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Objective: Many marginalized groups smoke at higher rates and have greater difficulty quitting than less marginalized groups. Most research on smoking cessation inequities has focused on a single sociodemographic attribute (eg, race or socioeconomic status), yet individuals possess multiple attributes that may increase risk. The current study used an intersectionality framework to examine how the interplay between multiple marginalized attributes may impact smoking cessation outcomes., Methods: A diverse sample of 344 adults enrolled in a smoking cessation program and reported on sociodemographic attributes (eg, race/ethnicity, gender, income) and continuous smoking abstinence on their quit date and at 1, 2, and 4 weeks postquit date. A Cox proportional hazard regression model was used to estimate whether intersectional links among race/ethnicity, gender, and income were related to smoking cessation outcomes., Results: Lower household income may be related to higher risk of smoking cessation failure. There were no significant interactions among race/ethnicity, gender, and income in predicting relapse. Pairwise intersectional group differences suggested some groups may be at higher risk of relapse. Number of marginalized sociodemographic attributes did not predict relapse., Conclusions: Intersectionality may be a promising framework for addressing health inequities, and may help elucidate how to best design and target intervention efforts for individuals characterized by sociodemographic intersections that concur particularly high risk for poor tobacco cessation outcomes., Implications: Despite an overall decline in smoking rates, socioeconomic inequities in smoking prevalence and cancer mortality are widening. Efforts targeting tobacco cessation should incorporate new theory to capture the complex set of factors that may account for tobacco cessation inequities (eg, multiple aspects of identity that may influence access to tobacco cessation treatment and exposure to certain stressors that impede cessation efforts). Intersectionality may be a promising framework for addressing health inequities in tobacco use and cessation and may help elucidate how to best design and target intervention efforts for individuals that concur particularly high risk for poor tobacco cessation outcomes., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

Background: Low socioeconomic status (SES) is linked to failure to quit smoking. Health inequity models suggest that low SES smokers experience barriers to quitting in part due to greater exposure to pro-smoking social contexts., Purpose: The current study examined longitudinal associations among socioeconomic status, pro-smoking social context factors (i.e., exposure to other smokers, places where smoking was allowed), cigarette availability, and smoking lapse during a quit attempt., Methods: Ecological momentary assessments (EMA) were gathered from a multiethnic sample of 365 smokers engaged in a quit attempt. A multilevel structural equation model estimated a latent variable for SES indicated by income, education, health insurance, and employment, associations among EMAs for pro-smoking social contexts and cigarette availability, and indirect effects of SES through, pro-smoking social contexts and cigarette availability to subsequent smoking lapse., Results: Lower SES scores were associated with a higher likelihood of smoking lapse. Decomposition of the path from SES to smoking lapse into indirect effects showed significant paths through exposure to places where smoking is allowed and cigarette availability. Additionally, significant serial indirect paths from SES through both exposure to other smokers and places where smoking was allowed, in turn, through cigarette availability, and, ultimately, to smoking lapse were noted., Conclusions: Consistent with models positing that SES influences health behaviors via contextual factors, the current study demonstrated that low SES smokers attempting to quit experienced greater pro-smoking social contexts that affected subsequent risk for lapse., (© Society of Behavioral Medicine 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

We investigated class clustering patterns of four behaviors-physical activity, fruit and vegetable (F&V) intake, smoking, and alcohol use-in a faith-based African American cohort. Guided by socio-ecological models, we also examined the psychosocial and neighborhood social environmental factors associated with the clustering patterns. Participants were 1,467 African American adults recruited from a mega church in the metropolitan Houston, TX, in 2008-2009. They completed a survey and health assessment. Latent class analysis and multinomial regression analysis were conducted. Results supported a three-class model: Class 1 was characterized by low physical activity, low F&V intake, and low substance use (smoking and alcohol use). Class 2 was characterized by high physical activity, low F&V intake, and mild drinking. Class 3 seemed to be the healthiest group, characterized by high physical activity, moderate-to-high F&V intake, and low substance use. The probabilities of being included in Classes 1, 2, and 3 were .33, .48, and .19, respectively. Participants in Class 1 (vs. Class 3) reported lower physical activity norm ( p < .001) and higher smoking norm ( p = .002) and lower neighborhood social cohesion ( p = .031). Participants in Class 2 (vs. Class 3) reported higher cancer risk perception ( p < .001), lower F&V norm ( p = .022), lower physical activity norm ( p < .001), higher smoking norm ( p < .001), and lower social cohesion ( p = .047). As health behaviors are clustered together, future interventions for African Americans may consider targeting multiple health behaviors instead of targeting a single health behavior. Interventions addressing social norm and neighborhood social cohesion may enhance multiple health behaviors engagement in this population.

Objectives: Financial strain represents a perceived inability to meet financial needs and obligations and is associated with poorer health outcomes. Distinct facets of perceived social support may mitigate the deleterious effects of financial strain on health. In the present study, we examined the extent to which appraisal, belonging, and tangible social support ameliorate the effects of financial strain on health-related quality of life (HRQoL)., Methods: A community sample (N = 238; 67.2% female; MAge = 43.4 years, SD = 13.1) completed inperson surveys as part of a larger study of health behaviors., Results: Greater financial strain and less social support were associated with poorer HRQoL. Additionally, both appraisal and belonging support moderated the effects of financial strain on some HRQoL components, such that higher appraisal and belonging support were associated with diminished effects of financial strain on HRQoL., Conclusions: These findings suggest nuanced associations between financial strain and HRQoL. We discuss the implications for prevention and intervention programs.

More than 60% of cancer-related deaths in the United States are attributable to tobacco use, poor nutrition, and physical inactivity, and these risk factors tend to cluster together. Thus, strategies for cancer risk reduction would benefit from addressing multiple health risk behaviors. We adapted an evidence-based intervention grounded in social cognitive theory and principles of motivational interviewing originally developed for smoking cessation to also address physical activity and fruit/vegetable consumption among Latinos exhibiting multiple health risk behaviors. Literature reviews, focus groups, expert consultation, pretesting, and pilot testing were used to inform adaptation decisions. We identified common mechanisms underlying change in smoking, physical activity, and diet used as treatment targets; identified practical models of patient-centered cross-cultural service provision; and identified that family preferences and support as particularly strong concerns among the priority population. Adaptations made to the original intervention are described. The current study is a practical example of how an intervention can be adapted to maximize relevance and acceptability and also maintain the core elements of the original evidence-based intervention. The intervention has significant potential to influence cancer prevention efforts among Latinos in the United States and is being evaluated in a sample of 400 Latino overweight/obese smokers., (© 2014 Society for Public Health Education.)

Background: Nearly half of U.S. adults have difficulties with health literacy (HL), which is defined as the ability to adequately obtain, process, and understand basic health information. Lower HL is associated with negative health behaviors and poor health outcomes. Racial/ethnic minorities and those with low socioeconomic status (SES) are disproportionately affected by poor HL. They also have higher smoking prevalence and more difficulty quitting smoking. Thus, lower HL may be uniquely associated with poorer cessation outcomes in this population., Methods: This study investigated the association between HL and smoking cessation outcomes among 200, low-SES, racially/ethnically diverse smokers enrolled in smoking cessation treatment. Logistic regression analyses adjusted for demographics (i.e., age, gender, race/ethnicity, relationship status), SES-related characteristics (i.e., education, income), and nicotine dependence were conducted to investigate associations between HL and smoking relapse at the end of treatment (3 weeks post quit day)., Results: Results indicated that smokers with lower HL (score of < 64.5 on the Rapid Estimate of Adult Literacy in Medicine [REALM]) were significantly more likely than those with higher HL (score of ≥ 64.5 on the REALM) to relapse by the end of treatment, even after controlling for established predictors of cessation including demographics, SES, and nicotine dependence (OR = 3.26; 95% CI = 1.14, 9.26)., Conclusions: Findings suggest that lower HL may serve as an independent risk factor for smoking relapse among low-SES, racially/ethnically diverse smokers enrolled in treatment. Future research is needed to investigate longitudinal relations between HL and cessation outcomes and potential mechanisms of this relationship.

Background: Most women in the United States do not meet minimum recommendations for physical activity or fruit/vegetable consumption. Thus, many are overweight/obese and are at increased risk for cancer morbidity and mortality. This study investigated women's perceptions about the importance of physical activity and a healthy diet in preventing cancer, perceptions of engaging in these behaviors, and whether or not the behaviors met cancer prevention recommendations., Method: A cross-sectional, national, random-digit-dialed telephone survey was conducted with 800 women, ages 18 and older. The response rate was 24.5%. Measures assessed demographics, perceived health status, beliefs about the role of physical activity and diet in cancer prevention, perceived engagement in these behaviors, and actual behaviors., Results: Only 9.9% of women who reported eating a healthy diet met minimum fruit and vegetable recommendations; 39.7% of women who reported regular physical activity met the minimum recommendation. Analyses adjusted for demographics indicated that low education was associated with reporting regular physical activity to prevent cancer, yet failing to meet the minimum recommendation (odds ratio [OR]=0.90, 95% confidence interval [CI]: 0.82-0.98, p=0.01). Racial/ethnic minority status was marginally significantly associated with reporting eating a healthy diet to prevent cancer, yet failing to consume sufficient fruits and vegetables (OR=2.94, 95% CI: 0.99-8.71, p=0.05)., Conclusions: Most women who reported eating a healthy diet and being physically active to prevent cancer failed to meet the minimum cancer prevention recommendations. Furthermore, low socioeconomic status and racial/ethnic minority women may be particularly vulnerable to discrepancies between beliefs and behavior.

Objectives: To examine associations of the US and community subjective social status (SSS) ladders with smoking status, at-risk drinking, fruit and vegetable intake, physical activity, and body mass index among 1467 church-going African American adults from a larger cohort study., Methods: Regression analyses, adjusted for sociodemographics, examined associations between SSS ladders and health behaviors., Results: The SSS-US ladder was significantly associated with fruit and vegetable consumption (p = .007) and physical activity (p = .005). The SSS-community ladder was not significantly associated with any health behaviors., Conclusions: Among this sample of African Americans, the SSS-US ladder is more predictive of some health behaviors than is the SSS-community ladder.

Hispanics have the lowest colorectal cancer (CRC) screening rates of all racial/ethnic groups and comprise the largest proportion of low-income manual laborers in the nation. We partnered with businesses to implement a community health worker (CHW)-led intervention among Hispanic workers in service-related and manual labor occupations, which often pay low wages and do not provide health insurance. CHWs measured knowledge, screening adherence and perceptions of CRC risk before and after educational interventions via interview. CHWs provided fecal immunochemical tests (FITs) to participants aged =50 years. Chi-square tests and logistic regression identified pre-intervention predictors of CRC knowledge of all participants and adherence among eligible participants. Adherence among participants increased from 40% (n = 307) pre-intervention to 66% post-intervention. Knowledge about CRC was associated with age =50 years (OR = 8.90 [95% CI = 2.61-30.35]; ref = 18-30) and perceived personal risk for CRC (Likely, OR = 3.06 [95% CI = 1.40-6.67]; ref = Not likely). Insurance status was associated with screening adherence pre-intervention (OR = 3.00 [95% CI 1.10-8.12]; ref = No insurance). Improvement in adherence post-intervention was associated with income between $25 000 and =$55 000 (OR = 8.49 [95% CI 1.49-48.32]; ref = $5000-<$10 000). Community-based health programs can improve CRC screening adherence among Hispanic workers in service-related and manual labor positions, but lowest-income workers may need additional support.

We investigated class clustering patterns of four behaviors--physical activity, fruit and vegetable (F&V) intake, smoking, and alcohol use--in a faith-based African American cohort. Guided by socio-ecological models, we also examined the psychosocial and neighborhood social environmental factors associated with the clustering patterns. Participants were 1,467 African American adults recruited from a mega church in the metropolitan Houston, TX, in 2008-2009. They completed a survey and health assessment. Latent class analysis and multinomial regression analysis were conducted. Results supported a three-class model: Class 1 was characterized by low physical activity, low F&V intake, and low substance use (smoking and alcohol use). Class 2 was characterized by high physical activity, low F&V intake, and mild drinking. Class 3 seemed to be the healthiest group, characterized by high physical activity, moderate-to-high F&V intake, and low substance use. The probabilities of being included in Classes 1, 2, and 3 were 0.33, 0.48, and 0.19, respectively. Participants in Class 1 (vs. Class 3) reported lower physical activity norm (p < 0.001) and higher smoking norm (p = 0.002) and lower neighborhood social cohesion (p = 0.031). Participants in Class 2 (vs. Class 3) reported higher cancer risk perception (p < 0.001), lower F&V norm (p = 0.022), lower physical activity norm (p < 0.001), higher smoking norm (p < 0.001), and lower social cohesion (p = 0.047). As health behaviors are clustered together, future interventions for African Americans may consider targeting multiple health behaviors instead of targeting a single health behavior. Interventions addressing social norm and neighborhood social cohesion may enhance multiple health behaviors engagement in this population.

Key modifiable risk behaviors such as smoking, poor diet and physical inactivity often cluster and may have multiplicative adverse effects on health. This study investigated barriers and facilitators to healthy eating and physical activity (PA) in overweight Mexican-origin smokers to inform the adaptation of an evidence-based smoking cessation program into a multiple health behavior change intervention. Five focus groups were conducted with overweight Mexican-origin men (n = 9) and women (n = 21) who smoked. Barriers and facilitators of healthy eating and PA were identified, and gender differences were assessed. Participants expressed some motivation to eat healthfully and identified strategies for doing so, yet many women experienced difficulties related to personal, family and work-related circumstances. Barriers to healthy eating among men were related to food preferences and lack of familiarity with fruits and vegetables. Participants performed PA primarily within the context of work and domestic responsibilities. Stress/depressed mood, lack of motivation and concern for physical well-being limited further PA engagement. Routines involving eating, PA and smoking highlight how these behaviors may be intertwined. Findings emphasize the importance of social, structural and cultural contexts and call for additional investigation into how to integrate healthy eating and PA into smoking cessation interventions for overweight Mexican-origin smokers. [ABSTRACT FROM AUTHOR]

Objectives: To examine whether health locus of control mediated relations of self-reported neighborhood vigilance and biochemically verified, continuous short-term smoking abstinence among 200 smokers enrolled in a cohort study. Methods: A nonparametric bootstrapping procedure was used to assess mediation. Results: Health locus of control-chance mediated relations between neighbor­hood vigilance and smoking abstinence in analyses adjusted for sociodemograph­ics and tobacco dependence (p < .05). Greater vigilance was associated with greater attributions that health was af­fected by chance, which was associated with a lower likelihood of smoking absti­nence. Conclusions: Results suggest that neighborhood perceptions influence resi­dents' attributions for health outcomes, which can affect smoking abstinence. [ABSTRACT FROM AUTHOR]

Background: Smoking, poor diet, and physical inactivity account for as much as 60% of cancer risk. Latinos experience profound disparities in health behaviors, as well as the cancers associated with them. Currently, there is a dearth of controlled trials addressing these health behaviors among Latinos. Further, to the best of our knowledge, no studies address all three behaviors simultaneously, are culturally sensitive, and are guided by formative work with the target population. Latinos represent 14% of the U.S. population and are the fastest growing minority group in the country. Efforts to intervene on these important lifestyle factors among Latinos may accelerate the elimination of cancer-related health disparities. Methods/design: The proposed study will evaluate the efficacy of an evidence-based and theoretically-driven Motivation And Problem Solving (MAPS) intervention, adapted and culturally-tailored for reducing cancer risk related to smoking, poor diet, and physical inactivity among high-risk Mexican-origin smokers who are overweight/ obese (n = 400). Participants will be randomly assigned to one of two groups: Health Education (HE) or MAPS (HE + up to 18 MAPS counseling calls over 18 months). Primary outcomes are smoking status, servings of fruits and vegetables, and both self-reported and objectively measured physical activity. Outcome assessments will occur at baseline, 6 months, 12 months, and 18 months. Discussion: The current study will contribute to a very limited evidence base on multiple risk factor intervention studies on Mexican-origin individuals and has the potential to inform both future research and practice related to reducing cancer risk disparities. An effective program targeting multiple cancer risk behaviors modeled after chronic care programs has the potential to make a large public health impact because of the dearth of evidence-based interventions for Latinos and the extended period of support that is provided in such a program. [ABSTRACT FROM AUTHOR]

Background. This study examined the characteristics, tobacco use patterns over time, and predictors of tobacco cessation among concomitant users of cigarettes and smokeless tobacco.Methods. Participants were employed adults residing in the southeastern United States who participated in the Working Well cancer prevention trial. Participants were assessed at baseline and followed-up 4 years later.Results and Conclusions. The study yielded several key findings: (a) the prevalence of concomitant smoking and smokeless tobacco use was high among males and nonexistent among females, (b) the characteristics of concomitant users were relatively distinct from those of both smokers and smokeless tobacco users, (c) concomitant users exhibited substantial variability in their tobacco use patterns and were less likely to stop using tobacco than were smokers or smokeless tobacco users, (d) indicators of nicotine dependence predicted tobacco cessation for both smokers and smokeless tobacco users, but were largely unrelated to tobacco cessation among concomitant users, and (e) demographics, environmental variables, and measures derived from the transtheoretical model were not consistent predictors of tobacco cessation after controlling for nicotine dependence. [Copyright &y& Elsevier]

The article discusses the association between socioeconomic status (SES) and smoking cessation. Topics covered include the neighborhood contextual factors underlying the SES-health relationship, neighborhood characteristics that predict smoking cessation rates, and the need to create comprehensive conceptual models that elucidate pathways between tobacco cessation and SES.

Objectives. Associations between subjective social status, a subjective measure of socioeconomic status, and predictors of risk for postpartum smoking were examined among 123 pregnant women (aged 18-24 years) who stopped smoking because of pregnancy. The goal was to identify how subjective social status might influence the risk for postpartum smoking and to elucidate targets for intervention. Methods. We used multiple regression equations to examine the predictive relations between subjective social status and tobacco dependence, self-rated likelihood of postpartum smoking, confidence, temptations, positive and negative affect, depression, stress, and social support. Adjusted analyses were also conducted with control for race/ethnicity, education, income, and whether participant had a partner or not (partner status). Results. In unadjusted and adjusted analyses, subjective social status predicted tobacco dependence, likelihood of postpartum smoking, confidence, temptations, positive affect, negative affect, and social support. Adjusted analyses predicting depression and stress approached significance. Conclusions. Among young pregnant women who quit smoking because of pregnancy, low subjective social status was associated with a constellation of characteristics indicative of increased vulnerability to postpartum smoking. Subjective social status provided unique information on risk for postpartum smoking over and above the effects of race/ethnicity, objective socioeconomic status, and partner status. (Am J Public Health. 2007;97:1476-1482. doi:10.2105/AJPH. 2006.101295) [ABSTRACT FROM AUTHOR]