weeks and three months after treatment. RESULTS: This study showed that race or ethnicity did not moderate treatment results for the four outcome variables. Additional within-group effect sizes were calculated for all racial and ethnic categories, showing that Hispanic/Latine and Black participants had larger effect sizes in all the outcome variables. DISCUSSION: The discussion examines the potential strength of Motivational Interviewing due to its client-centered spirit, which naturally allows for incorporating values and identity-based factors, such as culture, into the session. CONCLUSION: The results suggest similar BMI outcomes among White and Non-White emerging adults who engage in heavy drinking, potentially due to its client-centered approach. This is a preliminary study, and the results are therefore tentative.

A qualitative analysis of adolescents' perspectives on peer and influencer alcohol-related posts on social media.

INTRODUCTION: Adolescent exposure to alcohol-related content on social media is common and associated with alcohol use and perceived norms; however, little is known about how exposure differs by the source of the content (e.g., peer or 'influencer'). The purpose of this study was to utilise qualitative methods to compare adolescent perspectives on peer- versus influencer-generated alcohol content on social media. METHODS: Nine virtual semi-structured focus groups were conducted with adolescents (aged 15-19 years), following a general script aimed at ascertaining adolescent comparative perspectives on peer and influencer alcohol-related media content and the contexts in which it occurs. RESULTS: Five main themes emerged: (i) although both influencers and peers post predominantly positively-valenced alcohol content online, adolescents perceived some differences between these posts; (ii) adolescents perceived their peers to be more cautious and strategic when posting about alcohol than influencers are; (iii) the decision to engage with peer or influencer alcohol-related posts is influenced by a number of factors; (iv) both peer and influencer posts were perceived to send the message that drinking is acceptable, normal or cool; and (v) adolescents believed they are more likely to be influenced by peers' alcohol posts than influencers' alcohol posts, with some exceptions. DISCUSSION AND CONCLUSIONS: Future studies should aim to further understand the unique attributes and circumstances in which exposure to peer and influencer alcohol-related posts impact adolescent alcohol-related cognitions and behaviours. This knowledge will inform prevention and intervention efforts, such as media literacy training and media-specific parenting practices.

Technology-Based Smoking Cessation for Youth Exiting Foster Care: A Pilot Randomized Trial.

Despite high rates of cigarette use, little attention has been paid to screening and cessation services for youth in foster care. Study aims were to test the feasibility, acceptability, and preliminary efficacy of a technology-based smoking cessation intervention. Study enrollment, satisfaction, and engagement were high in the intervention arm, where readiness to change also significantly increased over time. Intervention and control participants significantly reduced cigarette use at 6-month follow up, though groups did not differ. Technology-based interventions appear to be attractive and offer a potentially scalable link to health care that this vulnerable population may not otherwise seek.

Associations Among Enacted Stigma, Perceived Chances for Success, Life Satisfaction, and Substance Use Among Sexual Minority and Heterosexual Youth.

Background: Sexual minority youth report high rates of substance use compared to heterosexual youth. Stigma can diminish perceptions of future success and life satisfaction and contribute to elevated substance use. This study examined whether experiences of enacted stigma (i.e., discrimination) and substance use among sexual minority and heterosexual youth were indirectly associated through perceived chances for success and life satisfaction. Method: In a sample of 487 adolescents who indicated their sexual identity (58% female, M age = 16.0, 20% sexual minority), we assessed substance use status and factors that might explain sexual minority disparities in substance use. Using structural equation modeling, we examined indirect associations between sexual minority status and substance use status through these factors. Results: Compared to heterosexual youth, sexual minority youth reported greater stigma, which was associated with both lower perceived chances for success and life satisfaction, which were in turn associated with greater likelihood of substance use. Conclusions: Findings highlight the importance of attending to stigma, perceived chances for success, and general life satisfaction to understand and intervene to prevent substance use among sexual minority youth.

Qualitative reactions to a low nicotine product standard for cigarettes from adolescents and young adults living in the United States who smoke.

The Biden Administration is considering a low nicotine product standard for cigarettes. This qualitative study examined reactions to a nicotine reduction policy among adolescents and young adults (AYA) who smoke cigarettes. After completing a lab study involving masked exposure either to low nicotine or normal nicotine research cigarettes and unmasked exposure to e-cigarettes varying in nicotine concentration and flavor, we conducted follow-up semi-structured interviews (N = 25) to explore participants' knowledge, attitudes, and perceptions of a low nicotine product standard and their anticipated tobacco use behavior after policy implementation. Interviews were audio-recorded, transcribed verbatim, double-coded, and analyzed using reflexive thematic analysis. Nearly half of participants supported the policy because they thought it would prevent young people from starting smoking and/or would help people quit. Reasons some participants opposed the policy included beliefs that adults should have the choice to smoke or that a nicotine reduction policy is counterintuitive because the government benefits from cigarette sales. Others believed the policy would be ineffective because youth could circumvent the policy (e.g., illicit market) or would increase their smoking to maintain the same nicotine level. Almost half of participants said they would quit smoking while the other half said they would continue smoking, although potentially reduce their smoking. Overall, our qualitative findings point to the need for pre-policy media campaigns targeting AYA who smoke to minimize negative reactions, dispel fears, and correct misperceptions as well as encourage quitting and provide information on accessing cessation resources.

The impact of the COVID-19 pandemic on a sample of US young adults who smoke cigarettes: A qualitative analysis.

INTRODUCTION: The ongoing COVID-19 pandemic has been associated with increased negative mood in youth, and a few reports of changes in tobacco use. We sought to increase the depth of knowledge on the effects of the pandemic on early young adult mood states, access to tobacco products and tobacco use behaviors, and knowledge of risks associated with tobacco use and COVID-19 by learning more about the lived experience of the pandemic among young adults early in their smoking trajectories. METHODS: Semi-structured qualitative interviews were conducted with 25 young adults ages 18-20 (M = 19) who smoked cigarettes daily or nearly every day and had used electronic cigarettes (ECs) on ≥ 2 occasions in their lifetime. RESULTS: Our results uncovered several themes: 1) The majority of teens experienced mental health disturbances as a result of the pandemic, which manifested as depression, anxiety, and/or acute loneliness due to social isolation; 2) tobacco purchasing behaviors sometimes changed, with both greater and less access reported among participants; 3) changes in tobacco use were also reported, with some reporting increases in use, others reporting decreases, and a few reporting quitting; and 4) while some youth reported that tobacco use could increase their risk related to COVID-19, the majority reported confusion and uncertainty about how tobacco use impacted their risk. CONCLUSIONS: The themes identified specific factors that may account for the heterogeneity of impacts of the pandemic on tobacco use, and highlight the value of qualitative work for centering the lived experience of youth for understanding larger trends in substance use.

Adolescents' perceptions of alcohol portrayals in the media and their impact on cognitions and behaviors.

OBJECTIVE: Exposure to alcohol in the media is pervasive and may influence adolescents' perceptions and use of alcohol. The purpose of this study was to better understand how adolescents perceive alcohol-related content in both entertainment and social media, with a focus on the valence of portrayals (i.e., positive, negative) and impacts on cognitions and behaviors. METHOD: Participants were 40 high school students (60% female). Nine focus groups were conducted via videoconferencing, stratified by grade (9th/10th, 11th/12th) and gender. Transcripts were analyzed via template-style thematic analyses to identify themes. RESULTS: Six themes were developed, including (a) some portrayals of alcohol may increase likelihood of using alcohol, (b) some portrayals of alcohol in the media can discourage drinking, (c) sometimes truly negative consequences of alcohol are portrayed positively or downplayed, (d) media portrayals of alcohol are perceived to be based in reality but are at times exaggerated, (e) adolescent and adult alcohol use is portrayed differently in entertainment media, and (f) the extent to which adolescents are influenced by the media may depend on their preexisting attitudes, beliefs, and education. CONCLUSIONS: Adolescents have awareness of media portrayals of alcohol, both positive and negative, and their associated impacts. Findings highlight the need for much more work to understand the conditions under which, and for whom, exposure to different types of positive portrayals of alcohol in the media translate into positive expectancies about alcohol or drinking motives. Such work may ultimately inform intervention targets to reduce early initiation and/or risky drinking among adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Interactive effects of financial strain and distress tolerance on prequit tobacco withdrawal symptoms in smokers preparing to initiate a quit attempt.

Smokers experiencing greater financial strain are less likely to successfully quit smoking, possibly due to greater severity of tobacco withdrawal. However, limited research has explored whether individual-level psychological factors (i.e., distress tolerance) may buffer the deleterious effects of financial strain on withdrawal. This study examined the main and interactive effects of financial strain and distress tolerance on tobacco withdrawal experienced prior to quitting smoking among smokers preparing to initiate a quit attempt. Fifty-nine adult smokers completed a baseline session including a financial strain measure and subjective and behavioral assessments of distress tolerance. Participants were then instructed to initiate a quit attempt, without any behavioral or pharmacological assistance, 14 days following baseline. Prequit tobacco withdrawal symptoms were assessed once per day for 3 days prior to quit date. Linear regression models tested main and interactive effects between financial strain and distress tolerance on experiences and perceptions of prequit withdrawal. Findings demonstrated significant interactions between financial strain, distress tolerance, and perceptions of tolerating withdrawal. Negative associations found between higher distress tolerance and lower perceptions of tobacco withdrawal and negative mood as being "intolerable" prior to quitting were stronger for those experiencing greater levels of financial strain. Financial strain may negatively impact one's perceived ability to tolerate mood- and tobacco-related withdrawal prior to quitting. Yet, higher distress tolerance may buffer the effects of financial strain on smoking cessation processes. Psychosocial interventions designed to promote tolerance of distress from both internal and external stressors may benefit cessation efforts among smokers experiencing high financial strain. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Social Network Composition, Relationship Type, and Alcohol Use Among Young Adults Not in Four-Year College.

Background: The drinking of social network members has been consistently associated with personal drinking. However, less attention has been paid to emerging adult populations outside of four-year college students and to potential moderators of this relationship. In a sample of emerging adults who never attended four-year college, this research examined: 1) the compositional characteristics of the social networks, 2) the association between the drinking of network members and personal drinking, and 3) how the association between network and personal drinking was moderated by relationship type (e.g., friend, parents, significant other). Methods: Data was provided by a sample of 525 emerging adults who participated in Qualtrics Panels. Results: In this noncollege sample, the composition of the social network was diverse, with roughly one-third of network members being friends and a little less than half being family members. Parents tended to consume alcohol more frequently than friends and significant others, but participants consumed alcohol more frequently with friends and significant others. Furthermore, drinking among friends and significant others tended to have stronger associations with personal alcohol use than drinking among parents. However, relationship type did not moderate the association between drinking with network members and personal alcohol use. Conclusions: Because of this, interventions need to be delivered to drinking groups.

Reducing Smoking Cessation Disparities: Capacity for a Primary Care- and Technology-Based Approach Among Medicaid Recipients.

While cigarette use among U.S adults has recently decreased, vulnerable subgroups continue to smoke at high rates, including individuals receiving Medicaid insurance. These individuals have also experienced treatment access disparities, highlighting the need for approaches that leverage their strong desire to quit. We conducted interviews with 100 adult primary care patients receiving Medicaid who were current tobacco users about their use, openness to technology-based interventions, and readiness to change. Most (92%) reported current cigarette use and readiness to change averaged 6.98 out of 10 (SD = 2.82). Nearly all were open to completing an iPad-based tobacco screening (95%) and brief intervention (90%) at their next appointment, while 91% and 88% were willing to talk with their provider or a cessation counselor, respectively, about the subsequent results. Results persisted across age, sex, and race/ethnicity. Openness to technology-based interventions in this population provides support for future work that may ultimately reduce disparities.

The Impact of Reducing Nicotine Content on Adolescent Cigarette Smoking and Nicotine Exposure: Results From a Randomized Controlled Trial.

INTRODUCTION: As the science base around the potential benefits of a reduced-nicotine standard for cigarettes grows, information on the potential effects on adolescent smokers is a high priority. The aim of this randomized trial was to test the influence of 3-week exposure to reduced nicotine cigarettes in a sample of adolescent daily smokers. AIMS AND METHODS: In this double-blind, two-arm, randomized controlled trial (NCT0258731), following a 1-week baseline, adolescent daily smokers not currently intending to quit (ages 15-19 years, n = 66 randomized) were urn randomized to use either very low nicotine content (VLNC; 0.4 mg/g; n = 33) or normal nicotine content (NNC, 15.8 mg/g; n = 33) research cigarettes for 3 weeks. Participants attended five study sessions at our clinical laboratory. The primary outcome was average total cigarettes smoked per day (CPD; including both study and non-study cigarettes) at week 3. RESULTS: Stepwise regression results demonstrated that compared with NNC cigarettes (n = 31), assignment to VLNC cigarettes (n = 29), was associated with 2.4 fewer CPD on average than NNC assignment (p < .05) week 3 when controlling for covariates (p < .01, Cohen's d = 0.52 n = 60 completed all procedures). VLNC cigarettes were also associated with lower levels of craving reduction than NNC cigarettes (Questionnaire on Smoking Urges Factor 2, p < .05). No group differences were found for secondary outcomes. CONCLUSIONS: Adolescent participants assigned to VLNC use for 3 weeks smoked fewer total CPD relative to the NNC group. Overall, data suggest that a VLNC policy would reduce cigarette smoking in adolescents who smoke, but high rates of incomplete adherence suggest that youth may seek alternative sources of nicotine in this scenario. IMPLICATIONS: The US Food and Drug Administration may enact a reduced-nicotine product standard that would affect all commercially available cigarettes. One important population affected by this policy would be adolescents who smoke. This study, the first clinical trial of VLNC cigarettes in adolescents, demonstrates that adolescents switched to VLNC cigarettes for 3 weeks reduced their CPD relative to the normal-nicotine cigarette control group, without leading to increased respiratory symptoms or increased withdrawal. Biomarkers indicated the use of other sources of nicotine, suggesting that such a policy will need to consider approaches to assist in transitioning away from smoking.

The role of the relational context and therapists' technical behaviors in brief motivational interviewing sessions for heavy alcohol consumption: Findings from a sample of Latinx adults.

INTRODUCTION: Motivational interviewing (MI) theory and process research highlights the role of therapist technical and relational behaviors in predicting client in-session statements for or against behavior change (i.e., change and sustain talk, respectively). These client statements, in turn, have been shown to predict intervention outcomes. The current study examines sequential associations between therapist behaviors and client change and sustain talk in a sample of Latinx individuals who engage in heavy alcohol consumption. DATA: Data are from a completed randomized clinical trial of a culturally adapted (CAMI) versus unadapted MI targeting alcohol use and consequences among Latinx individuals. METHOD: The study collected observational coding data with the Motivational Interviewing Skill Code (MISC 2.5, i.e., therapist behaviors and global ratings) and the Client Language Assessment - Proximal/Distal (CLA-PD, i.e., client language). Frequentist and Bayesian sequential analyses examined the relationship among nine different categories of therapist behaviors and three different categories of client language (i.e., change talk, sustain talk, neutral). We examined odds ratios and conditional probabilities for the direction, magnitude, and significance of the association between the use of MI technical behaviors and subsequent client statements about change. The study compared these same transitional associations between low/average (i.e., <4) and high (i.e., ≥4) MI Spirit sessions. RESULTS: The pattern of results was replicated across both analytic frameworks. Questions and reflections about change talk versus sustain talk versus neutral statements showed greater odds of predicting the intended client response (i.e., change talk, sustain talk, neutral, respectively) compared to other possible client responses. Conditional probabilities for these transitions were high, ranging from 0.55 to.88. The magnitude of certain technical transitions significantly differed between low/average and high MI Spirit sessions. CONCLUSIONS: Analyses supported the hypothesized associations between therapist use of technical MI behaviors and client change language within this Latinx sample. Analyses of MI Spirit as a moderator of these transitions showed partial support.

Examining Racial/Ethnic Differences in the Association of Victimization and Suicidal Thoughts and Behaviors with Alcohol Use Among Sexual Minority Youth.

Purpose: Integrating Minority Stress Theory and Bagge and Sher's Theoretical Framework of the Alcohol-Suicide Attempt Relation, this study aimed to test whether experiencing both minority stress and suicidal thoughts and behaviors (STBs) had a greater strength of association with Latinx and Black sexual minority youth (SMY)'s alcohol use compared with that of White SMY. Methods: Using data on 2341 non-Latinx Black, Latinx, and non-Latinx White SMY from the 2015 and 2017 Youth Risk Behavior Surveys, we tested the prevalence of STBs, victimization, and alcohol use for Black and Latinx participants compared with White participants. Multivariate logistic regression analyses tested the main effects of STBs, victimization, and race/ethnicity on alcohol use. Finally, interaction terms assessed the interaction among STBs, victimization, and race/ethnicity on alcohol use. Results: The results supported our hypothesis, based on Minority Stress Theory, that experiencing victimization would be associated with greater alcohol use. Results also supported Bagge and Sher's theoretical framework showing that suicide plan and attempts were associated with greater alcohol use. When taking all of these stressors into account, results showed that Latinx SMY who experienced victimization had greater current prevalence of alcohol use than their White counterparts. However, Latinx SMY who were victimized and experienced suicidal ideation reported lower alcohol use than White SMY. Conclusion: These findings support the double jeopardy and resiliency hypotheses, which suggest that minority stressors have differing associations for each racial/ethnic SMY group's alcohol use. More research is needed that helps to disentangle the protective and risk factors for alcohol use among Black and Latinx SMY.

Development and Evaluation of a Measure of Drinking Behavior in Response to Acculturation Stressors for Latinx Adults Entering Alcohol Treatment.

Introduction: The current study presents the development of a scale to assess drinking behavior in response to acculturation and immigration stress. Methods: The 19-item Measure of Immigration and Acculturation Stressors (MIAS) and a parallel assessment, a Measure of Drinking in Response to Immigration and Acculturation Stressors (MDRIAS), were administered at baseline, 6 months, and 12 months in a completed randomized controlled trial testing culturally adapted motivational interviewing to reduce heavy drinking and related problems in Latinx individuals who met criteria for heavy drinking (n=149). Results: Exploratory factor analysis of the MIAS showed best fit for a four-factor solution (Relational Stress, Perceived Ethnic Discrimination, Attenuated Aspirations, and Sense of Alienation) with 15 items. The MIAS subscales and the four corresponding MDRIAS subscales were shown to have good reliability (i.e., internal consistency, intercorrelations, and test-retest) and criterion-related validity (i.e., concurrent, convergent, and predictive). Conclusions: These findings suggest that the MIAS can be used to assess different types of immigration and acculturation stressors for Latinx adults and the MDRIAS can be used to assess drinking in response to those experiences. The MIAS and MDRIAS could be used in the future to adapt alcohol interventions to relevant stressors that contribute to Latinx adults' alcohol use.

Effects of very low nicotine content cigarettes on smoking across vulnerable populations.

There has been long-standing interest in a reduced-nicotine product standard for combusted tobacco, which is within the regulatory purview of the Food and Drug Administration (FDA). In weighing whether to establish this standard, it is important to consider potential responses among people who are at elevated risk for tobacco-related health harms. In this narrative review, we summarize studies of very low nicotine content (VLNC) cigarettes conducted between 2010 and 2021 in groups that the FDA has identified as vulnerable populations. Studies conducted to date in adults with mental health conditions, adults with opioid use disorder, socioeconomically-disadvantaged adults, and youth or young adults indicate that immediate switching to VLNC cigarettes decreases smoking, with minimal or no unintended negative consequences. Few studies have investigated the effects of VLNC cigarettes in racial or ethnic minorities, people who smoke menthol cigarettes, and pregnant women, but initial findings suggest that responses of these individuals are similar to responses observed in other vulnerable populations. We are not aware of studies that have investigated VLNC cigarettes in military/veteran populations, sexual or gender minority individuals, or people living in underserved rural environments. Future research directions include understanding how to promote cessation in the context of a reduced-nicotine standard, and how to correct VLNC misperceptions in vulnerable populations. Nevertheless, the evidence to date indicates that a reduced-nicotine standard is likely to have the same beneficial effects on smoking reductions as it does in less vulnerable populations, which should provide some confidence in pursuing this regulatory approach.

Effects of Very Low Nicotine Content Cigarette use on Cigarette Reinforcement among Smokers with Serious Mental Illness.

BACKGROUND: Among people without psychiatric disorders who smoke, very low nicotine content (VLNC) cigarette use reduces cigarette reinforcement. Whether this is true of people with serious mental illness (SMI) who smoke is unknown. Using a hypothetical purchase task, we compared the effects of 6-week use of VLNC versus normal nicotine content (NNC) cigarettes on study cigarette and usual brand (UB) cigarette reinforcement among people with SMI who smoke. METHODS: After a baseline period of UB cigarette use, participants with SMI (n = 58) were randomized to use NNC cigarettes (15.8 mg nicotine/g tobacco) or VLNC cigarettes (0.4 mg/g) for 6 weeks. At Week 6, they completed the CPT for both their assigned study cigarette and UB. The groups were compared on demand intensity (number of cigarettes purchased at no cost) and elasticity (rate of decline in demand as price increases) using extra sum-of-squares F-tests. The effects of treatment on demand indices while controlling for covariates were assessed using hierarchical regression. RESULTS: At Week 6, intensity of demand for study cigarettes was lower and elasticity was higher for the VLNC group relative to the NNC group (p < 0.0001). Furthermore, intensity of demand for UB cigarettes was lower for participants in the VLNC group relative to participants in the NNC group (p < 0.01). When controlling for baseline cigarettes per day, intensity remained significantly different for study cigarettes and usual brand cigarettes at Week 6. CONCLUSION: A nicotine reduction policy may reduce cigarette reinforcement in this vulnerable population.

Education-based stigma and discrimination among young adults not in 4-year college.

BACKGROUND: Lower levels of education are strongly associated with negative health outcomes. The current study examined the degree to which those without a history of 4-year college attendance experience social stigmatization of their educational status and if these experiences are associated with mental health symptoms. METHODS: Data was obtained from 488 emerging adults who never attended 4-year college using Qualtrics Panels. RESULTS: 79.4% of participants agreed to one of the six statements that not attending 4-year college is stigmatized, and 71.8% endorsed experiencing at least one form of discrimination. Higher levels of education-related stigma and more frequent experiences of education-related discrimination was associated with greater past-month anxiety and depression symptoms. CONCLUSIONS: These findings could serve to increase awareness regarding the unique and significant discrimination faced by young adults who do not attend 4-year college and identify specific areas of intervention that can help these young adults cope with the effects of stigma and discrimination.