Grant Number:	1R01CA309463-01A1 Interpret this number
Primary Investigator:	Dai, Hongying
Organization:	University Of Nebraska Medical Center
Project Title:	Real World Effectiveness of Naturalistic Use of Pharmacologic Smoking Cessation AIDS in Us Adults.
Fiscal Year:	2026

Project Summary Background: Tobacco cigarette smoking cessation substantially reduces the risk of premature mortality. Yet, quit rates remain low in the US, and FDA-approved cessation medications are underutilized, particularly in socioeconomically disadvantaged populations. One reason is that public health and clinical practitioners have hesitancy about endorsing quit smoking medications because the “real world” effectiveness has not matched efficacy results in randomized trials. Meanwhile, novel reduced-harm nonmedicinal nicotine and cannabis products are gaining popularity and being marketed as quit smoking aids, but their real-world effectiveness remains unknown. These critical knowledge gaps leave unclear whether public health officials should prioritize increasing medication access and if relaxing regulations on nonmedicinal commercial products may improve quit rates. Proposed study: To help address the efficacy–effectiveness gap in smoking cessation and elucidate the potential of non-FDA approved quit aids, this naturalistic cohort study will collect cigarette smoking cessation data as often as every two weeks to determine the real-world effectiveness of a spectrum of putative smoking cessation aids in US adults, and examine the markets, policies, and populations driving these relations. Data will be collected using the Understanding America Study, a nationally representative probability longitudinal panel of 20,000 U.S. adults. Current cigarette smokers will be repeatedly surveyed on quit readiness and attempts, abstinence, and use of medications (nicotine replacement, varenicline, bupropion) and commercial nicotine and cannabis products (e-cigarettes, non-tobacco oral nicotine products, THC, marijuana, cannabidiol [CBD]). Intensive longitudinal multi-level modeling of biweekly longitudinal survey data will examine the use of cessation aids as within-subject time-varying, time-lagged predictors of smoking cessation. This will capitalize on temporal precision for detecting the effects of quit aids on cessation processes and reduce static confounders that plagued past work. We will integrate survey data with geocoded multi-level data on policies (e.g., taxes, flavor bans, cannabis legalization) and commercial markets (e.g., local prices and sales of nicotine and cannabis products, tobacco and cannabis retail density, advertising and promotions). The aims of this study are: (Aim 1) To examine use of FDA-approved quit smoking medications and use of commercial nonmedicinal nicotine and cannabis products as predictors of attaining two smoking cessation milestones (short-term abstinence two weeks later and long-term abstinence up to 50 months). (Aim 2) To determine whether exposure to policies and commercial markets increases or decreases utilization of various cessation aids and has downstream effects on cessation outcomes. (Aim 3) We will also explore cross-population socioeconomic differences in the adoption and effectiveness of cessation aids. Impact: This project will help bridge the gap of efficacy-effectiveness discrepancy in smoking cessation with evidence of which putative cessation aids work in the real world, for whom, and why.





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