Alexandra Loukas - US grants

[unreadable] DESCRIPTION (provided by applicant): Although the prevalence of tobacco use decreased for most segments of the US population between 1993 and 2000, disparities persist. Young adults and individuals in the lowest socioeconomic status (SES) categories report the highest rates of tobacco use. Low SES increases exposure to multiple types of stress and stress is positively associated with tobacco use. Unfortunately, studies examining the putative mechanisms, or mediators, of the stress-tobacco use relationship for low SES young adults are scare. Also lacking from the literature is an understanding of the roles of race/ethnicity and cultural factors as moderators of the relationships among cumulative stress, depressive symptoms, and tobacco use. This application aims to: 1) determine whether depressive symptoms mediate the relationship between an accumulation of life events stress, discrimination stress, financial stress, role overload and tobacco use in low SES young adults and b) Explore the cultural factors that may moderate the cumulative stress and depressive symptoms effects. Quantitative (survey) and qualitative (focus group interviews) methodologies will be used to address these aims. Approximately 900 ethnically diverse young adult students enrolled in two 2-year post-secondary vocational programs will be asked to complete an anonymous survey examining varying types of stress, depressive symptoms, and tobacco use. A subset of these students will be asked to participate in focus group interviews aimed at understanding the cultural factors involved in tobacco use. The Specific Aims of the project will be to: 1) determine if levels of stress and depressive symptoms vary across tobacco use 2) examine the relationships among cumulative stress, depressive symptoms, tobacco use, and race/ethnicity, after accounting for gender and income and 3) explore cultural differences in young adult perceptions of why they use tobacco and the roles of stress and depressive symptoms in their tobacco use. This proposed project is consistent with the Healthy People 2010 Goal #2 of reducing health disparities and the objective of reducing cigarette smoking by adults. Tobacco use remains the leading cause of preventable death in the United States. Each year more than 440,000 adults die from tobacco-related diseases and smoking, the most common form of tobacco use, is causally linked to the development of numerous cancers including, but not limited to, lung, bladder, kidney, cervical, and esophageal. Young adults and individuals in the lowest socioeconomic status categories report the highest rates of tobacco use and the lowest rates of cessation. Development of effective prevention and intervention programs aimed at reducing tobacco use in this population require an understanding of the factors that contribute to their tobacco use. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): Young adults and individuals in the lowest socioeconomic status (SES) categories report the highest rates of cigarette use and lowest rates of cessation. Although young adult smokers from backgrounds characterized by low SES are just as likely as their higher SES peers to attempt to quit smoking, they are less likely to use effective cessation treatments and less likely to actually quit. Individuals who occupy lower SES categories may not use effective cessation treatments due to lack of resources, assistance, and/or support. These individuals may also prefer to quit on their own, without the use of cessation aids. Web-based programs tailored to individual characteristics relevant to smoking cessation are one of the only types of cessation programs that are self-directed and can reach large numbers of smokers for very little cost. Yet, research examining smoking cessation using tailored web-based programs has focused almost exclusively on higher SES, White female smokers. The purpose of this study is to examine the feasibility of a tailored web-based cessation program for a racially/ethnically diverse sample of young adult smokers from lower SES backgrounds. Utilization and acceptability will be assessed by randomly assigning individuals either to a tailored web-based smoking cessation program based on social cognitive theory and studies of persuasive communications or to a control condition comprising a non-tailored web-based program providing evidence- based smoking cessation information. Both programs will be self-paced, allowing individuals to choose when and where they visit them. Participants will be smokers enrolled in post-secondary vocational/technical programs who want to quit smoking. The Specific Aims of the proposed project are to 1) Determine if young adult smokers from low SES backgrounds will use a tailored web-based cessation program and find it an acceptable means for quitting, 2) Identify the psychosocial variables relevant to young adult smokers from low SES backgrounds (e.g., financial stress, role overload, depressive symptoms) that contribute to variability in utilization and acceptability of the web-based program, and 3) Use individual interviews to determine how to increase utilization and acceptability of the tailored web-based program, and maximize its appeal to young adult smokers from low SES backgrounds. If successful, this project will lead to a multi-year R01 proposal testing the efficacy of a tailored web-based smoking cessation program in a larger randomized controlled trial. Results from Specific Aims 2 and 3 will be used to modify the existing web-based program to further tailor it to the needs of young adults occupying lower SES categories. The long-term goal of this research is to develop effective smoking cessation programs for young adults from low SES backgrounds that ultimately will decrease disparities in tobacco use and tobacco-related morbidity and mortality. PUBLIC HEALTH RELEVANCE: Tobacco use remains the leading cause of preventable death in the United States. Young adults and individuals occupying the lowest socioeconomic status (SES) categories are disproportionately represented among smokers. Identifying low-cost smoking cessation programs that can reach, appeal to, and are effective for large numbers of smokers from low SES backgrounds, will have a major impact on decreasing disparities in smoking and smoking-related morbidity and mortality.

PROJECT SUMMARY Young adults have the highest prevalence of past-year depression and current tobacco use in the United States. Co-occurrence of depression and tobacco use is particularly problematic during young adulthood as nicotine addiction is solidified in this developmental period, and elevated levels of depressive symptoms promote sustained tobacco use and undermine quitting. Yet, there is limited research on young adults and evidence for the strength and direction of associations between depressive symptoms and tobacco use is inconclusive. Inconclusive findings indicate there may be heterogeneity in the patterns of associations between depressive symptoms and tobacco use across subgroups of young adults. Yet, few studies examine this heterogeneity. Further, most studies focus on cigarettes, although other products, such as electronic nicotine delivery systems, are increasingly prevalent and the concurrent use of two or more products (i.e., poly tobacco use) is more prevalent than single product use among young adults. Use of newly introduced vape pods, such as JUUL, is increasingly concerning. But, the role of vape pod use in the depressive symptoms-tobacco use association is not known. There is a critical need for longitudinal studies that identify for whom and under what conditions depressive symptoms are associated with use of all types of tobacco, and with transitions in use, such as from current to no tobacco use and vice versa. The primary objectives of this R01 are to determine if: 1) the role of depressive symptoms in tobacco use trajectories and transitions vary for subgroups across young adulthood, ages 18-34 and 2) the strength and direction of associations vary. We will identify moderating factors that capture the heterogeneity, and define for whom and under what conditions depressive symptoms are longitudinally associated with tobacco use outcomes. We will examine sociodemographic, intrapersonal, and contextual moderating factors, and all types of tobacco products and outcomes, including initiation, sustained use, addiction, cessation, poly tobacco use, and transitions in use. To do so, we will use eight waves of existing data collected in 2014-2019 from 5,482 initially 18-29 year old college students. The Specific Aims are to: 1) Identify the role of depressive symptoms in longitudinal tobacco use trajectories and transitions, and elucidate the temporal associations between depressive symptoms and tobacco use; 2) Examine the moderating roles of sociodemographic, intrapersonal, and contextual factors in the longitudinal trajectories, transitions, and temporal associations; and 3) Determine the role of vape pods, like JUUL, in the longitudinal tobacco use trajectories, transitions, and temporal associations. The expected outcome is identification of subgroups most vulnerable to initiating and continuing tobacco use, given elevated depressive symptoms. Results can be used to tailor tobacco interventions and determine to whom they should be targeted.