The Influence of COVID-19 on Tobacco Racial Health Disparities: Testing the Differential Effects of COVID-19 on Smoking Motivation Variables across Black and White Smokers

The COVID-19 pandemic has illuminated persistent racial differences in access and quality of healthcare resources that result in disproportionately poor health outcomes for Black and African Americans, relative to Whites. Given COVID-19’s influence on racial health disparities broadly, examination is warranted on whether the pandemic has more specificallyinfluenced smoking motivation and, subsequently, tobacco-related health disparities. The goal of this study was to test whether COVID-19 related video content differentially primed smoking motivation (cravings, cessation self-efficacy, and motivation to quit) among Black and White smokers. I used an online research platform to host an experiment with a 2x3 between-subjects factorial design (Race vs. Affective Health Threat Prime). Race included Black or White and Health Threat Prime videos included COVID-19 plus explicit health disparities, COVID-19 alone, or Foodborne Illness as a control. Black (n = 501) and White (n = 511) participants were randomly assigned to one of six groups. Results showed no main effects of Health Threat Prime on cravings or cessation self-efficacy and no interaction effects on any smoking motivation variable. However, there were main effects of Race on all smoking motivation variables. Blacks, relative to Whites, had lower cravings and higher cessation self-efficacy and motivation to quit smoking. Income was a significant moderator of the relationship between health threat prime and motivation to quit smoking. For Whites with higher income, there were no differences in motivation across conditions, but there was variability for Blacks with higher income. The most variability was among participants with lower income, with Blacks showing higher motivation than Whites overall. Findings suggest that either the health threat primes were not robust enough to elucidate affect associated with the pandemic or that COVID-19 has not had a robust influence on smoking motivation across Black and White smokers

The Effect of Acute Interpersonal Racial Discrimination on Smoking Motivation and Behavior among Black Smokers

In comparison to White smokers, Black smokers are more likely to report both discrimination and less success in smoking cessation. No previous study has tested the causal relationship between actual experienced racial discrimination and smoking variables associated with cessation. The goal of this study was to test the casual influence of interpersonal racial discrimination on smoking motivation (i.e., the urge to smoke cigarettes, cessation self-efficacy, and smoking behavior) using a controlled experimental design. We used a virtual ball-playing game to create a laboratory model of racial discrimination. A 2x2 between-subjects factorial design (inclusion/exclusion vs. ingroup/outgroup) was used to randomly assign participants to one of four groups: 1.) included/ingroup, 2.) included/outgroup, 3.) excluded/ingroup (ostracism), and 4.) excluded/outgroup (racial discrimination). Sixty-nine Black smokers were recruited from the Tampa Bay area. Results show that participants in the excluded conditions reported lower cessation self-efficacy than those in the included conditions. Participants in the outgroup conditions had reduced latency to smoke compared to those in the ingroup conditions. There were no main effects of social inclusion on cravings or latency to smoke, no statistically significant interactions for social inclusion x group membership, and no statistically significant mediation or moderation analyses. This laboratory simulation of racial discrimination shows a causal relationship between exclusion and low cessation self-efficacy, which contributes to a better understanding of what influences low success in smoking cessation attempts among Black smokers

Smoking cessation interventions for Hispanic/Latino(a) adults in the USA: protocol for a systematic review and planned meta-analysis

Introduction Hispanic smokers face multiple cultural and socioeconomic barriers to cessation that lead to prominent health disparities, including a lack of language-appropriate, culturally relevant, evidence-based smoking cessation interventions. This systematic review will examine the literature on smoking cessation interventions for Hispanic adults in the USA to assess (1) the availability of interventions, (2) the methodological quality of the studies evaluating the interventions and (3) the efficacy of the interventions.Methods and analysis A systematic literature search will be conducted, in English with no date limits, through the following databases starting at year of inception: Medical Allied Health Literature, Embase, American Psychology Association Psychology Articles, Cumulative Index to Nursing and Allied Health Literature Complete, ScienceDirect, Health & Medicine Collection and Web of Science Core Collection. Trial registries and grey literature sources will be searched to identify ongoing or unpublished studies. Literature search will be rerun prior to eventual submission of the review to ensure the inclusion of relevant studies. Quantitative studies evaluating the efficacy of a smoking cessation intervention (ie, smoking cessation as a measured outcome) for Hispanic adult smokers in the USA will be included in the systematic review. Two authors will independently identify relevant studies, extract data and conduct quality and risk of bias assessments. Discrepancies in coding will be discussed between the two reviewers and pending disagreements will be resolved by a third reviewer. First, the quality of all studies will be assessed, then randomised controlled trials (RCTs) will be further evaluated for risk of bias using Cochrane’s Risk of Bias Tool. All eligible studies will be summarised descriptively. If data allow, the efficacy of smoking cessation interventions tested in RCTs, with a minimum follow-up of 6 months, will be quantitatively estimated using ORs and 95% CIs. The association between intervention type/modality and efficacy will be assessed via subgroup analyses.PROSPERO registration number CRD42022291068

Telehealth for Dialectical Behavioral Therapy: A Commentary on the Experience of a Rapid Transition to Virtual Delivery of DBT

Telehealth has been rapidly adopted to provide continuity of delivery of mental health services in light of COVID-19. However, the remote implementation of intensive treatments like dialectical behavioral therapy (DBT) has been vastly understudied. The aim of the current commentary is to describe potential obstacles, propose solutions, and discuss advantages of transitioning from traditional in-person to a virtual delivery format for full model DBT. We speak to these points at multiple levels of relevance to clinical scientists and practitioners: 1) considerations about the virtual delivery format, 2) considerations for the virtual delivery of DBT specifically, and 3) person-level considerations (e.g., client, clinician). We illustrate the commentary using examples of obstacles encountered and solutions identified during our DBT team’s rapid transition to telehealth in response to COVID-19-related shut-downs and discuss considerations for the extension of telehealth delivery of DBT going forward. We are hopeful that the rapid transition to telehealth delivery of mental health services in response to COVID-19 serves as a call to action for clinicians to adapt and leverage technology to deliver DBT on a broader scale to improve patient health outcomes

Associations between Perceived Racial Discrimination and Tobacco Cessation among Diverse Treatment Seekers

This study investigated a) racial/ethnic differences in past-year discrimination experiences and b) associations between discrimination and smoking abstinence. Prospective, longitudinal analysis of smoking status. Perceived past-year discrimination was assessed at baseline. ANCOVAs and intent-to-treat hierarchical logistic regressions were conducted. Dual-site (Tampa, FL and Miami, FL) randomized controlled trial testing the effects of a group cessation intervention plus pharmacotherapy. Treatment-seeking adult smokers (N=347; non-Hispanic White, non-Hispanic African American/Black, or Hispanic). Biochemically verified 7-day point prevalence abstinence (7-day ppa) was assessed immediately post-intervention and at 6-month follow-up. After controlling for covariates, African Americans/Blacks reported greater perceived discrimination compared with non-Hispanic Whites (P=.02), and Hispanics (P=.06). Non-Hispanic Whites and Hispanics did not differ in perceived racial/ethnic discrimination experiences over the past year. Irrespective of race/ethnicity, past-year perceived discrimination was inversely associated with 7-day ppa, both post-intervention (AOR=.97, CI: .95-.99) and at 6-months (AOR=.98, CI: .96-.99). Among African Americans/Blacks, past-year perceived discrimination was inversely associated with 7-day ppa, both post-intervention (AOR=.95, CI: .92-.97) and at 6-months (AOR=.97, CI: .94-.99). Perceived discrimination was unrelated to 7-day ppa among Hispanics. Among non-Hispanic Whites, past-year perceived discrimination was inversely associated with post-intervention 7-day ppa (AOR=.95, CI: .91-.99), but not 6-months. Perceived racial/ethnic discrimination was greater among African American/Black smokers compared with non-Hispanic Whites. Perceived discrimination was negatively associated with tobacco cessation in the full sample, and for African Americans at 6-months post-intervention. These data have implications for intervention delivery and health disparities