The Impact of Social-Contextual Stressors on Psychopharmacological Mechanisms of Smoking Cessation and Relapse among Socioeconomically Disadvantaged Young Adults who Smoke Cigarettes

PROJECT SUMMARY Socioeconomically disadvantaged young adults (SDYA) are at a disproportionately greater risk of tobacco- related illness and disease compared to non-disadvantaged young adults in the U.S. Given that quitting smoking before age 30 reduces almost all of the mortality associated with ever smoking, understanding predictors of

smoking cessation and relapse in SDYA who smoke is critical to preventing the escalation and continuation of tobacco use in this high-risk group. SDYA who smoke and are transitioning into young adulthood are vulnerable to experiencing a wide range of social-contextual stressors (e.g., financial stress), which can interfere with their

motivation to quit and cessation efforts. In line with NIDA’s strategic plans to understand “how social determinants of health increase or decrease risk for addiction over the lifespan,” this MOSAIC K99/R00 grant application aims to provide empirical evidence on the social-contextual predictors of smoking cessation in SDYA who smoke.

Social-contextual stressors may be dynamic in nature and vary daily or moment-to-moment. To understand how day-to-day changes in social-contextual stressors affect smoking cessation in SDYA, we propose to combine: a) qualitative interviews focused on the lived experiences of SDYA who smoke to better understand how specific

social-contextual stressors are experienced in daily life with b) EMA of these stressors in a real-time, naturalistic environment. The specific aims of the K99 phase are to: 1) gain an in-depth understanding of how social- contextual stressors impact smoking cessation and relapse among SDYA who smoke and attempt to quit

smoking in the natural environment; and 2) develop and evaluate the acceptability and feasibility of an EMA protocol. To achieve these aims, a mixed methods approach (qualitative interviews with 30-40 SDYA ages 18- 25 who smoke and previously tried to quit; a pilot EMA study and exit interviews with 15 SDYA who smoke) will

be used to refine a protocol for a full EMA study. The R00 phase will include a larger-scale EMA study that will assess the impact of social-contextual stressors on psychopharmacological mechanisms of smoking cessation and relapse experienced at the event-level in 100 SDYA who smoke and are willing to make a serious quit

attempt in the next 30 days. The PI, Dr. Mariel Bello, will work with an exceptional team of mentors (Drs. Rachel Cassidy, Suzanne Colby, Jennifer Merrill, Tim Janssen, and Andrea Villanti) to develop expertise in five areas of training: 1) mixed methods research (qualitative + EMA); 2) EMA methodology; 3) intensive longitudinal data

analysis; 4) community-engaged research approaches; and 5) professional development skills. Successful completion of the research and training objectives detailed in this proposal will prepare Dr. Mariel Bello for a successful transition to independent faculty researcher, as well as further develop her program of research

focused on investigating the etiology and underlying mechanisms of tobacco-related health disparities among marginalized groups. Findings will provide initial evidence on how event-level characteristics lead to smoking relapse in SDYA, which will serve as preliminary data for future R01 applications.

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