Cigarette smokers and substance users discount the value of delayed outcomes more steeply than non-users. Higher discounting rates are associated with relapse and poorer treatment outcomes. The left dorsolateral prefontal cortex (DLPFC) exerts an inhibitory influence on impulsive or seductive choices and greater activity in the prefrontal cortex is associated with lower discounting rates. We hypothesized that increasing activity in the left DLPFC with high frequency repetitive transcranial magnetic stimulation (HF rTMS) would decrease delay discounting and decrease impulsive decision-making in a gambling task as well as decrease cigarette consumption, similar to other studies. In this single-blind, within-subjects design, smokers with no intention to quit (n=47) and nonsmokers (n=19) underwent three counterbalanced sessions of HF rTMS (20Hz, 10Hz, sham) delivered over the left DLPFC. Tasks were administered at baseline and after each stimulation session. Stimulation decreased discounting of monetary gains (F[3,250]=4.46, p<.01), but increased discounting of monetary losses (F[3,246]=4.30, p<.01), producing a reflection effect, normally absent in delay discounting. Stimulation had no effect on cigarette consumption. These findings provide new insights into cognitive processes involved with decision-making and cigarette consumption and suggest that like all medications for substance dependence, HF rTMS is likely to be most effective when paired with cognitive-behavioral interventions.

Objectives We examined socioeconomic disparities in a community-based tobacco dependence treatment program. Methods We provided cognitive-behavioral treatment and nicotine patches to 2739 smokers. We examined treatment use, clinical and environmental, and treatment outcome differences by socioeconomic status (SES). We used logistic regressions to model end-of-treatment and 3- and 6-month treatment outcomes. Results The probability of abstinence 3 months after treatment was 55% greater for the highest-SES than for the lowest-SES (adjusted odds ratio [AOR]= 1.55; 95% confidence interval [CI ]= 1.03, 2.33) smokers and increased to 2.5 times greater for the highest-SES than for the lowest-SES smokers 6 months after treatment (AOR = 2.47; 95% CI = 1.62, 3.77). Lower-SES participants received less treatment content and had fewer resources and environmental supports to manage a greater number of clinical and environmental challenges to abstinence. Conclusions Targets for enhancing therapeutic approaches for lower socio-economic groups should include efforts to ensure that lower-SES groups receive more treatment content, strategies to address specific clinical and environmental challenges associated with treatment outcomes for lower-SES smokers (i.e., higher dependence and stress levels and exposure to other smokers), and strategies to provide longer-term support.

We sought to gain an empirical and practical understanding of the barriers experienced by Arkansas Mississippi Delta residents to using the free telephone counseling (quitline) for tobacco dependence. Barriers included lack of knowledge about the quitline, lack of trust in the providers, as well as multiple root causes to seeking and achieving abstinence from tobacco including issues related to the poor socio-economic context and concerns about negative health effects of quitting. A strong belief in the role of faith in the process of quitting was expressed. Participants suggested strategies for increasing knowledge and trust levels, but were not hopeful about addressing root causes. Given the considerable resources being allocated to quitlines and the burden of tobacco use and disease in lower socioeconomic and minority groups, understanding utilization of quitlines by these groups has implications for policy development, the promotion of quitlines, and the provision of alternate tobacco treatment services.

Although quitlines often increase access to treatment for some lower SES smokers, significant socioeconomic disparities in treatment outcomes raise questions about whether current approaches are contributing to tobacco-related socioeconomic health disparities. Strategies to improve treatment outcomes for lower SES smokers might include novel methods to address multiple factors associated with socioeconomic disparities.