Self-reported Smoking Research Articles

Evaluating an Association Between Prenatal Smoking Behavior and Exclusive Breastfeeding: A Population-Based Study

Background: Prenatal smoking is consistently associated with adverse breastfeeding outcomes. We aimed to evaluate the association of smoking cessation or continuation during pregnancy with exclusive breastfeeding in a representative sample of the general Canadian population. Methods: We used the pooled sample of 9860 females with pregnancy experience of last under-five child from the Canadian Community Health Surveys 2015-2018 public use microdata file. We categorized self-reported prenatal smoking status as continuing, quitting, or no smoking. We evaluated the association between exclusive breastfeeding for 6 months or more with prenatal smoking status using multivariable logistic regression, adjusted for socio-demographic variables. Results: With the pooled prevalence of 33.2% (95% CI 31.7, 34.8), 34.4% (95% CI 32.8, 36.1) of non-smokers, 25.7% (95% CI 20.2, 32.2) of those who quit and 15.7% (95% CI 10.8, 22.2) of those who continued smoking reported exclusive breastfeeding for 6 months or more. Continuing smoking had lower odds of exclusive breastfeeding (aOR .47; 95% CI 0.30,0.75) but quitting smoking had no difference (aOR .78;95% CI 0.56,1.08) when compared to non-smokers. Conclusion: Continuing smoking during pregnancy was associated with lower rates of exclusive breastfeeding of infants for 6 months or more. Smoking cessation interventions during prenatal visits may improve exclusive breastfeeding rates.

Cost-Effectiveness of a Comprehensive Primary Care Smoking Treatment Program

Smoking is the leading preventable cause of death and disease in the U.S. This study evaluates the cost-effectiveness from a healthcare system perspective of a comprehensive primary care intervention to reduce smoking rates. This pragmatic trial implemented electronic health record prompts during primary care visits and employed certified tobacco cessation specialists to offer proactive outreach and smoking cessation treatment to patients who smoke. The data, analyzed in 2022, included 10,683 patients in the smoking registry from 2017 to 2020. Pre-post analyses compared intervention costs to treatment engagement, successful self-reported smoking cessation, and acute health care utilization (urgent care, emergency department visits, and inpatient hospitalization). Cost per quality-adjusted life year was determined by applying conversion factors obtained from the tobacco research literature to the cost per patient who quit smoking. Tobacco cessation outreach, medication, and counseling costs increased from $2.64 to $6.44 per patient per month, for a total post-implementation intervention cost of $500,216. Smoking cessation rates increased from 1.3% pre-implementation to 8.7% post-implementation, for an incremental effectiveness of 7.4%. The incremental cost-effectiveness ratio was $628 (95% CI: $568, $695) per person who quit smoking, and $905 (95% CI: $822, $1,001) per quality-adjusted life year gained. Acute health care costs decreased by an average of $42 (95% CI: -$59, $145) per patient per month for patients in the smoking registry. Implementation of a comprehensive and proactive smoking cessation outreach and treatment program for adult primary care patients who smoke meets typical cost-effectiveness thresholds for healthcare.

Lifestyle Behaviors and Health-Related Quality of Life in Cancer Survivors: A Latent Class Analysis.

Healthy lifestyle behaviors can improve health-related quality of life (HRQOL) in cancer survivors; but the combination of behaviors most important for HRQOL is not known. This study investigated the patterns of lifestyle behaviors among cancer survivors and differences in HRQOL between behavioral classes. Cancer survivors (n = 2,463) were invited to participate in a cross-sectional survey. Participants (N = 591) were predominately female (63%) and non-Hispanic White (90%). Survey items included self-reported physical activity, diet, smoking, sleep, HRQOL, and demographics. Behavioral classes were estimated by latent class analysis. Differences between classes were assessed by latent class regression. Compared with the "healthy lifestyles" class (higher probabilities of meeting aerobic/strength-based activity guidelines, high fruit/vegetable intake, and no sleep problems; 11% of sample), the "sleep and diet problems with inconsistent physical activity" class (higher probabilities of not meeting strength-based guidelines, low fruit/vegetable intake, some sleep problems; marginally higher probability of meeting aerobic guidelines; 41%) had poorer general and physical HRQOL. The "poor physical activity and diet" class (higher probabilities of not meeting aerobic/strength-based guidelines, low fruit/vegetable intake, and some sleep problems; 48%) had poorer general, physical, and mental HRQOL. Few participants exhibited healthy lifestyle patterns associated with HRQOL. The findings provide opportunities to develop differentiated multiple behavior-change interventions, targeted to two common patterns of behavior. A large subgroup of cancer survivors was susceptible to suboptimal physical activity and diet, warranting interventions exclusively targeting these behaviors. Another subgroup was susceptible to suboptimal physical activity, diet, and sleep, indicating interventions for this group should include strategies targeting these three behaviors.

Effects of a text messaging smoking cessation intervention amongst online help-seekers and primary health care visitors: findings from a randomised controlled trial

BackgroundSmoking continues to be a leading risk factor for several diseases globally. We hypothesised that an intervention delivered via text messages could help individuals who were looking to quit.MethodsA two-arm, parallel-groups, randomised controlled trial was employed. Both groups received treatment as usual, with the intervention group also receiving a 12-week text messaging intervention. Participants were adult, weekly or more frequent smokers, recruited online and in primary health care centres. Research personnel were blinded, while participants were not. Primary outcomes were prolonged abstinence and point prevalence of abstinence, 3 and 6 months post-randomisation. All randomised participants were included in analyses.ResultsBetween 18 September 2020 and 16 June 2022, we randomised 1012 participants (intervention: 505, control: 507). Outcome data was available for 67% (n = 682) of participants at 3 months and 64% (n = 643) at 6 months. At 3 months, the odds ratio (OR) of prolonged abstinence was 2.15 (95% compatibility interval [CoI] = 1.51; 3.06, probability of effect [POE] > 99.9%, p < 0.0001), and for point prevalence of abstinence, it was 1.70 (95% CoI = 1.18; 2.44, POE = 99.8%, p = 0.0034) in favour of the text messaging intervention. At 6 months, the OR of prolonged abstinence was 2.38 (95% CoI = 1.62; 3.57, POE > 99.9%, p = < 0.0001), and for point prevalence, it was 1.49 (95% CoI = 1.03; 2.14, POE = 98.3%, p = 0.0349) in favour of the text messaging intervention. Analyses with imputed data were not markedly different.ConclusionsAmongst general population help-seekers—who on average had smoked for 25 years—access to a 12-week text messaging intervention produced higher rates of self-reported smoking abstinence in comparison to treatment as usual only. The intervention could be part of the societal response to the burden which smoking causes; however, findings are limited by risk of bias due to attrition, self-reported outcomes, and lack of blinding.Trial registrationThe trial was preregistered in the ISRCTN registry on 27/07/2020 (ISRCTN13455271).

Evaluating the impact of varying expired carbon monoxide thresholds on smoking relapse identification: insights from the E3 trial on e-cigarette efficacy for smoking cessation

ObjectivesExpired carbon monoxide (ECO) is often used in smoking cessation trials to biochemically validate self-reported smoking status. The optimal ECO threshold to distinguish individuals who smoke from those who do...

Gene-Environment Analyses Reveal Novel Genetic Candidates with Prenatal Tobacco Exposure in Relation to Risk for Childhood Acute Lymphoblastic Leukemia.

Associations between maternal tobacco exposure during pregnancy and childhood acute lymphoblastic leukemia (ALL) have yielded mixed results. This may be due to biases in self-reported smoking or other differences in individual-level risk factors. We utilized a biological marker of maternal tobacco exposure to evaluate the association between maternal tobacco exposure during pregnancy, genetics, and subsequent childhood ALL risk in two large population-based studies of childhood ALL in California. Maternal exposure to tobacco smoke was assessed with a validated methylation marker (cg05575921) of the aryl hydrocarbon receptor repressor (AHRR) gene in newborn dried blood spots. We adjusted for sex, birthweight, gestational age, mode of delivery, year of birth, AHRR quantitative trait locus (mQTL) rs77111113, and a polygenetic risk score for childhood ALL. We additionally adjusted for principal components in a gene-environment interaction testing method that incorporates gene-only and environment-only effects along with interactions. AHRR hypomethylation overall was not associated with childhood ALL. In gene-environment interaction testing, several genetic variants displayed significant interaction with AHRR hypomethylation and childhood ALL. Our results suggest that novel candidates in PTPRK and DPP6 may play a role in tobacco-related leukemogenesis. Further research is necessary to better understand the effects of tobacco and these variants on childhood ALL risk. Despite the lack of an overall "main effect," tobacco exposure during pregnancy affects childhood ALL risk depending on specific genetic variants.

The Effect of the COVID-19 Pandemic on Self-Reported Health Status and Smoking and Drinking Habits in the General Urban Population.

The coronavirus disease 2019 pandemic created a significant crisis in global health. The aim of the study was to compare the impact of the COVID-19 pandemic on self-rated health status and smoking and alcohol habits. The Bialystok PLUS cohort study was conducted in 2018-2022. A total of 1222 randomly selected city residents were examined and divided into two groups: before and during the COVID-19 pandemic. The participants' lifestyle habits and medical history were collected from self-reported questionnaires. The Alcohol Use Disorders Identification Test (AUDIT) and the Fagerström Test for Nicotine Dependence (FTND) were used to assess the degree of alcohol and nicotine dependence. The survey revealed a reduced frequency of reported allergies vs. an increased frequency of reported sinusitis and asthma; increased incidence of declared hypercholesterolemia and visual impairment; a reduced number of cigarettes smoked per day, lower FTND score, and a greater desire to quit smoking in the next six months; and an increase in hs-CRP and FeNO levels in the population during the pandemic compared to the pre-pandemic population. The COVID-19 pandemic had a measurable impact on the general population's prevalence of certain medical conditions and lifestyle habits. Further research should continue to examine the long-term health implications of the pandemic.

Selection homophily and peer influence for adolescents’ smoking and vaping norms and outcomes in high and middle-income settings

The MECHANISMS study investigates how social norms for adolescent smoking and vaping are transmitted through school friendship networks, and is the first study to use behavioral economics methodology to assess smoking-related social norms. Here, we investigate the effects of selection homophily (the tendency to form friendships with similar peers) and peer influence (a social process whereby an individual’s behavior or attitudes are affected by peers acting as reference points for the individual) on experimentally measured smoking and vaping norms, and other smoking outcomes, in adolescents from high and middle-income settings. Full school year groups in six secondary schools in Northern Ireland (United Kingdom) and six secondary schools in Bogotá (Colombia) participated (n = 1344/1444, participation = 93.1%, target age 12–13 years). Over one semester, pupils received one previously tested school-based smoking prevention program (ASSIST or Dead Cool). Outcomes included experimentally measured smoking/vaping norms, self-report and objectively measured smoking behavior, and self-report smoking norms, intentions, susceptibility, attitudes, and psycho-social antecedents. We investigated selection homophily and peer influence using regressions and SIENA modeling. Regression results demonstrate lagged and contemporaneous selection homophily (odds ratios [ORs] = 0.87–1.26, p ≤ 0.01), and peer influence effects for various outcomes from average responses of friends, school classes, or school year groups (standardized coefficients [βs] = 0.07–0.55, ORs = 1.14–1.31, p ≤ 0.01). SIENA models showed that comparable proportions of smoking/vaping-based similarity between friends were due to selection homophily (32.8%) and peer influence (39.2%). A higher percentage of similarity between friends was due to selection homophily and/or peer influence for ASSIST schools compared to Dead Cool. Selection homophily was also more important in Bogotá, whilst peer influence was stronger in Northern Ireland. These findings support using social norms strategies in adolescent smoking prevention interventions. Future research should consider selection homophily and social influence jointly, and examine whether these findings translate to other high and low-middle-income settings with varying cultures and norms.

Cigarette Smoking Abstinence Among Pregnant Individuals Using E-Cigarettes or Nicotine Replacement Therapy

Smoking cigarettes during pregnancy can impair maternal and child health, and pregnant individuals have increasingly used electronic cigarettes (e-cigarettes) for various reasons, including quitting smoking. To assess smoking abstinence rates among pregnant individuals who used e-cigarettes compared with those who used nicotine replacement therapy (NRT). This cohort study is a secondary data analysis of phase 8 of the US Pregnancy Risk Assessment Monitoring System, conducted between 2016 and 2020. Eligible participants included pregnant individuals who smoked combustible cigarettes within the 3 months before pregnancy and either used e-cigarettes or NRT during pregnancy. Data analysis was conducted from March 2022 to April 2023. Combustible cigarette use within 3 months before pregnancy and use of either e-cigarettes or NRT during pregnancy. The primary outcome was the individual's self-reported smoking abstinence status during the last 3 months of pregnancy. Weighted percentages were reported and weighted multivariable logistic regression models were used to examine the association of e-cigarette use vs NRT with smoking abstinence. A propensity score was used to control for confounding by sociodemographics, pregnancy characteristics, prepregnancy smoking intensity, depression, behavioral support, and hookah use. The cohort included 1329 pregnant individuals (759 ≥25 years [60.2%]; 766 non-Hispanic White individuals [79.8%]) of whom 781 had an education level of high school or lower (61.4%), and 952 had an annual household income of $48 000 or less (81.5%). Of the 1329 individuals, 890 (unweighted percentage, 67.0%) were existing e-cigarette users, 67 (unweighted percentage, 5.0%) were new e-cigarette users, and 372 (unweighted percentage, 28.0%) were NRT users. Compared with individuals who used NRT during pregnancy, individuals who used e-cigarettes had a higher rate of smoking abstinence in late pregnancy (456 individuals [50.8%] vs 67 individuals [19.4%]; propensity score adjusted odds ratio [OR], 2.47; 95% CI, 1.17-5.20; P = .02). In the secondary analysis stratified by the timing of e-cigarette use initiation, existing users of e-cigarettes who initiated before pregnancy had a higher smoking abstinence rate than NRT users (446 users [53.1%] vs 67 users [19.4%]; adjusted OR, 2.61; 95% CI, 1.23-5.51; P = .01). However, new e-cigarette users who initiated use during pregnancy had a similar smoking abstinence rate in late pregnancy when compared with NRT users (10 users [20.6%] vs 67 users [19.4%]; adjusted OR, 1.13; 95% CI, 0.22-5.87; P = .88). These findings suggest that individuals who used e-cigarettes during pregnancy had a higher smoking abstinence rate in late pregnancy than individuals who used NRT, especially for those who initiated e-cigarette use before pregnancy, indicating that replacement of cigarettes with e-cigarettes during pregnancy may be a viable strategy for harm reduction.

Access to effective smoking cessation medications in patients with medicare, medicaid and private insurance

ObjectivesCompare financial barriers to the most effective smoking cessation medications - varenicline and combination nicotine replacement therapy (CNRT) across major insurance categories and determine whether these financial barriers impact smoking cessation outcomes. Study designLongitudinal retrospective observational cohort study. MethodsPatients seen at Duke Smoking Cessation Program 05/2016 through 07/2021 were studied. Those prescribed varenicline or CNRT were determined to have financial barriers to access if they could not purchase the medication using insurance or their own funds. Outcomes were compared between Medicare, Medicaid, and private insurers. Abstinence was defined as self-reported 7-day smoking abstinence. ResultsPatients with Medicare were 5.08 times more likely to face a financial barrier to highly effective smoking cessation medications compared to patients with private insurance (p<0.00001) and 2.81 times more likely compared to Medicaid (p<0.00001). Patients able to access these highly effective medications achieved a smoking abstinence rate that was 1.58 times higher than those who could not (p = 0.01) ConclusionsFindings suggest Medicare coverage of the most effective smoking cessation medications is considerably worse than Medicaid or private insurance; inability to access these medications may lead to lower rates of smoking abstinence.

BabyBreathe trial: protocol for a randomised controlled trial of a complex intervention to prevent postpartum return to smoking

IntroductionMany people quit smoking during pregnancy, but postpartum smoking relapse is common. Maintaining smoking abstinence achieved during pregnancy is key to improving maternal and child health. There are no evidence-based...

Development of an Electronic Health Record-Based Algorithm for Predicting Lung Cancer Screening Eligibility in the Population-Based Research to Optimize the Screening Process Lung Research Consortium.

Lung cancer screening (LCS) guidelines in the United States recommend LCS for those age 50-80 years with at least 20 pack-years smoking history who currently smoke or quit within the last 15 years. We tested the performance of simple smoking-related criteria derived from electronic health record (EHR) data and developed and tested the performance of a multivariable model in predicting LCS eligibility. Analyses were completed within the Population-based Research to Optimize the Screening Process Lung Consortium (PROSPR-Lung). In our primary validity analyses, the reference standard LCS eligibility was based on self-reported smoking data collected via survey. Within one PROSPR-Lung health system, we used a training data set and penalized multivariable logistic regression using the Least Absolute Shrinkage and Selection Operator to select EHR-based variables into the prediction model including demographics, smoking history, diagnoses, and prescription medications. A separate test data set assessed model performance. We also conducted external validation analysis in a separate health system and reported AUC, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy metrics associated with the Youden Index. There were 14,214 individuals with survey data to assess LCS eligibility in primary analyses. The overall performance for assigning LCS eligibility status as measured by the AUC values at the two health systems was 0.940 and 0.938. At the Youden Index cutoff value, performance metrics were as follows: accuracy, 0.855 and 0.895; sensitivity, 0.886 and 0.920; specificity, 0.896 and 0.850; PPV, 0.357 and 0.444; and NPV, 0.988 and 0.992. Our results suggest that health systems can use an EHR-derived multivariable prediction model to aid in the identification of those who may be eligible for LCS.

Cape York Kidney Care: service description and baseline characteristics of a client-centred multidisciplinary specialist kidney health service in remote Australia

BackgroundChronic Kidney disease (CKD) is over-represented amongst First Nation people with more than triple the rate of CKD in those aged 15 years and over. The impact of colonisation, including harmful experiences of health practices and research, has contributed to these health inequities. Cape York Kidney Care (CYKC) has been created as an unique service which provides specialist care that aims to centre the client within a multidisciplinary team that is integrated within the primary care setting of the remote health clinics in six communities in western Cape York, Australia. This research aims to describe the Cape York Kidney Care service delivery model, and baseline service data, including aggregated client health measures.MethodsThe model of care is described in detail. Review of the first 12 months of service provision has been undertaken with client demographic and clinical profile baseline data collected including kidney health measures. Participants are adults (> 18 years if age) with CKD grades 1–5. This data has been de-identified and aggregated.ResultsCYKC reviewed 204 individuals, with 182 not previously been reviewed by specialist kidney health services. Three quarters of clients identified as Aboriginal. The average age was 55 with a high level of comorbidity, with majority having a history of hypertension and Type 2 diabetes (average Hba1c 8.2%). Just under one third had cardiovascular disease. A large proportion of people had either Grade 2 CKD (32%) or Grade 3 CKD (~ 30%), and over half had severely increased albuminuria (A3), with Type 2 diabetes being the predominant presumed cause of CKD. Most clients did not meet evidence-based targets for diabetes, blood pressure or lipids and half were self-reported smokers. The proportion of clients reviewed represents 6.2% of the adult population in the participating First Nation communities.ConclusionThe CYKC model was able to target those clients at high risk of progression and increase the number of people with chronic kidney disease reviewed by specialist kidney services within community. Baseline data demonstrated a high burden of chronic disease that subsequently will increase risk of CKD progression and cardiovascular disease. People were seen to have more severe disease at younger ages, with a substantial number demonstrating risk factors for rapid progression of kidney disease including poorly controlled Type 2 diabetes and severely increased albuminuria. Further evaluation concerning implementation challenges, consumer and community satisfaction, and health outcomes is required.

Using polygenic risk scores to investigate the evolution of smoking and mental health outcomes in UK biobank participants.

Mendelian randomization studies report a bi-directional relation between cigarette smoking and mental disorders, yet from a clinical standpoint, mental disorders are the focus of treatment. Here, we used an event history framework to understand their evolution in the life course. Our objective was to estimate the relative contribution of genetic predispositions and self-reported smoking status (never, former, and present smoker) to hospitalizations for major depression, bipolar disorder, and schizophrenia. We calculated polygenic risk scores (PRS) for ever smoking, pack-years of smoking as a proportion of adult life, and neuroticism in 337,140 UK Biobank participants of white British ancestry. These PRS and self-reported smoking status were entered as explanatory variables in survival models for hospitalization. The estimated single nucleotide polymorphisms heritabilities (h2 ) were 23%, 5.7%, and 5.7% for pack-years, ever smoking, and neuroticism respectively. PRS pack-years and PRS neuroticism were associated with higher hospitalization risk for mental disorders in all smoking status groups. The hazard for mental health hospitalization was higher in both previous (HR: 1.50, CI: 1.35-1.67) and current (HR: 3.58, 2.97-4.31) compared to never smokers, after adjusting for confounders. Since genetic liabilities for smoking and neuroticism are fixed at conception and smoking initiation generally started before age 20, our results show that preventing smoking in adolescents probably prevents the development of mental disorders.

Racial Differences in Over-the-Counter Non-steroidal Anti-inflammatory Drug Use Among Individuals at Risk of Adverse Cardiovascular Events.

Black Americans are disproportionately affected by adverse cardiovascular events (ACEs). Over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs) confer increased risk for ACEs, yet racial differences in the use of these products remain understudied. This study sought to determine racial differences in OTC NSAID and high-potency powdered NSAID (HPP-NSAID) use. This retrospective analysis examined participants at risk of ACEs (defined as those with self-reported hypertension, diabetes, heart disease, or smoking history ≥ 20years) from the North Carolina Colon Cancer Study, a population-based case-control study. We used multivariable logistic regression models to assess the independent associations of race with any OTC NSAID use, HPP-NSAID use, and regular use of these products. Of the 1286 participants, 585 (45%) reported Black race and 701 (55%) reported non-Black race. Overall, 665 (52%) reported any OTC NSAID use and 204 (16%) reported HPP-NSAID use. Compared to non-Black individuals, Black individuals were more likely to report both any OTC NSAID use (57% versus 48%) and HPP-NSAID use (22% versus 11%). In multivariable analyses, Black (versus non-Black) race was independently associated with higher odds of both NSAID use (OR 1.4, 95% CI (1.1, 1.8)) and HPP-NSAID use (OR 1.8 (1.3, 2.5)). Black individuals at risk of ACEs had higher odds of any OTC NSAID and HPP-NSAID use than non-Black individuals, after controlling for pain and socio-economic status. Further research is necessary to identify potential mechanisms driving this increased use.

Characteristics and Health Service Use of a Longitudinal Cohort of Carers Aged over 45 in Central and Eastern Sydney, Australia

Carers are a large portion of the Australian community. In 2018, 2.65 million Australians identified as carers, and almost one-third (32.6%) of this group were primary carers. There is currently a lack of understanding of the impact of being a carer on a person’s health and wellbeing compared to non-carers. This research was undertaken to understand the health status, health risks, and health outcomes for carers in Central and Eastern Sydney, Australia (CES), who are 45 years of age or over. A record linkage study using data from the 45 and Up Study, Medicare Benefit Scheme claims, hospitalisations, and deaths was undertaken on participants in CES (n = 29,489). Characteristics of carers were described and outcomes over an eight-year period were also calculated. Around 12% of the cohort was carers at a given time, though most transitioned in and out of caring roles over a five-year period. Compared with non-carers, carers in CES had higher rates of self-reported smoking, anxiety, psychological distress, heart disease, and self-rated poor quality of life. Carers had higher rates of general practitioner use than non-carers (Adj. HR (95% CI): 1.21 (1.13, 1.30)). However, hospital admissions and mortality were not significantly different. This study confirms that a small proportion of carers remain in carer roles for many years. Caring often starts suddenly, and people need to quickly adapt to their new role. The finding that carers are well-engaged with GPs suggests they may play an important role in identifying carers who are struggling, and delivering interventions for carers.

Association between vmPFC gray matter volume and smoking initiation in adolescents

Smoking of cigarettes among young adolescents is a pressing public health issue. However, the neural mechanisms underlying smoking initiation and sustenance during adolescence, especially the potential causal interactions between altered brain development and smoking behaviour, remain elusive. Here, using large longitudinal adolescence imaging genetic cohorts, we identify associations between left ventromedial prefrontal cortex (vmPFC) gray matter volume (GMV) and subsequent self-reported smoking initiation, and between right vmPFC GMV and the maintenance of smoking behaviour. Rule-breaking behaviour mediates the association between smaller left vmPFC GMV and smoking behaviour based on longitudinal cross-lagged analysis and Mendelian randomisation. In contrast, smoking behaviour associated longitudinal covariation of right vmPFC GMV and sensation seeking (especially hedonic experience) highlights a potential reward-based mechanism for sustaining addictive behaviour. Taken together, our findings reveal vmPFC GMV as a possible biomarker for the early stages of nicotine addiction, with implications for its prevention and treatment.

Revisiting the Immigrant Health Advantage: Self-Reported Health and Smoking Among Sexual Minority Immigrants.

This study aims to examine how the immigrant health advantage (IHA) may differ by sexual orientation. Using data from the 2015-2019 National Health Interview Survey, we examined general health status (n = 131,635) and smoking behavior (n = 131, 658) for US-born and foreign-born heterosexual and sexual minority adults, as well as how the duration of stay in the U.S. may influence sexual minority immigrants' health. Logistic regression models were adopted to examine the health outcomes of immigration in different immigrant groups divided by sexual orientation. Findings show a weaker immigrant health advantage among sexual minorities than heterosexual persons, which disappears or turns into a disadvantage for several subpopulations (i.e., foreign-born homosexual individuals who stayed for 10-15 or 15 + years in the U.S.). Foreign-born homosexual individuals having stayed in the U.S. for a decade or more have substantially higher odds of reporting poor/fair health and smoking currently than their US-born counterparts. Although immigrants' health advantage overall attenuates over time, sexual minority immigrants' health erodes more with time spent in the U.S. The disparities in immigrants' health advantages suggest a segmented health acculturation (or even marginalization) process and entail higher sexual orientation-based health disparities among immigrants than among US-born individuals, likely reinforcing the preexisting health disparities in the country. The findings call for policies to address the multifaceted barriers to health equity at the intersection of social disadvantages.

Monitoring Cigarette Smoking and Relapse in Young Adults With and Without Remote Biochemical Verification: Randomized Brief Cessation Study.

Technological advancements to study young adult smoking, relapse, and to deliver interventions remotely offer conceptual appeal, but the incorporation of technological enhancement must demonstrate benefit over traditional methods without adversely affecting outcomes. Further, integrating remote biochemical verification of smoking and abstinence may yield value in the confirmation of self-reported smoking, in addition to ecologically valid, real-time assessments. The goal of this study was to evaluate the impact of remote biochemical verification on 24-hour self-reported smoking and biochemical verification agreement, retention, compliance with remote sessions, and abstinence during a brief, 5-week cessation attempt and relapse monitoring phase. Participants (N=39; aged 18-25 years; mean age 21.6, SD 2.1 years; n=22, 56% male; n=29, 74% White) who smoked cigarettes daily engaged in a 5-week cessation and monitoring study (including a 48-hour quit attempt and provision of tobacco treatment in the form of nicotine replacement therapy, brief cessation counseling, and financial incentives for abstinence during the 2-day quit attempt only). Smoking (cigarettes per day) was self-reported through ecological momentary assessment (EMA) procedures, and participants were randomized to either (1) the inclusion of remote biochemical verification (EMA + remote carbon monoxide [rCO]) 2× per day or (2) in-person, weekly CO (wCO). Groups were compared on the following outcomes: (1) agreement in self-reported smoking and breath carbon monoxide (CO) at common study time points, (2) EMA session compliance, (3) retention in study procedures, and (4) abstinence from smoking during the 2-day quit attempt and at the end of the 5-week study. No significant differences were demonstrated between the rCO group and the wCO (weekly in-person study visit) group on agreement between 24-hour self-reported smoking and breath CO (moderate to poor), compliance with remote sessions, or retention, though these outcomes numerically favored the wCO group. Abstinence was numerically higher in the wCO group after the 2-day quit attempt and significantly different at the end of treatment (day 35), favoring the wCO group. Though study results should be interpreted with caution given the small sample size, findings suggest that the inclusion of rCO breath added to EMA compared to EMA with weekly, in-person CO collection in young adults did not yield benefit and may have even adversely affected outcomes. Our results suggest that technological advancements may improve data accuracy through objective measurement but may also introduce barriers and burdens and could result in higher rates of missing data. The inclusion of technology to inform smoking cessation research and intervention delivery among young adults should consider (1) the research question and necessity of biochemical verification and then (2) how to seamlessly incorporate monitoring into personalized and dynamic systems to avoid the added burden and detrimental effects to compliance and honesty in self-report.

Efficacy of a Smoking Cessation Program for Underserved Ethnic Minority Communities: Results of a Smoking Cessation Trial.

Objectives: Using a participatory research approach, this study reports the efficacy of the Communities Engaged and Advocating for a Smoke-free Environment (CEASE)-4 intervention offered by the local peers. Methods: CEASE-4 is a theory-based tobacco-cessation intervention, tailored to the needs of underserved populations. 842 tobacco users self-selected into: a) self-help (n = 472), b) single-session class (n = 163), and c) four-session class (n = 207). While self-help group only received educational materials, curriculum for other arms was built on the social cognitive, motivational interviewing, and trans-theoretical- frameworks. Participants could also receive nicotine replacement therapy (NRT). Outcome was self-reported smoking cessation measured 12weeks after completion of the intervention, validated by exhaled carbon monoxide (CO) test. Results: Quit rate was statistically different across groups, with highest quit rate in four-session and lowest quit rate in self-help arm. Cessation rates at follow up (12weeks after completion of the intervention) were 2.3% in the self-help arm, 6.1% in the single-session arm and 13.0% in the four-session arm. Conclusion: While theory-based smoking cessation services are effective for underserved populations, four-session curriculum might be superior to a single session program.