Helping low-income smokers quit: findings from a randomized controlled trial comparing specialized quitline services with and without social needs navigation.

Background: Quitting smoking is especially challenging for low-income smokers due to high stress, high smoking prevalence around them, and limited support for quitting. This study aimed to determine whether any of three interventions designed specifically for low-income smokers would be more effective than standard tobacco quitline services: a specialized quitline, the specialized quitline with social needs navigation, or the standard quitline with social needs navigation. Methods: Using a randomized 2 × 2 factorial design, low-income daily cigarette smokers (n = 1944) in Missouri, USA who called a helpline seeking assistance with food, rent or other social needs were assigned to receive Standard Quitline alone (n = 485), Standard Quitline + Social Needs Navigation (n = 484), Specialized Quitline alone (n = 485), or Specialized Quitline + Social Needs Navigation (n = 490). The target sample size was 2000, 500 per group. The main outcome was 7-day self-reported point prevalence abstinence at 6-month follow-up. Multiple imputation was used to impute outcomes for those missing data at 6-month follow-up. Binary logistic regression analyses were used to assess differences between study groups. Findings: Participants were recruited from June 2017 to November 2020; most were African American (1111 [58%]) or White (666 [35%]), female (1396 [72%]), and reported <$10,000 (957 [51%]) or <$20,000 (1529 [82%]) annual pre-tax household income. At 6-month follow-up (58% retention), 101 participants in the Standard Quitline group reported 7-day point prevalence abstinence (20.8% of those assigned at baseline, 38.1% after imputation). Quit rates in the Specialized Quitline (90 quitters, 18.6%, 38.1%) and Specialized Quitline + Social Needs Navigation (103 quitters, 21.0%, 39.8%) were not different from the Standard Quitline. Quit rates for Standard Quitline + Social Needs Navigation (74 quitters, 15.3%, 30.1%) were significantly lower than Standard Quitline (OR = 0.70, 95% CI = 0.50-0.98). Interpretation: A specialized version of a state tobacco quitline was no more effective than standard quitline services in helping low-income smokers quit. Adding social needs navigation to a standard quitline decreased its effectiveness. Trial registration: ClinicalTrials.gov Identifier: NCT03194958. Funding: National Cancer Institute: R01CA201429.

Expanding population-level interventions to help more low-income smokers quit: Study protocol for a randomized controlled trial.

BACKGROUND: Low-income Americans have higher rates of smoking and a greater burden of smoking-related disease. In the United States, smokers in every state can access evidence-based telephone counseling through free tobacco quitlines. However, quitlines target smokers who are ready to quit in the next 30 days, which can exclude many low-income smokers. A smoke-free homes intervention may help engage smokers in tobacco control services who are not yet ready to quit. Previous research in low-income populations suggests that receiving a smoke-free homes intervention is associated with higher quit rates. This study tests whether, at a population level, expanding on quitlines to include a smoke-free homes intervention for smokers not ready to quit could engage more low-income smokers and increase long-term cessation rates. METHODS: In a Hybrid Type 2 design, participants are recruited from 211 helplines in 9 states and randomly assigned to standard quitline or quitline plus smoke-free homes intervention arms. Participants in both arms are initially offered quitline services. In the quitline plus smoke-free homes condition, participants who decline the quitline are then offered a smoke-free homes intervention. Participants complete a baseline and follow-up surveys at 3 and 6 months. Those who have not yet quit at the 3-month follow-up are re-offered the interventions, which differ by study arm. The primary study outcome is self-reported 7-day point prevalence abstinence from smoking at 6-month follow-up. CONCLUSION: This real-world cessation trial involving 9 state tobacco quitlines will help inform whether offering smoke-free homes as an alternative intervention could engage more low-income smokers with evidence-based interventions and increase overall cessation rates. This study has been registered at ClinicalTrials.gov (Study Identifier: NCT04311983).

Appeal of Tobacco Quitline Services Among Low-Income Smokers.

INTRODUCTION: State tobacco quitlines are delivering cessation assistance through an increasingly diverse range of channels. However, offerings vary from state to state, many smokers are unaware of what is available, and it is not yet clear how much demand exists for different types of assistance. In particular, the demand for online and digital cessation interventions among low-income smokers, who bear a disproportionate burden of tobacco-related disease, is not well understood. METHODS: We examined interest in using 13 tobacco quitline services in a racially diverse sample of 1,605 low-income smokers in 9 states who had called a 2-1-1 helpline and participated in an ongoing intervention trial from June 2020 through September 2022. We classified services as standard (used by ≥90% of state quitlines [eg, calls from a quit coach, nicotine replacement therapy, printed cessation booklets]) or nonstandard (mobile app, personalized web, personalized text, online chat with quit coach). RESULTS: Interest in nonstandard services was high. Half or more of the sample reported being very or somewhat interested in a mobile app (65%), a personalized web program (59%), or chatting online with quit coaches (49%) to help them quit. In multivariable regression analyses, younger smokers were more interested than older smokers in digital and online cessation services, as were women and smokers with greater nicotine dependence. CONCLUSION: On average, participants were very interested in at least 3 different cessation services, suggesting that bundled or combination interventions might be designed to appeal to different groups of low-income smokers. Findings provide some initial hints about potential subgroups and the services they might use in a rapidly changing landscape of behavioral interventions for smoking cessation.

Low housing quality, unmet social needs, stress and depression among low-income smokers.

Smokers are at greater risk of multiple health conditions that are exacerbated by environmental hazards associated with low housing quality. However, little is known about the prevalence of low housing quality among low-income smokers. Using correlations and logistic regression, we examined associations among eight housing quality indicators - pests, water leaks, mold, lead paint, and working smoke detectors, appliances, heating, and air conditioning - and between housing quality and social needs, depressive symptoms, perceived stress, sleep problems, and self-rated health in a community-based sample of 786 low-income smokers from 6 states. Most participants were female (68%), and White (45%) or African-American (43%). One in four (27%) completed less than high school education, and 41% reported annual pre-tax household income of less than $10,000. Housing quality problems were common. Most participants (64%) reported at least one problem in their home, and 41% reported two or more problems, most commonly pest infestations (40%), water leaks (22%), lack of air conditioning (22%) and mold (18%). Lack of heat and air conditioning were correlated, as were water leaks and mold. Using logistic regression analyses controlling for participant demographic characteristics, we found that reporting more housing quality problems was associated with greater odds of worse mental and physical health outcomes. Multiple health threats, including housing quality, depressive symptoms, stress, poor sleep, and financial strain may be mutually reinforcing and compound the health consequence of smoking. Future research should seek to replicate these findings in other samples, and examine associations longitudinally to better understand causality.

Identity and Guilt as Mediators of Pro-environmental Spillover.

Policymakers are interested in programs that increase targeted pro-environmental behavior (PEB) and spill over to increase non-targeted PEBs. Theoretically, guilt should lead to negative spillover and identity to positive spillover, though this has rarely been tested empirically. Additionally, little is known about how reminders of past PEB behavior might also lead to downstream spillover effects. Across two studies, participants (Study 1: 377 MTurk workers; Study 2: 172 undergraduates) were randomly assigned to write about a prior PEB, an anti-environmental behavior, or to a control condition. Subsequently, respondents were given an opportunity to perform a PEB2 and completed measures of PEB3 intentions. Results showed some evidence of positive (through increasing identity) and negative (through decreasing guilt) indirect spillover pathways from prior PEB reminders to PEB2 performance and PEB3 curtailment intentions (but not efficiency upgrade intentions). However, there were no overall spillover effects from PEB reminders to PEB2 performance or PEB3 intentions, as the positive and negative indirect effects canceled each other out. Results also showed positive spillover from PEB2 performance to PEB3 curtailment intentions through increasing environmental guilt. The strength of the spillover effects depended on the comparison group for the experimental manipulation, whether environmental guilt or global guilt was measured, and the type of PEB. The results suggest that environmental communications that remind people of their prior PEB may not meaningfully spill over to further PEB performance or intentions.

Decision making processes and alcohol use among college students.

Objective: The neurobiological model of risk-taking and the dual-process model of decision making each provide possible explanations of risky behavior among youth, but their interconnections have rarely been explored, especially among college students, a time of increased alcohol use. Participants: n = 382; Mage = 19.25, SD = 1.33. Method: Participants completed a survey about their deliberative and intuitive decision making style (based on the dual-process model), their socioemotional and cognitive control processes (based on the neurobiological model), and alcohol use. Results: Structural equation modeling showed that dual-process variables and neurobiological variables were positively related. Deliberative decision making and cognitive control were negatively related to alcohol use whereas intuitive decision making was not. Comment: Discussion focuses on the integration of theoretical models with real-world health behaviors and considers implications of the current findings in terms of prevention and intervention to reduce drinking among college students.

Effects of Workplace Generalized and Sexual Harassment on Abusive Drinking Among First Year Male and Female College Students: Does Prior Drinking Experience Matter?

BACKGROUND: Workplace harassment, a known risk factor for adult drinking, is understudied in college samples, but may help explain observed gender differences in drinking patterns. OBJECTIVE: We examine effects of sexual and generalized workplace harassment on changes in drinking behavior over the first semesters of college, and the extent to which these effects differ based on prematriculation drinking for men and women students. METHOD: Data derive from two waves of a longitudinal study of eight Midwestern colleges and universities. Data were collected from 2080 employed students via a Web-based survey assessing sexual and generalized workplace harassment, stressful life events, drinking to intoxication, and binge drinking prior to freshman year (fall 2011) and approximately one year later (summer to fall 2012). At baseline, lifetime drinking status, frequency of alcohol consumption, and demographics were also assessed. RESULTS: Linear-mixed modeling indicated that employed women students who were frequent drinkers prematriculation were at risk for high levels of drinking associated with workplace harassment, while men who were nondrinkers were most at risk of increasing problem drinking over time when exposed to workplace harassment. CONCLUSIONS: Alcohol use prevention efforts directed towards employed students are needed both prior to and during college, to instruct students how to identify workplace harassment and cope in healthier ways with stressful workplace experiences. These efforts might be particularly useful in stemming problematic drinking among women who drink frequently prior to college, and preventing men who are nondrinkers upon college entry from initiating problematic drinking during subsequent enrollment years.

Sexual Harassment, Psychological Distress, and Problematic Drinking Behavior Among College Students: An Examination of Reciprocal Causal Relations.

Sexual harassment on college campuses is a frequent occurrence and serious public health concern. Victims of sexual harassment are at risk for many possible negative health consequences. In addition, certain psychological distress symptoms and/or alcohol use may put individuals at increased risk of being victims of sexual harassment. Data from more than 2,000 college students in the Midwestern United States were used to examine reciprocal causal effects of the relations between (a) experiencing sexual harassment and alcohol use and (b) experiencing sexual harassment and psychological distress symptoms, specifically depression and anger/hostility. Analyses were conducted separately for sexual harassment which occurs at school and which occurs in college students' workplaces, and also separately for men and women. Results of cross-lagged panel models showed that there were reciprocal causal effects between sexual harassment and alcohol problems, depression, and anger. Discussion focuses on the overall patterns of results as well as the nuances within these findings.

Risk factors and outcomes of chronic sexual harassment during the transition to college: Examination of a two-part growth mixture model.

A two-part latent growth mixture model was implemented in order to examine heterogeneity in the growth of sexual harassment (SH) victimization in college and university students, and the extent to which SH class membership explains substance use and mental health outcomes for certain groups of students. Demographic risk factors, mental health, and substance use were examined as they related to chronically experienced SH victimization. Incoming freshmen students (N = 2855; 58% female; 54% White) completed a survey at five time points. In addition to self-reporting gender, race, and sexual orientation, students completed measures of sexual harassment, anxiety, depression, binge drinking, and marijuana use. Overall, self-reported SH declined upon college entry, although levels rebounded by the third year of college. Results also supported a two-class solution (Infrequent and Chronic) for SH victimization. Being female, White, and a sexual minority were linked to being classified into the Chronic (relative to the Infrequent) SH class. In turn, Chronic SH class membership predicted greater anxiety, depression, and substance use, supporting a mediational model.

Age Differences in the Longitudinal Relationship between Work-Family Conflict and Alcohol Use.

Research on the relationship between work-family conflict and alcohol use has generally shown small effects possibly due to failure to include important individual differences relevant to the experience of work-family conflict and alcohol use, notably age. This study examined whether the relationships between aspects of work-family conflict and alcohol use variables differed by age. Participants were 543 individuals (51.2% women) from a community sample of working adults in the greater Chicagoland area who responded to a mail survey at three time points. Results showed important differences between age groups in several predictors of alcohol use. Strain versus time-based conflict had different effects on drinking, and strain-based forms of work-family conflict were related to increased problematic alcohol use depending on age. This study indicates that individual differences, particularly age, should be systematically accounted for when studying the relationship between work-family conflict and alcohol use.

Bullying victimization among college students: negative consequences for alcohol use.

This study reports the prevalence of bullying victimization at school and work among college freshmen and the relationships between victimization and changes in alcohol consumption and alcohol problems. Web survey data at 2 time points from a sample of 2118 freshmen from 8 colleges and universities in the Midwestern United States indicated that 43% of students experienced bullying at school and that 33% of students experienced bullying at work. Bullying, particularly at school, consistently predicted alcohol consumption and problematic drinking, after controlling for baseline drinking and other school and work stressors.

The role of pubertal timing and temperamental vulnerability in adolescents' internalizing symptoms.

This longitudinal study examined the joint role of pubertal timing and temperament variables (emotional reactivity and self-regulation) in predicting adolescents' internalizing symptoms. The multiethnic sample included 1,025 adolescent girls and boys followed from age 11 to age 15 (M age = 11.03 years at Time 1). In structural equation models, age 11 measures of pubertal timing, emotional reactivity, and self-regulation and their interactions were used to predict adolescents' internalizing behavior concurrently and at age 15. Results indicated that, among girls, early pubertal timing, higher emotional reactivity, and lower self-regulation predicted increased internalizing behavior. In addition, self-regulation moderated the effect of pubertal timing such that effects of earlier timing on subsequent internalizing were seen primarily among girls with relatively poor self-regulation. Among boys, higher levels of emotional reactivity and lower self-regulation predicted increased internalizing, but there were no effects of pubertal timing. After controlling for Time 1 internalizing symptoms, only self-regulation predicted change in internalizing symptoms. Discussion focuses on the possible interplay of temperament and pubertal development in predicting internalizing problems during adolescence.

Work-family conflict and alcohol use: examination of a moderated mediation model.

Research consistently documents the negative effects of work-family conflict; however, little research focuses on alcohol use. This study embraces a tension reduction theory of drinking, wherein alcohol use is thought to reduce the negative effects of stress. The purpose of the study was to test a moderated mediation model of the relationship between work-family conflict and alcohol use in a Chicagoland community sample of 998 caregivers. Structural equation models showed that distress mediated the relationship between work-family conflict and alcohol use. Furthermore, tension reduction expectancies of alcohol exacerbated the relationship between distress and alcohol use. The results advance the study of work-family conflict and alcohol use, helping explain this complicated relationship using sophisticated statistical techniques. Implications for theory and practice are discussed.

Drinking in the age of the Great Recession.

The United States has been experiencing the most severe economic crisis since the Great Depression. This article presents the Life Change Consequences of the Great Recession (LCCGR), an instrument depicting work and personal life-related stressors reflecting the enduring effects of the Great Recession. A national sample of 663 respondents completed a mail survey including this instrument and measures of drinking outcomes. Multiple regression analyses addressed the links between the LCCGR and drinking. Economy-related stressors manifested significant effects on both male and female consumptions patterns, but most LCCGR subscales were more clearly related to problematic drinking patterns in men compared with women.

Parent and peer pathways to adolescent delinquency: variations by ethnicity and neighborhood context.

Effects of ethnicity and neighborhood quality often are confounded in research on adolescent delinquent behavior. This study examined the pathways to delinquency among 2,277 African American and 5,973 European American youth residing in high-risk and low-risk neighborhoods. Using data from a national study of youth, a meditational model was tested in which parenting practices (parental control and maternal support) were hypothesized to influence adolescents' participation in delinquent behavior through their affiliation with deviant peers. The relationships of family and neighborhood risk to parenting practices and deviant peer affiliation were also examined. Results of multi-group structural equation models provided support for the core meditational model in both ethnic groups, as well as evidence of a direct effect of maternal support on delinquency. When a similar model was tested within each ethnic group to compare youths residing in high-risk and low-risk neighborhoods, few neighborhood differences were found. The results indicate that, for both African American and European American youth, low parental control influences delinquency indirectly through its effect on deviant peer affiliation, whereas maternal support has both direct and indirect effects. However, the contextual factors influencing parenting practices and deviant peer affiliation appear to vary somewhat across ethnic groups. Overall the present study highlights the need to look at the joint influence of neighborhood context and ethnicity on adolescent problem behavior.

The Role of Emotional Reactivity, Self-regulation, and Puberty in Adolescents' Prosocial Behaviors.

This study was designed to examine the roles of emotional reactivity, self-regulation, and pubertal timing in prosocial behaviors during adolescence. Participants were 850 sixth graders (50% female, Mean age = 11.03, SD = .17) who were followed up at age 15. In hierarchical regression models, measures of emotional reactivity, self-regulation, pubertal timing and their interactions were used to predict (concurrently and over time) adolescents' prosocial behaviors in the home and with peers. Overall, the findings provide evidence for pubertal and temperament based predictors of prosocial behaviors expressed in different contexts. Self-regulation was positively related to both forms of prosocial behavior, concurrently and longitudinally. Emotional reactivity showed moderately consistent effects, showing negative concurrent relations to prosocial behavior with peers and negative longitudinal relations (four years later) to prosocial behavior at home. Some curvilinear effects of temperament on prosocial behaviors were also found. Effects of pubertal timing were found to interact with gender, such that boys who were early maturers showed the highest levels of prosocial behavior at home concurrently. Discussion focuses on the role of temperament-based mechanisms in the expression of prosocial behaviors in different contexts in adolescence.

The role of deliberative decision making, parenting, and friends in adolescent risk behaviors.

Adolescents may engage in risk behaviors that jeopardize their futures. Although adolescent risk-taking has long been attributed to faulty decision making, surprisingly little research has directly examined this link. This study examined the role of deliberative decision making (the tendency to consider options and consequences before making a decision) and social contextual variables (parenting and friend influences) in alcohol and drug use, risky sex, and delinquency. Participants were 7,748 adolescents (50% female) in grades 7-11 from the Add Health dataset (M age = 14.87, SD = 1.54). Hierarchical regression analyses revealed that deliberative decision making and contextual variables were associated with risk behavior concurrently and 1 year later. Furthermore, deliberative decision making interacted with social contextual variables in some models, indicating that deliberative decision making may be especially important in certain contexts. These findings suggest that both cognitive and social factors need to be considered to explain adolescents' decisions to engage in risk behavior.