Most users of unsupported Internet interventions visit that site only once, therefore there is a need to create interventions that can be offered as a single brief interaction with the user. The main goal of this study was to compare the effect of a one-session unsupported Internet intervention on participants' clinical symptoms (depressive and anxiety symptoms) and related variables (mood, confidence and motivation). A total of 765 adults residing in the United States took part in a randomized controlled trial. Participants were randomly assigned to one of five brief plain text interventions lasting 5-10 min. The interventions designed to address depressive symptoms were: thoughts (increasing helpful thoughts), activities (increasing activity level), sleep hygiene, assertiveness (increasing assertiveness awareness), Own Methods (utilizing methods that were previously successful). They were followed-up one week after consenting. A main effect of time was observed for both depression (F(1, 563) = 234.70, p < 0.001) and anxiety (F(1, 551) = 170.27, p < 0.001). In all cases, regardless of assigned condition and Major Depressive Episode status, mean scores on both positive outcomes (mood, confidence and motivation) and negative outcome scores (depression and anxiety) improved over time. Brief unsupported Internet interventions can improve depressive symptoms at one-week follow-up. Further outcome data and research implications will be discussed.

Internet interventions face significant challenges in recruitment and attrition rates are typically high and problematic. Finding innovative yet scientifically valid avenues for attaining and retaining participants is therefore of considerable importance. The main goal of this study was to compare recruitment process and participants characteristics between two similar randomized control trials of mood management interventions. One of the trials (Bunge et al., 2016) was conducted with participants recruited from Amazon's Mechanical Turk (AMT), and the other trial recruited via Unpaid Internet Resources (UIR). Methods: The AMT sample (Bunge et al., 2016) consisted of 765 adults, and the UIR sample (recruited specifically for this study) consisted of 329 adult US residents. Participants' levels of depression, anxiety, confidence, motivation, and perceived usefulness of the intervention were assessed. The AMT sample was financially compensated whereas the UIR was not. Results: AMT yielded higher recruitment rates per month (p < .05). At baseline, the AMT sample reported significantly lower depression and anxiety scores (p < .001 and p < .005, respectively) and significantly higher mood, motivation, and confidence (all p < .001) compared to the UIR sample. AMT participants spent significantly less time on the site (p < .05) and were more likely to complete follow-ups than the UIR sample (p < .05). Both samples reported a significant increase in their level of confidence and motivation from pre-to post-intervention. AMT participants showed a significant increase in perceived usefulness of the intervention (p < .0001), whereas the UIR sample did not (p =. 1642). Conclusions: By using AMT, researchers can recruit very rapidly and obtain higher retention rates; however, these participants may not be representative of the general online population interested in clinical interventions. Considering that AMT and UIR participants differed in most baseline variables, data from clinical studies resulting from AMT samples should be interpreted with caution.

Introduction: Tobacco disparities persist among low-income smokers who seek care from safety-net clinics. Many of these patients suffer from chronic illnesses (CILs) that are associated with and exacerbated by smoking. The objective of the current study was to examine the differences between...

Despite a general decline in smoking rates among the U.S. population, smoking among low-income populations remains disproportionately high, likely due to the social determinants of health. To inform tailored approaches and responsive public health policies, the aim of this study was to qualitatively explore the sociocultural contexts, attitudes, and behaviors regarding smoking and quitting in a sample of low-income adults who smoke. In-depth, semi-structured qualitative interviews were conducted with 20 adults. Participants were recruited through local safety-net primary care clinics and community sites. A thematic analytic approach was utilized to analyze transcribed interviews. In exploring smoking and quitting within the context of low-income individuals, the following six themes were identified: caught between health and tobacco use; the nuances of context; roadblocks to quitting; motivation without movement; a temporary escape; and one size does not fit all. Insights into sociocultural and environmental contexts that shape smoking and quitting among low-income individuals revealed a complex interplay of factors that perpetuate smoking behavior and make it difficult to achieve sustained cessation. The study findings point to the importance of patient-centered and collaborative approaches that tailor smoking cessation efforts to the unique needs and lived experiences of low-income people who smoke.

Introduction: Adults from low-income backgrounds who smoke face significant health disparities related to tobacco use, often at disproportionately high rates. These individuals are more likely to endure multiple mental and physical (MP) health conditions, which can negatively influence their self-rated health (SRH). The quality and effectiveness of patient-clinician communication (PCC) can influence how patients perceive their own health. Understanding how PCC influences SRH among low-income adults who smoke and suffer from multiple MP conditions is essential for clinical care as multimorbidity is on the rise. This study examines how PCC may influence the health perceptions of low-income adults who smoke and have varying MP conditions.Methods: Low-income adults who smoke (N = 58) were recruited from the San Francisco Health Network (SFHN) and were assessed for number of MP conditions, PCC, and SRH. A moderation analysis was performed to examine whether PCC moderated relations between MP conditions and SRH. Follow-up analyses were conducted to examine differences and relationships among variables. In planned exploratory analysis, all possible choices for moderator-independent-dependent-variable selections to explore the best model fit were conducted.Results: The results revealed that PCC moderated the association between MP conditions (p < 0.05) and SRH. In follow-up analyses, number of MP conditions predicted poorer SRH for low-income smokers who experienced low (p < 0.001) and average (p < 0.01) levels of PPC but not high levels of PCC. In planned exploratory analysis, based on the Akaike Information Criterion, a quantitative basis for considering SRH as the dependent variable was established.Conclusion: The intersection of tobacco-related disparities among low-income adults who smoke and manage multiple MP conditions is complex. Among this vulnerable population, poor and average PCC adversely influences how patients perceive their own health. Results highlight the importance of quality and effective communication between patients and providers. A culturally informed patient-centered approach to care may improve PCC as it encourages collaborative, individually tailored treatment that empowers patients to actively participate in their own health care.

Introduction: Alcohol use disorder (AUD) and PTSD have high rates of co-occurrence in U.S. Military Veterans resulting in incrementally worse functional outcomes relative to having either one of these disorders alone. Cognitive dysfunction can impede one’s ability to benefit from standard behavioral AUD and PTSD treatments. Cigarette smoking is also highly prevalent among U.S. Military Veterans, and cognitive dysfunction is associated with chronic cigarette use among individuals with AUD and PTSD independently. However, much less is known about to what extent cigarette smoking further impairs cognitive functioning in individuals with both co-occurring AUD and PTSD. Materials and Methods: U.S. Veterans with co-occurring AUD and PTSD (n = 162) completed a comprehensive cognitive assessment covering various domains: working memory, processing speed, mental switching, cognitive inhibition, auditory-verbal learning, auditory-verbal memory, and verbal fluency. To examine the impact of alcohol use, traumatic stress, and cigarette smoking on cognitive function, we conducted a three-way interaction examining the moderated effects of smoking status on the association between alcohol use and PTSD symptoms on a composite domain of global cognition. Results: Smoking status in Veterans with co-occurring AUD and PTSD moderated the relationship between alcohol use and global cognition (P = .042), such that higher levels of alcohol use in the past week were related to worse global cognitive function among Veterans cigarette smokers (P = .015) but not among nonsmokers (P = .833). On follow-up analyses of individual cognitive domains, greater alcohol use in the past week was associated with lower cognitive inhibition in smokers but not nonsmokers, with traumatic stress symptoms moderating this effect (P = .039). Additionally, smoking status moderated the relationship between alcohol use and auditory-verbal learning, such that there was a differential relationship between alcohol use and auditory-verbal learning between smokers and nonsmokers. Conclusions: Overall, results provide evidence for the compounding impact of alcohol use, traumatic stress, and cigarette smoking on cognitive functioning. Impaired cognitive performance on a global level as well as on individual domains of cognitive inhibition and auditory-verbal learning were evident. Cognitive dysfunction may impede a Veteran’s ability to benefit from therapeutic treatment, and these cognitive domains may represent potential targets for cognitive training efforts. Further, study results support smoking cessation initiatives and smoke-free policies enacted at Veterans Affairs healthcare facilities and medical centers.