FRESH Delivers: An Innovative Approach to Reducing Tobacco Use Among Rural Black/African American Smokers

Modified Project Summary/Abstract Section In 2019, cigarette smoking was nearly double the national average (23%-26%) in Arkansas rural Delta counties. Factors such as persistent poverty, low educational attainment, high rates of unemployment, poor transportation, and poor access to health care providers pose tremendous challenges to successful quitting. Quitting smoking can substantially reduce cancer morbidity and mortality among rural residents in the Delta, but successful quitting as well as the reach of evidence-based interventions to rural Arkansans is alarmingly low. Few studies have empirically tested the efficacy of a home-based food delivery intervention that address the dynamic interplay of cancer risk behaviors, like smoking and food insecurity. The long-term goal of Project 2, FRESH Delivers, is to fill a critical gap in knowledge on the role of a home-based food delivery intervention in the elimination of tobacco-caused cancers. Our aims are to 1) test the efficacy of a home food delivery intervention on smoking abstinence using a 3-arm randomized controlled design, 2) examine changes in measures of cigarette abuse liability across treatment groups, and 3) examine the extent to which a home food delivery intervention improves recruitment and retention of smokers in the rural Delta region in the treatment condition. Our academic-community partnership – the University of Arkansas for Medical Sciences, Coalition for a Tobacco Free Arkansas, and the Arkansas Foodbank – has a strong collaborative foundation and experience in working together to reduce tobacco use in rural Arkansas Delta counties. Multilevel interventions are needed to address persistent conditions that potentially increase the abuse liability of smoking and impede successful quitting. Smokers who are more food insecure are less likely to quit smoking. Our multidisciplinary team will use an ecological model to test our central hypothesis: smokers who receive evidence-based real-time video-based motivational counseling and a home-based food delivery intervention will have greater cotinine-verified 7-day point prevalence abstinence than those who receive motivational counseling alone or food delivery alone. Interventions that meet the immediate needs of smokers living in rural Delta regions hold tremendous promise for improving recruitment and retention into helpful cancer prevention community trials, increasing successful quitting, and reducing factors that perpetuate tobacco-caused cancers.