A proposed, expanded Common-Sense Model (CSM) contextualized to the self-regulation of cancer recurrence risk identifies risk representational attributes and recurrence worry as primary processes motivating protective behaviours in cancer survivors post-treatment. A systematic review examined evidence for CSM hypotheses regarding how these processes influence diet and physical activity (PA) among survivors. A research agenda is outlined and used to evaluate the status of the evidence base based on the studies meeting criteria for the systematic review. Common databases were searched for eligible, peer-reviewed, English language reports, yielding 18 studies quantitatively testing hypothesized relationships among representations of prior cancer, recurrence risk representations, recurrence worry, and diet and PA. The findings provide promising, but mixed and limited evidence for some of the hypothesized associations of specific risk recurrence attributes with recurrence worry, and risk recurrence attributes and recurrence worry with healthy diet and PA. Findings support the distinction of recurrence risk representations and illness representations of the prior cancer, with each showing different relationships with recurrence worry and behaviours. We discuss the status of the evidence base in relation to assessment, design, and analysis priorities and propose strategies that can yield more sensitive, rigorous tests of the CSM for cancer recurrence risk as applied to diet and PA.

Hispanics represent a critical target for culturally adapted diet interventions. In this formative research, we translated HealthyYouTXT, an mHealth program developed by the U.S. National Cancer Institute, into HealthyYouTXT en Español, a linguistically and culturally appropriate version for Spanish speakers in the United States. We report a three-stage, mixed-methods process through which we culturally adapted the text messages, evaluated their acceptability, and revised the program based on the findings. In Stage 1, we conducted initial translations and adaptations of the text libraries using an iterative, principle-guided process. In Stage 2, we used mixed methods including focus groups and surveys with 109 Hispanic adults to evaluate the acceptability and cultural appropriateness of the program. We used survey data to evaluate whether self-determination theory (SDT) factors (used to develop HealthyYouTXT) of autonomous motivation, controlled motivation, and amotivation and Hispanic cultural beliefs about familism, fatalism, and destiny predict program interest and its perceived efficacy. Mixed-methods analyses revealed substantial interest in HealthyYouTXT, with most participants desiring to use it and viewing it as highly efficacious. Both cultural beliefs (i.e., beliefs in destiny and, for men, high familism) and SDT motivations (i.e., autonomy) predicted HealthyYouTXT evaluations, suggesting utility in emphasizing them in messages. Higher destiny beliefs predicted lower interest, suggesting that they could impede program use. In Stage 3, we implemented the mixed-methods findings to finalize HealthyYouTXT en Español. The emergent linguistic principles and multistage, multimethods process can be applied in health communication adaptations.

Smoke-free homes (SFHs), the voluntary adoption of home smoking restrictions, are associated with reduced secondhand smoke exposure. However, SFHs are uncommon in permanent supportive housing (PSH) for formerly homeless adults, who have fivefold higher smoking rates than the general population. We pilot-tested a brief intervention to increase voluntary adoption of SFHs among PSH residents in the San Francisco Bay Area. We pilot-tested a brief intervention to increase voluntary adoption of SFHs among PSH residents in the San Francisco Bay Area. Rest of the methods, PSH residents (n = 100) and staff (n = 62) from 15 PSH sites participated in the intervention between October 2017 and February 2018. Research staff provided counseling to PSH residents on how to adopt an SFH and trained PSH staff on how to counsel residents on smoking cessation. The primary outcome was self-reported voluntary adoption of an SFH for ≥90 days, and the secondary outcome was carbon monoxide-verified PPA at 6-month follow-up. PSH staff completed the Smoking Knowledge, Attitudes, and Practices survey at baseline and 3-month follow-up. At 6 months, 31.3% of PSH residents had adopted an SFH (vs. 13.0% at baseline) and 16.9% reported carbon monoxide-verified PPA. A positive attitude toward an SFH policy was associated with increased odds of SFH adoption (adjusted odds ratio = 8.68, 95% confidence interval: 2.42, 31.17). Voluntary SFH adoption was associated with increased PPA (adjusted odds ratio = 26.27, 95% confidence interval: 3.43, 201.30). PSH staff reported improved attitudes toward and self-efficacy in delivering cessation care, and decreased barriers to discussing smoking cessation among PSH residents between baseline and 3-month follow-up. In this single-arm study, a brief intervention increased SFH adoption and PPA among PSH residents. To date, few interventions have addressed SFHs and their association with tobacco use among PSH residents. A “ground-up” approach that relies on buy-in from residents and that promotes voluntary SFHs is an innovative way to increase smoke-free living environments in PSH. This approach could pave a pathway for smoke-free policy implementation in these sites. PSH can play a role in reducing the burden of tobacco use by empowering its residents to adopt voluntary SFHs, which could increase smoking cessation among residents.

Objective: Graphic warning labels (GWLs) are effective in communicating tobacco-related harms. Methods: In this mixed-methods study, we used purposive sampling to recruit 100 low-income smokers in the San Francisco Bay Area between October 2017 and February 2018 to participate in an intervention promoting smoke-free homes. We presented the 2009 Food and Drug Administration-proposed GWLs and explored perceptions of affect, efficacy, and appeal using questionnaires at baseline, 3- and 6-months follow-up. Because of participants' interest in this topic, we subsequently conducted a qualitative sub-study among 20 participants exploring perceived efficacy of GWLs on smoking cessation. Results: In all, 87.3% and 59.2% agreed that GWLs were useful and would motivate cessation behaviors, respectively, at baseline. We found that the most common responses were shock (61.8%) and disgust (55.3%), whereas anger (29.0%) and annoyance (19.7%) were less common. Participants also reported that GWLs unequivocally illustrating smoking's harmful effects were more appealing than non-specific images, as were images that depicted positive cessation-related effects. Conclusions: GWLs appear to be an important health communication among low-income smokers. Future studies on GWLs should examine the association of negative affect and cessation among this population.

Background: Although rates of tobacco use in California have declined overall, adults in the San Joaquin Valley (SJV), particularly Hispanic or Latinos (“Latinos”), have disproportionately high rates of tobacco use, tobacco-related illness, and mortality. Residents of the SJV also have limited access to cessation support services and need accessible, nonclinical alternatives. Given high smartphone use rates among Latinos and residents of rural communities, digital health tools may present an accessible approach to expand cessation support. Objective: This study explored tobacco use behaviors, cessation experiences, and views about digital cessation tools for tobacco cessation among SJV residents. The secondary objective was to assess the appeal, usability, and necessary adaptations of 2 existing digital smoking cessation tools—a smoking cessation app and a social media–based cessation intervention. Methods: Through an SJV-based academic-community partnership, we recruited 29 predominantly Latino adults who reported current smoking. We conducted 4 focus group discussions to explore tobacco use and cessation experiences and preferences for smoking cessation tools: 1 in-person in English, 1 online in English, and 2 online in Spanish. Subsequently, 9 participants from the focus group discussions completed individual, in-depth interviews where they viewed videos describing 2 digital smoking cessation tools—a cessation app and a social media cessation intervention—to assess their appeal and usability. Focus groups and interviews were recorded, transcribed, and analyzed to identify themes. Results: Overall, 82.1% (23/28) had made a quit attempt in the past year, and most intended to quit smoking in the next 6 months, with 11.1% (3/27) never expecting to quit. Most participants were motivated to quit despite experiencing barriers, and they emphasized the need for culturally tailored digital cessation tools to help overcome the barriers to quitting smoking. They preferred interventions that integrated culturally relevant content reflecting lived experiences, featured language-concordant communications, and provided social supports, such as chat rooms for peer connection. Participants reported polyuse of tobacco with other substances, including cannabis, which may need to be addressed when delivering smoking cessation interventions. While participants appreciated the app’s private interface and comprehensive curriculum, they preferred the social media–based program for its engaging design, despite privacy concerns. Preferences for specific interventions varied by age and digital literacy. Participants also expressed preference for material rewards to incentivize the use of digital health tools to quit smoking. Conclusions: This sample of predominantly Latino adults from the SJV expressed favorable interest in digital cessation support, yet existing tools require adaptation to improve cultural relevance, accessibility, usability, and privacy concerns. Participants emphasized language-concordant services, representation from people with lived experience, and community-building features. While digital interventions were well received, privacy concerns and digital literacy barriers must be addressed to enhance engagement.