ISSUE ADDRESSED:Tobacco smoking disproportionately affects people experiencing socioeconomic disadvantage. Improving access to effective smoking cessation programmes and medications is crucial to reducing this gap. Here, we report on a programme trialling the provision of free nicotine replacement therapy to priority populations through community pharmacies. METHODS:This study evaluates the engagement and acceptability of this approach using a multiphase mixed methods design. Two groups were involved in the programme: community pharmacists (n = 8) and people who smoke cigarettes (n = 55). At the conclusion of the programme, 7 pharmacists and 10 smokers completed semi-structured interviews. Qualitative data collected through interviews were analysed using a hybrid approach of inductive and deductive thematic analysis. An inductive reflexive thematic analysis was performed first, followed by a deductive thematic analysis to code the data into the seven constructs of the Theoretical Framework of Acceptability. RESULTS:Analyses revealed pharmacists and smokers were mostly positive about the pilot programme. Although the burden was perceived to be considerable by pharmacists, and the self-efficacy and opportunity costs appear to have limited the engagement of some smokers in the programme. CONCLUSION:This evaluation provides insights into what works to support people from priority populations who want to quit smoking. It highlights that both engagement with and acceptability of smoking cessation support are influenced by practical considerations and the service setting. Furthermore, it highlights the important role that existing health destinations, such as community pharmacies, can play in the delivery of public health interventions.

Smoking tobacco continues to be a leading cause of death and disease. This study aimed to provide health literacy profiles which include strengths and challenges of Australian adults who smoke, to identify their needs and inform future smoking interventions. We conducted a cross-sectional survey using the Health Literacy Questionnaire to measure and describe the health literacy profiles. A total of 563 Australian adults who smoke completed the questionnaire. Data were analysed using hierarchical cluster analysis with Ward's method for linkage. Ten clusters were identified as the optimal cluster solution. These clusters had distinct health literacy profiles with diverse needs and demographic characteristics. Most participants self-reported strengths in understanding health information well enough to know what to do, but identified challenges in navigating the healthcare system. This cluster analysis revealed that Australian adults who smoke have varying health literacy competencies and needs. These findings can be used to educate stakeholders and to inform tailored interventions to support people who smoke to quit smoking.

INTRODUCTION:In 2024, Canada became the first country to implement warning messages on cigarette sticks. Warnings were required on king-size cigarettes in April 2024 at the manufacturer level and July 2024 at the retail level. The purpose of this study was to evaluate responses to cigarette stick warnings among adults who smoke in Canada using a standard survey and a daily diary study. METHODS:We used two separate online survey (i.e. questionnaire) methods with Canadian adults who smoke daily and use king-size cigarettes, with data collected in February, May, and August 2024. The first method was a standard cohort survey (observations=1724; participants=999), with one survey each data collection period. Participants were followed up in subsequent waves. Participants reported noticing health information on cigarette sticks 'any' vs 'none', and ≥ 'almost all' vs 'fewer cigarettes' in last month. The second method was a daily diary study (observations=10572; participants=527), with brief surveys every evening for two weeks during each data collection period. Participants reported noticing health information on cigarette sticks ('any' vs 'none' in last 24 hours). Samples for the two studies were distinct. In both studies, we also assessed feelings about the look of cigarette sticks (1=very bad to 5=very good), forgoing cigarettes normally smoked (no vs yes), and quit motivation (continuous). Generalized estimating equations regressed outcomes on survey period, adjusting for sociodemographic and smoking-related covariates. RESULTS:Noticing stick warnings increased in both surveys [standard 'any': May=58%, August=73%, OR=2.29 (95% CI: 1.81-2.91); standard ≥ 'almost all': May=27%, August=44%, OR=2.56 (95% CI: 1.99-3.30); daily diary: February=6%, May=10%, OR=1.77 (95% CI: 1.29-2.44), August=16%, OR=2.92 (95% CI: 1.73-4.93), all p<0.001]. Over time, negative feelings toward sticks [February=4.10, August=3.91, mean diff= -0.19 (95% CI: -0.32 - -0.05), p=0.006], forgoing cigarettes [February=56%, August=63%, OR=1.44 (95% CI: 1.12-1.86), p=0.004] and quit motivation [February=4.74, August=5.03, mean diff=0.30 (95% CI: 0.06-0.53), p=0.014] increased in the standard surveys, but not the daily diary study. CONCLUSIONS:Canadian adults who smoke king-size cigarettes increasingly noticed cigarette stick warnings over the early implementation period. The standard survey also found increases in cessation-related responses to stick warnings. Future research should assess long-term impacts of this policy and validate standard and daily diary survey methods for evaluating labeling policies.

Introduction Tobacco warning labels typically feature confronting health-risk messages that aim to evoke fear to change behavior. Evidence shows these graphic health warning labels (GHWLs) can be effective but can also lead to unintended responses, including avoidance or defensiveness. Theory suggests that targeting beliefs about the likelihood and benefits of successfully quitting may increase adaptive responses to risk information.Methods Participants with nil imminent quitting intentions were recruited to a randomized controlled trial (RCT) in the United Kingdom investigating the effects of receiving daily textual SMS messages targeting risk, self-efficacy, and response-efficacy beliefs on cessation behavior. To explore their experiences receiving SMS messages during the RCT as well as their naturalistic exposure to GHWLs, we undertook a qualitative investigation conducting semi-structured interviews with 20 participants. Four main themes were generated via thematic analysis.Results Participants found efficacy messaging motivating, reporting increased hope for cessation. Further, these messages bolstered knowledge about cessation benefits and treatment options, which may increase treatment-related health literacy. Self-efficacy and response-efficacy messages were well-received and seen to complement each other whereas naturalistic exposure to GHWLs was associated with defensive responses and the use of strategies to manage negative affect. GHWLs were seen to contribute to the stigmatization of people who smoke (PWS) as part of a broader denormalization of smoking.Conclusions GHWLs in their current form can have unintended consequences for PWS and can lead to defensive responses. By contrast, messages that address efficacy beliefs can increase hope, knowledge of cessation supports, and motivation, thus supporting adaptive responses to smoking health risks.Implications Continued use of confronting graphic health warning labels in their current form should be reconsidered. Future policy and research should investigate how efficacy content can be effectively integrated into tobacco packaging to optimize the impact of this space in targeting determinants of cessation. Efficacy content can give people who smoke hope for the future and valuable information about pathways to cessation. These benefits may have applications in other streams of health promotion such as primary care, m-health initiatives, or public service announcements.

OBJECTIVE:Evaluate Canada's innovative policy mandating warning messages on cigarette sticks. METHODS:We analyzed data from an open cohort of Canadian adults who smoke, surveyed every 3 months (February 2023-November 2024; n = 11,487 observations from 4716 individuals). Participants reported: liking the look of their cigarette sticks (1-Dislike a lot to 7-Like a lot); feelings when looking at sticks (1-Very bad to 7-Very good); frequency of thinking about smoking-related harms due to sticks (1-Not at all to 5-Extremely); and forgoing cigarettes they normally smoke due to the look of sticks (no vs. yes). Linear and logistic generalized estimating equations regressed these outcomes on implementation period (i.e., pre-policy 2023 surveys [ref.] vs post-policy 2024 surveys), adjusting for covariates and post-stratification weights. Analyzing participants followed to the next survey (n = 6959 observations, 2356 individuals), separate adjusted mixed-effects logistic models regressed quit attempts in the 3-month interval since the prior survey on each stick measure from the prior survey (coded: neutral [ref.], dislike, like; neutral [ref.], bad, good; no forgoing [ref.], forwent cigarettes). RESULTS:From pre- to post-policy periods, liking and feelings about sticks became more negative (B = -0.15, 95 %CI = -0.22, -0.08; B = -0.07, 95 %CI = -0.13, -0.01) and forgoing cigarettes increased (AOR = 1.18, 95 %CI = 1.06, 1.32). Those who felt bad (vs. neutral) when looking at sticks were more likely to try to quit by the next survey (AOR = 1.31, 95 %CI = 1.05, 1.62), as were those who forwent cigarettes (AOR = 1.73, 95 %CI = 1.40, 2.15). CONCLUSIONS:Countries should consider expanding cigarette labeling to include on-cigarette warnings, which appear to have increased outcomes that predict quit attempts in Canada.

Background. Primary adrenal insufficiency (PAI) mortality and morbidity remain unacceptably high, possibly arising as glucocorticoid replacement does not replicate natural physiology. A pulsatile subcutaneous pump can closely replicate cortisol's circadian and ultradian rhythm.Objectives. To assess the effect of pump therapy on quality of life, mood, functional neuroimaging, behavioural/cognitive responses, sleep and metabolism.Methods. A 6-week randomised, crossover, double-blinded and placebo-controlled feasibility study of usual dose hydrocortisone in PAI administered as either pulsed subcutaneous or standard care in Bristol, United Kingdom (ISRCTN67193733). Participants were stratified by adrenal insufficiency type. All participants who received study drugs are included in the analysis. The primary outcome, the facial expression recognition task (FERT), occurred at week 6.Results. Between December 2014 and 2017, 22 participants were recruited - 20 completed both arms, and 21 were analysed. The pump was well-tolerated. No change was seen in the FERT primary outcome; however, there were subjective improvements in fatigue and mood. Additionally, functional magnetic resonance imaging revealed differential neural processing to emotional cues and visual stimulation. Region of interest analysis identified the left amygdala and insula, key glucocorticoid-sensitive regions involved in emotional ambiguity. FERT post hoc analysis confirmed this response. There were four serious adverse events (AE): three intercurrent illnesses requiring hospitalisation (1/3, 33.3% pump) and a planned procedure (1/1, 100% pump). There was a small number of expected AEs: infusion site bruising/itching (3/5, 60% pump), intercurrent illness requiring extra (3/7, 42% pump) and no extra (4/6, 66% pump) steroid.Conclusions. These findings support the administration of hormone therapy that mimics physiology.

INTRODUCTION:Cigarette package inserts that describe quitting benefits and tips may promote cessation; however, research is needed to understand better their effects, including potentially enhancing the effects of pictorial health warning labels (PHWLs).METHODS:A randomized trial with a 2×2 factorial design was conducted with adult smokers (n=356) assigned to either small text-only health warning labels (HWLs; control); inserts with cessation messages, and the small text-only HWLs (inserts-only); large PHWLs (PHWLs-only); both inserts and PHWLs (inserts + PHWLs). Participants received a 14-day supply of their preferred cigarettes with packs labeled to reflect their group. Upon finishing the trial, participants reported their past 14-day frequency of noticing, reading, thinking about smoking harms and cessation benefits, talking about labels, and forgoing cigarettes because of the labels. Ordered logistic models regressed these outcomes on labeling groups, and mediation analyses assessed whether attention (i.e. noticing, reading) to labels mediated effects of labeling exposure on other outcomes (i.e. thinking about harms/benefits, talking, forgoing).RESULTS:The inserts + PHWLs group reported higher frequencies than the control group for all outcomes. Compared to the control group, both the inserts-only and PHWLs-only groups reported higher frequency of noticing (AOR=3.53 and 2.46, respectively) and reading labels (AOR=2.89 and 1.71), thinking about smoking risks because of the labels (AOR=1.93 and 1.82), and talking about labels (AOR=2.30 and 2.70). Participants in the inserts-only group also reported more frequent thinking about quitting benefits (AOR=1.98). Attention mediated all labeling effects except for the contrast between PHWLs only and control.CONCLUSIONS:Compared to text-only HWLS, cigarette labeling that involves inserts, PHWLs, or both appears more effective at drawing attention to warnings, which mediated the effects on cessation-related psychosocial and behavioral outcomes.

Introduction: Little experimental research has evaluated whether the effects of cigarette package inserts with efficacy messages and/or pictorial health warning labels (PHWLs) differ across key subgroups of adults who smoke. Aims and Methods Adults who reported currently smoking (n = 367) were randomly assigned to one of four groups: Small text-only HWLs on pack sides (control); inserts with efficacy messages and small HWLs (inserts-only); PHWLs showing harms of smoking (PHWLs-only); both (inserts + PHWLs). Participants received a 14-day supply of cigarettes labeled to reflect their group. Every evening over 2 weeks, participants reported forgoing and stubbing out cigarettes before they finished smoking over the prior 24 hours, combined into a binary indicator of either behavior (eg, forgoing/stubbing). Separate mixed-effects logistic models were estimated to evaluate moderation of labeling group contrasts (ie, PHWLs vs not; inserts vs. not; inserts-only vs. inserts + PHWLs; PHWLs-only vs. inserts + PHWLs) by baseline covariates (self-efficacy to quit, intention to quit, education, health literacy, and time discounting), predicting day-level forgoing/stubbing. Results: Education moderated PHWL effects, with PHWLs predicting more forgoing/stubbing only among those with low education (OR = 4.68, p < .001). Time discounting moderated insert effects, with inserts promoting forgoing/stubbing only among those with low time discounting (ie, lower impulsivity; OR = 4.35, p < .001). Conclusions: Inserts with efficacy messages appear effective mostly among people with low time discounting, whereas PHWLs appear most effective among those with low education, suggesting their potential to address education-related disparities. Labeling strategies appeared equally effective across subgroups defined by self-efficacy to quit, quit intention, and health literacy. Combining inserts with PHWLs did not appear to mitigate moderation effects. Implications: This randomized trial with adults who smoke suggests that cigarette packs with inserts describing cessation benefits and tips can promote cessation-related behaviors (ie, forgoing or stubbing out cigarettes) among those with low-time discounting (ie, low impulsivity). Alternative interventions may be needed for people with high-time discounting, as found in cessation trials. PHWLs appear most effective among those with low education, potentially addressing education-related disparities. No differential effects were found for those with different levels of self-efficacy to quit, quit intentions, or health literacy. Combining inserts and PHWLs may not be more effective than either alone.

BACKGROUND:To control infections, behavioral non-pharmaceutical interventions (NPIs) such as social distancing and hygiene measures (masking, hand hygiene) were implemented widely during the COVID-19 pandemic. At the same time, adherence to NPIs has also been implied in an increase in mental health problems. However, the designs of many existing studies are often poorly suited to disentangle complex relationships between NPI adherence, mental health symptoms, and health-related cognitions (risk perceptions, control beliefs).PURPOSE:To separate between- and temporal within-person associations between mental health, health-related cognitions, and NPI adherence.METHODS:Six-month ecological momentary assessment (EMA) study with six 4-day assessment bouts in 397 German adults. Daily measurement of adherence, mental health symptoms, and cognitions during bouts. We used dynamic temporal network analysis to estimate between-person, as well as contemporaneous and lagged within-person effects for distancing and hygiene NPIs.RESULTS:Distinct network clusters of mental health, health cognitions, and adherence emerged. Participants with higher control beliefs and higher susceptibility were also more adherent (between-person perspective). Within-person, similar findings emerged, additionally, distancing and loneliness were associated. Lagged findings suggest that better adherence to NPIs was associated with better mental health on subsequent days, whereas higher loneliness was associated with better subsequent hygiene adherence.CONCLUSIONS:Findings suggest no negative impact of NPI adherence on mental health or vice versa, but instead suggest that adherence might improve mental health symptoms. Control beliefs and risk perceptions are important covariates of adherence-both on between-person and within-person level.

Smoking is one of the major causes of preventable death and is considered the greatest threat to global public health. While the prevalence of smoking has decreased, population growth has led to an increase in the absolute number of smokers. There are many proven smoking cessation interventions available to support smokers in their quit attempts. Most people who smoke, however, underutilize the treatments available to them. This scoping review aimed to identify the current barriers experienced by all stakeholders (smokers, service providers and policymakers) to existing evidence-based smoking cessation interventions in community healthcare settings. Five electronic databases (CINAHL, Ovid MEDLINE, PsycINFO, Scopus and Web of Science) were searched for relevant literature. A total of 40 eligible articles from different countries published between 2015 and 2022 were included in the review and content analysis carried out to identify the key barriers to smoking cessation interventions. Seven key themes were found to be common to all stakeholders: (i) literacy, (ii) competing demands and priorities, (iii) time, (iv) access to product, (v) access to service, (vi) workforce and (vii) motivation/readiness. These themes were mapped to the Capability, Opportunity, Motivation-Behaviour (COM-B) model. This study presents the effect the barriers within these themes have on current smoking cessation services and highlights priorities for future interventions.

Primary adrenal insufficiency (PAI) mortality and morbidity remain unacceptably high, possibly arising as glucocorticoid replacement does not replicate natural physiology. A pulsatile subcutaneous pump can closely replicate cortisol's circadian and ultradian rhythm. To assess the effect of pump therapy on quality of life, mood, functional neuroimaging, behavioural/cognitive responses, sleep and metabolism. A 6-week randomised, crossover, double-blinded and placebo-controlled feasibility study of usual dose hydrocortisone in PAI administered as either pulsed subcutaneous or standard care in Bristol, United Kingdom (ISRCTN67193733). Participants were stratified by adrenal insufficiency type. All participants who received study drugs are included in the analysis. The primary outcome, the facial expression recognition task (FERT), occurred at week 6. Between December 2014 and 2017, 22 participants were recruited – 20 completed both arms, and 21 were analysed. The pump was well-tolerated. No change was seen in the FERT primary outcome; however, there were subjective improvements in fatigue and mood. Additionally, functional magnetic resonance imaging revealed differential neural processing to emotional cues and visual stimulation. Region of interest analysis identified the left amygdala and insula, key glucocorticoid-sensitive regions involved in emotional ambiguity. FERT post hoc analysis confirmed this response. There were four serious adverse events (AE): three intercurrent illnesses requiring hospitalisation (1/3, 33.3% pump) and a planned procedure (1/1, 100% pump). There was a small number of expected AEs: infusion site bruising/itching (3/5, 60% pump), intercurrent illness requiring extra (3/7, 42% pump) and no extra (4/6, 66% pump) steroid. These findings support the administration of hormone therapy that mimics physiology.

BACKGROUND Cigarette pack inserts with messages on cessation benefits and advice are a promising labeling policy that may help promote smoking cessation. PURPOSE To assess insert effects, with and without accompanying pictorial health warning labels(HWLs), on hypothesized psychosocial and behavioral outcomes. METHODS We conducted a 2 × 2 between-subject randomized trial (inserts with efficacy messages vs. no inserts; large pictorial HWLs vs. small text HWLs), with 367 adults who smoked at least 10 cigarettes a day. Participants received a 14-day supply of their preferred cigarettes with packs modified to reflect their experimental condition. Over 2 weeks, we surveyed participants approximately 4-5 times a day during their smoking sessions, querying feelings about smoking, level of worry about harms from smoking, self-efficacy to cut down on cigarettes, self-efficacy to quit, hopefulness about quitting, and motivation to quit. Each evening, participants reported their perceived susceptibility to smoking harms and, for the last 24 hr, their frequency of thinking about smoking harms and cessation benefits, conversations about smoking cessation or harms, and foregoing or stubbing out cigarettes before they finished smoking. Mixed-effects ordinal and logistic models were estimated to evaluate differences between groups. RESULTS Participants whose packs included inserts were more likely than those whose packs did not include inserts to report foregoing or stubbing out of cigarettes (OR = 2.39, 95% CI = 1.36, 4.20). Otherwise, no statistically significant associations were found between labeling conditions and outcomes. CONCLUSIONS This study provides some evidence, albeit limited, that pack inserts with efficacy messages can promote behaviors that predict smoking cessation attempts.

Underrepresentation of historically marginalized populations in clinical trials continues to threaten the validity of health intervention research. Evidence supports the merits of intercept and other proactive forms of recruitment for achieving more equitable representation. However, researchers also report lower retention and adherence to protocols among these populations, particularly in longitudinal studies. Few studies have compared recruitment methods for longitudinal randomized trials testing health interventions, with even fewer having done so for trials involving ecological momentary assessment (EMA). As intervention research integrates EMA and other data collection approaches requiring substantial participant effort, it is critical to better understand the effectiveness and implications of strategies to improve the representativeness of health research. This secondary data analysis compared outcomes of proactive and reactive recruitment strategies (mobile lab intercepts and internet/flyer advertising, respectively) in study inclusion, task completion, and retention within a 14-day randomized controlled trial that used EMA to evaluate cigarette package health messages. Proactive recruitment resulted in higher proportions of participants with low income and education, limited health literacy, and of diverse racial/ethnic makeup. However, this recruitment method also resulted in lower task completion, especially in the second week of the trial period, and lower retention, although group differences were not explained by participant sociodemographic characteristics targeted by inclusion efforts. We conclude that proactive recruitment via intercepts is an effective strategy for health intervention research that aims to include stakeholders from historically marginalized groups but that researchers and funders must recognize these methods require additional resources, considerations, and capacity to address non-trivial challenges to successful participation.

Objectives: Adhering to behavioral recommendations and non-pharmaceutical interventions (NPIs) is key to control COVID-19 infection rates. However, rates have decreased globally, and potentially modifiable determinants of ongoing adherence and their interaction with social and physical momentary environments are still poorly understood. Here, we comprehensively examine within-person variations and between-person differences in known behavioral determinants (capability, motivation), as well as the moderating role of situationally variable environmental factors (opportunity) in predicting adherence to hygiene and social distancing behaviors. Methods: Ecological momentary assessment study over six months with monthly assessment bouts (four days each, five daily assessments) in 623 German adults. Repeated daily assessments of Capability-Opportunity-Motivation model of behavior (COM-B) factors. Bayesian multilevel logistic regression models were estimated to examine main effects of COM-B factors and moderating effects of momentary environmental factors. Results: Momentary adherence to NPIs was predicted by within-person changes in COM-B factors (motivation: intentions, goal conflict, control beliefs; opportunities: regulations, norms). Between-person differences in capabilities (habit strength) and motivation (intentions, control beliefs) predicted adherence across situations. Situation-specific environmental factors moderated the motivation-behavior association (regulation measures increased; goal conflict, and non-adherent others decreased the association). Conclusions: Individual momentary (within-person) and stable (between-person) motivation indicators predicted adherence. However, situational environmental factors such as regulations or norms have strong main effects and moderate the motivation-behavior translation. These findings have policy implications, supporting recent claims to not rely on the narrative of “personal responsibility”, but instead combine health education measures to increase individual motivation with consistent regulation.

Background: Attentional bias towards food related stimuli has been proposed as a potential target for dieting intervention, however the evidence supporting a relationship between attentional bias and food intake is mixed. Theory holds that food related attentional bias should be positively associated with measures of stimulus-controlled eating, and that implicit processes such as impulsivity moderate this association. The aim of the present study was to examine whether the proposed relationship between food-related attentional bias and stimulus control exists, and whether it is moderated by impulsivity.Method: A community sample of 68 participants completed a food-related attentional bias task and impulsiveness scale during a laboratory visit, after which they recorded their real-world eating in real-time over 14 days using Ecological Momentary Assessment (EMA). During this time, participants also responded to 4-5 randomly timed assessments per day. Food outlet presence (e.g., fast food restaurants, cafes, corner stores etc.) was assessed during both eating and non-eating assessments. EMA data was then used to determine levels of stimulus controlled eating for each participant.Findings: Substantial variation was seen in both our measure of both food-related attentional bias (Range: 33.9 to 80.0) and in the degree to which the participant's eating could be categorised as being under stimulus control (Range: 0.50 to 0.93). However, food-related attentional bias scores were not a significant independent predictor of stimulus control and nor was this relationship moderated by impulsivity. Conclusion: Contrary to theoretical predictions, we found no evidence that of an association between attentional bias, impulsivity, and stimulus control. More work is needed to better understand the implicit processes underlying eating behaviour in the real-world.

While many countries require prominent pictorial health warning labels (PHWLs) on the outside of cigarette packs to communicate the harms of smoking, there is evidence that cigarette pack inserts that contain efficacy messages may enhance the effectiveness of PHWLs. The US Food and Drug Administration (FDA) has regulatory authority to communicate with smokers through inserts. While current labeling regulations do not require inclusion of inserts, the FDA could implement them in the future. This study assesses US smokers' perceptions of cigarette package inserts at the conclusion of a two-week randomized trial on cigarette labeling where half of participants were exposed to insert messages (two response-efficacy messages and two self-efficacy messages) in their packs. Participants (n = 359) completed a 30- to 60-min interview with both quantitative and qualitative assessments, including measures of recall and perceived message effectiveness (PME) for specific inserts. Correlates of recall and PME were estimated using mixed-effects regression models. Qualitative responses to PME items were analyzed using thematic analysis. Response-efficacy messages had higher PME and recall than self-efficacy messages. People had diverse responses to the inserts, including that they were positive, thought-provoking, and helpful. Reactions to and perceptions of the inserts indicate potential benefits of integrating efficacy messages into labeling policies.

Public Health Significance Statement The co-occurrence between food addiction and problematic substance use detected in this study indicates that treatment approaches may need to simultaneously consider addictive eating and problematic substance use. Parental history of problematic alcohol use appears to be a risk factor for addictive eating and may identify individuals for targeted prevention efforts. Public health approaches that have successfully reduced the negative impact of other addictive substances (e.g., marketing restrictions, taxation) may be important to consider for highly processed foods. Objective: The present study investigates the rates of co-occurrence among food addiction (FA), problematic substance use (alcohol, cannabis, cigarettes, nicotine vaping), parental history of problematic alcohol use, and obesity as an important step to understanding whether an addictive-like eating phenotype exists. Method: A community sample of 357 U.S. adults (49.7% male, 77.6% White, M-age 40.7) completed the Yale Food Addiction Scale 2.0 (YFAS2.0), the Alcohol Use Disorders Identification Test, the Cannabis Use Disorders Identification Test, the Fagerstrom Test for Nicotine Dependence, the E-Cigarette Dependence Scale, the Family Tree Questionnaire, and demographic/self-report body mass index questions through Amazon Mechanical Turk. Risk ratios (RRs; unadjusted and adjusted for sociodemographic covariates) were calculated using modified Poisson's regression. Results: Risk of FA was higher in participants with problematic alcohol use (RR = 2.13, 99% CI [1.32, 3.45]), smoking (RR = 1.86, 99% CI [0.82, 3.36]), cannabis use (unadjusted; RR = 2.22, 99% CI [1.17, 4.18]), vaping (RR = 2.71, 99% CI [1.75, 4.21]), and parental history of problematic alcohol use (RR = 2.35, 99% CI [1.46, 3.79]). Risk of FA in participants with obesity was only higher in adjusted models (RR = 1.87, 99% CI [1.06, 3.27]). Obesity was not significantly associated with problematic substance use and parental history of problematic alcohol use. Conclusions: FA, but not obesity, co-occurred with problematic substance use and a parental history of problematic alcohol use. Results support the conceptualization of FA as an addictive disorder. The inclusion of FA as an addictive disorder in diagnostic frameworks is an important area of future consideration.