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Objective: Racial and ethnic disparities in smoking cessation persist. This randomized controlled trial compared the efficacy of group cognitive behavioral therapy (CBT) for cessation among African American/Black, Latino/Hispanic, and White adults. Method: African American/Black (39%), Latino/Hispanic (29%), and White (32%) adults (N = 347) were randomly assigned to eight group sessions of CBT or general health education (GHE), both including nicotine patch therapy. Biochemically confirmed 7-day point prevalence abstinence (7-day ppa) was measured at the end-of-therapy, and at 3-, 6-, and 12-month followups. Generalized linear mixed models and logistic regressions tested abstinence rates by condition, stratified by race and ethnicity, and interaction effects. Results: CBT led to greater abstinence than GHE across 12-months of follow-up (AOR = 1.84, 95% CI [1.59, 2.13]) overall [12-month follow-up: CBT = 54% vs. GHE = 38%] and within racial and ethnic groups [12-months: African American/Black (CBT = 52%, GHE = 29%), Latino/Hispanic (CBT = 57%, GHE = 47%), and White (CBT = 54%, GHE = 41%)]. African American participants were less likely than White participants to quit irrespective of condition, as were persons with lower education and income. Socioeconomic status indicators positively predicted abstinence among racial and ethnic minority participants, but not White participants. Conclusions: Group CBT was efficacious compared with GHE. However, cessation patterns suggested that intensive group interventions were less beneficial over the longer term among lower socioeconomic African American and Latino individuals, compared with White participants. Tobacco interventions should target racial and ethnic and socioeconomic differences, via culturally specific approaches and other means. Public Health Significance Statement When treating individuals who wish to quit smoking, this study demonstrated that cognitive behavioral therapy (CBT) delivered in a group format is efficacious across racial and ethnic groups. An intersectional look within racial and ethnic groups, revealed that CBT worked equally well among White persons irrespective of their socioeconomic status (SES), yet was more effective among higher SES racial and ethnic minority persons. Within group diversity is an important consideration when "gold-standard" interventions are recommended universally. To address cessation disparities particularly among racial and ethnic minority individuals with less privileged socioeconomic status, the implementation of culturally specific approaches may be beneficial. [ABSTRACT FROM AUTHOR]

BackgroundThere is a pressing need to address the unacceptable disparities and underrepresentation of racial and ethnic minority groups, including Hispanics or Latinxs, in smoking cessation trials. ObjectiveGiven the lack of research on recruitment strategies for this population, this study aims to assess effective recruitment methods based on enrollment and cost. MethodsRecruitment and enrollment data were collected from a nationwide randomized controlled trial (RCT) of a Spanish-language smoking cessation intervention (N=1417). The effectiveness of each recruitment strategy was evaluated by computing the cost per participant (CPP), which is the ratio of direct cost over the number enrolled. More effective strategies yielded lower CPPs. Demographic and smoking-related characteristics of participants recruited via the two most effective strategies were also compared (n=1307). ResultsFacebook was the most effective method (CPP=US $74.12), followed by TV advertisements (CPP=US $191.31), whereas public bus interior card advertising was the least effective method (CPP=US $642.50). Participants recruited via Facebook had lower average age (P=.008) and had spent fewer years in the United States (P

Prior research indicates bisexual individuals have higher smoking and vaping rates and heightened vulnerability to negative health outcomes. Thus, we compared adult bisexual (n = 294) and heterosexual (n = 2412) participants enrolled in a smoking cessation trial on baseline smoking and vaping use behaviors, motivations, and expectancies/beliefs as well as follow-up smoking and vaping status. This is a secondary analysis of a large randomized controlled trial testing a smoking cessation intervention for dual users of combustible and electronic cigarettes (e-cigarettes) in the United States. Self-reported 7-day point prevalence smoking and vaping abstinence were collected at 3-, 12-, and 24-month assessments. Bisexual and heterosexual participants did not differ in sociodemographic variables or baseline smoking and vaping history and behavior. We found significant differences among bisexual and heterosexual individuals in smoking and vaping beliefs/expectancies. Specifically, bisexual participants expressed overall greater positive expectancies regarding smoking and vaping, such as smoking and vaping to reduce negative affect and stress. There were no differences in smoking at any follow-up assessment. Only at 3 months were bisexual individuals more likely to be abstinent from vaping and less likely to be dual users than heterosexual individuals. Despite similar smoking and vaping status over time, bisexual individuals reported greater positive expectancies regarding smoking and vaping. Our findings revealed few targets for tailoring cessation interventions to bisexual individuals; thus, it is possible that there may be greater utility in targeting the disparities in prevalence (i.e., via prevention efforts). [ABSTRACT FROM AUTHOR]

Introduction The US Food and Drug Administration (FDA) and other organizations have produced and disseminated public health campaigns designed to deter youth from vaping. Yet it is unknown how these campaigns affect adult smokers exposed to these messages with respect to their perceptions of e-cigarettes and their motivation to use these products to reduce or quit smoking. Aims and Methods A controlled experimental design was used to investigate the effects of an FDA-distributed youth-targeted anti-vaping public service announcement (PSA), "Vaping is an Epidemic," upon adult smokers. We randomized 161 daily smokers to view either the FDA PSA or a matched video absent of e-cigarette content, and we hypothesized that the PSA would impact variables related to harm reduction usage of e-cigarettes, including cognitive expectancies, perceived harm, smoking cessation effectiveness, and reported likelihood of switching from smoking to vaping. Results The PSA produced increases in both health risk and potency expectancies. Viewing the PSA compared to the control video resulted in overall more negative expectancies about e-cigarettes and all other variables related to harm reduction usage. Those who viewed the PSA rated e-cigarettes as more harmful (p  < .001) and less effective for smoking cessation (p  < .01), and they reported lower switching motivation (p  < .001). Conclusions Findings indicated that adult smokers who viewed the PSA were less likely to consider e-cigarettes for smoking cessation, thus reducing acceptance of a potential cessation aid with growing empirical support. Sensationalized youth-oriented anti-vaping messages may have unintended public health consequences upon adult audiences. Implications This study is the first controlled experiment examining the effects of youth-oriented anti-vaping PSAs upon adult smokers' cognitive expectancies and beliefs about e-cigarettes. Exposure to the PSA resulted in overall more negative expectancies about e-cigarettes, as well as increased perceived harmfulness and reduced effectiveness of e-cigarettes for smoking cessation. Findings showed that these PSAs could deter adult smokers from the utilization of e-cigarettes as a smoking cessation or harm reduction strategy. [ABSTRACT FROM AUTHOR]

Tobacco addiction and chronic pain represent 2 highly prevalent and comorbid conditions that engender substantial burdens upon individuals and systems. Interrelations between pain and smoking have been of clinical and empirical interest for decades, and research in this area has increased dramatically over the past 5 years. We conceptualize the interaction of pain and smoking as a prototypical example of the biopsychosocial model. Accordingly, we extrapolated from behavioral, cognitive, affective, biomedical, and social perspectives to propose causal mechanisms that may contribute to the observed comorbidity between these 2 conditions. The extant literature was 1st dichotomized into investigations of either "effects of smoking on pain" or "effects of pain on smoking". We then integrated these findings to present a reciprocal model of pain and smoking that is hypothesized to interact in the manner of a positive feedback loop, resulting in greater pain and increased smoking. Finally, we proposed directions for future research and discussed clinical implications for smokers with comorbid pain disorders. We observed modest evidence that smoking may be a risk factor in the multifactorial etiology of some chronically painful conditions and that pain may come to serve as a potent motivator of smoking. We also found that whereas animal studies yielded consistent support for direct pain-inhibitory effects of nicotine and tobacco, results from human studies were much less consistent. Future research in the emerging area of pain and smoking has the potential to inform theoretical and clinical applications with respect to tobacco smoking, chronic pain, and their comorbid presentation. (Contains 2 figures, 2 tables and 1 footnote.)

A significant proportion of women who self-quit smoking during pregnancy subsequently relapse to smoking post-partum. This study examined free-text responses describing attributions of smoking relapse or maintained abstinence at 1, 8, and 12 months post-partum. This study reports secondary analyses from a randomized clinical trial (N = 504) for preventing post-partum smoking relapse. At each follow-up, one survey item asked the participant to describe why she resumed smoking or what helped her maintain abstinence. A thematic content analysis was conducted on responses from the 472 participants (94.0% of the original sample) who returned at least 1 survey. Content analyses revealed several themes for participants' reasons for relapse and abstinence. Stress was the most frequently cited reason for smoking relapse across all follow-ups. Health concerns for children and family was the most common reason provided for remaining abstinent. Chi square analyses revealed differences in written responses related to income, age, and depressive symptoms. Overall, these findings suggest that during the post-partum period, stress and familial health concerns are perceived contributors to smoking relapse and abstinence, respectively. These results confirmed key risk and protective factors that have been identified through other assessment modalities (e.g., quantitative surveys and focus groups). They also provide support for targeting these variables in the development, content, and delivery of future post-partum smoking relapse-prevention interventions. The high response rate to these open-ended attribution questions suggests that future studies would benefit from including these and similar items to allow for additional insight into participant perspectives. Keywords Post-partum * Smoking * Relapse prevention * Content analysis, Introduction Despite a recent decline in the prevalence of smoking during pregnancy, 12% of pregnant women continue to smoke while they are pregnant [1]. It is estimated that between 35 [...]

Relapse prevention remains a major challenge to smoking cessation efforts. T. H. Brandon, B. N. Collins, L. M. Juliano, and A. B. Lazev (2000) found that a series of 8 empirically based relapse-prevention booklets mailed to ex-smokers over 1 year significantly reduced relapse. This study dismantled 2 components of that intervention: the amount of content (number of booklets) and the frequency of contact. Content and contact were crossed in a 2 X 2 factorial design. The criteria of at least 1 week of abstinence at baseline was met by 431 participants, 75%-85% of whom returned 12-, 18-, and 24-month follow-up questionnaires. Eight booklets produced consistently higher point-prevalence abstinence rates than did a single booklet, but frequency of contact did not affect outcome. Moreover, the high-content interventions were highly cost-effective.

Augmented reality (AR) is a rapidly developing technology that has substantial potential as a novel approach for addiction treatment, including tobacco use. AR can facilitate the delivery of cue exposure therapy (CET) such that individuals can experience the treatment in their natural environments as viewed via a smartphone screen, addressing the limited generalizbility of extinction learning. Previously, our team developed a basic AR app for smoking cessation and demonstrated the necessary mechanisms for CET. Specifically, we showed that the AR smoking cues, compared to neutral cues, elicited substantial cue reactivity (i.e. increased urge) and that repeated exposure to the AR smoking cues reduced urge (i.e. extinction) in a laboratory setting. Here we report the next step in the systematic development of the AR app, in which we assessed the usability and acceptability of the app among daily smokers in their natural environments. Daily smokers (N = 23, 78.3% female, Mean Age = 43.4, Mean Cigarettes/Day = 14.9), not actively quitting, were instructed to use the AR app in locations and situations where they smoke (e.g. home, bar) at least 5 times per day over one week. The study is registered in clinicaltrials.gov (NCT04101422). Results indicated high usability and acceptability. Most of the participants (73.9%) used the AR app on at least 5 days. Participants found the AR cues realistic and well-integrated in their natural environments. The AR app was perceived as easy to use (Mean = 4.1/5) and learn (mean of 2 days to learn). Overall satisfaction with the app was also high. Secondary analyses found that 56.5% reported reduced smoking, with an average 26% reduction in cigarettes per day at follow-up. These findings set the stage for a randomized controlled trial testing the AR app as an adjuvant therapy for treating tobacco dependence, with potential applicability to other substances. This study found that the augmented reality (AR) smartphone application that utlized cue exposure treatment for smoking cessation was perceived as easy to use and learn in the natural, day-to-day environment of daily smokers. Findings set the stage for a larger clinical trial testing the AR app as an adjuvant therapy for treating tobacco dependence, with potential applicability to other addictive behaviors. [ABSTRACT FROM AUTHOR]

Objective: Cue-exposure therapy (CET) aims to extinguish conditioned cue reactivity (CR) to aid in smoking cessation. A key disadvantage of extant CET is its limited ability to generalize extinction to the real world. Our team developed a set of augmented reality smoking-related and neutral cues that can appear in real-time in smokers' natural environments as viewed through a smartphone screen. Prior to deployment as a clinical tool, the present study tested the ability of AR smoking cues to extinguish CR in a controlled laboratory study with an AR smartphone application developed for this project. We hypothesized that daily smokers who completed a single session of cue exposure with AR smoking cues (extinction condition) would demonstrate lower cue-provoked urge to smoke at posttest compared to those who viewed AR neutral cues (control condition). Method: Daily smokers (N = 129, 46.5% female, Mage = 47.6, Mcigarettes/day = 19.1) in acute abstinence were randomized to either the extinction or control condition comprising 28 AR trials. Results: As hypothesized, we found a Time × Condition interaction indicating that posttest urge ratings were lower in the extinction condition than in the control condition (p = .034). A secondary hypothesis that participants in the extinction condition would show a longer latency to smoke when provided a cigarette was not supported. Conclusions: These laboratory findings provide evidence supporting the potential clinical efficacy of AR cues for cue-exposure trials, setting the stage for testing in smokers' naturalistic environments. [ABSTRACT FROM AUTHOR]

Introduction: Although e-cigarettes are not a federally approved tobacco cessation aid in the United States, many smokers use them to quit or cut down on smoking. Tailored behavioral support could improve rates of complete smoking cessation for those individuals.Aims and Methods: A novel behavioral treatment to help dual cigarette and e-cigarette users quit smoking was tested in a randomized pilot with a state tobacco quitline. Ninety-six dual users of cigarettes and e-cigarettes were recruited from incoming state quitline callers and randomized to receive enhanced e-cigarette coaching (EEC) or quitline treatment as usual (TAU) to examine EEC feasibility and acceptability. Outcomes at 3 months were treatment satisfaction, engagement, beliefs, and smoking cessation. This pilot was not powered to detect differences in quit rates.Results: Sixty-nine percent responded to the 3-month survey. EEC treatment satisfaction was noninferior to TAU: 93.8% (30/32) of EEC and 73.5% (25/34) of TAU reported being "very satisfied" or "satisfied" with treatment, respectively. EEC participants completed more coaching calls than TAU (M = 3.4 vs. M = 2.7, p = .03), and the majority in both groups elected to receive nicotine replacement therapy (EEC: 100%, TAU: 94%, p = .24). With missing data imputed as smoking, intent-to-treat 7-day point prevalence smoking abstinence rates were 41.3% (19/46) for EEC and 28.0% (14/50) for TAU (p = .20).Conclusions: The EEC quitline intervention for dual cigarette and e-cigarette users demonstrated high levels of treatment satisfaction and engagement. This pilot was not powered to detect significant differences in smoking cessation; however, cessation rates were promising and warrant evaluation in a fully powered trial.Implications: If this scalable behavioral treatment to help dual cigarette and e-cigarette users quit smoking proves to be effective in a larger trial, quitlines could implement this harm reduction approach to improve outcomes for callers who already use e-cigarettes and are planning to use them while quitting smoking. [ABSTRACT FROM AUTHOR]