Rural areas in South Carolina have higher rates of cancer and cancer-related deaths than cities, largely due to higher rates of smoking in these areas. Young adults (ages 21-29) living in rural areas are especially at risk, as they tend to smoke more, are more dependent on nicotine, have fewer resources to help them quit, and are less likely to successfully quit smoking. At the same time, newer products like nicotine pouches and e-cigarettes are becoming more common. These products provide nicotine without tobacco and may help reduce smoking because they are more accessible and easier to use. Quitting smoking before age 30 can greatly lower the risk of developing cancer, making it especially important to understand whether these products can help young adults cut back or quit. In this virtual study, the DREAM Lab will work with 60 young adults living in rural South Carolina who smoke cigarettes. We will: 1) conduct interviews to learn more about their experiences with quitting smoking and their perspectives on using these products for quitting, and 2) examine how these products affect tobacco withdrawal symptoms. Findings will help guide future policies and programs aimed at reducing smoking and cancer risk in rural communities.

Eligible participants (ages 18+ whom have daily cigarette use) will attend an in-person assessment (though some aspects of the study, including consent, can be completed remotely). Participants will submit a breath sample for assessment of expired carbon monoxide. Approximately 5-7 days after completion of the in-person assessment, participants will meet with research staff. A medical clinician will meet with the participant to present a smoking cessation treatment recommendation along with resources. Participants will also complete surveys to assess their treatment preferences, motivation, and self-efficacy following receipt of the recommendation.

Quitting smoking is hard, and many Veterans struggle even with current treatments. This study is testing a safe, non-invasive brain stimulation called repetitive transcranial magnetic stimulation (rTMS), which is already FDA-approved to help people stop smoking. We're comparing two types—standard and personalized—to see which works better. We aim to find the best option to help Veterans quit for good.

Tobacco-free oral nicotine pouches (such as Zyn brand) are a less harmful alternative to combustible tobacco (cigarette/cigarillo/little cigar) smoking. Pouches, however, contain nicotine, and addictive substance that is not risk-free. The present study is evaluating how well nicotine pouches, at different nicotine levels, help people switch away from smoking combustible tobacco. People who smoke will be asked to answer questions about their tobacco product use and provide breath samples and cheek swab samples at an in-person visit to MUSC Charleston. Participants will then be provided with a 28-day supply of nicotine pouches, and will be asked to switch from smoking to pouches over the course of 4 weeks. Finally, participants will complete a final visit at MUSC, and will answer more questions about their tobacco use 1-month later.

While cigarette smoking is detrimental to health and a known risk factor for cancer, e-cigarettes are thought to be less harmful but not entirely risk-free, and less is known about e-cigarette use and changes to health. The purpose of the present study is to evaluate changes in health that may occur when people stop using e-cigarettes. Participants who use e-cigarettes (and who never smoked, smoked in the past, or currently smoke) will be recruited to participate in a laboratory session followed by a week of abstaining from any nicotine use. Throughout the study, participants will provide biological samples for analysis of DNA damage, immune functioning, inflammation, and respiratory functioning at the MUSC Charleston campus. Results will provide insight into the health benefits of quitting vaping.

For patients in cancer care, quitting smoking is critical, but a significant portion of patients in cancer care refuse all components of tobacco treatment, even when offered proactively and free of charge. The proposed clinical trial will assess one harm reduction intervention, switching completely from cigarettes to e-cigarettes, among oncology outpatients who smoke and refuse traditional tobacco treatment.

The purpose of this study is to better understand tobacco outcomes using a commonly prescribed stop smoking medication (varenicline) and financial incentives for adults who also use cannabis. Varenicline is not FDA approved for e-cigarette cessation, but is FDA approved for cigarette cessation. We are also interested in how cannabis/marijuana and tobacco interact during a tobacco quit attempt. All participants will receive e-cigarette cessation treatment for 12 weeks. To qualify, participants must be between the ages of 18-40 and use both tobacco and cannabis. Participants do not need to be interested in quitting cannabis to qualify. This study is being conducted at three sites: the Medical University of South Carolina in Charleston, SC, Behavioral Health Services in Pickens, SC, and MUSC Lancaster