Financial Incentives for Smoking Cessation Among Socioeconomically Disadvantaged Adults: A Randomized Clinical Trial.

Importance: Socioeconomically disadvantaged individuals (ie, those with low socioeconomic status [SES]) have difficulty quitting smoking and may benefit from incentive-based cessation interventions. Objectives: To evaluate the impact of incentivizing smoking abstinence on smoking cessation among adults with low SES. Design, Setting, and Participants: This study used a 2-group randomized clinical trial design. Data collection occurred between January 30, 2017, and February 7, 2022. Participants included adults with low SES who were willing to undergo smoking cessation treatment. Data were analyzed from April 18, 2023, to April 19, 2024. Interventions: Participants were randomized to usual care (UC) for smoking cessation (counseling plus pharmacotherapy) or UC plus abstinence-contingent financial incentives (UC plus FI). Main Outcomes and Measures: The primary outcome was biochemically verified 7-day point prevalence smoking abstinence (PPA) at 26 weeks after the quit date. Secondary outcomes included biochemically verified 7-day PPA at earlier follow-ups, 30-day PPA at 12 and 26 weeks, repeated 7-day PPA, and continuous abstinence. Multiple approaches were employed to handle missing outcomes at follow-up, including categorizing missing data as smoking (primary), complete case analysis, and multiple imputation. Results: The 320 participants had a mean (SD) age of 48.9 (11.6) and were predominantly female (202 [63.1%]); 82 (25.6%) were Black, 15 (4.7%) were Hispanic, and 200 (62.5%) were White; and 146 (45.6%) participated during the COVID-19 pandemic. Overall, 161 were randomized to UC and 159 were randomized to UC plus FI. After covariate adjustment with missing data treated as smoking, assignment to UC plus FI was associated with a greater likelihood of 7-day PPA at the 4-week (adjusted odds ratio [AOR], 3.11 [95% CI, 1.81-5.34]), 8-week (AOR, 2.93 [95% CI, 1.62-5.31]), and 12-week (AOR, 3.18 [95% CI, 1.70-5.95]) follow-ups, but not at the 26-week follow-up (22 [13.8%] vs 14 [8.7%] abstinent; AOR, 1.79 [95% CI, 0.85-3.80]). However, the association of group assignment with smoking cessation reached statistical significance at all follow-ups, including 26 weeks, with multiple imputation (37.37 [23.5%] in the UC plus FI group vs 19.48 [12.1%] in the UC group were abstinent; AOR, 2.29 [95% CI, 1.14-4.63]). Repeated-measures analyses indicated that participants in the UC plus FI group were significantly more likely to achieve PPA across assessments through 26 weeks with all missing data estimation methods. Other secondary cessation outcomes also showed comparable patterns across estimation methods. Participants earned a mean (SD) of $72 ($90) (of $250 possible) in abstinence-contingent incentives. Participation during the COVID-19 pandemic reduced the likelihood of cessation across assessments. Conclusions and Relevance: In this randomized clinical trial, incentivizing smoking cessation did not increase cessation at 26 weeks when missing data were treated as smoking; however, the UC plus FI group had greater odds of quitting at follow-ups through 12 weeks. Cessation rates were higher for the UC plus FI group at all follow-ups through 26 weeks when multiple imputation was used to estimate missing outcomes. Trial Registration: ClinicalTrials.gov Identifier: NCT02737566.

Greater Discrimination Frequency and Lower Distress Tolerance Are Associated with Mental Health Problems Among Racially Privileged and Minoritized Adults Accessing an Urban Day Shelter.

INTRODUCTION: Discrimination experiences may be a contributing factor to the elevated prevalence of mental health problems among adults experiencing homelessness. METHODS: Using survey data (N = 552) collected from adults seeking services at an urban day shelter, the relationships between everyday and major discrimination experiences, distress tolerance, and mental health problems (depression, anxiety, post-traumatic stress disorder, poor mental health days) were characterized. Distress tolerance was examined as a moderator of the relationship between discrimination and mental health problems. RESULTS: Participants were predominantly from racially minoritized groups (59.6%), non-Hispanic (88.7%), and male (70.9%), with an average age of 45.7 years old (SD = 11.7). Descriptive analyses indicated that the main reason for discrimination differed between racially privileged (i.e., White participants) and racially minoritized participants (i.e., participants who identified as Black, American Indian/Alaska Native, Asian, Native Hawaiian/Pacific Islander, or multi-race), such that homelessness was most commonly endorsed among racially privileged participants while racial discrimination was most commonly reported among racially minoritized participants. Multivariate logistic regression analyses revealed associations between everyday discrimination, major discrimination, and distress tolerance with mental health problems. Distress tolerance did not moderate the relations between discrimination and mental health problems in most analyses. Notably, major discrimination was no longer associated with all mental health variables when both everyday and major discrimination were included in all models. CONCLUSION: Findings suggest that reducing everyday discrimination and addressing the adverse impact of everyday discrimination experiences may have a beneficial impact on mental health.

The association of sleep with physical and mental health among people experiencing homelessness.

BACKGROUND: Sleep deprivation is a critical risk factor for physical and mental health problems. The current study examined whether sleep problems were related to housing status and physical and mental health among people experiencing homelessness. METHODS: Data were collected via an anonymous survey completed by adults accessing services at a day shelter in Oklahoma City, OK. Demographic characteristics, sleep problems, days of poor physical and mental health, and self-rated health were assessed and compared across housing subgroups. Logistic regression analyses were performed to examine potential associations between sleep and health. RESULTS: Participants (N = 404) were predominantly male (71.0%) and racially minoritized (57.4%) with an average age of 47.0 (SD=11.6) years. Days of unintentional sleep over the past 30days differed significantly by housing status. Logistic regression analyses indicated that short sleep duration of ≤6 hours was associated with poorer self-rated health and more days of poor physical health over the past 30days compared to those who reported an optimal sleep duration of 7-9 hours. Additionally, reporting ≥1 day of unintentional daytime sleep was associated with more days of poor mental and physical health over the past 30-day. Reporting more days of inadequate sleep was associated with poorer self-rated health, and more days of poor physical and mental health over the past 30days. CONCLUSION: Sleep problems were associated with poorer physical and mental health among people experiencing homelessness. Safe environments where adults experiencing homelessness can sleep comfortably and without interruption may be needed to support good physical and mental health.

Identifying disparities in suicidal thoughts and behaviors among US adolescents during the COVID-19 pandemic.

BACKGROUND: Suicidal thoughts and behaviors (STBs) became more common among racial and ethnic minorities and sexual and gender minorities (SGM) during the COVID-19 pandemic relative to White and non-SGM adolescents. This study examines associations between pandemic-related stressors and STBs among a nationally representative sample of adolescents to identify vulnerable subpopulations. METHODS: We analyzed data from 6769 high school students using the 2021 Adolescent Behaviors and Experiences Survey. Pandemic-related stressors were assessed via seven items related to negative experiences (e.g., parent job loss; food insecurity) during the COVID-19 pandemic. Logistic regression analyses estimated the association between pandemic-related stressors and four outcomes: (1) sadness/hopelessness; (2) suicidal ideation; (3) suicide planning; and (4) recent suicide attempt (i.e., past 12 months). Interactions were modeled by sex, race/ethnicity, and sexual identity. RESULTS: A greater number of pandemic-related stressors was associated with higher odds for sadness and hopelessness (aOR: 1.55; 95% CI:1.44-1.67), suicidal ideation (aOR: 1.48; 95% CI:1.39-1.57), suicide planning (aOR:1.47; 95% CI: 1.36-1.59), and recent suicide attempt (aOR: 1.64; 95% CI:1.42-1.88). Pandemic-related stressors were also more strongly associated with some types of STBs in males (relative to females) and SGM females (relative to heterosexual females). CONCLUSION: Study findings indicate that pandemic-related stressors are associated with STBs within the US adolescent population, particularly among male and SGM female adolescents. Researchers are encouraged to use this knowledge to ensure nationwide suicide prevention efforts adequately address inequities in suicide risk.

Cannabis use among adults undergoing cancer treatment.

BACKGROUND: Little is known about the risks and benefits of cannabis use in the context of cancer care. This study characterized the prevalence, reasons for use, and perceived benefits of cannabis and compared symptoms and perceived risks between those who reported past 30-day cannabis use and those who did not. METHODS: Adults undergoing cancer treatment at a National Cancer Institute-designated cancer center completed measures of sociodemographic characteristics, cannabis use, use modalities, reasons for use, perceived harms/benefits of use, physical and psychological symptoms, and other substance/medication use. Analyses compared patients who used or did not use cannabis in the past 30 days. RESULTS: Participants (N = 267) were 58 years old on average, primarily female (70%), and predominantly White (88%). Over a quarter of respondents (26%) reported past 30-day cannabis use, and among those, 4.5% screened positive for cannabis use disorder. Participants who used cannabis most often used edibles (65%) or smoked cannabis (51%), and they were younger and more likely to be male, Black, and disabled, and to have lower income and Medicaid insurance than participants who did not use cannabis. Those who used cannabis reported more severe symptoms and perceived cannabis as less harmful than those who did not use cannabis. The most common medical reasons for cannabis use were pain, cancer, sleep problems, anxiety, nausea/vomiting, and poor appetite. Participants reported the greatest cannabis-related symptom relief from sleep problems, nausea/vomiting, headaches, pain, muscle spasms, and anxiety. CONCLUSIONS: Patients with cancer who used cannabis perceived benefits for many symptoms, although they showed worse overall symptomatology. PLAIN LANGUAGE SUMMARY: Among adults undergoing cancer treatment, 26% reported cannabis use in the past 30 days. Those who used cannabis were more likely to be male and disabled and to have lower income and Medicaid insurance than those who did not use cannabis. Participants most commonly reported using cannabis for pain, cancer, sleep, anxiety, and nausea/vomiting and reported the greatest perceived benefits for sleep, nausea/vomiting, headaches, pain, muscle spasms, and anxiety, yet participants who used cannabis also reported feeling worse physically and psychologically compared to those who did not use cannabis. Participants who used cannabis were more likely to report that cannabis was less risky to their health than alcohol, smoking, and opioids than those who did not use cannabis.

The Association of Cultural Identification with Obesity among African Americans.

INTRODUCTION: The influence of culture on body mass index (BMI) and obesity within the African American population is an underexplored area in the literature. Therefore, this study explored the extent to which cultural identity was associated with BMI and obesity among African Americans and whether the association of cultural identity with obesity differed between males and females. METHODS: Participants were African Americans (n = 304) who responded to an online survey. BMI was calculated using self-reported weight and height; a BMI ≥ 30 indicated obesity. Sex assigned at birth was measured by self-report, and identification with African American culture was assessed using scores from six Black Identity Classification Scale (BICS) subscales. Primary analyses were conducted using a series of linear and logistic regression analyses. RESULTS: In almost all cases, BICS was not associated with BMI and obesity among all African Americans, but moderation analyses revealed that stronger identification with certain subscales of BICS, such as Afrocentrism, Black Americanism, and Racial Salience, was associated with an increase in the odds of obesity for males and not for females. CONCLUSIONS: Study findings suggest that culture may influence obesity differently among males and females. Uncovering mechanisms linking cultural identification to obesity will provide novel contributions to behavioral interventions designed to reduce obesity within the African American population.

Seeing is believing: How cannabis marketing exposure is associated with cannabis use attitudes and behavior in a permissive medical cannabis policy environment.

BACKGROUND AND OBJECTIVES: Oklahoma has a fast-growing medical cannabis industry, showing a proliferation of industry marketing. While cannabis marketing exposure (CME) is a risk factor for cannabis use and positive attitudes about use, no studies have examined the impact of CME on attitudes and use behavior in a permissive cannabis policy environment, like Oklahoma. METHODS: N = 5428 Oklahoma adults ages 18 and older completed assessments of demographics, past 30-day cannabis use, and past 30-day exposure to each of four types of cannabis marketing: outdoor (billboards, signs), social media, print (magazines), and Internet. Regression models examined associations of CME with positive attitudes towards cannabis use, cannabis harm perceptions, interest in obtaining a medical cannabis license (among nonlicensed participants), and past 30-day cannabis use. RESULTS: Three quarters (74.5%) reported any past 30-day CME. Outdoor CME was most prevalent (61.1%), followed by social media (46.5%), Internet (46.1%), and print (35.2%). Correlates of CME included younger age, higher educational attainment and income, and medical cannabis license. In adjusted regression models, past 30-day CME and number of sources of CME were associated with current cannabis use behavior, positive attitudes about cannabis, lower cannabis harm perceptions, and greater interest in obtaining a medical cannabis license. Similar associations between CME and positive attitudes about cannabis were shown among noncannabis users. DISCUSSION AND CONCLUSIONS: Public health messaging should be employed to minimize the potential adverse impacts of CME. SCIENTIFIC SIGNIFICANCE: No studies have examined correlates of CME in a rapidly growing and relatively unrestrained marketing environment.

Perceptions of Mental Health and Exploring the Role of Social Activism Among African Americans Exposed to Media Coverage of Police Brutality and Protests.

This study explored the role of social activism in the association of exposure to media coverage of police brutality and protests with perceptions of mental health. Data for this study came from a sample of African Americans (N = 304) who responded to an online survey. Perceptions of mental health were assessed using a single item developed by the research team. Exposure to police brutality and protests was measured by asking how often they had seen or heard about African Americans being victims of police brutality and seen or heard about protests on television, social media, or other outlets. Participants were also asked about the extent to which these events caused them emotional distress. Social activism was assessed by asking participants if they had ever participated in political activities, such as calling their representative. Moderation and mediation analyses were conducted using linear regression. Moderation analyses showed that greater emotional distress from watching media coverage of police brutality and protests was associated with worse perceptions of mental health only when engagement in social activism was low. In contrast, mediation analyses indicated that greater frequency of and emotional distress from exposure to media coverage was indirectly associated with worse perceptions of mental health through increased engagement in social activism. Social activism may be an important method for coping with emotional distress from watching media coverage of police brutality and protests, but more research is needed to understand how African Americans might engage in social activism without adversely impacting mental health.

Efficacy of Web-Delivered Acceptance and Commitment Therapy (ACT) for Helping Black Adults Quit Smoking.

BACKGROUND: Digital smoking cessation interventions may reduce racial disparities in cessation because they are low cost, scalable, and can provide support at any place or time. Despite their promise, whether Black adults engage with and benefit from these tools is largely unknown. In a secondary analysis of a randomized trial, we explored the efficacy of an acceptance and commitment therapy (ACT)-based website (WebQuit) for smoking cessation compared to a US clinical practice guidelines-based website (Smokefree.gov) among Black adults. METHODS: A total of 316 Black adult smokers were enrolled in the trial between May 2017 and September 2018 and received access to WebQuit or Smokefree for 12 months. Participants self-reported on 30-day and 7-day abstinence from cigarette smoking at 3, 6, and 12-months. Treatment engagement was objectively measured and compared between arms. Participants also reported on their willingness to accept cues to smoke without smoking. RESULTS: WebQuit versus Smokefree participants engaged more with their website (higher number of logins, Incidence Rate Ratio (IRR) = 2.21; 95% CI: 1.70, 2.89). Complete-case 30-day point prevalence abstinence (PPA) at 12-months was 34% for WebQuit vs. 29% for Smokefree (OR = 1.22 95% CI: 0.73, 2.04). Increases in participants' willingness to accept cues to smoke mediated the intervention effect on abstinence from cigarette smoking at 12 months. CONCLUSIONS: This study addressed the lack of research on the utilization and efficacy of digital interventions for helping Black adults quit smoking. WebQuit participants engaged more with their website and quit smoking at a somewhat higher rate relative to Smokefree participants, albeit nonsignificant. Findings suggest high acceptability of ACT-based digital interventions to enable Black adult smokers to engage and sustain behavior changes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01812278.

Pandemic-Related Stress May Be Associated with Symptoms of Poor Mental Health Among African Americans.

The COVID-19 pandemic has disproportionately affected African Americans and has been a significant source of stress for this population due to increased economic hardship and social isolation. This study characterized the associations between COVID-19 vulnerability (e.g., contracting the illness or losing a loved one), pandemic-related stress, and symptoms of poor mental health among African Americans. The study sample included African Americans (N = 304) who responded to an online survey. Symptoms of poor mental health were assessed using the PHQ-4, which assessed symptoms of depression and anxiety. Vulnerability to COVID-19 was measured via self-report in three ways: (1) personal vulnerability, (2) family vulnerability, and (3) community vulnerability (i.e., friends, neighbors, and co-workers). Pandemic-related stress was measured by asking participants to rate how difficult it has been to access essential resources and services, manage finances, and plan or attend social events since March 13, 2020. Data were analyzed using multivariable logistic regression. Results showed that COVID-19 vulnerability was not associated with symptoms of depression or anxiety, but pandemic-related stress was consistently associated with symptoms of poor mental health. Study findings highlight the need to monitor and intervene on pandemic-related stress to prevent further psychological distress within this vulnerable and underserved population.

The Role of Financial Strain and Educational Attainment on Smoking Abstinence of African Americans and Whites Who Smoke.

Objective: To examine if reduced financial strain and higher educational attainment would confer less advantage for successful cessation among African Americans than for White individuals. Design: A secondary data analysis of the Quit2Live study, a smoking cessation intervention for individuals who smoke. Setting: Recruited participants from a metropolitan city in the Midwest. Participants: The sample included 224 African American and 225 White individuals who smoke. Main Outcome Measures: Our outcome variable was cotinine-verified smoking abstinence at the end-of-treatment (week 12). Our explanatory variables were a combination of financial strain (high, low) and educational attainment (high, low). Methods: We implemented a logistic regression analysis and a two-way interaction of the combined financial strain and educational attainment variable and race on smoking abstinence. Results: About 25% of the study participants were low financial strain and high education, 41% high financial strain and high education, 23% high financial strain and low education, and 11% low financial strain and low education. A greater proportion of African Americans vs Whites were in the high financial strain/low educational attainment category (28% vs 18%, P = .01). Participants with high financial strain and low educational attainment had substantially lower odds of abstinence (OR = .29 [95% CI: .12, .68]) compared to participants with low financial strain and high educational attainment. Contrary to our hypothesis, race did not moderate this association. Conclusion: Findings highlight the constraining role of high financial strain and low educational attainment, irrespective of race, on smoking abstinence among smokers actively engaged in a quit attempt.

Non-adherence to psychiatric medication in adults experiencing homelessness is associated with incurred concussions.

This study investigated the relationship between concussions and medication adherence among 247 adults experiencing homelessness in Oklahoma City, Oklahoma, who were prescribed medication for a psychiatric disorder. Participants were asked whether they had "ever experienced a blow to the head that caused a concussion," and medication adherence was measured by asking participants whether they had taken their psychiatric medication yesterday. The data were analyzed using univariate and multivariable logistic regressions. Results showed that more than half of the sample had a concussion history (61.9%), and homeless adults with a concussion history had higher odds of non-adherence to psychiatric medications compared with those who reported no concussion history [OR = 2.13 (95% CI = 1.08, 4.18)]. Findings suggest that medication non-adherence is associated with incurred concussions. Raising awareness among service providers of the relationship between traumatic brain injury and medication adherence may increase efforts to improve adherence in this underserved population.

Discrimination, Substance Use, and Mental Health among Sexual and Gender Minority Adults Accessing Day Shelter Services.

BACKGROUND: Sexual and gender minority (SGM) adults are overrepresented in the population of individuals experiencing homelessness, and high rates of substance use are common in this group. Plausibly, poor mental health and discrimination may contribute to substance use among SGM adults experiencing homelessness. This study described participant characteristics, and the interrelations among sociodemographic variables, substance use, mental health, and discrimination experiences among 87 SGM adults seeking services at a day shelter in Oklahoma City, OK. Discrimination experiences were characterized by race (White vs. non-White), sex (female vs. male), sexual identity (heterosexual vs. sexual minority), and gender identity (gender conforming vs. gender minority). METHODS: Participants reported their past 30-day tobacco (cigarette/cigarillos, alternative tobacco products [ATP]), alcohol, and marijuana use, as well as everyday and lifetime major discrimination experiences, substance use problems, depression, anxiety, and post-traumatic stress disorder (PTSD). Independent samples t-tests examined differences in discrimination based on substance use and mental health. RESULTS: Participants had high rates of tobacco and marijuana use, substance use problems, depression, anxiety, and PTSD. Over 80% reported experiencing everyday or lifetime major discrimination. Depression and PTSD were associated with ATP use, and anxiety was associated with alcohol use. All mental health variables were associated with substance use problems and everyday discrimination. Depression was associated with lifetime major discrimination. CONCLUSIONS: SGM adults accessing shelter services frequently experienced discrimination and poor mental health, and substance use was common. Future research should examine the causal impact of discrimination on mental health and substance use among SGM adults experiencing homelessness.

Mobile contingency management for smoking cessation among socioeconomically disadvantaged adults: Protocol for a randomized trial.

BACKGROUND: Smoking rates remain high among socioeconomically disadvantaged adults. Offering small escalating financial incentives for abstinence (i.e., contingency management [CM]), alongside clinic-based treatment dramatically increases cessation rates in this vulnerable population. However, innovative approaches are needed for those who are less able to attend office visits. The current study will evaluate an automated mobile phone-based CM approach that will allow socioeconomically disadvantaged individuals to remotely earn financial incentives for smoking cessation. METHODS: The investigators have previously combined technologies, including 1) carbon monoxide monitors that connect with mobile phones to remotely verify abstinence, 2) facial recognition software to confirm identity during breath sample submissions, and 3) automated delivery of incentives triggered by biochemical abstinence confirmation. This automated CM approach will be evaluated in a randomized controlled trial of 532 low-income adults seeking cessation treatment. Participants will be randomly assigned to telephone counseling and nicotine replacement therapy (standard care [SC]) or SC plus mobile financial incentives (CM) for abstinence. RESULTS: Biochemically-verified 7-day point prevalence abstinence at 26 weeks post-quit is the primary outcome. The cost-effectiveness of the interventions will be evaluated. Potential treatment mechanisms, including self-efficacy, motivation, and treatment engagement, will be explored to optimize future interventions. DISCUSSION: Automated mobile CM may offer a low-cost approach to smoking cessation that can be combined with telephone counseling and pharmacological interventions. This approach represents a critical step toward the widespread dissemination of CM treatment to real-world settings, to reduce tobacco-related disease and disparities.

Differential expression of microRNA between triple negative breast cancer patients of African American and European American descent.

There are racial disparities in the outcome of triple negative breast cancer (TNBC) patients between women of African ancestry and women of European ancestry, even after accounting for lifestyle, socioeconomic and clinical factors. MicroRNA (miRNA) are non-coding molecules whose level of expression is associated with cancer suppression, proliferation and drug resistance; therefore, these have potential for biomarker applications in cancers including TNBC. Historically, miRNAs up-regulated in African American (AA) patients have received less attention than for patients of European ancestry. Using laser capture microdissection (LCM) to acquire ultrapure tumor cell samples, miRNA expression was evaluated in 15 AA and 15 European American (EA) TNBC patients. Tumor sections were evaluated using RNA extraction followed by miRNA analysis and profiling. Results were compared based on ethnicity and method of tissue fixation. miRNAs that showed high differential expression in AA TNBC patients compared to EA included: miR-19a, miR-192, miR-302a, miR-302b, miR-302c, miR-335, miR-520b, miR-520f and miR-645. LCM is a useful technique for isolation of tumor cells. We found a greater abundance of RNA in frozen samples compared to formalin fixed, paraffin embedded samples. miRNA appears to be a useful biomarker for TNBC to improve diagnosis and treatment.

The relations between discrimination, stressful life events, and substance use among adults experiencing homelessness.

The current study investigated whether stressful life events and everyday discrimination experiences were associated with using one or more substances in the past 30-days and substance use disorder (SUD) among adults experiencing homelessness. We obtained survey data from adults (N = 501) seeking services at a day shelter. Participants self-reported whether they used cigarettes, other tobacco products, cannabis, alcohol, opioids, amphetamine, and cocaine/crack in the past 30-days, and the total number of substances used were also calculated. We measured stressful life events and everyday discrimination using validated scales. We used multivariable logistic and negative binomial regression analyses to evaluate hypothesised associations. Results indicated that reporting a higher number of stressful life events was associated with past 30-days cannabis, tobacco, alcohol, and other substance use, screening positive for a SUD, and using a greater number of substances in the past 30 days. After accounting for stressful life events, everyday discrimination was associated with only past 30-days cannabis use. Overall, we found that reporting stressful life events was related to current substance use and screening positive for a SUD. Findings suggest that life stressors, and discrimination to a lesser extent, were associated with substance use and SUD among adults experiencing homelessness.

Tobacco use characteristics, treatment preferences, and motivation to quit among adults accessing a day shelter in Oklahoma City.

Background: Smoking rates are exceptionally high among adults experiencing homelessness (AEH). Research is needed to inform treatment approaches in this population. Methods: Participants (n=404) were adults who accessed an urban day shelter and reported current smoking. Participants completed surveys regarding their sociodemographic characteristics, tobacco and substance use, mental health, motivation to quit smoking (MTQS), and smoking cessation treatment preferences. Participant characteristics were described and compared by MTQS. Results: Participants who reported current smoking (N=404) were primarily male (74.8%); White (41.4%), Black (27.8%), or American Indian/Alaska Native (14.1%) race; and 10.7% Hispanic. Participants reported a mean age of 45.6 (SD=11.2) years, and they smoked an average of 12.6 (SD=9.4) cigarettes per day. Most participants reported moderate or high MTQS (57%) and were interested in receiving free cessation treatment (51%). Participants most frequently selected the following options as among the top 3 treatments that offered the best chance of quitting: Nicotine replacement therapy (25%), money/gift cards for quitting (17%), prescription medications (17%), and switching to e-cigarettes (16%). Craving (55%), stress/mood (40%), habit (39%), and being around other smokers (36%) were frequently identified as the most challenging aspects of quitting. Low MTQS was associated with White race, lack of religious participation, lack of health insurance, lower income, greater cigarettes smoked per day, and higher expired carbon monoxide. Higher MTQS was associated with sleeping unsheltered, cell phone ownership, higher health literacy, more years of smoking, and interest in free treatment. Discussion: Multi-level, multi-component interventions are needed to address tobacco disparities among AEH.

Affirming the Abuse Liability and Addiction Potential of Menthol: Differences in Subjective Appeal to Smoking Menthol Versus Non-Menthol Cigarettes Across African American and White Young Adult Smokers.

INTRODUCTION: Menthol cigarettes are popular among young adults and are disproportionately used by African American smokers. Menthol's minty and cooling sensations have been hypothesized to enhance the appeal and reinforcement of smoking; however, differences in menthol's subjective appeal across races have been inconsistent. This secondary data analysis examined differences in subjective appeal for smoking menthol versus non-menthol cigarettes between African American and White young adult smokers. METHODS: Young adults (ages 18-24) recruited from Amazon Mechanical Turk (December 2018-January 2019) completed an online survey of tobacco use behavior. Past year smokers (n = 1726) answered questions about subjective responses to smoking (reward, satisfaction, throat hit, craving reduction, and aversion). RESULTS: Significantly more African American (73.2%) compared to White (52.4%) smokers preferred menthol cigarettes (p < .001). Menthol smokers reported greater positive and negative subjective responses to smoking than non-menthol smokers. Positive and negative subjective response were both associated with greater smoking intensity and lower cigarette harm perceptions. Interactions of menthol preference and race on indices of subjective appeal also emerged. African American non-menthol smokers reported lower levels of satisfaction, reward, and craving reduction compared to White non-menthol smokers. CONCLUSIONS: The relationship between menthol preference and subjective response to smoking differs by race. Menthol is rated as more appealing than non-menthol smoking, and appeal indices were linked to smoking intensity and lower harm perceptions, indicating greater abuse liability of menthol cigarettes. Policies that ban menthol cigarettes may have a particularly positive impact on the cigarette smoking of African American young adult smokers. IMPLICATIONS: The FDA issued an Advanced Notice of Proposed Rule Making to examine the role menthol in tobacco products to inform regulations to restrict or ban flavors. This study showed that menthol smokers reported greater appeal to smoking than non-menthol smokers; and an interaction of race x menthol preference showed African American non-menthol smokers reported the lowest levels of appeal to smoking. Multiple indices of cigarette appeal were positively correlated with smoking intensity and lower cigarette harm perceptions, highlighting the addiction potential of menthol cigarettes. Findings suggest a menthol cigarette ban could help reduce tobacco use among young adults.

Daily use of nicotine replacement medications is related to daily smoking status: An ecological momentary assessment study.

BACKGROUND: Few studies have examined how daily adherence to nicotine replacement therapy (NRT) impacts daily smoking abstinence. METHODS: Data from a pilot randomized controlled trial of a smartphone-based smoking cessation intervention were used. Separate, generalized linear mixed models examined the association between ecological momentary assessments of NRT use and same-day and next day smoking status. Separate models examined the relationship between daily smoking status and (1) any use of NRT, (2) quantity of nicotine gum used, and (3) nicotine patch wear time. Reasons for medication non-adherence were also examined. RESULTS: Participants (n = 77) were predominantly White (66.2%) and female (50.6%), 50.4 years old (SD=11.6) on average, and they smoked an average of 21.8 cigarettes per day (SD=11.0) at baseline. Daily NRT use was significantly associated with a lower likelihood of smoking both within that same day and the following day. While using the gum and patch together, and using the patch alone were associated with reduced odds of same-day and next-day smoking, using the gum alone was not significantly associated with reduced odds of smoking. The most commonly cited reasons for not using the patch or gum was "other" (43.3%), followed by "side effects" (27.1%), and "forgot" (18.9%). CONCLUSION: Daily use of the patch or both the patch and gum was associated with a lower risk of daily smoking. Low levels of nicotine gum use alone may not be an effective cessation strategy. Future studies should further explore reasons for NRT non-compliance, and ways to increase NRT adherence.