Cessation Resources Research Articles

E-cigarette Quit Attempts in Emerging Adults: Motivations for Attempts and Predictors of Cessation Barriers.

Although young adults use electronic nicotine delivery systems (ENDS) more often than any other demographic group, most are interested in cessation; however, little is known about their cessation experiences. The present study examined characteristics associated with quit attempts, reasons for quitting and resources utilized, and psychological symptoms [i.e., depression, anxiety, anxiety sensitivity, attention-deficit/hyperactivity disorder (ADHD)] associated with cessation barriers. College-attending adults from six U.S. institutions who endorsed lifetime ENDS use (N=2007; 75% female) completed a one-hour online survey between Fall 2022-Spring 2023. More than half of participants (53%) made a cessation attempt; of those participants, more than half (53%) made multiple attempts. Male sex; college region; earlier ENDS initiation; higher ENDS dependence; disposable or pod device use; and past 30-day combustible use were associated with cessation attempts. Health concerns motivated many quit attempts (44%), although participants identified a range of reasons that converged with prior research. Unassisted cessation methods were most common [e.g., cold turkey (68%), willpower (53%)]. Although utilized far less often, replacing vaping with another activity, support from family/friends, nicotine replacement, and prescription cessation medications were perceived to be helpful. Anxiety sensitivity and ADHD symptoms were associated with more barriers to cessation, particularly with affect management and withdrawal. ENDS quit attempts are common among young adults, particularly males and those with higher dependence, but largely are unassisted. Encouraging the use of multiple interventions and tailoring interventions to those with psychological vulnerabilities are critical next steps to improving young adults' success with ENDS cessation. Young adults are motivated to quit ENDS for a wide range of intra- and interpersonal reasons. However, their limited uptake of ENDS cessation resources suggests an opportunity to better publicize and increase access to these resources, particularly to digital resources, nicotine replacement therapy, and prescription cessation medications. To be maximally effective, cessation interventions should be multipronged and address the unique challenges faced by individuals with greater anxiety sensitivity and ADHD symptoms, prominent issues in this developmental stage.

Associations of sociodemographic and smoking characteristics with intention to quit among Chinese adults aged 20–69 years who smoke: Findings from nationwide China Health Literacy Survey during 2018–19

ObjectiveTo identify factors influencing the intention to quit (ItQ) among Chinese who smoke, focusing on 10th Revision of the International Classification of Diseases (ICD-10) Nicotine dependence. Additionally, to estimate the number of individuals with ItQ, supporting optimal allocation of cessation resources. MethodsThis study used data from the 2018 China Health Literacy Survey, a nationally representative cross-sectional study with 20,288 participants who smoke currently aged 20–69 years. The ItQ proportions were estimated overall and by subgroup. Logistic regression was employed to estimate ORs and 95 % CIs for ItQ. The number of people who smoke with ItQ was estimated based on the census data. ResultsIn China, 41.34 % of individuals who smoke had ItQ, higher in females (44.89 %) than males (41.34 %). Provincial proportions ranged from 23.53 % to 63.56 %. ItQ was significantly associated with smoking characteristics, including occasional smoking (OR = 2.08, 95 % CI = 1.88–2.20), fewer pack-years (OR = 0.70, 95 % CI = 0.68–0.73), older smoking initiation age (OR = 1.22, 95 % CI = 1.18–1.27), and ICD-10 Nicotine dependence (OR = 1.12, 95 % CI = 1.06–1.19), as well as age, sex, socioeconomic factors, and health status. Withdrawal symptoms were positively associated with ItQ in individuals who smoke without ICD-10 Nicotine dependence but negatively in those with ICD-10 Nicotine dependence. An estimated 100.3 million adults aged 20–69 in China have ItQ, with 52.14 million suffering from ICD-10 Nicotine dependence. ConclusionsThe intention to quit smoking among Chinese who smoke is low and varies by ICD-10 Nicotine dependence and region, underscoring the need for targeted smoking cessation interventions across diverse smoking populations.

Co-producing an advocacy video on e-cigarette advertising with adolescents in Scotland: a multi-stage qualitative study

BackgroundResearchers, advocacy workers, and adolescents have raised concerns about the uptake of e-cigarettes (‘vapes’) among adolescents. Currently, vaping is not part of NHS Scotland's smoking cessation resources. This study investigated adolescents’ exposure to and perceptions of e-cigarette advertising to co-produce an advocacy video. This focus on e-cigarette marketing and adolescents is timely as policymakers in the UK are actively shaping new regulations in response to these concerns, such as banning disposable e-cigarettes. MethodsBetween March and September, 2023, a four-phase project was conducted with adolescents aged 11–16 years from the central belt of Scotland. The phases included 1) three workshops with 33 adolescents (10–12 per workshop) about their experiences with e-cigarette marketing; 2) photographs from 28 adolescents depicting examples of marketing in their local areas and online; 3) six focus groups (a total of 28 adolescents, 2–6 per group) to discuss the photographs and 4) co-production of an advocacy video with a video production company, including one additional workshop with six adolescents. Workshops were not recorded; however, researchers took field notes, and the materials produced were kept for analysis. Focus group transcripts were thematically analysed. FindingsThis study explored adolescents’ exposure to and views on e-cigarette advertising to co-produce an advocacy video aimed at reducing such exposure. Our qualitative thematic analysis of the workshop and focus group data revealed adolescents’ concerns about e-cigarettes’ potential health effects, pervasive advertising targeting adolescents, and peer usage, which became the focus of the final video. Although none of our participants were current e-cigarette users, some had encountered targeted online advertisements, despite being under 18, or had seen friends of public figures using e-cigarettes on social media. The advocacy video, produced in collaboration with the adolescents, effectively integrated their insights and experiences, highlighting their collective concerns about e-cigarette advertising. InterpretationOur findings show adolescents are highly exposed to e-cigarette advertising, feel uncertain about their harms, and are aware of marketing tactics like vibrant colours and flavour variations. This highlights the need for advocacy work which focuses on promoting stronger marketing legislation to protect them. Our advocacy video, is one such example of this which is being used by advocacy groups to raise awareness about e-cigarette advertisements. FundingCancer Research UK.

Social Determinants of Successful Smoking Cessation: An Eight-Year Analysis of Population Assessment of Tobacco and Health (PATH) Data.

Smoking cessation is a crucial public health goal due to its substantial impact on reducing the morbidity and mortality associated with tobacco use. However, significant disparities in smoking cessation success persist across socioeconomic groups in the United States. This study aimed to examine differences in smoking cessation rates among daily smokers based on race, ethnicity, and socioeconomic status (SES) using data from the Population Assessment of Tobacco and Health (PATH) study, spanning waves 1 to 6 (eight years). Longitudinal data from PATH were analyzed, focusing on baseline daily cigarette smokers followed over an eight-year period to assess cessation outcomes. SES was measured by education and poverty status. Successful smoking cessation was defined as sustained abstinence from cigarettes for 12 months or more at the final wave. Logistic regression models identified predictors of successful cessation, adjusting for potential confounders, including age, nicotine dependence, and access to cessation resources. The analysis revealed significant disparities in cessation success across racial, ethnic, and SES groups. Smokers living in poverty and those with lower educational attainment were less likely to achieve cessation success than their counterparts. Race (Black) and ethnicity (Latino) were also significantly associated with lower cessation success. This study highlights the social determinants of smoking cessation success among U.S. adult smokers, with lower success rates observed among those in poverty and with less educational attainment. These findings emphasize the need for targeted interventions that address the unique barriers to cessation faced by low-SES groups. Public health strategies should prioritize equitable access to cessation resources and culturally tailored interventions to reduce these disparities and improve cessation outcomes among all smokers.

Smoking Behaviour, Knowledge, Attitude, and Practice among Students of University of Aseer Region at KSA

Background: Tobacco smoking remains a major global public health challenge, contributing significantly to respiratory, cardiovascular, and neoplastic diseases. (9)In Saudi Arabia, smoking rates among college students are of particular concern, reflecting a growing need for targeted interventions.(10) Objective: This study aimed to assess the knowledge, attitudes, and practices regarding cigarette smoking among college students at the University of Bisha, Aseer region, to better understand smoking behavior and inform public health strategies.(12) Methods: A cross-sectional descriptive study was conducted using a self-administered questionnaire based on the Global Adult Tobacco Survey (GATS). (18) The study included 100 college students who were surveyed about their smoking status, knowledge, attitudes, and practices related to smoking. Data were analyzed using IBM SPSS software, version 24, with chisquare tests employed for statistical significance (p < 0.05). Results: Among the 100 participants, 66.4% were never smokers, 23.6% were current smokers, and 10.0% were ex-smokers. The study found that male students were significantly more likely to be current or ex-smokers compared to female students. (16) Increased education level correlated with a decrease in smoking prevalence.(15) Knowledge levels about smoking's effects and attitudes towards smoking differed significantly between never smokers, current smokers, and ex-smokers. (19)The majority of never smokers and ex-smokers cited health concerns as their primary reason for avoiding or quitting smoking, while current smokers predominantly viewed smoking as a stress reliever.(14) Only 49.2% of current smokers consistently declared their smoking status to healthcare providers, and 61.0% received advice to quit.(11) Discussion: The study highlights a significant disparity in smoking prevalence and attitudes between genders and across education levels. The results suggest that enhanced awareness and educational interventions are needed, especially targeting current smokers and integrating effective cessation methods such as counseling and nicotine replacement therapy.(17) Conclusion: This study underscores the importance of improving knowledge and attitudes toward smoking to reduce smoking rates among college students. Early intervention, increased access to cessation resources, and targeted health education can play crucial roles in addressing smoking behaviors in this population.(13)

Could We Prevent Tobacco Products in Young Populations?

The well-documented detrimental effects of tobacco on children and adolescents make it imperative to prevent tobacco use in young populations, which is a critical public health objective. Youth are particularly susceptible to nicotine’s addictive properties, and they are more susceptible to developing an addiction to tobacco products if they begin using them at a young age, according to research. The reduction of tobacco use among young people can be achieved by implementing evidence-based strategies, including increasing the minimum legal age for purchasing tobacco products, increasing taxation on these products, restricting marketing aimed at youth, and facilitating comprehensive school-based prevention programs, etc. Furthermore, prevention initiatives may be further bolstered by initiatives to encourage smoke-free environments and offer access to smoking cessation resources. In order to effectively prevent tobacco use in young populations and promote healthier outcomes for future generations, it is necessary to target various levels of intervention and involve multiple sectors, including healthcare professionals, educators, policymakers, and community leaders.

Efficacy of a smoking cessation program for patients with lung cancer.

357 Background: Smoking cessation improves overall mortality and cancer-specific mortality in patients with lung cancer. However, cessation is rarely successful without medical assistance, indicating a need for focused intervention in patients with lung cancer. Referrals for formal counseling can facilitate access to smoking cessation resources and serve as an impetus for cessation. In this study, we analyzed the efficacy of the smoking cessation program at our institution’s cancer center and identified opportunities for improvement in patient outreach, education, recruitment, and retention. Methods: A retrospective chart review of patients at our institution's cancer-dedicated smoking cessation center was conducted between January 1, 2022, to August 31, 2023. All referred patients with primary lung cancer or documented lung metastasis were included. Patient demographic and medical information were collected from the electronic medical record. Data was analyzed with descriptive (frequency, mean, median, interquartile ranges (IQR), 95% confidence interval) and inferential (t-test, Chi-Squared/Fisher’s Exact) statistics. P-value <0.05 was deemed significant. Results: 138 patients were referred for smoking cessation counseling, 24 (17.4%) attended counseling, and 14 (58.3%) attended ≥2 visits. Patients had a median time from referral to first session of 14 days (IQR=8.5). All counseled patients were prescribed nicotine replacement therapy (NRT) with 19 receiving multiple modalities. Of the 23 patients actively smoking at first meeting, 19 (82.6%) saw some reduction in packs/day (PPD) compared with 55 (51.9%, n=106) in actively smoking non-counseled patients (p=0.006). Counseled patients saw improvement in packs/day smoking with a mean reduction of 0.66 PPD (p=0.0001, [0.36, 0.95 95% CI]). Patients who attended >2 meetings saw a mean PPD reduction of 1.13 (p=0.004, [0.49, 1.78 95% CI]). In patients who did not attend counseling, 82 (71.9%, n=114) were never successfully contacted. There was no significant difference in age, gender, race, or insurance between patients who attended or did-not-attend counseling. Conclusions: Our smoking cessation program demonstrates effectiveness in facilitating a significant decrease in PPD. However, low utilization presents an opportunity for quality improvement to identify barriers to engagement and improve patient outreach. Proposed interventions include strategies such as patient-portal mediated outreach, provider reminders in the EMR, and utilization of referral and scheduling at initial oncology appointment as quality metrics. Smoking cessation program. Program Efficacy Number of Visits Mean Packs/Day Decrease [95% CI] 1 (n=9) 0.31 [-0.12, 0.73] 2 (n=6)* 0.56 [0.20, 0.91] >2 (n=8)** 1.13 [0.49, 1.78] Total (n=23)*** 0.66 [0.36, 0.95] Attended Counseling n (%) Did Not Attend Counseling n (%) Patients with Any Decrease in Packs/Day* 19 (82.6) 55 (51.9) Patients Attaining Relapse Free Cessation 9 (37.5) 26 (22.8) *p<0.05, **p<0.005, ***p<0.0005.

Abstract C007: Building capacity in health clinics and community organizations serving LGBTQ+ communities on tobacco prevention

Abstract Background. Tobacco use remains a significant public health issue, particularly among the LGBTQ+ community. Los Angeles County, which is home to the second-largest LGBTQ+ population in the US, has notably higher prevalence of tobacco use compared to the general population, partly due to targeted marketing by the tobacco industry, social stressors, and discrimination. These factors contribute to higher rates of smoking and tobacco-related health disparities; however, little is known about the capacity of community-based organizations, clinical providers, support staff, and other personnel that work closely with the LGBTQ+ community to provide smoking cessation services. Methods. Cedars Sinai Cancer Center Community Outreach and Engagement (COE) assisted in the facilitation of conducting a needs assessment, Clinical Provider and Staff Survey, to assess the opinions of clinical providers and community leaders about tobacco cessation-related topics related to 1) Building culturally competent tobacco cessation services; 2) Reducing health disparities in tobacco cessation services; 3) Improving access to care (Medicaid/Medi-Cal access and uptake) for diverse populations that are affected by tobacco-related disparities; 4) Improving the utilization of tobacco cessation services. The survey was administered online from December 2022 to April 2023 with providers throughout Los Angeles County. Results. A total of 261 surveys were collected which revealed several key issues at the organization level: they do not prioritize tobacco screening, treatment, or referrals; there is no standardized process for client management; staff have limited knowledge on tobacco prevention and patient navigation; and there is limited staff capacity and funding. To address organizational-focused barriers, COE trained 147 clinical providers and staff from 4 local health clinics and organizations and on capacity building, including the basics of tobacco, evidence-based interventions like "Ask, Advice, Refer," and lung cancer screening. Additionally, to address Client/Patient-Focused Barriers for Organizations, such as: lack of motivation to quit, low perception of the severity of smoking, and a lack of culturally competent or targeted cessation resources, COE staff assisted in navigating resources, ensuring both providers and clients were aware of and could access relevant support services. This involved sharing LGBTQ+ affirming resources, including medical care, behavioral health, and housing, and referred smokers to gender-affirming cessation support groups. Conclusion. The survey highlighted the need to enhance service delivery and support for the LGBTQ+ community. With these findings, our COE staff were able to increase organizational capacity through training and education for clinical providers and staff to enhance their knowledge and skills in tobacco cessation and share gender-affirming resources and navigation, which are crucial towards improving the overall effectiveness of tobacco cessation services for LGBTQ+ populations. Citation Format: Victor Cristanto, Alexandra Caro, Reener Balingit, Zul Surani. Building capacity in health clinics and community organizations serving LGBTQ+ communities on tobacco prevention [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C007.

Abstract A090: Comparing baseline knowledge and attitudes towards tobacco use and cessation among providers at substance use treatment centers and medical healthcare centers in rural and/or medically underserved areas of Texas

Abstract Introduction: Tobacco use intervention in healthcare settings is consistent with best practice guidelines and has been shown to facilitate tobacco cessation. Such intervention is particularly important in rural and medically underserved areas (MUAs), where tobacco use is elevated, as is cancer mortality. Providers’ knowledge and attitudes about the danger of tobacco use and their role in mitigating the same may play a role in whether their patients receive guideline-compliant care. This study investigates knowledge and attitudes toward tobacco use and cessation care delivery among providers at substance use treatment centers (SUTCs) and medical healthcare centers (MHCs; e.g., Federally Qualified Health Centers) in rural and/or MUAs of Texas to identify modifiable barriers to effective tobacco cessation treatment. Methods: Providers from healthcare centers (12 SUTCs, 9 MHCs) participating in a tobacco-free workplace program responded to a baseline solicitation assessing, among other things, their interest in receiving tobacco cessation care training and resources. In total, 347 providers from SUTCs (n=174) and MHCs (n=173) serving 49.6% of Texas’ counties responded to face-valid items assessing their knowledge and attitudes about tobacco use and provision of tobacco cessation care. Generalized or linear mixed models were used to analyze differences between SUTCs and MHCs. Results: More SUTC than MHC providers accurately identified that adults with mental health and/or non-nicotine substance misuse disorders are 2x more likely to smoke cigarettes than the general population (69% vs. 57%, p<0.008) and that quitting smoking can improve associated mental health symptomatology/substance misuse (61% vs. 54%, p<0.05), but also that patients’ tobacco product use is a personal decision that does not concern the direct service provider (30% vs. 19%, p<0.03). Conversely, more MHC than SUTC providers agreed that smoking cessation counseling is an important part of their job (66% vs. 41%, p<0.001), that their patients who smoke want to quit (38% vs. 21%, p<0.002), that providers should advise patients to quit even if it is not the reason for the visit (65% vs. 43%, p<0.001), that counseling by a provider motivates tobacco product users to quit (68% vs. 50%, p<0.005), and that providers should make appointments to specifically help patients quit tobacco product use (59% vs. 39%, p<0.003). Overall, only 48.4% of providers felt somewhat or completely prepared to help patients quit (56% MHC vs. 41% SUTCs, p<0.03). Conclusion: Addressing tobacco use in rural and/or MUAs of Texas where patients receive healthcare is critical to cancer prevention and achieving health equity. Responding SUTC and MHC providers evinced a need for training to enhance their understanding of tobacco use and to elevate the importance of cessation care provision. This is particularly the case in SUTCs, where providers primarily treat addiction. Findings will inform workplace interventions and their adaptation for use in each setting to facilitate guideline-compliant care provision. Citation Format: Sriya N. Kakarla, Brian J. Carter, Ammar D. Siddiqi, Maggie Britton, Tzuan A. Chen, Isabel Martinez Leal, Teresa Williams, Kathleen Casey, Hector Sanchez, Lorraine R. Reitzel. Comparing baseline knowledge and attitudes towards tobacco use and cessation among providers at substance use treatment centers and medical healthcare centers in rural and/or medically underserved areas of Texas [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A090.

Abstract A093: Assessing cigarette smoking intensity among California adults and the need for tailored interventions to reduce health disparities

Abstract Background: Smoking causes about 20% of all cancers and about 30% of all cancer deaths in the U.S (ACS, 2024). Smoking increases the risk for cancers of the mouth, larynx, pharynx, esophagus, kidney, cervix, breast, liver, bladder, pancreas, stomach, colon, and acute myeloid leukemia and there is no safe form of tobacco smoke (CDC, 2023; ACS, 2024). This study aims to inform public health strategies that can mitigate smoking related disparities and improve health outcomes for marginalized populations. Methods: This study assessed the prevalence of cigarette smoking by demographic characteristics among California adults. We used secondary data from the 2019 California Health Interview Survey (CHIS) that was collected through a random-digit dial telephone survey. Adults ages 18+ were interviewed. We utilized secondary data comprised of 22,160 participants. We conducted interactions between gender and race/ethnicity, and one's smoking status. Multinomial logistic regression test was conducted to predict the probability of participants' level. This study was approved by the researchers Institutional Review Board. Results: Majority or participants were non-smokers (93.1%), mostly females (51.2%,). Many had a bachelor’s degree (23.9%) or some college, vocational training, or an associate degree (22.8%). Many participants (59.8%) were married/living with a partner, and (25.7%) were single. Most participants spoke English (55.4%) and the largest race/ethnic groups were White (40.2%) followed by Latinos (21.8%). Age distribution was as follows: 18–29 (22.9%), 30–39 (17.6%), and 40–49-year-olds (16.2%). For low-intensity smokers , in terms of race/ethnicity, Latino participants were less likely to be low-intensity smokers relative to non-smokers in comparison to White participants (RRR = .411, p = .043). For moderate-intensity smokers , education was statistically significant, with participants holding a graduate degree being significantly less likely to be moderate-intensity smokers relative to non-smokers in comparison to participants who had a HS degree (RRR = .068, p = .025). For high-intensity smokers , single participants were more likely to be high-intensity smokers compared to those married or living with a partner (RRR = 2.72, p = .011). In terms of age, only participants that were 30 to 39 years old were statistically significant, with this group more likely to be high-intensity smokers relative to non-smokers in comparison to participants who were 20 to 29 years of age (RRR = 3.40, p = .031). Conclusion: Findings suggest that one’s demographics characteristics does play a role in smoking consumption rates. Addressing disparities in smoking and cancer requires a multifaceted approach that includes policy changes, targeted interventions, and improved access to healthcare and smoking cessation resources. Hence, public health efforts should create evidence-based interventions and consider the social, economic, and cultural contexts of target populations to reduce disparities in smoking and cancer. Citation Format: Salome Kapella Mshigeni, Anhthu Nguyen, Julian C Sacdalan, Elizabeth Pinder-McSwain, Felipe Aperador Tarazona. Assessing cigarette smoking intensity among California adults and the need for tailored interventions to reduce health disparities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A093.

Abstract B042: Gender-affirming cessation support for LGBTQ+ tobacco users: Establishing TheQuitAlliance

Abstract Background. The LGBTQ+ community faces various stressors, including stigma, discrimination, and harassment, which are linked to their sexual orientation or gender identity. Additionally, they are targeted by tobacco companies through marketing, which increases tobacco use and other health problems. LGB adults use commercial tobacco products at a higher rate than the general population (25.1% versus 18.8%), and tobacco use is even higher among transgender adults according to the CDC. Without peer support, counseling, nicotine replacement therapy (NRT), and community resources to address barriers to quitting, tobacco users are less likely to succeed in quitting. Research has shown that gender-affirming tobacco cessation interventions can be highly effective in helping LGBTQ+ individuals quit tobacco; however, little is known about its effectiveness in Latinx communities and other groups with intersectional identities. Methods. To improve access to culturally tailored and gender-affirming cessation resources that acknowledge the unique experiences and stressors faced by our community, Cedars-Sinai Cancer COE developed TheQuitAlliance, a LGBTQ+ focused tobacco cessation program. This multi-level approach involved web-based resources, information and presentation to the community. A series of gender affirming support groups facilitated by trained Spanish speaking tobacco cessation specialists who are members of the LGBTQ+ community was offered to tobacco users. The first steps involved improving their knowledge on how tobacco affects specific populations, such as transgender, non-binary, gender non-conforming individuals, people living with HIV, youth, and the types of nicotine replacement therapies available. RESULTS: In 2023, our partners The Wall Las Memorias and Latino Equality Alliance implemented a screening tool using the Ask, Advise, and Refer model, expanded outreach efforts, and successfully identified N=242 LGBTQ+ tobacco users who were referred to our virtual gender affirming support group. Among current smokers who participated in a series of three support groups, 85% (17 of 20) indicated positive attitudes towards the importance of changing their smoking behaviors, readiness to change, and having control over their ability to make positive change right now, while 90% are committed to taking steps towards change right now (18 of 20). In 2024, The Wall Las Memorias reached 500 LGBTQ+ community members and linked 70 tobacco users to cessation support groups. Conclusion. Our survey indicated that participating in a gender affirming cessation intervention can increase self-efficacy to take steps towards quitting tobacco. Through safe spaces created by The Quit Alliance, we found that LGBTQ+ tobacco users are also able to make connections with others to be supported in their journey to becoming tobacco free. Citation Format: Victor Crisanto, Alexandra Caro, Reener Balingit, Zul Surani. Gender-affirming cessation support for LGBTQ+ tobacco users: Establishing TheQuitAlliance [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B042.

Adolescents’ Experiences and Perceptions of E-Cigarettes and Nicotine Addiction

Background: E-cigarettes are the most-used tobacco product among US adolescents and are associated with nicotine addiction. This qualitative investigation aimed to understand adolescents’ experiences and perceptions with nicotine addiction, and related influences of addiction, to inform product regulation, health communication, and cessation resource development. Methods: Between May 2020 and December 2021, in-depth, semi-structured individual interviews were conducted with 47 California (United States) adolescents ages 13–17 who reported recent tobacco use (primarily e-cigarette use). The topic of addiction both arose organically and followed specific interviewer questions. Researchers used thematic analysis techniques to identify unifying themes related to addiction. Results: Adolescents described e-cigarette addiction in ways that reflected a loss of control over their routines and activities and as physical symptoms, including reward and withdrawal. While some viewed addiction risk as a reason not to vape, others perceived it possible to use e-cigarettes and avoid or manage addiction. Specific characteristics of e-cigarette devices, particularly disposable nicotine-salt products, including flavors, “cool” designs, concealable size and odor, low price, and ease-of-use, were seen as enhancing addiction risk. Quit attempts were difficult and usually unsupported by adults or formal cessation aids. Conclusions: For many adolescents, addiction is a major component of their experience with e-cigarettes, often in ways that disrupt their routines and reduce their quality of life. Tobacco control or regulation could target e-cigarette product characteristics to decrease potential for addiction among adolescents. Needed are youth-targeted public communication about nicotine addiction and adolescent-tailored, evidence-based cessation support.

Implementation and Evaluation of a Multi-level, Place-Based Tobacco Prevention and Control Program at a Minority-Serving Institution in Texas.

Multi-level, place-based interventions have proven effective at promoting a range of health behaviors, including tobacco control and discouraging the uptake of tobacco products. This paper describes the implementation and impact of a 3-year, multi-level tobacco prevention and control program at a community-college minority-serving institution (MSI) on the Texas Gulf Coast within the context of a broader multi-sector, cross-functional health coalition. The intervention studied included a tobacco-free policy, a large-scale communication campaign highlighting parts of the intervention and prevention and cessation resources. The intervention was bolstered by the support of a community-led Steering Committee and tobacco control experts. Results from the first 3years of implementation show that tobacco-free policies were largely supported by community members, awareness of the policy increased over time, and tobacco prevention and cessation resources were successfully embedded into campus norms. This multi-component approach shows how a community college was able to effectively reach students and staff on their campus to increase awareness of both the campus tobacco-free policy and the availability of tobacco prevention and cessation resources. Additionally, it also offers lessons for future tobacco prevention and control work in higher education.

Smartphone-Based Smoking Cessation Intervention (OKquit) for Oklahoma Tobacco Helpline Users: Protocol for a Randomized Controlled Trial.

Tobacco quitlines provide effective resources (eg, nicotine replacement therapy, smoking cessation counseling, and text and web-based support) for those who want to quit smoking in the United States. However, quitlines reach approximately only 1%-3% of people who smoke each year. Novel, smartphone-based, and low-burden interventions that offer 24/7 access to smoking cessation resources that are tailored to current readiness to quit may increase appeal, reach, and effectiveness of smoking cessation interventions. This study will examine the efficacy of OKquit, a low-burden smartphone-based app for smoking cessation. Approximately 500 people who smoke cigarettes and access the Oklahoma Tobacco Helpline (OTH) will be randomized to receive standard OTH care (SC) or SC plus the novel OKquit smartphone app for smoking cessation (OKquit). All participants will use a smartphone app to complete study surveys (ie, baseline, 27 weekly surveys, brief daily check-ins, and 27-week follow-up). Upon completion of daily check-ins and weekly surveys, participants will receive either trivia type messages (SC) or messages that are tailored to current readiness to quit smoking and currently experienced lapse triggers (OKquit). In addition, those assigned to receive the OKquit app will have access to on-demand smoking cessation content (eg, quit tips, smoking cessation medication tips). It is hypothesized that participants assigned to OKquit will be more likely to achieve biochemically verified 7-day point prevalence abstinence than those assigned to SC at 27 weeks post enrollment. In addition, participants who use more OTH resources (eg, more cessation coaching sessions completed) or more OKquit resources (eg, access more quit tips) will have greater biochemically verified smoking cessation rates. Data collection began in September 2022 and final follow-ups are expected to be completed by May 2025. Data from this randomized controlled trial will determine whether the OKquit smartphone app combined with OTH care will increase smoking cessation rates over standard OTH care alone. If successful, OKquit could provide tailored intervention content at a fraction of the cost of traditional interventions. Furthermore, this type of low-burden intervention may offer a way to reach underserved populations of adults who smoke and want to quit. ClinicalTrials.gov NCT05539209; https://clinicaltrials.gov/study/NCT05539209. DERR1-10.2196/56827.

Smoking Cessation Tool Utilization Among Individuals with and Without Cancer Across Smoking Status

Background: There are many tools to assist with cigarette smoking cessation (e.g., counseling, pharmacotherapy). However, tool use among cancer patients is understudied despite the consequences of continued smoking after a cancer diagnosis. Objectives: Study aims included describing and comparing cessation tool use among individuals with and without cancer who were currently smoking and who quit to determine if there are different preferences among those with cancer. Methods: Participants (N = 203) completed an online survey about demographics, cigarette use, and cessation tool use. Results: Eighty-nine participants reported being diagnosed with cancer (45 quit after diagnosis, 44 currently smoking) and 114 reported not having cancer (57 quit, 57 currently smoking). Individuals with cancer who were smoking used more evidence-based resources than those with cancer who quit (B = 1.86, SE = 0.50, p < 0.0001). Individuals with cancer who were smoking used more total cessation resources than participants without cancer who were smoking (B = 2.00, SE = 0.58, p = 0.001), but there was no difference in use of evidence-based resources between these two groups (p > 0.05). Lastly, individuals with cancer who quit also used more total cessation tools (B = 1.23, SE = 0.41, p = 0.003) and evidence-based tools (B = 1.03, SE = 0.36, p = 0.005) than those without cancer who quit. Conclusions: Individuals with cancer may be using more resources before successfully quitting. Cancer patients may need additional help to quit smoking, and further research is needed to better understand unique barriers that preclude quitting among this vulnerable population.

Come for the Tobacco, Stay for the Flavor: Flavored Cigarillo-Use Trajectories Among Young Adult Sexual Gender Minority Women.

The purpose of this research was to identify how young adult sexual gender minority (SGM) women who use cigarillos may respond to cigar flavor restrictions. Young adults aged 21-28 years in the United States who currently use cigarillos were recruited between October 2020 and April 2021 to participate in an online survey. Due to high prevalence of cigarillo use among individuals who identify as sexual and/or gender minority (SGM) women, their (n = 192) flavored tobacco-use behaviors and anticipated responses to cigarillo flavor restrictions were compared to cisgender heterosexual (CisHet) women (n = 110). Logistic regression was used to model cigarillo cessation and product-switching behaviors (flavored and unflavored). SGM women were significantly less likely to report the use of flavor at the initiation of cigarillo use (61.7% vs. 86.1%) but were no different in current flavor use compared to CisHet women, with more than 80% of all women using any flavor. SGM women were 2.36 times as likely to say they would discontinue using cigarillos if flavors were unavailable. Among those who would continue using cigarillos, SGM women were 4.53 times as likely to endorse switching to an unflavored tobacco product but had the same likelihood of saying they would switch to flavored product compared to CisHet women. Flavor restriction policies may not reduce the initiation of cigarillos among SGM women and may elicit differential cigarillo use and tobacco product substitution by SGM identity. Flavor restriction policies should be coupled with targeted cessation resources to address potential remaining disparities. SGM US women have a unique cigarillo-use trajectory. These women are more likely to initiate cigarillos without flavor and then later integrate it into their behavior. National cigar flavor restrictions are expected to have a greater impact decreasing cigarillo initiation among CisHet women and decreasing current cigarillo use among SGM women. However, for those who would continue using unflavored cigarillos, SGM women may remain at risk for nicotine dependence due to increased product substitution. SGM women should be prioritized for cessation resources to reduce tobacco-use disparities leading up to and following the implementation of cigar flavor restrictions.

Boosting self-efficacy and improving practices for smoking prevention and cessation among South American cancer care providers with a web-based algorithm

BackgroundDigital technologies have positively impacted the availability and usability of clinical algorithms through the advancement in mobile health. Therefore, this study aimed to determine if a web-based algorithm designed to support the decision-making process of cancer care providers (CCPs) differentially impacted their self-reported self-efficacy and practices for providing smoking prevention and cessation services in Peru and Colombia.MethodsA simple decision-making tree algorithm was built in REDCap using information from an extensive review of the currently available smoking prevention and cessation resources. We employed a pre-post study design with a mixed-methods approach among 53 CCPs in Peru and Colombia for pilot-testing the web-based algorithm during a 3-month period. Wilcoxon signed-rank test was used to compare the CCPs’ self-efficacy and practices before and after using the web-based algorithm. The usability of the web-based algorithm was quantitatively measured with the system usability scale (SUS), as well as qualitatively through the analysis of four focus groups conducted among the participating CCPs.ResultsThe pre-post assessments indicated that the CCPs significantly improved their self-efficacy and practices toward smoking prevention and cessation services after using the web-based algorithm. The overall average SUS score obtained among study participants was 82.9 (± 9.33) [Peru 81.5; Colombia 84.1]. After completing the qualitative analysis of the focus groups transcripts, four themes emerged: limited resources currently available for smoking prevention and cessation in oncology settings, merits of the web-based algorithm, challenges with the web-based algorithm, and suggestions for improving this web-based decision-making tool.ConclusionThe web-based algorithm showed high usability and was well-received by the CCPs in Colombia and Peru, promoting a preliminary improvement in their smoking prevention and cessation self-efficacy and practices.

Adapting a Financial Incentives Intervention for Smoking Cessation With Alaska Native Families: Phase 1 Qualitative Research to Inform the Aniqsaaq (To Breathe) Study.

Alaska Native and American Indian (ANAI) peoples in Alaska currently experience a disproportionate burden of morbidity and mortality from tobacco cigarette use. Financial incentives for smoking cessation are evidence-based, but a family-level incentive structure has not been evaluated. We used a community-based participatory research and qualitative approach to culturally adapt a smoking cessation intervention with ANAI families. We conducted individual, semistructured telephone interviews with 12 ANAI adults who smoke, 12 adult family members, and 13 Alaska Tribal Health System stakeholders statewide between November 2022 and March 2023. Through content analysis, we explored intervention receptivity, incentive preferences, culturally aligned recruitment and intervention messaging, and future implementation needs. Participants were receptive to the intervention. Involving a family member was viewed as novel and aligned with ANAI cultural values of commitment to community and familial interdependence. Major themes included choosing a family member who is supportive and understanding, keeping materials positive and encouraging, and offering cash and noncash incentives for family members to choose (eg, fuel, groceries, activities). Participants indicated that messaging should emphasize family collaboration and that cessation resources and support tips should be provided. Stakeholders also reinforced that program materials should encourage the use of other existing evidence-based cessation therapies (eg, nicotine replacement, counseling). Adaptations, grounded in ANAI cultural strengths, were made to the intervention and recruitment materials based on participant feedback. Next steps include a beta-test for feasibility and a randomized controlled trial for efficacy. This is the first study to design and adapt a financial incentives intervention promoting smoking cessation among ANAI peoples and the first to involve the family system. Feedback from this formative work was used to develop a meaningful family-level incentive structure with ANAI people who smoke and family members and ensure intervention messaging is supportive and culturally aligned. The results provide qualitative knowledge that can inform future family-based interventions with ANAI communities, including our planned randomized controlled trial of the intervention.

Tobacco use disparities in rural communities

This exploratory study described facilitators and barriers to reducing tobacco disparities in 2 small rural communities and identified ways to reduce tobacco use. This was a descriptive design using qualitative methods. We created a resource database for 2 rural Kentucky counties, using a Culture of Health Framework. We recruited 16 organizational stakeholders serving low-socioeconomic populations and conducted focus groups and key informant interviews. We also completed key informant interviews with 7 tobacco users. Lastly, we tailored Community Action Plans for each county based on the data and then solicited feedback from the key stakeholders. The 2 counties were similar in population size, but County A had fewer resources than County B, and the stakeholders expressed differences toward tobacco use and quitting. County A stakeholders talked most about the protobacco culture and that tobacco users accept the risks of smoking outweighing the benefits of quitting; they also expressed concerns about youth use and the influences of family, society, and industry. County B stakeholders described ambivalence about the health effects of use and quitting. County A's Action Plan identified an opportunity to build Community Health Worker-delivered tobacco treatment into a new school-based health center. County B's Action Plan focused on reaching tobacco users by providing incentives for participation and tailoring messages to different audiences. Tobacco control resources and stakeholder perspectives vary in small rural communities, implying a need for tailored approaches. Tobacco users in rural areas are a critical population to target with cessation resources.

Tobacco Quitline utilization compared with cigarette smoking prevalence in Virginia across rurality and Appalachian Status, 2011–2019

IntroductionWhile cigarette smoking rates have declined, rural and Appalachian populations in the United States have not seen similar decreases. Quitline programs are promising strategies in reducing disparities in these areas, but research on their usage is limited. MethodsWe employed Small Area Estimation on the Virginia Behavioral Risk Factor Surveillance System (2011–2019) to estimate county-level smoking prevalence and utilized The Quit Now Virginia Quitline data (2011–2019) to estimate Quitline users. We analyzed differences in Quitline utilization by rurality and Appalachian status using statistical t-tests. Stepwise regression assessed the absolute estimate of county features, including poverty rate, tobacco retailer density, physician availability, coal mining industry, and tobacco agriculture, on Quitline usage. ResultsWhile the average smoking rate overall was 15.3 %, only 7.4 % of smokers accessed Quitline services from 2011 to 2019. Appalachian regions exhibited higher smoking rates (20.9 %) and lower quitline usage (4.8 %) compared to non-Appalachian areas (14 % smoking prevalence, 8 % quitline usage). Rural regions had higher smoking prevalence (19.0 %) than urban areas (12.9 %), but no significant difference in Quitline utilization (7.6 % vs. 7.2 %, p = 0.7). Stepwise regression revealed counties with more tobacco agriculture had 3.2 % (p = 0.04) lower Quitline utilization. Also, more physicians availability in the county was associated with 3.9 % higher Quitline usage (p = 0.03) and Appalachian counties exhibited a 3.6 % lower Quitline usage rate compared to non-Appalachian counties. ConclusionA significant gap exists between cigarette smoking prevalence and Quitline utilization, particularly in underserved rural and Appalachian areas, despite no clear barriers to accessing this remote cessation resource. ImplicationThe study underscores persistent disparities in smoking rates, with rural and Appalachian regions in the United States facing higher smoking prevalence and limited utilization of Quitline services. Despite no clear barriers to access, the gap between smoking prevalence and Quitline usage remains significant, particularly in underserved areas. Tailoring interventions to address regional disparities and factors like tobacco agriculture and physician availability is essential to reduce smoking rates and improve Quitline utilization in these communities.