Selective enhancement of cost sensitivity by methylphenidate in adult ADHD: a randomized placebo-controlled trial.

Tobacco use is a leading preventable cause of morbidity and mortality in the United States (). Although the rates of tobacco use have declined significantly in the general population, tobacco use remains high among adults experiencing food insecurity, including the 42 million Americans enrolled in the Supplemental Nutrition Assistance Program (SNAP) program (; , , ). In recognizing the high rates of tobacco use among SNAP participants, public health researchers and practitioners have recommended integrating smoking cessation services and food assistance programming to provide an accessible and synergistic point of entry into smoking cessation treatment for food assistance recipients (; ). However, limited research has focused on understanding the needs and barriers to smoking cessation among people enrolled in food assistance programs. Food insecurity is strongly and positively associated with psychological distress, and this relationship appears to be bidirectional in nature (). Food insecurity can increase psychological distress through mechanisms of hunger, nutritional deficiencies, sleep disturbances, and shame or frustration at being unable to obtain sufficient food (; ). Psychological distress may in-turn contribute to food insecurity by increasing social isolation and withdrawal, increasing anhedonia or lethargy that reduces motivation and energy to purchase and prepare food, and limiting workforce participation and income to afford sufficient food (). There are also broader structural factors that place individuals at increased risk for both food insecurity and psychological distress, including structural racism, sexism, ableism, and immigration policies that contribute to concentrated poverty and reduced access to food, health insurance, and mental health care (). Psychological distress is also a well-documented risk factor for cigarette smoking and relapse (; ; ; ). Previous research has demonstrated that there is a greater and increasing prevalence of serious psychological distress among people who smoke (). Of relevance for food assistance programs, research demonstrates bidirectional causal relationships between psychological distress, food insecurity, and smoking (; ). In 2020, Kim-Mozeleski and Pandey conducted a scoping review of the literature on the relationships between food insecurity and tobacco use, the results of which informed an intersecting theoretical model through which food insecurity, distress, and tobacco use are sequentially associated and reinforce one another (). Their model proposes that individuals experiencing food insecurity may turn to smoking cigarettes to cope with distress, hunger, and broader social conditions (e.g. discrimination) (; ; ), while smoking can exacerbate food insecurity and distress through multiple pathways including financial strain (e.g. spending on cigarettes limits money available for food and other basic needs), hunger suppression, modified food acquisition practices (e.g. purchasing unhealthy food at retailers that sell cigarettes), and declining health that limits workforce participation and income (; ).