Background Socioeconomic disadvantage is associated with a reduced likelihood of smoking cessation. Smartphone ownership is increasing rapidly, including among low-income adults, and smartphone interventions for smoking cessation may increase access to smoking cessation treatment among socioeconomically disadvantaged adults. Objective This study aimed to evaluate the feasibility of an automated smartphone-based approach to delivering financial incentives for smoking cessation. Methods Socioeconomically disadvantaged adults initiating tobacco cessation treatment were followed from 1 week before a scheduled quit attempt through 26 weeks after the quit date. Participants received telephone counseling and nicotine replacement therapy. Smoking cessation was verified 5 times per week via smartphone prompts to self-report smoking status and submit a breath sample via a portable carbon monoxide (CO) monitor that was connected with participants’ smartphones. Identity was verified during smoking status assessments using smartphone-based facial recognition software. When smoking abstinence and identity were verified, an automated credit card payment was triggered. Participants were incentivized for abstinence on the quit date and up to five days per week during the first 4 weeks after the scheduled quit date, with additional incentives offered during postquit weeks 8 and 12. In total, participants had the opportunity to earn up to US $250 in abstinence-contingent incentives over the first 12 weeks of the quit attempt. Results Participants (N=16) were predominantly female (12/16, 75%) and non-Hispanic white (11/16, 69%), black (4/16, 25%), or Hispanic of any race (1/16, 6%). Most participants (9/16, 56%) reported an annual household income of <US $11,000. During the first 4 weeks after the scheduled quit date, participants completed a median of 16 (out of 21; range 1-21) mobile smoking status assessments, and they earned a median of US $28 in abstinence-contingent incentives (out of a possible US $150; range US $0-US $135). Median earnings did not change during the 8- and 12-week incentivized follow-up periods (total median earnings over 12 weeks=US $28; range US $0-US $167). During the first 4 weeks after the scheduled quit date, participants abstained from smoking on a median of 5 (out of 21) assessment days (range 0-20). At the in-person follow-up visits, the expired CO-confirmed 7-day point prevalence abstinence rates were 19% (3/16) and 13% (2/16) at 12 and 26 weeks postquit, respectively. Overall, most participants reported that the system was easy to use and that they would recommend this treatment to their friends and family. Conclusions Preliminary data suggest that this smartphone-based approach to verifying identity and smoking status and automating the delivery of abstinence-contingent incentives to a credit card is feasible for use among socioeconomically disadvantaged adults. However, continued refinement is warranted.

Introduction: Perceived social support and smoking cues, such as cigarette availability, are important factors that affect smoking cessation outcomes. However, very few studies examine the influences of social support and smoking cues on lapse during a quit attempt.Methods: Socioeconomically disadvantaged smokers participating in a smoking cessation program at a safety net hospital completed smartphone-based ecological momentary assessments (EMAs) for two consecutive weeks (1-week pre-quit through 1-week post-quit). A mixed-effects logistic regression model was used to evaluate whether perceived support to quit smoking, perceived pressure to quit smoking, and situational cues (i.e., being offered a cigarette) were related to the likelihood of reporting smoking cigarettes on any EMA within a day.Results: Perceived social pressure and support to quit were not related to daily smoking status. Participants were more likely to smoke on days when they were offered a cigarette compared to days when no such event occurred (OR = 3.31 [95% CI = 1.21, 9.06]). This effect was also significant after adjusting for perceived social pressure to quit and support to quit (OR = 3.38 [95% CI = 1.23, 9.31]). Conclusion:The results suggest that being offered a cigarette negatively impacts smoking cessation. The results reinforce the need for including cigarette refusal skills in smoking cessation *

This study explored the role of social activism in the association of exposure to media coverage of police brutality and protests with perceptions of mental health. Data for this study came from a sample of African Americans (N = 304) who responded to an online survey. Perceptions of mental health were assessed using a single item developed by the research team. Exposure to police brutality and protests was measured by asking how often they had seen or heard about African Americans being victims of police brutality and seen or heard about protests on television, social media, or other outlets. Participants were also asked about the extent to which these events caused them emotional distress. Social activism was assessed by asking participants if they had ever participated in political activities, such as calling their representative. Moderation and mediation analyses were conducted using linear regression. Moderation analyses showed that greater emotional distress from watching media coverage of police brutality and protests was associated with worse perceptions of mental health only when engagement in social activism was low. In contrast, mediation analyses indicated that greater frequency of and emotional distress from exposure to media coverage was indirectly associated with worse perceptions of mental health through increased engagement in social activism. Social activism may be an important method for coping with emotional distress from watching media coverage of police brutality and protests, but more research is needed to understand how African Americans might engage in social activism without adversely impacting mental health.

The current study investigated whether stressful life events and everyday discrimination experiences were associated with using one or more substances in the past 30‐days and substance use disorder (SUD) among adults experiencing homelessness. We obtained survey data from adults (N = 501) seeking services at a day shelter. Participants self‐reported whether they used cigarettes, other tobacco products, cannabis, alcohol, opioids, amphetamine, and cocaine/crack in the past 30‐days, and the total number of substances used were also calculated. We measured stressful life events and everyday discrimination using validated scales. We used multivariable logistic and negative binomial regression analyses to evaluate hypothesised associations. Results indicated that reporting a higher number of stressful life events was associated with past 30‐days cannabis, tobacco, alcohol, and other substance use, screening positive for a SUD, and using a greater number of substances in the past 30 days. After accounting for stressful life events, everyday discrimination was associated with only past 30‐days cannabis use. Overall, we found that reporting stressful life events was related to current substance use and screening positive for a SUD. Findings suggest that life stressors, and discrimination to a lesser extent, were associated with substance use and SUD among adults experiencing homelessness.

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