Tobacco-Related Health Disparities

This priority focuses on scientific research aimed at preventing, treating and reducing tobacco use and nicotine dependence and problem cannabis use; multiple health behavior interventions (e.g., obesity and tobacco-related treatments, co-use of cannabis, tobacco, alcohol and/or other substances); embedding tobacco treatments into existing programs (e.g., palliative care programs, cancer treatment or patient-centered medical home health care models); reducing secondhand tobacco and cannabis smoke exposure. Focus also will be on reducing tobacco-related diseases in priority groups and research that promotes a smoke-free life and environment among the following priority groups (alphabetical listing) and other groups with high rates of tobacco use:

• Active military and veterans
• Blue-collar workers
• Children, adolescents and young adults
• Incarcerated and formerly incarcerated individuals
• Individuals with mental illness, including addictive disorders
• Migrant agricultural workers
• People of low socioeconomic status, including the homeless
• People with disabilities
• People with limited education, including high school non-completers
• People with mental illness
• Pregnant and breastfeeding women
• Racial/ethnic minorities (e.g., African Americans, American Indians and Alaska Natives, Asian Americans, Latinos, Native Hawaiians and other Pacific Islanders, and individuals identifying with multiple racial groups)
• Rural residents
• Sexual/gender minorities (e.g., Lesbian, Gay, Bisexual, Transgender people)

Researchers may focus on other priority groups as long as they provide rationale to support including other groups disproportionately impacted by tobacco use and tobacco-related diseases.

• Collaborations and community engagement
• Social determinants of health
• Sub-focus areas
• Examples of relevant research topics

Collaborations and Community Engagement

Best practices are needed to effectively communicate tobacco prevention messages using cultural- and language-appropriate tools for California’s diverse population. Healthcare providers, social media, news media, online resources, and traditional print are widely accessed for health information by diverse groups. Studies are also needed to develop and disseminate effective communication strategies to counter tobacco industry marketing and advertising of traditional and new tobacco products to priority groups. Best practices are also needed to synthesize and communicate scientific evidence on TRHDs in a manner that can inform policy decisions at the local, state, and federal level.

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Social Determinants of Health

Evidence-based tobacco treatments remain underutilized by priority groups. Provisions in the Patient Protection and Affordable Care Act have expanded access to FDA-approved cessation medications for Medi-Cal patients and public/private insurance covers medications at low or no cost. Strategies are needed to increase access to cessation resources, educate smokers about the appropriate use of cessation medications, permit exploration of multiple cessation aids that considers negative side effects, and monitor and overcome barriers to utilization. We encourage research that aims to improve the uptake of evidence-based tobacco treatments in settings accessed by priority groups.

Research is needed to improve the science of tobacco/nicotine cessation interventions for priority groups, particularly for youth and young adults, and to determine if evidence-based programs developed for the general population are sufficient to reduce tobacco use in priority groups, the cost effectiveness of tailored interventions and non-tailored interventions, and for which priority groups tailoring improves effectiveness. Interventions focused on cessation should build on existing theories and evidence-based treatments and strive to promote the generalizability of intervention effects within and across priority groups.

Cessation Medications: Applicants proposing to use a cessation medication with adult smokers in their study may be able to obtain study medication at no cost through a TRDRP arrangement with a pharmaceutical company. Contact the Program for details.

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Sub-Focus Areas

Scientific research with potential to obtain impactful findings in the following areas is considered responsive to priority of reducing TRHDs:

• Optimizing tobacco-related prevention interventions
• Innovative tobacco cessation and cannabis-related interventions
• Harm reduction interventions
• Prevent and reduce child, adolescent and young adult tobacco use and secondhand smoke exposure
• Impacting the social determinants of TRHDs
• Self-reported health effects and contextual factors of new tobacco product and cannabis use

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Examples of relevant research topics

Optimizing tobacco-related prevention interventions

• Theoretical frameworks that support culturally sensitive health communications
• Innovative health messaging strategies and communication toolkits for multiple health behaviors (e.g., messaging that seeks to modify obesity and tobacco-related knowledge, attitudes and behavior)
• Tobacco treatments tailored for and evaluated in comprehensive health care programs (e.g., palliative care programs, cancer treatment or patient-centered medical home health care models)
• Social media and mobile technologies in health communications about tobacco use and other health risk behaviors
• Randomized controlled trials and quasi-experimental studies that compare health communications between and within priority groups
• Scientific evaluation of health messaging based on community practice-based knowledge or testing evidence-based interventions successful for other health issues (e.g., asthma, weight or diabetes management messages) for effectiveness in tobacco prevention

Innovative tobacco cessation and cannabis-related interventions

• Randomized controlled trials and quasi-experimental studies on culturally sensitive tobacco treatments that address current patterns of use (e.g. interventions that consider poly-tobacco use of cigarettes, e-cigarettes and/or little-flavored cigars; or treatments tailored to light and non-daily smoking)
• Improving access to culturally sensitive tobacco treatments (behavioral and multiple types of pharmacotherapies)
• Interventions that increase and sustain motivation for tobacco abstinence and repeated attempts to quit tobacco;
• Scientific evaluation of community practice-based interventions to expand cessation resources in diverse settings
• Clinical trials of practice-based and evidence-based tobacco treatments in priority groups not typically included in research (e.g., recently incarcerated individuals, rural residents, undocumented immigrants, refugees or people with severe mental illness)
• Multiple health behavior interventions (e.g., obesity, diabetes, illicit substance use or oral health interventions with a tobacco focus)
• Treatments that address tobacco and cannabis co-use issues with and without other substances (e.g., alcohol, prescription opiate misuse);
• Treatments that address problem cannabis use
• Examination of the potential for cannabis to mitigate or worsen opioid dependence and other cannabis co-use issues with other substances
• Health care provider knowledge of medicinal cannabis research and health effects from cannabis use
• Healthcare provider communication with patients about cannabis treatment for health problems
• Scientific evaluation of culturally sensitive and effective training models to prepare physicians, nurses, pharmacists and allied health professionals to address tobacco and cannabis use in diverse communities

Harm reduction interventions

• Theoretical models of harm reduction that account for TRHDs
• Extent of electronic nicotine delivery systems as cessation aids for priority groups
• Interventions focused on sustained abstinence among successful cigarette quitters
• Characterizing health effects and changes in dependence from long-term nicotine use
• Impact of secondhand exposure to smoke and vapor on former smokers, including recent quitters
• Health communication development for harm reduction strategies
• End-game strategies and their effect on behavior and social norm change for priority groups

Prevent and reduce child, adolescent and young adult tobacco use and secondhand smoke exposure

• Updating and modernizing school-based tobacco prevention curricula, as most evidence-based curricula are outdated
• Developing metrics to assess youth tobacco prevention activities that account for variability in intervention modality
• Scientific evaluation of practice-based tobacco prevention interventions conducted in diverse school and after school settings
• Targeted health communications for menthol and flavored tobacco and cannabis prevention, including non-nicotine/non-cannabis electronic cigarettes
• Youth-tailored communication toolkits for new and emerging tobacco products (e.g., "heat-not-burn" tobacco sticks) and cannabis products
• Reducing youth exposure to secondhand tobacco and cannabis smoke and vapor
• Impact of cannabis outlet density and proximity to schools on cannabis-related knowledge, attitudes and behavior
• Elucidating barriers and facilitators to smoking cessation among nicotine dependent youth
• Developing youth leaders in tobacco control and prevention

Impacting the social determinants of TRHDs

• Mechanistic studies to disentangle effects of social determinants of health on tobacco use among priority groups
• Innovative strategies to modify social and physical environments that promote tobacco-free lifestyles
• Extent to which addressing discrimination, stigma, ethnic identity and acculturation benefits tobacco prevention efforts and treatment interventions
• Nuanced interventions for American Indians that differentiate ceremonial tobacco use from commercial tobacco use
• Geospatial research that characterizes impacts of social determinants of health

Self-reported health effects and contextual factors of new tobacco product use and cannabis use

• Development of typologies and theoretical models for problem e-cigarette or cannabis use that define and characterize correlates of problem use for future research
• Theoretical frameworks for problem e-cigarette or cannabis use that take into account the social determinants of health, including cultural factors
• Extent to which heavy cannabis users are similar to or different from heavy tobacco smokers and heavy users of other substances
• Comparing the cannabis use across the lifespan (from youth experimentation to effects of chronic use on the aging brain) to the continuum of nicotine use and dependence
• Examining the health effects of cannabis use in priority populations
• Statistical models to estimate the epidemiological co-occurrence of cannabis use and cardiovascular disease, pulmonary disease and cancer incidence, progression or remission
• Elucidating factors associated with the social determinants of health and cannabis outlet density
• Social and contextual factors that encourage and discourage e-cigarette use and cannabis use across the lifespan
• Trajectories of cannabis use within priority groups (extent to which cannabis use is consistently light, heavy or intermittent as people age)
• Evaluating translational aspects of tobacco control research methods and theoretical models for cannabis research
• Comparison of self-reported health effects from secondhand cannabis smoke exposure to secondhand tobacco smoke and nicotine vapor exposure
• Extent to which social normalization of cannabis use re-normalizes tobacco use in California
• Comparative health effects and impairment by mode of cannabis use (smoking, vaping, edibles, dabs, topical application, tinctures/oils, etc.)
• Development of prevention interventions for cannabis use during pregnancy and breastfeeding
• Elucidating relationships between cannabis use and cognitive functioning and mental health (e.g., benefits and harms of cannabis use on PTSD, psychotic disorders, affective and anxiety disorders)

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