American Smokers Research Articles

Plasma Proteomic Markers of Iron and Risk of Diabetes in a Cohort of African American and White American Current and Former Smokers.

Little information is available on iron with diabetes risk among African Americans, a population where both anemia and elevated ferritin are common. We tested whether plasma proteomic measurements of ferritin and transferrin were associated with increased diabetes risk in a cohort of current and former African American (NHB) and Non-Hispanic White (NHW) smokers. NHB and NHW participants from the COPDGene study who were free of diabetes (n = 4693) at baseline were followed for incident diabetes. The SomaScan was used to determine the relative amounts of natural log-transformed ferritin, transferrin, and hepcidin. During an average of 5.6 years of follow-up, diabetes incidence was 7.9%. Ferritin at follow-up was higher in NHB than NHW participants (p = <0.0001). Ferritin at follow-up was associated with increased diabetes risk (OR = 1.36, 95% CI = 1.08-1.70), while transferrin was associated with decreased risk (OR = 0.25, 95% CI = 0.08-0.77) controlling for age, sex, BMI, smoking pack-years, hepcidin, CRP, and Il-6. Race-specifically, increased risk associated with higher ferritin levels among NHB (OR = 1.56, 95% CI = 1.13-2.16) but not NHW (OR = 1.22, 95% CI = 0.89-1.68) participants. Sex-specifically, ferritin's relationship was similar among NHB men and women and NHW women (ORs ranging from 1.41-1.59); but not NHW men (OR = 0.98, 95% CI = 0.64-1.49). Similarly, transferrin ORs non-significantly ranged from 0.19-0.30 for NHB men and women and NHW women, but was significant for NHW men (OR = 0.07, 95% CI = 0.01-0.63). Higher body iron stores is associated with increased diabetes risk among both NHB and NHW people. Unsuspected elevated iron stores may increase diabetes risk in NHB patients and should be monitored.

Medical mistrust and receptivity to lung cancer screening among African American and white American smokers

ABSTRACT Although medical mistrust is associated with lower cancer screening uptake among racial minorities, such as African Americans, potential impacts on cancer screening among White Americans are generally understudied. In this study, we examined links from medical mistrust to lung cancer screening among African American (N = 203) and White American (N = 201) smokers. Participants completed the Group-Based Medical Mistrust Scale and viewed a brief online educational module about lung cancer risks, etiology, and screening. Thereafter, participants reported their receptivity to lung cancer screening using a Theory of Planned Behavior (TPB) measurement framework (attitudes, normative beliefs, perceived control, and intentions). Medical mistrust predicted lower screening receptivity across all TPB measures for both racial groups. Although medical mistrust was higher among African Americans, there were no race differences in screening receptivity. However, there was some evidence that race moderates the relationship between medical mistrust and screening attitudes. While greater mistrust predicted more negative attitudes among both races, this effect was stronger among White Americans than African Americans. Findings suggest that group-based medical mistrust is a barrier to lung cancer screening for both African Americans and White Americans and illustrates the need to address medical mistrust as a barrier to screening for both racial minority and nonminority populations.

Fine-mapping the CYP2A6 regional association with nicotine metabolism among African American smokers.

The nicotine metabolite ratio (NMR; 3'hydroxycotinine/cotinine) is a stable biomarker for CYP2A6 enzyme activity and nicotine clearance, with demonstrated clinical utility in personalizing smoking cessation treatment. Common genetic variation in the CYP2A6 region is strongly associated with NMR in smokers. Here, we investigated this regional association in more detail. We evaluated the association of CYP2A6 single-nucleotide polymorphisms (SNPs) and * alleles with NMR among African American smokers (N = 953) from two clinical trials of smoking cessation. Stepwise conditional analysis and Bayesian fine-mapping were undertaken. Putative causal variants were incorporated into an existing African ancestry-specific genetic risk score (GRS) for NMR, and the performance of the updated GRS was evaluated in both African American (n = 953) and European ancestry smokers (n = 933) from these clinical trials. Five independent associations with NMR in the CYP2A6 region were identified using stepwise conditional analysis, including the deletion variant CYP2A6*4 (beta = -0.90, p = 1.55 × 10-11). Six putative causal variants were identified using Bayesian fine-mapping (posterior probability, PP = 0.67), with the top causal configuration including CYP2A6*4, rs116670633, CYP2A6*9, rs28399451, rs8192720, and rs10853742 (PP = 0.09). Incorporating these putative causal variants into an existing ancestry-specific GRS resulted in comparable prediction of NMR within African American smokers, and improved trans-ancestry portability of the GRS to European smokers. Our findings suggest that both * alleles and SNPs underlie the association of the CYP2A6 region with NMR among African American smokers, identify a shortlist of variants that may causally influence nicotine clearance, and suggest that portability of GRSs across populations can be improved through inclusion of putative causal variants.

Association of Urinary Biomarkers of Tobacco Exposure with Lung Cancer Risk in African American and White Cigarette Smokers in the Southern Community Cohort Study.

After accounting for smoking history, lung cancer incidence is greater in African Americans than Whites. In the multiethnic cohort, total nicotine equivalents (TNE) are higher in African Americans than Whites at similar reported cigarettes per day. Greater toxicant uptake per cigarette may contribute to the greater lung cancer risk of African Americans. In a nested case-control lung cancer study within the Southern Community Cohort, smoking-related biomarkers were measured in 259 cases and 503 controls (40% White; 56% African American). TNE, the trans-3-hydroxycotinine/cotinine ratio, 4-(methylnitrosamino)-1-3-(pyridyl)-1-butanol (NNAL), mercapturic acid metabolites of volatile organic compounds, phenanthrene metabolites, cadmium (Cd), and (Z)-7-(1R,2R,3R,5S)-3,5-dihydroxy-2-[(E,3S)-3-hydroxyoct-1-enyl]cyclopenyl]hept-5-enoic acid were quantified in urine. Unconditional logistic regression was used to estimate the ORs and 95% confidence intervals (CI) for each biomarker and lung cancer risk. TNE, NNAL, and Cd were higher in cases than controls (adjusted for age, race, sex, body mass index, and cigarettes per day). Among cases, these levels were higher in African Americans compared with Whites. After accounting for age, sex, body mass index, and pack-years, a one-SD increase in log-TNE (OR = 1.30; 95% CI, 1.10-1.54) and log-NNAL (OR = 1.27; 95% CI, 1.03-1.58 with TNE adjustment) was associated with lung cancer risk. In this study, in which NNAL concentration is relatively high, the association for log-TNE was attenuated after adjustment for log-NNAL. Smoking-related biomarkers provide additional information for lung cancer risk in smokers beyond smoking pack-years. Urinary NNAL, TNE, and Cd concentrations in current smokers, particularly African American smokers, may be useful for predicting lung cancer risk.

Cigarette smoking and prostate cancer aggressiveness among African and European American men

PurposeSmoking is a modifiable lifestyle factor that has not been established as a prostate cancer risk factor, nor emphasized in prostate cancer prevention. Studies have shown that African American (AA) smokers have a poorer cancer prognosis than European Americans (EAs), while having a lower prevalence of heavy smoking. We examined the relationship between cigarette smoking and prostate cancer aggressiveness and assessed racial differences in smoking habits on the probability of high-aggressive prostate cancer.MethodsUsing data from the North Carolina-Louisiana Prostate Cancer Project (n = 1,279), prostate cancer aggressiveness was defined as high or low based on Gleason scores, serum prostate-specific antigen levels, and tumor stage. Cigarette smoking was categorized as current, former, or never smokers. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI).ResultsSelf-reported current (OR = 1.99; 95% CI 1.30–3.06) smoking was associated with high-aggressive prostate cancer relative to never smokers. When stratified by self-reported race, the odds of having high-aggressive cancer increased among AA current (OR = 3.58; 95% CI 2.04–6.28) and former smokers (OR = 2.21; 95% CI 1.38–3.53) compared to AA never smokers, but the odds were diminished among the EA stratum (Pself-reported race x smoking status = 0.003).ConclusionCigarette smoking is associated with prostate cancer aggressiveness, a relationship modulated by self-reported race. Future research is needed to investigate types of cigarettes smoked and metabolic differences that may be contributing to the racial disparities observed.

Abstract 1015: Potential of kava in reducing lung cancer risk and associated disparities: Mechanism-based biomarker discovery and analysis

Abstract Background: Lung cancer is the leading cause of cancer-related deaths. Tobacco smoke is well-recognized as the dominant risk factor. Stress, lung inflammation, air pollution and other factors also contribute to the risk of developing lung cancer Racial/ethnic disparities in lung cancer risks exit as well. The quantitative contributions of different these risk factors to lung cancer and associated disparities, however, have not been systematically characterized. One major barrier is the lack of tools to non-invasively and objectively quantify these risk factors, which precludes the identification of high-risk individuals and the development of effective prevention. Data from our group, particularly results from a pilot clinical trial, suggest that kava, traditionally consumed in the South Pacific Islands as a beverage to reduce stress and promote relaxation, may holistically reduce lung cancer risk by impacting multiple factors that contribute to lung cancer risk. Aim: This study aims to discover mechanism-based non-invasive biomarkers reflective of different lung cancer risk factors and explore their potential roles in lung cancer risk disparities. Such biomarkers are also employed to characterize the holistic effects of kava in reducing lung cancer risk and its potential in mitigating associated disparities. Results and Analysis: One-week of kava significantly reduced the level of nicotine exposure among smokers, quantified by the Total Nicotine Equivalents (TNE) in the 24-h urine sample. Excitingly the reduction in TNE appeared to be higher among African American smokers in comparison to participants of other race/ethnicity. Biomarkers for stress (plasma cortisol and urinary total cortisol equivalents (TCE)) were significantly reduced upon one-week kava use, which may mechanistically contribute to the reductions in tobacco use. The reduction in plasma cortisol and TCE were higher among African American smokers as well. One-week kava exposure also increased urinary excretion of total NNAL and reduced urinary 3-methyladenine (3-mA) in participants, suggestive of its ability to reduce the carcinogenicity of nicotine-derived nitrosamine ketone (NNK). Kava effects on NNAL and 3mA were again more pronounced among African American smokers. Conclusion and future directions: These results demonstrate the potential of mechanism-based biomarkers in investigating lung cancer risks and associated disparities. Such biomarkers may also facilitate the translational development of effective and targeted interventions, such as kava, which may not only reduce lung cancer risk but also mitigate the associated disparities. Additional mechanism-based biomarkers on other tobacco carcinogens and inflammation are currently under development. Two clinical trials are ongoing that the current clinical samples will help validate these discoveries. Citation Format: Chengguo Xing, Breanne Freeman, Jessica Mamallapalli, Allison Lynch, Naomi Fujioka, Ramzi G. Salloum, John Malaty, Frank Orlando, Zhiguang Huo. Potential of kava in reducing lung cancer risk and associated disparities: Mechanism-based biomarker discovery and analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1015.

Co-action and changes in alcohol use during a smoking cessation attempt.

Three smoking cessation studies (CARE, Break Free, Por Nuestra Salud [PNS]) were used to measure changes in average alcohol consumption, binge drinking and alcohol-related problems during a smoking cessation attempt and to explore co-action with smoking abstinence. CARE and PNS were longitudinal cohort cessation studies; Break Free was a two-arm randomized clinical trial. Texas, USA. Participants were current smokers who were recruited from the community and received smoking cessation interventions. All participants received nicotine replacement therapy and smoking cessation counseling. CARE included 424 smokers (1/3 White, 1/3 African American and 1/3 Latino); Break Free included 399 African American smokers; PNS included 199 Spanish-speaking Mexican-American smokers. Weekly alcohol consumption was collected multiple times pre and post-quit, and binge drinking and alcohol-related problems were collected at baseline and 26 weeks post-quit. Analyses included only those who indicated current alcohol use. Average alcohol consumption decreased from baseline to 26 weeks post-quit in CARE (F = 17.09, P < 0.001), Break Free (F = 12.08, P<0.001) and PNS (F = 10.21, P < 0.001). Binge drinking decreased from baseline to 26 weeks post-quit in CARE (F = 3.94, P = 0.04) and Break Free (F = 10.41, P < 0.001) but not PNS. Alcohol-related problems decreased from baseline to 26 weeks post-quit in CARE (Chi-sq = 6.41, P = 0.010) and Break Free (Chi sq = 14.44, P = 0.001), but not PNS. Among current drinkers, alcohol use/problems appear to decrease during a smoking cessation attempt and remain low through 26 weeks after the quit attempt. Little evidence was found for co-action, with smoking abstainers and relapsers showing similar change in alcohol use/problems.

Who likely experiences reactance to quitting messages: How individual cultural identification moderates the effect of controlling language on psychological reactance

Psychological reactance can undermine the persuasiveness of smoking campaigns, but this effect may vary as a function of culture. Previous research has been conducted at the national level or examined the influence of one cultural variable. This study investigated whether the boomerang effect of controlling language varied across countries and whether individualism and power distance moderated the relationship between controlling language and psychological reactance. A total of 400 Chinese and 441 American smokers were randomly assigned to either high or low controlling language. High controlling language elicited psychological reactance, which caused negative attitudes and eventually reduced intentions to quit smoking in both countries. Moreover, the effect of controlling language on reactance was stronger among low power distance Americans, Chinese of high individualism and high power distance as well as of low individualism and low power distance. The boomerang effect of controlling language held across cultures. Power distance moderated the relationship between controlling language and psychological reactance as well as the moderation effect of individualism on this relationship. Practitioners should be cautious to evoke reactance especially when targeting at the three groups mentioned above.

Discrimination experiences and mental health outcomes among African American homeless smokers

ABSTRACT Daily discrimination experiences are associated with both the physical and psychological well-being among African Americans (AAs). Little is known about the impact of daily discrimination on mental health among people experiencing homelessness (PEH), especially AA persons experiencing homelessness (AA PEH). In this study, we measured perceived discrimination, depression, and anxiety using the Everyday Discrimination Scale, the Centers for Epidemiologic Studies-Depression Scale, and the Generalized Anxiety Disorder Scale-7, respectively. Multivariable linear regression modeling was used, with depression and anxiety as outcome variables. We used a change in estimate approach to select the variables included in the final models between everyday discrimination and mental health outcomes of depression and anxiety. Participants (n = 100) reported race (43%) and homelessness (37%) as the main reasons for discrimination experiences. After adjusting for anxiety, age, and education, everyday discrimination was significantly associated with depression scores (b = 0.187; CI: 0.01, 0.37; p = 0.04). Everyday discrimination may be associated with depressive symptoms among AA PEH. Future research should further examine the association between diverse forms of discrimination and mental health outcomes among AA PEH and explore effective coping strategies tailored to this subgroup. Interventions to reduce the occurrence and impact of discrimination experiences may be warranted for AA PEH.

APOL1 Risk Variants Associate With the Prevalence of Stroke in African American Current and Past Smokers.

African American smokers have 2.5 times higher risk for stroke compared with nonsmokers (higher than other races). About 50% of the African American population carry 1 or 2 genetic variants (G1 and G2; rare in other races) of the apolipoprotein L1 gene (APOL1). Studies showed these variants may be associated with stroke. However, the role of the APOL1 risk variants in tobacco-related stroke is unknown. In a cross-sectional study, we examined whether APOL1 risk variants modified the relationship between tobacco smoking and stroke prevalence in 513 African American adults recruited at University of California, San Francisco. Using DNA, plasma, and questionnaires we determined APOL1 variants, smoking status, and stroke prevalence. Using logistic regression models, we examined the association between smoking (ever versus never smokers) and stroke overall, and among carriers of APOL1 risk variants (1 or 2 risk alleles), and noncarriers, separately. Among participants, 41% were ever (current and past) smokers, 54% were carriers of the APOL1 risk variants, and 41 had a history of stroke. The association between smoking and stroke differed by APOL1 genotype (Pinteraction term=0.014). Among carriers, ever versus never smokers had odds ratio (OR) 2.46 (95% CI, 1.08-5.59) for stroke (P=0.034); OR 2.00 (95% CI, 0.81-4.96) among carriers of 1 risk allele, and OR 4.72 (95% CI, 0.62-36.02) for 2 risk alleles. Among noncarriers, smoking was not associated with a stroke. Current and past smokers who carry APOL1 G1 and/or G2 risk variants may be more susceptible to stroke among the African American population.

Discrimination, Mental Health, and Readiness to Quit Smoking.

We conducted a cross-sectional study, examining the mediation effects of depression and anxiety on the association between discrimination and readiness to quit cigarette smoking among African American adult cigarette smokers experiencing homelessness. Using a convenience sample, participants were recruited from a homeless shelter in Southern California. Scores of discrimination, depressive, and anxiety symptoms, and readiness to quit smoking were analyzed using linear regression modeling. We enrolled 100 participants; 58 participants were male. In the final model, discrimination had no association with readiness to quit (b = 0.02; 95% CI [-0.04, 0.08]; p = 0.47). The indirect effects of depression (b = 0.04, [0.01, 0.07]; p = 0.02) and anxiety (b = 0.03; [0.01, 0.05]; p = 0.04) reached statistical significance; the direct effects of depression (b = -0.01; [-0.09, 0.04]; p = 0.70) and anxiety (b = -0.00; [-0.09, 0.06]; p = 0.86) did not. Future studies should explore these associations to enhance smoking cessation programs for this population.

Young patients undergoing carotid stenting procedures have an increased rate of procedural failure at 1-year follow-up

The outcomes of patients with premature cerebrovascular disease (age ≤ 55 years) who undergo carotid artery stenting are not well defined. Our study objective was to analyze the outcomes of younger patients undergoing carotid stenting. The SVS VQI was queried for transfemoral carotid artery stenting (TF-CAS) and transcarotid artery revascularization (TCAR) between 2016-2020. Patients were stratified based on age ≤ 55 or > 55 years. Primary endpoints were periprocedural stroke, death, myocardial infarction (MI), and composite outcomes. Secondary endpoints included procedural failure (defined as ipsilateral restenosis ≥80% or occlusion) and reintervention rates. Of the 35,802 patients who underwent either TF-CAS or TCAR, 2912 (6.1%) were ≤ 55 years. Younger patients were less likely than older patients to have coronary disease (30.5% vs 50.2%, p <.001), diabetes (31.5% vs 37.9%, p < .001) and hypertension (71.8% vs 89.8%, p <.001), but were more likely to be female (45% vs 35.4%, p <.001) and active smokers (50.9% vs 24.0%, p< .001) Younger patients were also more likely to have had a prior transient ischemic attack (TIA) or stroke than older patients (70.7% vs 56.9%, p <.001). TF-CAS was more frequently performed in younger patients (79.7% vs 55.4%, p <.001). In the periprocedural period, younger patients were less likely to have a MI than older patients (0.3% vs, 0.7%, p<.001), but there was no significant difference in the rates of periprocedural stroke (1.5% vs. 2.0%, p = .173) and composite outcomes of stroke/death (2.6% vs 2.7%, p =.686) and stroke/death/MI (2.9% vs 3.2%, p = .353) between our two cohorts. The mean follow-up was 12 months regardless of age. During follow up, younger patients were significantly more likely to experience significant (≥ 80%) restenosis or occlusion (4.7% vs. 2.3%, p= .001) and to undergo reintervention (3.3% vs. 1.7%, p< .001). However, there was no statistical difference in the frequency of late strokes between younger and older patients (3.8% vs. 3.2%, p = .129). Patients with premature cerebrovascular disease undergoing carotid artery stenting are more likely to be African American, female, and active smokers than their older counterparts. Young patients are also more likely to present symptomatically. Although periprocedural outcomes are similar, younger patients have higher rates of procedural failure (significant restenosis or occlusion) and reintervention at 1 year follow-up. However, the clinical implication of late procedural failure is unknown given that we found no significant difference in the rate of stroke at follow-up. Until further longitudinal studies are completed, clinicians should carefully consider the indications for carotid stenting in patients with premature cerebrovascular disease, and those who do undergo stenting may require close follow-up given.

Concurrent Choice Assessment of Preference and Substitutability of E-cigarettes and Heated Tobacco Products for Combustible Cigarettes Among African American and White Smokers.

Alternative nicotine delivery products, including electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs), contain fewer toxicants than combustible cigarettes and offer a potential for harm reduction. Research on the substitutability of e-cigarettes and HTPs is crucial for understanding their impact on public health. This study examined subjective and behavioral preferences for an e-cigarette and HTP relative to participants' usual brand combustible cigarette (UBC) in African American and White smokers naïve to alternative products. Twenty-two adult African American (n = 12) and White (n = 10) smokers completed randomized study sessions with their UBC and study provided e-cigarette and HTP. A concurrent choice task allowed participants to earn puffs of the products but placed UBC on a progressive ratio schedule, making puffs harder to earn, and e-cigarette and HTP on a fixed ratio schedule to assess behavioral preference for the products. Behavioral preference was then compared to self-reported subjective preference. Most participants had a subjective preference for UBC (n = 11, 52.4%), followed by an equal preference for e-cigarette (n = 5, 23.8%) and HTP (n = 5, 23.8%). During the concurrent choice task, participants showed a behavioral preference (i.e., more earned puffs) for the e-cigarette (n = 9, 42.9%), followed by HTP (n = 8, 38.1%), and UBC (n = 4, 19.1%). Participants earned significantly more puffs of the alternative products compared to UBC (p = .011) with no difference in earned puffs between e-cigarettes and HTP (p = .806). In a simulated lab setting, African American and White smokers were willing to substitute UBC for an e-cigarette or HTP when the attainment of UBC became more difficult. NCT04646668. Findings suggest that African American and White smokers are willing to substitute their UBC for an alternative nicotine delivery product (e-cigarette or HTP) when the attainment of cigarettes became more difficult in a simulated lab setting. Findings require confirmation among a larger sample under real-world conditions but add to growing evidence suggesting the acceptability of alternative nicotine delivery products among racially diverse smokers. These data are important as policies that limit the availability or appeal of combustible cigarettes are considered or enacted.

Young patients undergoing carotid endarterectomy have increased rates of recurrent disease and late neurological events

There are few data regarding outcomes of patients with premature cerebrovascular disease (age ≤55years) who undergo carotid endarterectomy (CEA). The objective of this study was to analyze the demographics, presentation, perioperative and later outcomes of younger patients undergoing CEA. The Society for Vascular Surgery Vascular Quality Initiative was queried for CEA cases between 2012 and 2022. Patients were stratified based on age of less than 55 or age greater than 55years. Primary end points were periprocedural stroke, death, myocardial infarction, and composite outcomes. Secondary end points included restenosis (≥80%) or occlusion, late neurological events and reintervention. Of 120,549 patients undergoing CEA, 7009 (5.5%) were 55years old or younger (mean age, 51.3years). Younger patients were more likely to be African American (7.7% vs 4.5%; P< .001), female (45.2% vs 38.9%; P< .001), and active smokers (57.3% vs 24.1%; P< .001). They were less likely than older patients to have hypertension (82.5% vs 89.7%; P< .001), coronary artery disease (25.0% vs 27.3%; P< .001), and congestive heart failure (7.8% vs 11.4%; P< .001). Younger patients were significantly less likely than older patients to be on aspirin, anticoagulation, statins, or beta-blockers, but were more likely to be taking P2Y12 inhibitors (37.2 vs 33.7%; P< .001). Younger patients were more likely to present with symptomatic disease (35.1% vs 27.6%; P< .001) and were more likely to undergo nonelective CEA (19.2% vs 12.8%; P< .001). Younger and older patients had similar rates of perioperative stroke/death (2% vs 2%; P= NS) and postoperative neurological events (1.9% vs 1.8%; P= NS). However, younger patients had lower rates of overall postoperative complications compared with their older counterparts (3.7% vs 4.7%; P< .001). Of these patients, 72.6% had recorded follow-up (mean, 13months). During follow-up, younger patients were significantly more likely than older patients to experience a late failure, defined as significant restenosis (≥80%) or complete occlusion of the operated artery (2.4% vs 1.5%; P< .001) and were more likely to experience any neurological event (3.1% vs 2.3%; P< .001). Reintervention rates did not significantly differ between the two cohorts. After controlling for covariates using a logistic regression model, age 55years or younger was independently associated with increased odds of late restenosis or occlusion (odds ratio, 1.591; 95% confidence interval, 1.221-2.073; P< .001) as well as late neurological events (odds ratio, 1.304; 95% confidence interval, 1.079-1.576; P= .006). Young patients undergoing CEA are more likely to be African American, female, and active smokers. They are more likely to present symptomatically and undergo nonelective CEA. Although perioperative outcomes are similar, younger patients are more likely to experience carotid occlusion or restenosis as well as subsequent neurological events, during a relatively short follow-up period. These data suggest that younger CEA patients may require more diligent follow-up, as well as a continued aggressive approach to medical management of atherosclerosis to prevent future events related to the operated artery, given the particularly aggressive nature of premature atherosclerosis.

Smoking Cessation Interventions for Chinese American Smokers: A Systematic Review and Meta-Analysis.

Smoking cessation interventions are important for decreasing lung cancer mortality rate among Chinese Americans. This study aims to investigate and summarize the intervention methods focusing on smoking cessation among Chinese Americans and to compare the effects of intervention methods on the smoking cessation rates. A systematic review and meta-analysis design was used in this study. Keyword searching was conducted in August 2021 on PubMed, Google Scholar, PsycINFO, and CINAHL. The methodological quality of each study was assessed using the PEDro scale or The Methodological item for non-randomized studies (MINORS). The Review Manager Version 5.4 software was used to conduct the meta-analysis. Random effect model and subgroup analysis were applied in the analysis. Twenty and 11 studies were included in the systematic review and meta-analysis, respectively. Of the 20 studies, 8 were randomized control studies, 9 were pre-post single group intervention studies, 1 was retrospective analysis for an intervention study, 1 was a baseline data analysis from a cluster randomized trial, 1 was a feasibility intervention study. Results showed that compared to the control group, the group that received interventions on smoking cessation had a significantly increased smoking cessation rate (OR, 3.76; 95% CI, 1.72-8.21; P=0.0009). Subgroup analysis showed individual-based (OR, 5.88) NRT outreach interventions (OR, 3.80) conducted in person (OR, 2.53) with smokers (OR, 6.64) seemed to be more effective to increase smoking cessation rates among Chinese Americans compared with group-based, telephone counseling, indirect remote interventions conducted among Chinese American smokers and their non-smoke family members. Individual-based NRT outreach interventions conducted in person with smokers is an effective way to increase smoking cessation rates among Chinese Americans. More culturally sensitive and effective interventions are needed to help Chinese American smokers to quit smoking.

Defining the impact of continuous positive airway pressure therapy on diastolic function in adults with moderate-to-severe obstructive sleep apnea.

Although studies have shown that continuous positive airway pressure (CPAP) therapy to treat obstructive sleep apnea improves left ventricular diastolic function, modifiers of improvement are unknown. We explored race and pre-treatment 24-h non-dipping blood pressure status as modifiers of improved diastolic function. Participants (N=220) with obstructive sleep apnea (apnea-hypopnea index ≥15 events/h) and hypertension were recruited to a cohort study that examined effects of 3-month CPAP therapy on 24-h blood pressure. Those who completed echocardiogram at baseline and follow-up were included in this analysis. Diastolic function parameters (E, A, e', E/A, E/e') were assessed. Race was categorised to African American versus others. Participants were categorised as nocturnal dippers (night-time blood pressure decrease by ≥10%) versus non-dippers. We compared changes in parameters of diastolic function by race and nocturnal dipping status. A total of 92 participants were included. They were men (86%), African American (67.4%), and current smoker (29.5%). Mean apnea-hypopnea index was 32.9 events/h. Mean CPAP usage was 3.15 h/day. After 3 months of CPAP treatment, there were significant improvements in measures of diastolic function: a median (interquartile range [IQR]) increase in E velocity by 4.00(-5.75 to 13.75)cm/s, an increase in e' by 2.00(0-4.00)cm/s, and a decrease in the E/e' ratio by 1.74(-4.27 to 0.00) at follow-up (p < 0.05). These changes did not differ by race or nocturnal dipping status. Improvements in diastolic function after CPAP therapy did not differ by race or nocturnal dipping status. Further studies are needed to understand predictors of CPAP effects on diastolic function.

Preliminary Testing of A Web-Based Lung Cancer Screening Decision Coaching Tool for Older Chinese American Smokers and Their Providers

To examine the acceptability of a culturally targeted lung cancer screening decision aid developed for older Chinese Americans with a smoking history and primary care providers serving this patient population. Study participants reviewed a web-based decision aid (DA) for lung cancer screening named "Lung Decisions Coaching Tool (LDC-T)." Participants completed a baseline survey and were invited to join an interview. During the interview, participants engaged with the Lung Decisions Coaching Tool and then completed standardized measures of acceptability, usability, and satisfaction. Chinese American smokers (N =22) and Chinese American physicians (N=10) rated the acceptability and usability of a patient version and provider versions of the LDC-T, respectively. Patient version demonstrated high levels of acceptability, usability and satisfaction. Most participants rated the information provided as good or excellent, the amount of tool information was just right, and they thought the tool would be useful for making a screening decision. The tool was well received by participants for ease of use and well-integrated functions. Furthermore, participants indicated they would like to use the tool to help prepare for lung cancer screening shared decision-making with their provider. Similar results were found for the provider version of the LDC-T. Lung cancer screening represents an evidence-based approach to reducing lung cancer morbidity and mortality among chronic high-frequency smokers. Study results suggest the acceptability of a culturally targeted lung cancer screening decision aid for Chinese American smokers and providers. Additional research is needed to determine the effectiveness of the DA in increasing appropriate levels of screening in this underserved population.

Using the Past to Understand the Future of U.S. and Global Smoking Disparities: A Birth Cohort Perspective

Using the Past to Understand the Future of U.S. and Global Smoking Disparities: A Birth Cohort Perspective

Abstract C006: Ancestry-specific genetic feedback about lung cancer risk in African American smokers: Cognitive, emotional, and motivational effects

Abstract Genetic factors play an important role in the risk of developing lung cancer, a disease that disproportionately affects African American smokers in the U.S. population. Accumulating evidence now suggests that there may be risk factors that are particularly salient among smokers with African genetic ancestry, and that specific ancestry-informative genetic markers can be predictive of lung cancer risk in African American smokers. Although testing for and communication of genetic risk to patients should impact health and screening, results have been mixed. The goal of this study was to evaluate the effects of genetic risk communication that included ancestry-specific risk information among African American smokers. To that end, we conducted a factorial experiment, in which African American smokers (n=166) were randomly assigned to receive hypothetical genetic test results that indicated: 1) high vs. low ancestry-specific genetic risk for lung cancer ("Risk"), and 2) high vs. low African genetic ancestry ("Ancestry"). We hypothesized that participants who are told that they are at high risk for lung cancer based on genes that are prominent in African populations would exhibit increases in cognitive (perceived lung cancer risk), emotional (cancer worry, psychological distress), and motivational (motivation to quit smoking) factors that have been shown in previous research to predict longer-term health behavior change. We further predicted that effects would be particularly salient among participants told that their genetic profile revealed high African ancestry. We assessed outcomes using well-validated Likert-type indices, immediately before and after exposure to the risk information. Results of a 2 (Risk) x 2 (Ancestry) x 2 (Time) mixed effects ANOVA revealed significant and large effects of Risk x Time for all outcomes, such that participants told they have high levels of ancestry-specific risk genes for lung cancer exhibited increases in perceived lung cancer risk, cancer worry, distress and motivation to quit smoking, (p's &amp;lt;0.0001; 0.12 &amp;lt; η2 &amp;lt; 0.24). There was also a significant Ancestry x Time effect on perceived lung cancer risk, but not on the other outcomes, suggesting increased risk perceptions among participants who learned that they have high African genetic heritage. Higher-order interactions of Risk x Ancestry x Time, however, were not significant. Findings highlight the potential utility of providing ancestry-specific genetic feedback to vulnerable and underserved at-risk populations in increasing at key cognitive, emotional, and motivational factors critical to behavior change. Citation Format: Dina Bitterman, Khin Htet, Elizabeth Blackman, Isaac Lipkus, Cherie Erkmen, Camille Ragin, Joel Erblich. Ancestry-specific genetic feedback about lung cancer risk in African American smokers: Cognitive, emotional, and motivational effects [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C006.

DEVELOPMENT AND EVALUATION OF A WEB-BASED DECISION AID FOR LUNG CANCER SCREENING FOR OLDER CHINESE AMERICANS

Abstract Low dose computed tomography (LDCT) lung cancer screening is effective in reducing lung cancer mortality. In the United States, Chinese Americans are disproportionately impacted by lung cancer compared to other Asian subgroups. Our prior study showed that over 25% of older Chinese male smokers met eligibility for LDCT screening based on the CMS guidelines. However, in general, cancer screening rates among Chinese Americans are lower compared to other Americans. Therefore, we developed a culturally and logistically web-based decision aid (DA) for LDCT screening “Lung Decision Coaching Tool (LDC-T)” to improve the older Chinese American's knowledge of lung cancer and screening and to facilitate the decision making with the physician. Compared to traditional paper-based DA, the LDC-T DA has key elements including video, pack-year calculator, eligibility determination, and visual aids to support comprehension and shared decision-making. We conducted acceptability and usability tests among 22 older Chinese American smokers. The tool was highly received by participants for its usefulness and ease to use. Over 80% reported the way of information presented in LDC-T is "good or very good" and the length of the information is "just right". Overall, the majority were satisfied with the LDC-T DA (95%) and agreed that the tool includes sufficient information for people to make the screening decision (90%) and prepare shared decision making with their healthcare providers (81%). Our study results will inform strategies for reducing lung cancer disparities among Chinese Americans and other underserved smokers thus filling important gaps in the literature.