Steven A. Branstetter

Background/Objectives: Sexual minority (SM) adults experience higher cigarette smoking prevalence and poorer cessation outcomes than heterosexual adults, yet few empirically supported cessation programs are tailored to SM populations. In addition, the social and behavioral determinants of smoking disparities among SM remain understudied. A clearer understanding of factors associated with cessation in this population is necessary to inform targeted interventions. This study examined predictors of smoking cessation over a one-year period among sexual minority adults. Methods: Data were drawn from Waves 6 and 7 of the Population Assessment of Tobacco and Health (PATH) Study. Complex Samples logistic regression models assessed whether baseline smoking intensity, nicotine dependence, race, income, education, psychological distress, and quality of life predicted cessation one year later. An eight-category intersectional variable combined race, sex, and sexual orientation. Results: Smoking intensity and psychological distress were among the strongest predictors of cessation outcomes. Lower income and non-White race were also associated with reduced cessation likelihood. Cessation outcomes varied significantly across the combined race by sex by sexual orientation groups, with White heterosexual men exhibiting the most favorable cessation profile. Several other groups demonstrated reduced likelihood of quitting after accounting for smoking intensity, nicotine dependence, socioeconomic factors, psychological distress, and quality of life. Conclusions: Smoking cessation disparities operate across intersecting social identities. Behavioral dependence, socioeconomic disadvantages, and psychological distress collectively shape cessation outcomes. Effective interventions should address nicotine dependence within the broader structural and mental health contexts influencing racially and sexually minoritized populations.

Introduction: Despite a reduction in overall cigarette smoking rates in the last several decades, recent increases in the use of electronic nicotine delivery systems (ENDS), such as e-cigarettes and Juul devices, prompted the Surgeon General to declare the use of such products to be an “epidemic.” Along with the increase in the overall incidence of ENDS use, there are corresponding disparities in initiation, attitudes, and use patterns among Latinx populations. The present study sought to examine how elements of several behavioral theories, including parent, peer, media and environmental factors, are associated with a comprehensive measure of ENDS use susceptibility among both Latinx and non- Latinx youth. Methods: Data from 9630 adolescents between the ages of 12 and 17 years were collected in wave 3 of the Population Assessment of Tobacco and Health (PATH). Data were used to create and test a covariance structural path model examining the effects of parental modeling, communication, attitudes, rule-setting, and peer perceptions on ENDS use susceptibility. Multigroup model comparisons between Latinx and non-Latinx youth were completed. Results: Despite non-Latinx youth having more risk factors associated with ENDS use susceptibility, including parental ENDS use, more lenient rules regarding ENDS use in the home, and less perceived harm from ENDS use, Latinx youth had higher overall susceptibility. Additionally, despite predictions from prior research and theory, perceived social norms regarding ENDS use were not associated with susceptibility among non-Latinx youth. Parental ENDS use and having ENDS products available in the home were associated with greater susceptibility in Latinx, but not non-Latinx youth. Conclusions: Key differences in ENDS susceptibility between Latinx and non-Latinx youth warrant both further investigation and increased culturally tailored prevention programming.

Background: Low-dose computed tomography (LDCT) increases the early detection of lung cancer. Identifying modifiable behaviors that may affect tumor progression in LDCT-detected patients increases the likelihood of long-term survival and a good quality of life. Methods: We examined cigarette smoking behaviors on lung cancer stage, progression, and survival in 299 ever-smoking patients with low-dose CT-detected tumors from the National Lung Screening Trial. Univariate and multivariate Cox models were used to estimate the hazard ratio (HR) for smoking variables on survival time. Results: Current vs. former smokers and early morning smokers (≤5 min after waking, i.e., time to first cigarette (TTFC) ≤ 5 min) had more advanced-stage lung cancer. The adjusted HR for current vs. former smokers was 1.3 (95% confidence interval [CI] 0.911–1.98, p = 0.136) for overall survival (OS) and 1.3 (0.893–1.87, p = 0.1736) for progression-free survival (PFS). The univariate hazard ratios for TTFC ≤ 5 min vs. >5 min were 1.56 (1.1–2.2, p = 0.013) for OS and 1.53 (1.1–2.12, p = 0.01) for PFS. Among current smokers, the corresponding HRs for early TTFC were 1.78 (1.16–2.74, p = 0.0088) and 1.95 (1.29–2.95, p = 0.0016) for OS and PFS, respectively. In causal mediation analysis, the TTFC effect on survival time was mediated entirely through lung cancer stage. Conclusion: The current findings indicate smoking behaviors at diagnosis may affect lung cancer stage and prognosis.

Sexual minority women face a range of health disparities, including high rates of mental health issues, alcohol and tobacco use, obesity, stroke, and general poorer health compared to heterosexual women. The minority stress model describes how members of a minority group, including sexual minorities, face unique stressors related to a stigmatized social status. Research has shown that sexual minorities who face increased discrimination, as described in the minority stress model, tend to have increased smoking rates. The present study sought to examine how increased mental health-related stress associated with the COVID-19 pandemic impacted the smoking behaviors of sexual minority women. Data from the 2021 National Survey on Drug Use and Health were used to build OLS regression and mediation models determining how female sexual minority status moderated the relation between COVID-19-related impacts on mental health and smoking. Results found that sexual minority women with the highest levels of negative impacts on mental health as a result of COVID-19 smoked the fewest cigarettes as compared to heterosexual women. The finding that high levels of mental health distress are related to a reduction in smoking among sexual minority women warrants further research to examine if this effect is COVID-19-specific, or a more generalized pattern of stress and mental health impacts on smoking behavior.

The present study examines the contributions of individual-level health determinants on young adult tobacco use initiation to improve understanding of racial and ethnic distinctions and to inform effective tobacco prevention strategies. Using time-to-event analyses, the 10–wave (2011–2016) Truth Initiative Young Adult Cohort, a probability-based, nationally representative sample of the US young adults aged 18–34 years (N = 7 665), provides data to examine differences in variables that influence tobacco uptake, by race and ethnicity. Among Non–Hispanic White young adults, having fewer peers who smoke cigarettes is protective against any tobacco initiation, whereas hazard of tobacco initiation increases for males, having low confidence to resist smoking, and having higher proclivity for sensation seeking. Depressive and anxiety symptoms increase uptake hazard most in the Non–Hispanic All Other Races group and least among Non–Hispanic Black individuals. Among Hispanic young adults, being female and perceiving tobacco as harmful are notably protective while being male is a notable uptake hazard. Unlike other groups, higher income levels do not lower hazards among Hispanic individuals. Cannabis use and overestimating the smoking rate among peers increase hazard least among Hispanic individuals. In the Non–Hispanic All Other Races group, aging is least protective; hazard increases notably if individuals engage in regular alcohol or cannabis use. Tobacco prevention efforts are critical during young adulthood. Specific tobacco uptake hazard and protective factors exist by race and ethnicity and should be considered when developing selective young adult prevention, particularly among groups with the highest risk for tobacco initiation during this life stage. Rising rates of tobacco initiation among the US young adults necessitate expanded efforts to prevent tobacco use initiation and progression beyond youth. Results highlight nuanced and differential tobacco uptake hazards by race and ethnicity for late initiation and sustained non–tobacco use among young adults. The study confirms existing evidence on tobacco use patterns and contributes to new knowledge on risk and protective factors. Tobacco prevention and control interventions, including policies, tailored in more meaningful ways could reduce tobacco use disparities among those most disproportionately affected.

Continued smoking after a cancer diagnosis is causally associated with increased risks of all-cause and cancer-specific mortality, and of smoking-related second primary cancers. Patient navigation provides individualized assistance to address barriers to smoking cessation treatment and represents a promising bridge to smoking cessation in persons with cancer who smoke cigarettes. We conducted a single-arm interventional cohort study of current smokers identified through prospective health record screening and recruited from Penn State Cancer Institute outpatient clinics. Consented participants received two telephone intervention sessions and gain-framed messaging-based smoking cessation educational materials designed for persons with cancer. The primary study outcome was the feasibility of the patient navigation-based intervention; the secondary outcome was the engagement in smoking cessation treatment at the two-month follow-up. Of 1168 unique screened Cancer Institute patients, 134 (11.5%) were identified as current cigarette smokers. Among 67 patients approached at outpatient clinics, 24 (35.8%) were interested in participating, 12 (17.9%) were enrolled, eight (11.9%) completed the intervention sessions and study assessments, and six engaged in smoking cessation treatment. The participants expressed satisfaction with the intervention sessions (median = 8.5, scale 0–10). The low recruitment rates preclude patient navigation as a feasible method for connecting cancer patients to smoking cessation treatment resources.

Up to one-half of cigarette smokers may wake up during the night and smoke. This behavior may result in greater likelihood of cessation failure, clinically relevant sleep difficulties, and a range ...

Objective. Environmental factors, such as household smoking restrictions (HSR), may impact a range of smoking-related outcomes. The current study examined the effects of various levels of HSR on smoking behaviors, including the number of cigarettes smoked per day and levels of nicotine dependence in a population of adult smokers. (1) Having specific HSR reduces the urges to smoke (path A); (2) having specific HSR reduces CPD (path B); (3) having specific HSR results in lower overall nicotine addiction (path C), and later, TTFC will be associated with (4) lower urges to smoke in the morning (path A’), (5) fewer CPD (path B’), and (6) lower levels of nicotine addiction (path C’).Method. Regression models using self-reported data from the Pennsylvania Adult Smoking Study (N= 353) were used. TTFC was measured minutes between waking and the first cigarette of the day. Household smoking restrictions were measured as follows: (1) full ban on smoking in the home, (2) partial ban, or (3) no ban.Results. Subjects with no household smoking restrictions had lower incomes and education than those with at least some household smoking restrictions; those with full bans smoked less and had an earlier TTFC than those with at least some household smoking restrictions. Smokers with a full ban had a later TTFC, mediated by fewer cigarettes per day and lower cravings. Among those with partial bans, there is no reduction in cigarettes per day and an increase in urges to smoke.Conclusions. Partial household smoking restrictions are no better than no household smoking restrictions with regard to cigarettes per day and TTFC, and may cause an increase in urges to smoke in the morning.