Project Trinity Explores Connections Between Trauma and Tobacco Use

Tobacco Stops With Me spoke with Adam Alexander, Ph.D., Assistant Professor with the TSET Health Promotion Research Center, about Project Trinity, a new long-term project exploring connections between tobacco use and trauma.

What is Project Trinity and why is it important to understand how the recent social unrest and pandemic impact specific communities?

My work focuses on addressing smoking cessation among African Americans and there’s a great deal of research out there that shows that African Americans are less likely to quit tobacco. When I came to the TSET HPRC, I wanted to explore factors that serve as either barriers or facilitators of smoking cessation, and I’ve been doing that for three years.

Project Trinity is a two-year research project that aims to document and illustrate the health and economic effects of the pandemic and unprecedented social unrest on the lives of African Americans in Oklahoma. We know that everyone was somewhat exposed to the trauma of the movement. The knowledge gathered will provide actionable information that can be used to inform policy and research to promote health equity and to restore trust between African Americans, law enforcement and other public institutions.

What inspired you to pursue a career researching health disparities and tobacco?

Growing up in Memphis, Tennessee, I was interested in criminal justice and originally intended to be a lawyer. But in college, I had a statistics professor active in tobacco research who became a mentor and encouraged me to go to graduate school. Personally, I observed the destructive impact of tobacco in my own life – several members of family used tobacco and were unable to quit. In some cases, it cost them their lives.

Those experiences put me on the path that led to where I am today. We focus on evidence-based treatment, and evidence-based treatments are great, but they have a broad appeal to a wide variety of people. As the overall prevalence of smoking goes down, we are learning that certain subgroups in America, and in Oklahoma, need additional resources to help them quit smoking. The group I focus on because it’s closest to me are African Americans.

What are some specific challenges that face African Americans when it comes to the fight against tobacco?

Menthol use is very common among African Americans. About 80% of all African Americans who smoke use menthol cigarettes as their primary brand or type of cigarette. And when you look at menthol, it acts as a minty flavor helping disguise the harsh and unpleasant taste of nicotine and tobacco. That’s why you see a lot of flavors being banned for youth, because tobacco companies know that if they can mask that smell or that taste of tobacco, then they can hook a young population to nicotine. Also, research shows menthol cigarettes are also more difficult to quit than non-menthol.

African Americans also face challenges such as discrimination that can be addressed in intervention, and right now, we’re not designing behavioral interventions for smoking cessation to treat culturally relevant factors that influence smoking. We must look at those cultural risk factors that influence vulnerable populations.

Is Project Trinity still enrolling participants?

Yes! We have successfully recruited 250 individuals and are accepting 50 more into the project. African Americans throughout Oklahoma who volunteer for this study will be compensated to complete online survey assessments for two years and be will be asked to provide information regarding the extent to which COVID-19 and social unrest have impacted their health and health-related behaviors. For more information, email

Now that Project Trinity is operational, what’s next?

We are working on some interesting areas, including researching the effectiveness of a smartphone application that provides financial incentives for smoking cessation and increasing physical activity. A major problem we are trying to solve is how to create effective interventions for individuals experiencing homelessness. Over 70% of the homeless population smokes combustible cigarettes, and they have extremely low success rates when they attempt to quit. This summer, we are trying a new approach and I’m excited to see if succeeds.

Published by Tobacco Stops With Me on April 28, 2021