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

> **NIH NIH P50** · UNIV OF ARKANSAS FOR MED SCIS · 2021 · $645,796

## Abstract

SUMMARY – PROJECT 2
Blacks/African Americans have the highest cigarette smoking-attributable cancer mortality rates in the United
States. Cigarette smoking is nearly double the national average (23%-26%) in Arkansas rural counties where
more than 48% of the population is Black/African American. Social structural stressors such as persistent
poverty, low educational attainment, high rates of unemployment, the COVID-19 pandemic, poor transportation,
poor access to health care, and historical oppression pose tremendous barriers to successful quitting. Quitting
smoking can substantially reduce cancer morbidity and mortality among African Americans, but successful
quitting as well as the reach of evidence-based interventions to rural African Americans is alarmingly low. Few
studies have empirically tested the efficacy of social structural interventions (home-based food delivery) that
address the dynamic interplay of cancer risk behaviors, like smoking, and social factors that perpetuate
disparities like food insecurity. The long-term goal of this study is to fill a critical gap in knowledge on the role of
social structural interventions in the elimination of cancer health disparities in low resource rural Arkansas
counties with high proportions of Blacks/African Americans and high smoking prevalence. Our aims are to 1) test
the efficacy of a social change intervention (home-based food delivery) on smoking abstinence using a 3-armed
randomized controlled design, 2) examine changes in measures of cigarette abuse liability, and 3) examine the
extent to which home-based food delivery improves recruitment and retention of Black/African American smokers
in the treatment conditions. 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 with high
proportions of Blacks/African Americans. Multilevel interventions are needed to address persistent social
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 the Socioecological
Model to test our central hypothesis: smokers who receive evidence-based real-time video-based motivational
counseling and a social change intervention (home-based food delivery) will have greater cotinine-verified 7-day
point prevalence abstinence than those who receive motivational counseling alone or social change alone.
Social structural interventions that meet the immediate social needs of Black/African American smokers hold
tremendous promise for improving Black/African American recruitment and retention into helpful cancer
prevention community trials, increasing successful quitting, and reducing social disparities that perpetuate
tobacco-caused cancer disparities.

## Key facts

- **NIH application ID:** 10436493
- **Project number:** 1P50MD017319-01
- **Recipient organization:** UNIV OF ARKANSAS FOR MED SCIS
- **Principal Investigator:** Pebbles Fagan
- **Activity code:** P50 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $645,796
- **Award type:** 1
- **Project period:** 2021-09-24 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10436493

## Citation

> US National Institutes of Health, RePORTER application 10436493, FRESH Delivers: An Innovative Approach to Reducing Tobacco Use Among Rural Black/African American Smokers (1P50MD017319-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10436493. Licensed CC0.

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