Tobacco Cessation Interventions in Non-Respiratory Cancers: A Systematic Review With Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Considering the high rates of persistent tobacco use, effective cessation interventions are needed for cancer patients and caregivers. Despite the need, there is a significant lack of research on tobacco cessation, especially for non-respiratory cancers (breast, prostate, colorectal, cervical, and bladder cancer). PURPOSE: The objective was to evaluate tobacco use and tobacco cessation interventions among patients and caregivers for non-respiratory cancers. METHODS: Randomized controlled trials assessing tobacco cessation interventions were identified. Five electronic databases were searched in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines through July 2023. Studies exclusive to lung, oral, thoracic, and head and neck cancers were excluded. Effect sizes were estimated; risk of bias was assessed. RESULTS: Of 3,304 studies, 17 were included. Interventions included behavioral (n = 6), pharmacotherapy (n = 2), and a combination (n = 9) treatment. Eight studies included a health behavior model; mean behavioral change techniques were 5.57. Pooled magnitude of the odds of cessation was positive and significant (odds ratio = 1.24, 95% confidence interval [Lower Limit 1.02, Upper Limit 1.51]) relative to usual care/placebo. Cumulative meta-analysis examined the accumulation of results over-time and demonstrated that studies have been significant since 2020. Two studies included caregivers' who were involved in the provision of social support. CONCLUSIONS: Current interventions have the potential to reduce tobacco use in non-respiratory cancers. Results may be beneficial for promoting tobacco cessation among non-respiratory cancers. There is a considerable lack of dyadic interventions for cancer survivors and caregivers; researchers are encouraged to explore dyadic approaches.

We aimed to understand effective ways for cancer patients and caregivers to quit using tobacco. We focused on non-respiratory cancers (cancers not related to breathing issues) like breast, prostate, and colorectal cancer. We reviewed 17 randomized controlled trials designed to help people quit tobacco, which included behavioral therapies (e.g., education and counseling), pharmacotherapy (i.e., medicine), and combinations of both. We found that people in these studies quit using tobacco, especially when more than one approach was used. The studies also showed that these approaches have been more successful since 2020. The research highlighted a need for more studies that include both patients and their caregivers together in the quitting process. This approach, called dyadic intervention, could be more effective in supporting patients and their caregivers. Overall, while the current approaches are promising, more research is needed to develop better ways to help cancer patients and caregivers quit smoking for longer.

A pilot study of home-based genetic testing completion rate in telegenetics cancer clinics in West Virginia Appalachia.

Telegenetics has shifted some genetic testing performance to the patient's own home, with the patient collecting his/her own sample. Little is known regarding the rate of test completion of such home-based genetic testing. This study compared the completion rate of home-based genetic tests before and after a reminder system was implemented. In the pre-reminder group, we reviewed medical records for patients who were seen via telegenetics and agreed to complete genetic testing using an at-home test kit. In the reminder group, a prospective analysis of the genetic test completion rate was performed taking a clinical quality improvement approach where three reminders were provided for patients who had not submitted their at-home genetic testing. Our study included 94 patients' records: 46 pre-reminders and 48 reminders. The lab received 24 patient samples (52.2%) in the pre-reminder group. In the reminder group, 30 patients returned their kits (62.5%). Despite a higher percentage of patients completing their test in the reminder group, there was no statistically significant difference between the pre-reminder and reminder groups. The rate of test completion in our pilot test was statistically similar between the two groups, but the reminder group was trending toward a higher percent of completion which may be clinically meaningful.

Assessing the impact of the skin cancer awareness now (SCAN!) intervention several months following the intervention.

BACKGROUND: West Virginia (WV) is the third most rural state in the US and has a high incidence of skin cancer. Intervention efforts in WV are impeded by structural barriers, low health literacy, and lack of health care access. Community pharmacies and pharmacists are highly accessible and may be helpful in promoting skin cancer prevention. OBJECTIVE(S): The purpose of the study was to evaluate the impact of the Skin Cancer Awareness Now (SCAN!) pharmacy-based sun-safety intervention at follow-up. METHODS: Surveys assessed SCAN's effect on skin cancer prevention at preintervention and follow-up. The follow-up survey was administered between 8 and 12 months after our initial feasibility study. Questions included demographics, cancer history, cancer worry, knowledge, cancer communication, and skin cancer screening intentions. Multivariate repeated measures ANOVA assessed the change in worry, importance, knowledge, and intentions to be sun safe. RESULTS: Participants (n=56, response rate= 62.2%) had a mean age of 44.7 (standard deviation: 19.3) years. Most were females (87.5%), Whites (92.9%), and 48.2% lived in rural areas. Knowledge and intentions significantly improved over time. At follow-up, participants (41.1%) mentioned that they plan on discussing skin cancer prevention with their pharmacist in the future. CONCLUSION: The SCAN! intervention can be a useful resource for skin cancer prevention in community pharmacy settings. Community pharmacies have the potential to be change agents in skin cancer prevention by providing education on sun protection or detection and by promoting sun-safety behaviors.

Cancer disparities in the context of rurality: risk factors and screening across various U.S. rural classification codes.

PURPOSE: Prior cancer research is limited by inconsistencies in defining rurality. The purpose of this study was to describe the prevalence of cancer risk factors and cancer screening behaviors across various county-based rural classification codes, including measures reflecting a continuum, to inform our understanding of cancer disparities according to the extent of rurality. METHODS: Using an ecological cross-sectional design, we examined differences in cancer risk factors and cancer screening behaviors from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008-2013) across rural counties and between rural and urban counties using four rural-urban classification codes for counties and county-equivalents in 2013: U.S. Office of Management and Budget, National Center for Health Statistics, USDA Economic Research Service's rural-urban continuum codes, and Urban Influence Codes. RESULTS: Although a rural-to-urban gradient was not consistently evident across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all ptrend < 0.03), while colorectal, cervical and breast cancer screening decreased (all ptrend < 0.001) with increasing rurality. Differences in the prevalence of risk factors and screening behaviors across rural areas were greater than differences between rural and urban counties for obesity (2.4% vs. 1.5%), physical activity (2.9% vs. 2.5%), binge alcohol use (3.4% vs. 0.4%), cervical cancer screening (6.8% vs. 4.0%), and colorectal cancer screening (4.4% vs. 3.8%). CONCLUSIONS: Rural cancer disparities persist across multiple rural-urban classification codes, with marked variation in cancer risk factors and screening evident within rural regions. Focusing only on a rural-urban dichotomy may not sufficiently capture subpopulations of rural residents at greater risk for cancer and cancer-related mortality.

A systematic review with meta-analysis of parental interventions for human papillomavirus vaccine uptake.

OBJECTIVES: With the growing ability of pharmacists to vaccinate against HPV, this systematic review with meta-analysis examined the efficacy of interventions targeting parents of children and adolescents in the US to increase HPV vaccine uptake. DATA SOURCES: A systematic search of PubMed, Web of Science, SCOPUS, CINAHL, and Medline was conducted from January 2006 to January 2022. STUDY SELECTION: We included parent-based randomized controlled trials (RCTs) in the US that measured actual HPV vaccine initiation and completion from patients' medical records. DATA EXTRACTION: The revised Cochrane risk-of-bias tool for randomized trials (RoB2) was used to assess studies for risk of bias, and the Michie and Prestwich Theory Coding Scheme will be used to assess the extent of theory use. Results were pooled using the inverse-variance heterogeneity model (IVhet). RESULTS: Of 770 studies, 13 were included for data extraction, and 12 were included in the meta-analysis. Parent-based interventions, when compared to controls, did not demonstrate a statistically significant increase in HPV vaccine initiation (OR = 1.24, 95% CI [0.86, 1.77]) or completion (OR = 1.23, 95% CI [0.78, 1.96]). However, sensitivity analysis suggested parent-based RCTs could improve HPV vaccine initiation (OR = 1.19, 95% CI [0.16, 1.22]) but not completion (OR = 1.25, 95% CI [0.86, 1.81]), after removing cluster RCTs. Reminders/recall interventions showed a significant increase in HPV vaccine initiation (OR = 1.19, 95% CI [0.16, 1.22]) and completion (OR = 1.52, 95% CI [1.04, 2.21]). Eight studies reported theory use in intervention development. No statistically significant differences were observed between atheoretical versus non-theory-based trials. CONCLUSION: Overall, parent-based interventions do not increase HPV vaccine uptake. Reminder and recall systems have the potential to improve HPV vaccine initiation and completion, and pharmacies can leverage these tools to improve vaccination. Behavioral theories and pharmacy-based HPV vaccination appear to be under-utilized.

SCAN! A pharmacy-based, sun safety feasibility study.

OBJECTIVES: Skin cancer is the most common form of cancer, and individuals from the medically underserved Appalachian region are at elevated risks for cancer morbidity and mortality. Skin cancer can be prevented by decreasing ultraviolet light exposure (sunscreen sun protection factor 30, shade, clothing, sunglasses, hats) and can be caught at an early treatable stage through a routine skin examination. The Skin Cancer Awareness Now! (SCAN!) pilot project promoted skin cancer prevention and screening in community pharmacies, using a dynamic communication model. The objectives of the study were to understand (1) the feasibility of the SCAN! and (2) the preliminary impact of the SCAN! METHODS: We conducted pre- and postintervention surveys of the SCAN!, a student pharmacist-led or pharmacy resident-led intervention in community pharmacies (n = 3). RESULTS: Participants (n = 90) had a mean age of 43.8 (SD= 18.4) years, were predominantly white (92.1%), without a college degree (65.6%), and had an average family income in the range of $25,000-$49,999, with approximately 16% falling below the poverty level. To begin, the SCAN! scored highly in attention (mean = 5.8), liking (mean = 6.1), comprehension (mean = 6.7), and intentions to be sun safe (mean = 6.0). Most improved in their knowledge of the amount of sunscreen needed per application for sun safety (66%, P < 0.01) and of melanoma features from pre- and postintervention (39%, P < 0.01). A multivariate analysis of variance indicated that knowledge and intentions improved (all P's < 0.01). Interaction effects indicated that improvements in knowledge were greater for those in the rural pharmacy (P = 0.03), and improvements in perceived importance were greater for those in urban pharmacies (P = 0.01). CONCLUSION: The SCAN! intervention was well received by the population. Our study provides evidence that community pharmacy is a novel venue for skin cancer prevention interventions, particularly for rural, medically underserved populations.

Impact of Diffuse Large B-Cell Lymphoma on Mammography and Bone Density Testing in Women.

Women with diffuse large B-cell lymphoma (DLBCL) are at an increased risk of mortality from breast cancer and osteoporosis. However, the impact of DLBCL on rates of mammography and bone density testing (BDT) is unknown. We compared female DLBCL and non-cancer patients utilizing the Surveillance, Epidemiology, and End Results-Medicare dataset to analyze the predictors of mammography and BDT. Guided by the Social Ecological Model (SEM), we used multivariable logistic regressions with inverse probability treatment weighting to examine the association of intrapersonal, interpersonal, healthcare system, and community factors with mammography and BDT. The rates of mammography (59.8%) and BDT (18.5%) in women with DLBCL were similar to those without cancer (60.2% and 19.6%, respectively). After adjusting for the SEM factors, DLBCL patients were less likely to get mammography and BDT than non-cancer patients. The treatments of radiotherapy and stem cell transplant were not associated with either mammography or BDT. DLBCL diagnosis was associated with lower rates of mammography and BDT rates among women with DLBCL, as compared to non-cancer patients. To reduce the morbidity and mortality from breast cancer and fractures in women with DLBCL, providers should increase their recommendations for mammography in those receiving radiotherapy and BDT in stem cell transplant patients.

Receipt of Guideline-Concordant Care Among Older Women With Stage I-III Breast Cancer: A Population-Based Study.

Background: This study examined receipt of guideline-concordant care (GCC) according to evidence-based treatment guidelines and quality measures and specific types of treatment among older women with breast cancer. Patients and Methods: A total of 142,433 patients aged ≥66 years diagnosed with stage I-III breast cancer between 2007 and 2011 were identified in the SEER-Medicare linked database. Algorithms considering cancer characteristics and the appropriate course of care as per guidelines versus actual care received determined receipt of GCC. Multivariable logistic regression estimated the likelihood of GCC and specific types of treatment for women aged ≥75 versus 66 to 74 years. Results: Overall, 39.7% of patients received GCC. Patients diagnosed at stage II or III, with certain preexisting conditions, and of nonwhite race were less likely to receive GCC. Patients with hormone-negative tumors, higher grade tumors, and greater access to oncology care resources were more likely to receive GCC. Patients aged ≥75 years were approximately 40% less likely to receive GCC or adjuvant endocrine therapy, 78% less likely to have any surgery, 61% less likely to have chemotherapy, and about half as likely to have radiation therapy than those aged 66 to 74 years. Conclusions: Fewer than half of older women with breast cancer received GCC, with the lowest rates observed among the oldest age groups, racial/ethnic minorities, and women with later-stage cancers. However, patients with more aggressive tumor characteristics and greater access to oncology resources were more likely to receive GCC. Considering that older women have the highest incidence of breast cancer and that many are diagnosed at stages requiring more aggressive treatment, efforts to increase rates of earlier stage diagnosis and the development of less toxic treatments could help improve GCC and survival while preserving quality of life.

Colon Cancer Worry in Appalachia.

Appalachia has a higher incidence of and mortality from colon cancer (CC) than other regions of the United States; thus, it is important to know the potential impact of elevated risk on cancer worry. Guided by the Self-regulation model, we investigated the association of demographic, cultural (e.g., fatalism, religious commitment), and psychological factors (e.g., perceived risk, general mood) with CC worry among a sample of Appalachian women. A mixed method design was utilized. Appalachian women completed surveys in the quantitative section (n = 134) and semi-structured interviews in the qualitative section (n = 24). Logistic regression was employed to calculate odds ratios (OR) for quantitative data, and immersion/crystallization was utilized to analyze qualitative data. In the quantitative section, 45% of the participants expressed some degree of CC worry. CC worry was associated with higher than high school education (OR 3.63), absolute perceived risk for CC (OR 5.82), high anxiety (OR 4.68), and awareness of easy access (OR 3.98) or difficult access (OR 3.18) to health care specialists as compared to not being aware of the access. there was no association between CC worry and adherence to CC screening guidelines. The qualitative section revealed fear, disengagement, depression, shock, and worry. Additionally, embarrassment, discomfort, and worry were reported with regard to CC screening. Fears included having to wear a colostomy bag and being a burden on family. CC worry was common in Appalachians and associated with higher perceptions of risk for CC and general anxiety, but not with adherence to screening guidelines. The mixed method design allowed for enhanced understanding of CC-related feelings, especially CC worry, including social/contextual fears.

Car Seat Safety: Typologies of Protective Health and Safety Behaviors for Mothers in West Virginia.

Objective Parenting practices differ for a variety of reasons, and three parenting behaviors may be directly influenced by research, policy, and overall parenting trends: car safety seats, vaccination, and breastfeeding. Mothers were categorized in terms of their rear-facing car safety seat utilization and its relationship to other parental health and safety behaviors. Methods A cross-sectional, online survey of mothers of children under 3 years of age (n = 124) was conducted. Items assessed mother's perceived risk and worry about being in an automobile accident, as well as duration of rear-facing car seat utilization. A cluster analysis based on these variables was performed to differentiate the sample into four distinct groups. Outcomes were knowledge of car safety seats, breastfeeding duration, and adherence to vaccination schedules. Results The sample was predominantly White, had an average age of 32 years, had breastfed, and had at least some college education. Two groups of interest had (Group 1) long duration of rear-facing use with low perceived risk and worry and (Group 2) short use with high perceived risk and worry. Fisher's Exact test indicated Group 1 had higher knowledge of airbag use with car seats (p = 0.035), lower intentions to use the recommended vaccinations schedule (p = 0.005), and were more likely to breastfeed (p = 0.044) for longer duration (p = 0.012). Conclusion Propensity for mothers' risk aversion may be the crucial element in both an appropriate duration of rear-facing car safety seat use and refusal of recommended vaccination schedule.

Cancer Risk Information Sharing: The Experience of Individuals Receiving Genetic Counseling for BRCA1/2 Mutations.

Genetic counseling and testing for familial cancer is a unique context for the communication of risk information in the family. This study utilized a theoretical framework based on the family systems perspective to understand intrafamilial cancer risk communication patterns in the Ashkenazi Jewish population. Individuals (n = 120) at an elevated risk for BRCA1/2 mutations were included. Change in communication patterns over time was assessed using McNemar tests. Associations with communication patterns were assessed with multivariable logistic regression. Overall, the proportion of participants encouraged by others significantly (p < .001) increased from before to after genetic counseling. A higher proportion of participants were encouraged by female family members compared with male family members. Participants who were older, had no personal history of cancer, and had a higher cancer risk perception were more likely to be encouraged by others for genetic testing. Participant's intent to encourage family members for genetic testing from before counseling to after receipt of genetic test results decreased by 16.7%. Participants who had no personal history of cancer and had informative test results for a BRCA1/2 mutation were more likely to encourage other family members for genetic testing. In addition, qualitative findings suggested that closeness among family members, concern for family, especially future generations, and cognizance about cancer risk facilitate information sharing and encouragement for genetic testing. Our findings indicate that intrafamilial cancer risk communication varies with the structure of family relationships and that genetic counseling can play an important role in improving intrafamilial cancer risk communication.

Genetic counseling content: How does it impact health behavior?

Women with hereditary breast-ovarian cancer face decisions about screening (transvaginal ultrasound, CA125, mammography, breast exams) and proactive (before cancer) or reactive (after cancer) surgery (oophorectomy, mastectomy). The content of genetic counseling and its relation to these key health behaviors is largely unexamined. Ashkenazi Jewish women (n = 78) were surveyed through the process of genetic testing and had audiorecorded counseling sessions available for Linguistic Inquiry and Word Count analysis. Proportions for participant and counselor cognitive and affective content during sessions were used as primary predictor variables in linear mixed models for change in intentions for screening and treatment and in self-reported screening. Cognitive and affective content were important predictors of behavior. Counselor cognitive content was associated with ovarian screening. An interaction effect also emerged for CA-125, such that counselor cognitive content plus participant cognitive content or counselor affective content were associated with more screening. Teasing out the factors in risk communication that impact decision-making are critical, and affect from a risk communicator can spur action, such as cancer screening.

Improving family history collection.

Family history is important for assessing risk of cancer. This study aimed to improve cancer family history communication and collection by training and motivating lay individuals to construct pedigrees. The authors' ultimate goal is to improve identification of familial cancer. Participants (n = 200) completed preintervention, postintervention, and 1-week follow-up surveys to assess pedigree construction. The intervention reviewed basic construction and interpretation of a pedigree for familial cancer. As a result of intervention, individuals reported more positive attitudes about collecting family history, were more likely to intend to speak to family and physicians about cancer risk, better understood a sample pedigree, and constructed more detailed pedigrees of their family history. At follow-up, 25% of the sample had spoken with their families about cancer risk. For those individuals who had not spoken with family, higher postintervention pedigree knowledge was associated with greater intentions to speak with family in the future. The intervention improved the communication and collection of pedigrees and communication about cancer risk, which could be used to improve the identification of individuals with familial cancers and awareness of family cancer risk.

Cervical cancer worry and screening among appalachian women.

Although many have sought to understand cervical cancer screening (CCS) behavior, little research has examined worry about cervical cancer and its relationship to CCS, particularly in the underserved, predominantly rural Appalachian region. Our mixed method investigation aimed to obtain a more complete and theoretically-informed understanding of the role of cancer worry in CCS among Appalachian women, using the Self-Regulation Model (SRM). Our quantitative analysis indicated that the perception of being at higher risk of cervical cancer and having greater distress about cancer were both associated with greater worry about cancer. In our qualitative analysis, we found that, consistent with the SRM, negative affect had a largely concrete-experiential component, with many women having first-hand experience of the physical consequences of cervical cancer. Based on the results of this manuscript, we describe a number of approaches to lessen the fear associated with CCS. Intervention in this elevated risk community is merited and may focus on decreasing feelings of worry about cervical cancer and increasing communication of objective risk and need for screening. From a policy perspective, increasing the quantity and quality of care may also improve CCS rates and decrease the burden of cancer in Appalachia.

Pharmacists' Perceptions of Tobacco Sales in an Elevated-Risk Population.

Background: Policies by the American Medical Association and the American Pharmacists Association advocate for the discontinuation of tobacco sales in pharmacies, yet tobacco sales remain lucrative for pharmacies in the United States. West Virginia has the highest smoking rate (29%) and the second highest lung cancer incidence in the country. Objective: This study examined pharmacists' perceptions of tobacco sales in pharmacies and awareness of relevant policies. Methods: West Virginia pharmacists (n = 195) were surveyed to understand tobacco sales in West Virginia pharmacy, utilizing Diffusion of Innovations as a theoretical framework. Results: Eighty-one percent were community pharmacists, and 39% practiced at independent pharmacies. Sixty-two percent reported that their pharmacies did not sell tobacco. Pharmacists at independent pharmacies were more likely to be in rural areas/small towns, have decision-making control over tobacco sales, and not currently selling tobacco products. Other community pharmacists (ie, at regional and national chains) were more likely to sell tobacco products, not have decision-making control over tobacco sales, and perceive revenue loss from discontinuing tobacco sales. Other types of pharmacists (eg, hospital) estimated a greater number of patients who were smokers/tobacco users. A logistic regression showed that less perceived revenue loss was associated with greater likelihood of not selling tobacco products (all Ps < .05). Conclusions: Findings indicate a strong movement among community pharmacists to curtail the use of tobacco. Generating support for the elimination of tobacco sales and adoption of tobacco cessation initiatives in community pharmacy could help reduce smoking rates in elevated-risk populations.

Linking genetic counseling content to short-term outcomes in individuals at elevated breast cancer risk.

Few studies have linked actual genetic counseling content to short-term outcomes. Using the Self-regulation Model, the impact of cognitive and affective content in genetic counseling on short-term outcomes was studied in individuals at elevated risk of familial breast-ovarian cancer. Surveys assessed dependent variables: distress, perceived risk, and 6 knowledge measures (Meaning of Positive Test; Meaning of Negative Test; Personal Behavior; Practitioner Knowledge; Mechanisms of Cancer Inheritance; Frequency of Inherited Cancer) measured at pre- and post-counseling. Proportion of participant cognitive and affective and counselor cognitive and affective content during sessions (using LIWC software) were predictors in regressions. Knowledge increased for 5 measures and decreased for Personal Behavior, Distress and Perceived Risk. Controlling for age and education, results were significant/marginally significant for three measures. More counselor content was associated with decreases in knowledge of Personal Behavior. More participant and less counselor affective content was associated with gains in Practitioner Knowledge. More counselor cognitive, and interaction of counselor cognitive and affective content, were associated with higher perceived risk. Genetic counselors dominate the content of counseling sessions. Therefore, their content is tied more closely to short term outcomes than participant content. A lack of patient communication in sessions may pose problems for understanding of complex concepts.

Menstrual Products: Attitudes About Taxation and Safety.

Background: This study explored factors associated with the differences between women and men in attitudes, norms, and the support of taxation of menstrual products (MPs) and menstrual-adjacent products. It also investigated the use of these products in women. Methods: Young adults from 18 to 30 years of age were recruited via social media, listserve emails, and flyers placed throughout a university campus. Following cognitive interviewing, a survey investigated attitudes, beliefs, and behaviors associated with MPs. Results: Individuals self-identified as men or women. Women (n = 154) had more positive general attitudes, less positive safety attitudes, and less support for taxation of MPs than men (n = 43). Regression analyses indicated that factors, such as race, age, attitudes, norms, and taxation, were associated with product use. Conclusions: Attitudes about safety and taxation differ for men and women. Tax policies and attitude-shifting interventions need to be tailored to their audience, and our study can inform that effort.

Illness representations of vaping associated lung injury (VALI) and E-cigarette use: common sense model of self-regulation driven mixed-method approach.

OBJECTIVE: The study explored differences in illness representations of VALI guided by the Common-Sense Model of Self-Regulation (CSM-SR) among non-patient adults. DESIGN: We employed a cross-sectional concurrent mixed-methods design. In the quantitative analysis, we used multivariate analysis of covariance (MANCOVA). Immersion/crystallization was used to analyze qualitative data. MAIN OUTCOME MEASURES: We measured differences in illness representations of VALI by e-cigarette use status, gender, and urban/rural residence. RESULTS: E-cigarette use was associated with illness representations of VALI. Current e-cigarette users discounted the detrimental nature of VALI, compared to former and never e-cigarette users. Gender and urban/rural residence moderated the association between e-cigarette use and illness representation of VALI. In the qualitative analysis, 49.3% respondents reported components of the timeline (e.g. permanent), identity (e.g. shortness of breath), causes (e.g. THC products), consequences (e.g. life-threatening), cure/control (e.g. stop vaping), and worry (e.g. fearful). CONCLUSION: Perceptions about VALI, such as cure and timeline, were associated with e-cigarettes use. Understanding the context in which adults perceive VALI, such as gender and rurality, may contribute to developing interventions that influence e-cigarette cessation. Future research employing CSM-SR to target strategies for promoting vaping abstinence is warranted.