Project Summary/Abstract Cigarettes are used by over 34 million U.S. adults and cause more than 480,000 deaths annually due to smoking and smoke exposure. Despite smoking at similar rates and consuming less cigarettes per day, African Americans are more likely to die from several tobacco-caused cancers compared to Whites. Quitting smoking reduces the risk of premature death and adds years to life expectancy; however, a disparity exists in annual quit rates between African Americans and Whites (4.9% vs. 7.1%). This disparity is due to several social determinants. Thus, it is critical to investigate scalable, evidence-based strategies to increase smoking cessation among African Americans. African Americans are twice as likely to use quitlines compared to Whites. However, little is known about the impact of mHealth interventions among African Americans using quitlines. In preliminary studies conducted by Penn State investigators, we found that automated text messaging was feasible for monitoring smoking status and providing smoking cessation support. However, these studies were not designed to assess the impact of interventions in minority populations. A recent study compared engagement and abstinence rates between Black and White smokers in a national texting cessation program and found that Blacks were just as likely as Whites to enroll and remain in the program; yet Blacks were less likely to respond to abstinence assessments and report cessation. Few studies have focused on the behaviors and perceptions of quitline texting services among African Americans. The current project proposes to assess data from the Pennsylvania quitline to inform a tailored mHealth smoking cessation intervention. The overall goal of this Mentored Career Development Award (K01) is to build on the candidate’s advanced postdoctoral training by developing her expertise to investigate and alleviate disparities in tobacco-related disease for racial minorities through the use of technology interventions. Career development objectives are to develop expertise in: 1) mHealth applications for smoking cessation, 2) qualitative data analysis, and 3) clinical research skills in ecological momentary assessment. The central hypothesis is that social determinants will explain differences in smoking abstinence between African Americans and White smokers using technology as a cessation aid. The specific aims for this study will be to 1) conduct a secondary analysis of the PA quitline texting program data and provide an overview of service engagement and smoking rates during enrollment and at 6-month follow-up; 2) to conduct qualitative interviews with African Americans who enrolled in the PA quitline texting program to better understand the factors that serve as barriers to engagement and abstinence; 3) To conduct a pilot EMA study to inform a tailored mHealth smoking cessation intervention for African Americans. The research environment is an academic medical center with the facilities, technology, resources, and advanced equipment to support the research and training proposed in this award.

Project Narrative This project focuses on improving the impact of mobile health (mHealth) technology among African Americans using state quitline services. This research has implications for how smoking cessation interventions are designed with the potential to reduce disparities in tobacco-caused diseases. This project has the potential to be expanded to other state quitlines and leverage the use of advanced statistical methodologies such as just- in-time adaptive interventions (JITAIs).