Disparities, cessation and neuroscience

This research priority has two elements:

Prevent and treat tobacco use and promote equity among disproportionately impacted groups

Tobacco use and tobacco-related diseases disproportionately affect racial/ethnic minorities, sexual/gender minorities, the poor, homeless, individuals with mental illness and military communities in California. (For more about these disparities, see Fagan, et al., 2004; Fagan, Moolchan, Lawrence, Fernander, & Ponder, 2007; Moolchan et al., 2007.)

We are interested in supporting research identified by the scientific literature and communities as important to reducing tobacco-related health disparities. Specifically, research is needed on groups with little or no epidemiological data, as well as tobacco prevention and cessation interventions that include the following groups:

• Racial/ethnic minorities (African Americans, Koreans, Latinos, Native Americans, Pacific Islanders, Vietnamese)
• Sexual/gender minorities (Lesbian, Gay, Bisexual, Transgender)
• The poor
• The homeless
• Individuals with mental illness (including addictive disorders)
• Older smokers
• Active military and veterans
• Rural communities
• Blue-collar workers
• Youth (children and adolescents, including transitional age youth (16-25))

Investigators seeking to focus their research on a priority group that is not listed here are encouraged to contact us before submitting a letter of intent.

In order to more fully understand the context in which tobacco-related disparities occur, a greater understanding of social, cultural, and behavioral factors associated with tobacco-related disparities is still needed. We encourage research projects that focus on elucidating socioeconomic, psychological, cultural, and economic correlates of tobacco prevention and cessation in priority populations. Disentangling the contextual factors of tobacco-related disparities in a manner that can inform policymakers and policy change is a critical need.

Electronic nicotine delivery systems (ENDS) have taken nicotine experimentation, regular use, and addiction into uncharted territory (ENDS: A Research Agenda). We welcome proposals that elucidate social, behavioral, cultural, and economic correlates of ENDS.

Delivering tobacco dependence treatments to those most in need: Provisions in the Affordable Care Act are expected to expand healthcare services to low-income groups. We encourage research focused on improving delivery of tobacco dependence treatments to priority groups, particularly interventions delivered in non-traditional settings, including service agencies accessed by low-income families (e.g., WIC), prison re-entry and juvenile justice related programs, employment agencies, homeless shelters, mental health settings, and faith-based organizations. Research on tobacco treatment services for priority groups in traditional settings (e.g., primary care) continues to be a need. Proposals focused on service delivery should also address adherence, retention, acceptability/feasibility, generalizability of approaches, and optimization for ethnic and cultural groups proposed in the recruitment plan.

*Applicants proposing the use of cessation medication with adult smokers may be able to obtain medication at no cost through a TRDRP arrangement with a pharmaceutical company. Contact us for details

Youth-focused epidemiological, prevention and cessation research conducted inside and outside of schools is needed. TRDRP and the California Department of Education have identified the following research areas as responsive to tobacco control priorities. However, applicants may also submit applications addressing other youth-focused research needs.

Particular areas of focus include:

• Prevalence, prevention and cessation of ENDS and non-nicotine analogues
• Research that can inform school policy on ENDS and non-nicotine analogues
• Evaluation research on the impact of statewide tobacco use prevention efforts for youth
• Elucidation of the association and correlates of marijuana and tobacco dual use
• Risk and protective factors for tobacco use among priority population youth
• Tobacco industry marketing practices targeted to youth; best practices to counter industry influence
• Best practices for instructional content for youth tobacco prevention
• Strategies to enhance youth understanding of the environmental toxicity of tobacco litter and engage youth in anti-tobacco litter advocacy
• Best practices for embedding tobacco prevention in a multiple risk behavior intervention

Studies on the basic neuroscience of nicotine addiction

Over 30 million people remain addicted to tobacco products generally and nicotine in particular. While advances have been made in understanding how nicotine affects the brain and subsequently leads to dependence, the key mechanisms and pathways that can blunt nicotine's addictive properties are yet to be fully identified and understood.

Recently, there have been advances in understanding the efficacy of nicotine vaccines. Some studies show promise, while others question this direction for smoking cessation (Fagerström & Tonstad, 2013; Esterlis et al., 2013). These contradictory findings further highlight the need for focused research on what therapeutic agents and processes can be identified to stem the tide of nicotine addiction.

Examples of relevant research topics include:

• Identifying or improving vaccines that can prevent the uptake of nicotine
• Improving the efficacy of existing cessation drugs and/or identifying and developing more efficacious partial agonists
• Testing the efficacy and side effects of existing cessation drugs in racial/ethnic minority, LGBT and low socioeconomic status groups, sectors typically not fully represented in clinical trials
• The addictive potential of e-cigarette vapor
• The addictive potential and abuse liability of different tobacco products
• The effects of long-term use of low dose nicotine products