Background: Electronic cigarette (e-cigarette) use among adolescents is a growing public health concern, particularly in low-income and Black communities. However, little is known about how social determinants of health shape e-cigarette perceptions in this population. Aims: This study examined social determinants associated with perceptions of e-cigarette safety among Baltimore high school students. Methods: A cross-sectional survey (CEASE Youth: School Survey) was conducted with 604 Baltimore high school students aged 14–20. Participants completed a questionnaire assessing perceptions of e-cigarette safety, as well as parental education, race/ethnicity, parental employment, household composition, and community tobacco use. Results: Higher parental education was associated with lower perceived e-cigarette safety among students. Students in higher grades also reported lower perceived e-cigarette safety. In contrast, male students—particularly those in upper grades—were more likely to perceive e-cigarettes as safe. Race/ethnicity, household composition, parental employment, and community tobacco exposure were not associated with perceived e-cigarette safety. Conclusion: Higher parental education, female gender, and being in higher grades were associated with perceiving e-cigarettes as unsafe. These findings highlight the need for targeted interventions to address vaping perceptions among youth in urban settings.

Background: Women have consistently shown lower quit rates in tobacco cessation programs compared to men. This gender disparity persists despite comprehensive interventions and access to cessation resources. While prior studies suggest that factors such as social support, chronic disease burden, and socioeconomic status may contribute to these differences, there is limited empirical evidence to confirm these mechanisms. Aims: This study aimed to investigate potential mechanisms underlying gender differences in quit rates in a tobacco cessation program, testing whether demographic, socioeconomic, health, or behavioral factors explain the observed disparities. Methods: Participants were assigned to one of three smoking cessation interventions: an in-person program (CEASE), a self-help approach, or an online/hybrid program. The main outcome measured was smoking abstinence, evaluated three months after the intervention. Secondary analyses explored whether demographic, socioeconomic, health, or tobacco use-related factors mediated the association between gender and quit rates. Results: Women had significantly lower quit rates than men (p < 0.01). This association remained significant after adjusting for demographic, socioeconomic, health, and addiction-related factors. While women reported higher social support and a higher prevalence of chronic cardiometabolic conditions, these factors did not explain the gender disparity in quit rates. Conclusions: Gender differences in quit rates persist despite controlling for known factors that could influence cessation success. Although women had higher social support, they had lower quit rate. Future research should explore unmeasured variables, such as psychological, biological, and structural influences, to develop more effective cessation strategies tailored for women.

Background: Menthol-flavored tobacco products are disproportionately used in low-income African American communities, a result of decades of targeted marketing and systemic inequities. Menthol use has been associated with lower quit rates, often compounded by factors such as lower trust in healthcare systems, reduced access to cessation programs, and other structural barriers. Despite this, few studies have systematically examined the explanatory mechanisms that might clarify why menthol-flavored tobacco is linked to poorer cessation outcomes among participants in tobacco cessation programs. Aims: This study aimed to investigate the potential mechanisms by which menthol tobacco use is associated with lower quit rates across three types of smoking cessation interventions. Methods: Participants were randomized into one of three smoking cessation interventions: in-person (CEASE), self-help, or online/hybrid programs. Smoking abstinence was assessed three months post-intervention as the primary outcome. Secondary analyses explored whether demographic, socioeconomic, or behavioral factors mediated the association between menthol use and quit rates across the intervention arms. Results: Menthol tobacco use was significantly associated with lower quit rates (p < 0.01). This association was not explained by demographic, socioeconomic, health, or addiction-related factors. While menthol use was associated with lower education and employment levels, demographic characteristics, physical or mental health, or addiction did not explain the effect of menthol on tobacco cessation. These findings suggest that the lower quit rates observed among menthol users cannot be attributed to any third factors assessed in this study. Conclusions: Menthol tobacco use independently predicts lower quit rates, and the mechanisms behind this disparity remain unclear. The consistent findings across different intervention types highlight the need for further research to uncover the underlying pathways and to design targeted strategies to improve cessation outcomes for menthol users.

Background: Despite advancements in smoking cessation interventions, few programs have demonstrated sustained effectiveness among low-income, underserved populations. The Communities Engaged and Advocating for a Smoke-free Environment (CEASE) program was developed to address this gap and support tobacco cessation in these communities. However, it remains unclear whether self-reported outcome measures in this context are in line with more objective outcome measures. Aims: This study aimed to validate self-reported quit rates using the Fagerström Test for Nicotine Dependence (FTND) as a gold standard outcome measure for evaluation of the effectiveness of the CEASE smoking cessation intervention compared to a self-help approach among low-income, underserved adult smokers. Methods: A quasi-experimental design was employed to evaluate this community-based intervention. Although participants were initially assigned to three groups, this report focuses on two arms that show the major difference in the efficacy of the program: (1) the self-help group (reference; Arm 1) and (2) the in-person CEASE group (Arm 2). Outcomes included successful quitting, assessed through self-reports, and changes in FTND scores. To examine the concordance between these measures, we tested whether changes in FTND scores fully explained the relationship between the intervention and self-reported quitting. Potential confounders included demographic, socioeconomic, and health-related variables. Data were analyzed using regression and structural equation modeling (SEM). Results: The majority of participants were Black Americans, followed by White individuals and those of other racial backgrounds. The CEASE intervention (Arm 2) demonstrated effectiveness in reducing nicotine dependence (measured by FTND) and increasing self-reported quit rates compared to the self-help group. Importantly, changes in FTND scores fully explained the effect of the CEASE intervention on self-reported quitting, highlighting the program’s impact on addiction severity. Conclusion: Successful quitting measured using self-report is in line with the decline in nicotine addiction severity among low-income racial minority populations. CEASE holds promise as a scalable solution to address smoking disparities in underserved communities.