Judith J Prochaska

• PhD, MPH
• Professor (Full) at Stanford University

Introduction Smoking, obesity, and insufficient physical activity are modifiable health risk behaviors. Self-regulation is one fundamental behavior change mechanism often incorporated within digital therapeutics as it varies momentarily across time and contexts and may play a causal role in improving these health behaviors. However, the role of mom...

Highlights •Non-alcoholic beverages that mirror alcohol have potential benefits and risks. •Providers are currently offering varied health guidance on use of these beverages. •Research is needed to yield consensus on non-alcoholic beverage use health effects.

BACKGROUND Prolonged sitting and lack of moderate to vigorous physical activity represent two independent risk factors for myriad poor health outcomes. The negative effects of prolonged sitting can be ameliorated with as little as 2 minutes of large muscle movement. Further, cardiovascular benefits from moderate to vigorous activity can be accumula...

This Viewpoint discusses the current restrictions of nonalcoholic beverage sales to minors across several states and the need for expansion of those restrictions.

Background. Individuals with mental health disorders face major barriers in accessing smoking cessation care, often due to the stigmas associated with mental disorders and addiction. Consequently, accessible population-based smoking cessation interventions are needed for this vulnerable group. Objective. This secondary analysis utilized data from a...

Importance The prevalence of e-cigarette use among US adults, especially young adults, is rising. Many would like to quit vaping nicotine but are unable to do so. Cytisinicline, a plant-based alkaloid, targets nicotinic acetylcholine receptors, reduces nicotine dependence, and helps adults to stop smoking cigarettes. Cytisinicline may also help e-c...

Introduction Alaska Native and American Indian (ANAI) peoples in Alaska currently experience a disproportionate burden of morbidity and mortality from tobacco cigarette use. Financial incentives for smoking cessation are evidence-based, but a family-level incentive structure has not been evaluated. We used a community-based participatory research a...

An estimated 1.1 billion people currently smoke cigarettes,1 and 50 to 70% likely will die from tobacco-related causes.2 This translates to 550 to 770 million expected tobacco deaths among those who currently smoke. Many additional deaths will accrue in successive generations if the status quo continues. Of interest is the reversibility of the exce...

Background and aims: Non-alcoholic beverages (NABs) that mimic alcohol without inducing intoxication, such as non-alcoholic beers, non-alcoholic wines and spirit-free drinks, are increasing in popularity. It is unknown whether NABs help to mitigate or stimulate alcohol use. The present study aimed to describe NAB consumption practices among US adu...

Smoking causes one in three cancer deaths and may worsen COVID-19 outcomes. Telehealth tobacco cessation treatment is offered as a covered benefit for patients at the Stanford Cancer Center. We examined predictors of engagement during the COVID-19 pandemic. Data were abstracted from the Electronic Health Record between 3/17/20 (start of pandemic sh...

Purpose: Sexual and gender minority (SGM) individuals may receive social support through active use of social media (i.e., posting and interacting). This study examined associations between active social media use, social support, and health indicators in a large sample of SGM adults in the United States. Methods: Data were derived from the 2017 wa...

Background Smoking contributes to 1 in 3 cancer deaths. At the Stanford Cancer Center, tobacco cessation medication management and counseling are provided as a covered benefit. Patients charted as using tobacco are contacted by a tobacco treatment specialist and offered cessation services. As a novel addition, this study examined the acceptability...

BACKGROUND Smoking contributes to 1 in 3 cancer deaths. At the Stanford Cancer Center, tobacco cessation medication management and counseling are provided as a covered benefit. Patients charted as using tobacco are contacted by a tobacco treatment specialist and offered cessation services. As a novel addition, this study examined the acceptability...

Background and Aims: Non-alcoholic beverages (NABs) that mimic alcohol without inducing intoxication, such as non-alcoholic beers, non-alcoholic wines, and spirit-free drinks, are increasing in popularity. Unknown is whether NABs help mitigate or stimulate alcohol use. The present study aimed to describe NAB consumption practices among U.S. adults...

Background: Adolescents face unprecedented mental health challenges, and technology has the opportunity to facilitate access and support digitally connected generations. The combination of digital tools and live human connection may hold particular promise for resonating with and flexibly supporting young people's mental health. Objective: This...

Kratom products are derived from trees native to Southeast Asia and have dose-dependent stimulant and opioid-like effects. Despite being on the Drug Enforcement Administration "Drugs and Chemicals of Concern List," kratom is legal for sale in most US states. However, there are scarce data on its availability. The goal of this study was to examine k...

Importance: Cytisinicline (cytisine) is a plant-based alkaloid that, like varenicline, binds selectively to α4β2 nicotinic acetylcholine receptors, which mediate nicotine dependence. Although not licensed in the US, cytisinicline is used in some European countries to aid smoking cessation, but its traditional dosing regimen and treatment duration...

Nicotine vaping among adolescents, a major public health concern, may be exacerbated by exposure to pro-vaping social media content. This study interviewed adolescents about their perceptions of nicotine vaping-related social media content and its effects. Adolescents (analytic sample N = 30, age 13–18, in California, 73.3% never-vapers) participat...

Background The Cancer Center Cessation Initiative (C3I) is a National Cancer Institute (NCI) Cancer Moonshot Program that supports NCI-designated cancer centers developing tobacco treatment programs for oncology patients who smoke. C3I-funded centers implement evidence-based programs that offer various smoking cessation treatment components (e.g.,...

Background: Alaska Native and American Indian (ANAI) communities in Alaska are disproportionately affected by commercial tobacco use. Financial incentive interventions promote cigarette smoking cessation, but family-level incentives have not been evaluated. We describe the study protocol to adapt and evaluate the effectiveness and implementation o...

Our recently published study of >2.4 million adults in Northern California indicated that current versus never-tobacco smoking was associated with lower risk of SARS-CoV-2 infection and less severe coronavirus disease 2019 (COVID-19). We extended this research by evaluating whether these associations were moderated by socio-demographic factors and...

Purpose Negotiation is a consequential activity that can exacerbate power differentials, especially for women. While traditional contexts can prime stereotypical gender roles and promote conditions that lead to performance differences, these can be mitigated by context shifts. This proof-of-concept study explores whether an easy-to-apply context sh...

Introduction VLN King menthol and non-menthol are the first combustible cigarettes to receive US Food and Drug Administration (FDA) authorisation as modified risk tobacco products. Focusing on the first retail test market, this study characterised VLN advertising, product placement, discounts and price. Methods All Chicago-area Circle K stores (n=...

BACKGROUND Adolescents face unprecedented mental health challenges, and technology has the opportunity to facilitate access and support digitally connected generations. The combination of digital tools and live human connection may hold particular promise for resonating with and flexibly supporting young people’s mental health. OBJECTIVE This stud...

Although the harmful effects of smoking after a cancer diagnosis have been clearly demonstrated, many patients continue to smoke cigarettes during treatment and beyond. The NCCN Guidelines for Smoking Cessation emphasize the importance of smoking cessation in all patients with cancer and seek to establish evidence-based recommendations tailored to...

Background: Substance use disorders (SUDs) are prevalent and compromise health and wellbeing. Scalable solutions, such as digital therapeutics, may offer a population-based strategy for addressing SUDs. Two formative studies supported the feasibility and acceptability of the relational agent Woebot, an animated screen-based social robot, for treat...

Purpose We aimed to better understand hesitancy to use nicotine replacement therapy (NRT) to quit smoking. Design We content coded and analyzed NRT-related posts in online quit smoking support groups to understand NRT-use hesitancy and to examine associations with health outcomes. Setting NRT posts were analyzed in unmoderated social-media suppor...

Smoking continues to be the leading cause of preventable death in the United States, responsible for about one of every five deaths. Worldwide, 1 billion men and 250 million women use tobacco products. Nicotine, the primary psychoactive and addictive chemical in tobacco, drives tobacco use, leading to serious health consequences including the death...

Social media platforms have potential for reach and effectiveness to motivate smoking cessation and use of evidence-based cessation treatment, even during the worldwide COVID-19 pandemic. This study builds on our prior community participatory approach to developing content postings for the CAN Quit Facebook intervention among Alaska Native (AN) peo...

This cross-sectional study assessed how traditional eating relates to cultural and community factors. Alaska Native adults from the Norton Sound region were recruited and surveyed between 2015–2018 for a randomized clinical trial of multiple risk behavior change interventions for cardiovascular disease prevention. Participants (n = 291) were 49% fe...

Introduction: There is some evidence that social media interventions can promote smoking cessation. This randomized controlled pilot study is the first to evaluate the feasibility and potential efficacy of a Facebook smoking cessation intervention among Alaska Native adults. Methods: Recruitment and data collection occurred December 2019-March 2...

Introduction: Innovations are needed for preventing cardiovascular disease (CVD) and for reaching diverse communities in remote regions. The current study reports on a telemedicine-delivered intervention promoting a traditional heart-healthy diet and medication adherence with Alaska Native men and women residing in the Norton Sound region of Alask...

It is unknown whether use of e-cigarettes increases susceptibility to COVID-19. In a large clinical sample of young adults, we evaluated whether current or ever e-cigarette use was associated with polymerase chain reaction (PCR)-confirmed COVID-19. To address the confounding of combustible smoking, the sample was restricted to never smokers. This r...

Buddies, serving as in-group influencers to aid demographically similar cobuddies, are extensively used in face-to-face support groups to enhance positive social influence. The authors examine the efficacy of buddies in online support groups and investigate underlying mediating processes using social network analysis. They observe what happens when...

Introduction The relationship between cigarette smoking status and SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) severity is highly debated. We conducted a retrospective cohort study of >2.4 million adults in a large healthcare system to evaluate whether smoking is associated with SARS-CoV-2 infection and disease severity. Methods T...

Introduction: Self-regulation has been implicated in health risk behaviors and is a target of many health behavior interventions. Despite most prior research focusing on self-regulation as an individual-level trait, we hypothesize that self-regulation is a time-varying mechanism of health and risk behavior that may be influenced by momentary conte...

Objective: Prior studies indicate lower employment and greater difficulty securing reemployment among individuals who smoke or are overweight. In an anonymous online survey, we examined willingness to hire candidates who smoke cigarettes or are overweight for different job types and tested respondents' smoking history and body weight as moderating...

Background In this paper, we argue for Gender as a Sociocultural Variable (GASV) as a complement to Sex as a Biological Variable (SABV). Sex (biology) and gender (sociocultural behaviors and attitudes) interact to influence health and disease processes across the lifespan—which is currently playing out in the COVID-19 pandemic. This study develops...

Objective: The COVID-19 pandemic has produced major life disruptions and increased stress. We explored associations between pandemic-related stress and substance use problems. Method: Adults (N = 180; 65% female) with problematic substance use (CAGE-AID > 1) were recruited online June-August 2020. Measures included the 15-item Short Inventory of...

The NCI’s Cancer Center Cessation Initiative (C3I) has a specific objective of helping cancer centers develop and implement sustainable programs to routinely address tobacco cessation with patients. Sustaining tobacco treatment programs requires the maintenance of (1) core program components, (2) ongoing implementation strategies, and (3) program o...

Introduction Owned by a major US tobacco company with no American Indian/Alaska Native (AI/AN) tribal affiliation, Natural American Spirit (NAS) cigarette packs feature an American Indian warrior, thunderbird and peace pipe. The current study examined AI/AN adults’ perceptions of NAS cigarette packs in the US, which have not been reported on prior....

Background This study examined young people’s e-cigarette risk perceptions, policy attitudes, and past-month nicotine vaping in 30 US cities in relation to city e-cigarette retail policy. Methods Participants ages 13-20 were recruited online September-November 2020 (N=900, approximately 30 per city). Cities (median population=688,531) were in 23 s...

Background: Binge drinking and smoking among adolescents are serious public concerns. However, very few studies have explored the reinforcement of bullying victimization by such behavior. Our study aimed at examining the individual and combined associations of smoking and bullying victimization with binge drinking among adolescents in Beijing, Chin...

Background The COVID-19 pandemic disrupted access to treatment for substance use disorders (SUDs), while alcohol and cannabis retail sales increased. During the pandemic, we tested a tailored digital health solution, Woebot-SUDs (W-SUDs), for reducing substance misuse. Methods In a randomized controlled trial, we compared W-SUDs for 8 weeks to a w...

During the COVID-19 pandemic, studies have documented increased and decreased cigarette smoking among adults. Individual differences in the perceived susceptibility and seriousness of the virus, for people who smoke in general and for oneself personally, may relate to changes in smoking. Using the Health Belief Model (HBM) as a theoretical framewor...

Background Health behavior change interventions delivered by social media allow for real-time, dynamic interaction, peer social support, and experimenter-provided content. Aims We tested the feasibility, acceptability, and preliminary efficacy of a novel Twitter-based walking break intervention with daily behavior change strategies and prompts for...

Background Sexual and gender minority (SGM) individuals experience minority stress, especially when they lack social support. SGM young adults may turn to social media in search of a supportive community; however, social media use can become problematic when it interferes with functioning. Problematic social media use may be associated with experie...

Research on nicotine metabolism has primarily focused on white adults. This study examined associations between nicotine metabolism, tobacco use, and demographic characteristics among Alaska Native adults who smoke cigarettes. Participants (N = 244) were Alaska Native adults who smoked and who provided a plasma sample at baseline (70.1%) or follow-...

Background The Cancer Center Cessation Initiative (C3I) was launched in 2017 as a part of the NCI Cancer Moonshot program to assist NCI-designated cancer centers in developing tobacco treatment programs for oncology patients. Participating centers have implemented varied evidence-based programs that fit their institutional resources and needs, offe...

With patented nicotine salt technology, JUUL dominates the e-cigarette market. We reviewed studies of JUUL’s nicotine pharmacokinetic profile and studies quantifying nicotine in a JUULpod, emitted in the aerosol and absorbed by users. Examined in eight studies, JUUL’s peak nicotine levels were half to three-quarters that of a combustible cigarette...

UNSTRUCTURED Social media presents an effective tool to reach, engage, and connect smokers in cessation efforts. Our team developed the Facebook group, CAN Quit (Connecting Alaska Native People to Quit smoking), to promote utilization of evidence-based smoking cessation resources for Alaska Native (AN) people living in Alaska, which are underutiliz...

Social media provides an effective tool to reach, engage, and connect smokers in cessation efforts. Our team developed a Facebook group, CAN Quit (Connecting Alaska Native People to Quit smoking), to promote use of evidence-based smoking cessation resources for Alaska Native people living in Alaska, which are underused despite their effectiveness....

Background Co-occurrence of tobacco use and heavy episodic drinking (HED; 5+ drinks for men and 4+ drinks for women per occasion) is common among young adults; both warrant attention and intervention. In a two-group randomized pilot trial, we investigated whether a Facebook-based smoking cessation intervention addressing both alcohol and tobacco us...

Background Most U.S. states have legalized cannabis for medical and/or recreational use. In a 6-month prospective observational study, we examined changes in adult cannabis use patterns and health perceptions following broadened legalization of cannabis use from medical to recreational purposes in California. Methods Respondents were part of Stanf...

This study examined nicotine and cannabis vaping among adolescents in treatment for substance use disorders. Participants were 363 adolescents aged 12–17 (66% male, mean age=15.5 [SD=1.3], 46% non-Hispanic white) seen for a specialty addiction intake evaluation between 2017 and 2019 at one of six medical offices of a large, integrated health care s...

Background: The Cancer Center Cessation Initiative (C3I) was launched in 2017 as a part of the NCI Cancer Moonshot program to assist NCI-designated cancer centers in developing tobacco treatment programs for oncology patients. Participating centers have implemented varied evidence-based programs that fit their institutional resources and needs, off...

A social media scan of glo advertising in July 2020 revealed a covert marketing strategy. Social media influencers participating in glo online challenges linked to #ohnewennundoder ("#noifandor") without revealing the nature of the glo product or the relationship with the tobacco industry. Glo challenges emphasised a 'best of both worlds' theme -'T...

Background: The Cancer Center Cessation Initiative (C3I) was launched in 2017 as a part of the NCI Cancer Moonshot program to assist NCI-designated cancer centers in developing tobacco treatment programs for oncology patients. Participating centers have implemented varied evidence-based programs that fit their institutional resources and needs, off...

Objective Physical activity (PA) during COVID-19 shelter-in-place (SIP) may offset stress. This study examined associations between PA, stress and stress management strategies during SIP. Design and main outcome measures Participants (N = 990) from a cohort of Northern California adults completed surveys during early SIP (3/23/20-4/2/20) and mid-S...

Sexual identity is associated with tobacco use in adults. We examined tobacco use and susceptibility to use by sexual identity in adolescents. Data were collected in February 2019 via Qualtrics research participant panels. Data analyses were performed in June 2019 and updated in October 2020. Respondents aged 13-17 reported sexual identity (heteros...

Background Face-to-face tobacco cessation has had limited reach and efficacy in Alaska Native (AN) communities. We describe our 2-phased approach to develop content for CANQuit, a Facebook (FB) group intervention to reduce barriers to evidence-based smoking cessation treatment for AN people in Alaska. Methods Phase 1 included semi-structured telep...

Though not native to Alaska, tobacco use is common among Alaska Native people in the Norton Sound region, an area consisting of 16 communities with population size 107 to 3,695. We summarise best practices in recruiting Alaska Native adults who smoke for a randomised controlled tobacco treatment trial. Participants were Alaska Native, 19 years and...

Introduction U.S. reductions in smoking have not been experienced equally. Smoking prevalence is greater among persons of lower education, lower income, and unemployed. We evaluated whether a cessation intervention for job-seekers would result in significantly fewer cigarettes smoked per day and a greater likelihood of tobacco abstinence and re-emp...

Millions of U.S. adults join online support groups to attain health goals, but the social ties they form are often too weak to provide the support they need. What impedes the strengthening of ties in such groups? We explore the role of demographic differences in causing the impediment and demographic self-disclosure in removing it. Using a field st...

BACKGROUND Misuse of substances is common, can be serious and costly to society, and often goes untreated due to barriers accessing care. Digital health programs offer greater public health reach. Woebot is a mental health digital solution informed by Cognitive Behavioral Therapy and built upon an artificial intelligence (AI) driven platform to del...

Background Misuse of substances is common, can be serious and costly to society, and often goes untreated due to barriers to accessing care. Woebot is a mental health digital solution informed by cognitive behavioral therapy and built upon an artificial intelligence–driven platform to deliver tailored content to users. In a previous 2-week randomiz...

Background: Although cigarette smoking typically begins in adolescence, evidence for successful pharmacological smoking cessation interventions for this population is scarce. In adult smokers, varenicline is the most effective single pharmacotherapy. The aim of this study was to assess the efficacy and tolerability of varenicline for smoking cessa...

This study develops a gender assessment tool for use in clinical and population research, including large-scale health surveys involving diverse Western populations. While analyzing sex as a biological variable is widely mandated, gender as a sociocultural variable is not, largely because the field lacks quantitative tools for analyzing the influen...

Background Secondhand smoke (SHS) exposure in children and adolescents has adverse health effects. For adolescents of lower socioeconomic status (SES), exposure is widespread, evidenced in the measurement of urinary cotinine, a major metabolite of nicotine. Direct intervention with exposed children has been proposed as a novel method, yet there is...

BACKGROUND Sexual and gender minority (SGM) individuals experience minority stress, especially when they lack social support. SGM young adults may turn to social media in search of a supportive community; however, social media use can become problematic when it interferes with functioning. Problematic social media use may be associated with experie...

Heavy blunt use is common among young adult cannabis users, especially African Americans. This exploratory qualitative study aimed to examine how African American young adults understand, talk about and experience their blunt use. Semi-structured interviews were conducted with adults reporting daily or almost daily blunt use in the past month (N =...

Introduction: The decline in tobacco smoking among US adolescents has been exceeded by the exponential rise in nicotine vaping with an overall net gain in youth tobacco product use. While cigarette companies are restricted from advertising on television/radio, vaping promotions have been largely unrestricted. This study examined exposure to tobacc...

Introduction Research has documented higher smoking prevalence with unemployment and greater difficulty with gaining re-employment for those who smoke. Using photo elicitation methods, we sought to gain a deeper understanding of the connection between job-seeking and tobacco use. Methods Unemployed daily smokers (18 men, 1 woman) were recruited fr...

Background Often perceived as a safer smoke, Natural American Spirit (NAS) may find particular appeal in communities with strong non-smoking norms. We hypothesized NAS would be more popular in cities with lower smoking prevalence, with the pattern unique to NAS. We tested household income, cigarette taxes, and young adult population as alternative...

Purpose Natural American Spirit (NAS) cigarettes, which have recently grown in popularity, are marketed as eco-friendly and natural. The present study examined whether NAS's on-the-pack messaging influences adolescents' health perceptions of the brand. Methods In a mixed-factor design, adolescent participants (N = 1,003, ages 13–17, 75% female) we...

Introduction: Approximately 9 million American adults use two or more tobacco products regularly, referred to as dual or poly tobacco users. In Alaska, where tobacco is not native, approximately 20% of the population smokes cigarettes, and among smokers, 10% use two or more tobacco products. Previous research suggests that dual tobacco product use...

BACKGROUND Prolonged sitting is an independent risk behavior for chronic disease. With most interventions focusing on physical activity and exercise, there is a separate need for investigation into innovative and accessible interventions to decrease sedentary behavior throughout the day. Twitter is a social-media based platform with application for...

Background Prolonged sitting is an independent risk behavior for the development of chronic disease. With most interventions focusing on physical activity and exercise, there is a separate need for investigation into innovative and accessible interventions to decrease sedentary behavior throughout the day. Twitter is a social media platform with ap...

Stigma – which involves stereotyping, discrimination, and status loss – is a central driver of morbidity and mortality. Given the de-normalization of smoking and the status loss of unemployment, unemployed individuals who smoke may occupy multiple stigmatized identities. As such, this study examined aspects and correlates of smoking and unemploymen...

As part of a National Cancer Institute Moonshot P30 Supplement, the Stanford Cancer Center piloted and integrated tobacco treatment into cancer care. This quality improvement (QI) project reports on the process from initial pilot to adoption within 14 clinics. The Head and Neck Oncology Clinic was engaged first in January 2019 as a pilot site given...

BACKGROUND Secondhand smoke (SHS) exposure in children and adolescents has adverse health effects. For adolescents of lower socioeconomic status (SES), exposure is widespread, evidenced in the measurement of urinary cotinine, a major metabolite of nicotine. Direct intervention with exposed children has been proposed as a novel method, yet there is...

Objective Tobacco use is detrimental to physical and financial wellbeing. Smoking is associated with unemployment and a harder time finding re-employment. The current study examined job-seekers’ prioritization of smoking over other discretionary items. Methods Adult, unemployed job-seekers smoking daily ranked items from 1 (highest) to 13 (lowest)...

Background: People with a psychiatric diagnosis smoke at high rates, yet are rarely treated for tobacco use. Health care systems often use a 'no treatment' default for tobacco, such that providers must actively choose (opt-in) to treat their patients who express interest in quitting. Default bias theory suggests that opt-in systems may reinforce t...