About

Dr. Adam Goldstein is the Elizabeth and Oscar Goodwin Distinguished Professor at the University of North Carolina (UNC) Department of Family Medicine. He serves as the Director of Tobacco Intervention Programs, which include the Tobacco Treatment Program and the Tobacco Prevention and Evaluation Program, at the UNC School of Medicine. His research has had extensive influence at local, regional, and national levels through print, radio, and television media, with over 200 articles, essays, book chapters, and books featured in outlets such as CNN, CBS evening news, the New York Times, and the Wall Street Journal. Dr. Goldstein mentors medical students, residents, fellows, and graduate students, and has taught internationally on topics including leadership development, substance abuse, health policy, cancer, and clinical medicine in countries such as Moldova, Ukraine, Armenia, Argentina, Chile, Haiti, and Israel. His areas of interest include health policy related to tobacco regulatory science, patient-centered tobacco cessation, disparities in tobacco use, health communication and behavior change, and gun violence prevention.

Research topics

• Demography
• Psychology
• Medicine
• Political Science
• Economics
• Economic growth
• Nursing
• Family medicine
• Internal medicine
• Social psychology
• Business
• Psychiatry
• Virology
• Environmental health
• Clinical psychology

Selected publications

• Exploring the Relationship Between Racial Microaggressions and Substance Use in Asian Americans

  Figshare · 2026-05-19

  articleOpen access

  While racial microaggressions (behaviors and statements made toward a person with or without the intention of expressing prejudice) are associated with increased substance use among several racial groups, the relationship between racial microaggressions and substance use in Asian American adults is less defined. It is also unknown if ethnic identity strength (the quality of an individual’s affiliation with their ethnic group) moderates any associations between racial microaggressions and substance use in Asian American adults. We conducted a cross-sectional survey of English-speaking Asian American adults aged 18 years and older living in the United States (<i>N</i> = 523). Validated scales assessed distinct subsets of racial microaggressions and ethnic identity strength. We assessed former (ever use, but not in the past 30 days) and past 30-day tobacco, cannabis, and alcohol substance use. Adjusted logistic regression models examined associations between racial microaggression subscales and substance use outcomes, as well as potential moderation by ethnic identity strength. Participants’ mean age was 42.9 years. The most reported ethnicities were Indian (15.7%), Filipino (14.5%), Japanese (13.6%), and Chinese (13.0%). Greater exposure to racial microaggressions was associated with higher odds of past 30-day tobacco, cannabis, and alcohol use, while associations with former substance use were less consistent. Ethnic identity strength did not significantly moderate these associations. Racial microaggressions are associated with multiple forms of substance use among Asian American adults. Clinical and public health interventions that address racial microaggressions may help improve substance-use-related health outcomes in this population.

  PublisherDOI

• Exploring the Relationship Between Racial Microaggressions and Substance Use in Asian Americans

  Figshare · 2026-05-19

  articleOpen access

  While racial microaggressions (behaviors and statements made toward a person with or without the intention of expressing prejudice) are associated with increased substance use among several racial groups, the relationship between racial microaggressions and substance use in Asian American adults is less defined. It is also unknown if ethnic identity strength (the quality of an individual’s affiliation with their ethnic group) moderates any associations between racial microaggressions and substance use in Asian American adults. We conducted a cross-sectional survey of English-speaking Asian American adults aged 18 years and older living in the United States (<i>N</i> = 523). Validated scales assessed distinct subsets of racial microaggressions and ethnic identity strength. We assessed former (ever use, but not in the past 30 days) and past 30-day tobacco, cannabis, and alcohol substance use. Adjusted logistic regression models examined associations between racial microaggression subscales and substance use outcomes, as well as potential moderation by ethnic identity strength. Participants’ mean age was 42.9 years. The most reported ethnicities were Indian (15.7%), Filipino (14.5%), Japanese (13.6%), and Chinese (13.0%). Greater exposure to racial microaggressions was associated with higher odds of past 30-day tobacco, cannabis, and alcohol use, while associations with former substance use were less consistent. Ethnic identity strength did not significantly moderate these associations. Racial microaggressions are associated with multiple forms of substance use among Asian American adults. Clinical and public health interventions that address racial microaggressions may help improve substance-use-related health outcomes in this population.

  PublisherDOI

• IP04-29 ANALYZING SMOKING CESSATION CHALLENGES IN BLADDER CANCER PATIENTS FROM AN ONLINE FORUM: HOW SMOKE SIGNALS IGNITE INTEGRATIVE DISCUSSIONS

  The Journal of Urology · 2025-04-08

  article
  PublisherDOI

• Campaign messages to support pictorial health warning labels for little cigars and cigarillos: an online survey-based experiment

  BMJ Open · 2025-06-01

  articleOpen accessSenior author

  OBJECTIVES: Campaigns to support pictorial health warning labels (HWLs) for cigarettes have enhanced their effectiveness, but little to no research on campaign messages to support little cigars and cigarillos (LCC) pictorial HWLs exists. The goal of this study was to examine the effectiveness of messages to augment pictorial HWLs on LCCs among priority populations. DESIGN: Online survey-based experiment. SETTING: Qualtrics research panel online of US adults, recruited between January and February 2023. PARTICIPANTS: Adults ages 21-29 who reported current cigar use and reside in the USA. INTERVENTIONS: Participants (n=315) were randomly assigned to one of three conditions: (1) messages designed to elaborate pictorial HWLs, (2) pictorial HWLs alone and (3) messages and pictorial HWLs paired together. PROCEDURES AND OUTCOME MEASURES: Within conditions, participants were shown six negative health effects of LCCs and answered questions about perceived message effectiveness (PME), negative affect, thinking about risks (TAR) and self-reported learning (SRL) as well as questions on quit intention, concern about their health and reactance. Using mixed-effects models and ANOVA, we evaluated for differences across conditions. RESULTS: Most participants identified as male (60%) and either Black (45%) or White (45%). PME was very high across all three conditions (≥ 3.85) but no difference between conditions in a statistically significant manner (p=0.18). Mixed-effects models indicated that negative affect varied across conditions, highest in condition 2 (3.76; 95% CI 3.58, 3.94) and lowest in condition 3 (3.44; 95% CI 3.27, 3.61) (p=0.01), and showed no statistically significant difference between conditions for SRL (p=0.31) or TAR (p=0.43). No statistically significant difference was noted for quit intentions (p=0.16), health concern (p=0.28) or reactance (p=0.84). CONCLUSIONS: Pictorial HWLs, campaign messages and the combination of the conditions were all perceived as very effective, with little differences in PME. Such findings indicate that pictorial HWLs on LCCs and communication messages about LCCs both appear as promising approaches to reducing LCC use among target populations. Longitudinal studies with ongoing exposure may identify factors that can enhance the effectiveness of campaign messages to enhance pictorial HWLs for LCCs.

  PublisherDOI

• Perceived risks, reasons for use, and barriers to cessation among youth who use multiple tobacco products

  UNC Libraries · 2025-12-02

  articleOpen access1st authorCorresponding

  Background Many interventions aim to reduce youth tobacco use, but few have focused on youth who use multiple tobacco products (MTPs). This qualitative study sought to understand how youth who use MTPs view tobacco product risks, describe reasons for MTP use, and perceive barriers and facilitators to cessation. Methods We conducted seven virtual focus groups with 30 US youth ages 14&ndash;20 years who reported using e-cigarettes and smoking a combustible tobacco product in the past 30 days. We used a semi-structured focus group guide to ask youth about perceived health risks of tobacco products, reasons for MTP use, and thoughts about quitting. We conducted a thematic analysis of transcripts. Results The mean age of participants was 18.7 years; 47% identified as white. Most participants were female (63%) and lesbian, gay, or bisexual (63%). Three central themes emerged: 1) uncertainty or misperceptions about e-cigarettes were common, including what ingredients they contain, whether they are tobacco products, and their harm relative to cigarettes; 2) convenience and social factors were mentioned as reasons for using MTPs, rather than using e-cigarettes to quit cigarettes; 3) barriers to cessation included nicotine dependence (especially to e-cigarettes) and environmental factors, while cessation resources were rarely mentioned. Conclusions These findings suggest that educational interventions to reduce youth MTP use could focus on correcting misperceptions about e-cigarettes and communicating the harms of combustible tobacco use. Furthermore, behavioral interventions could capitalize on peer and social support while acknowledging unique barriers resulting from MTP use, such as high nicotine dependence.

  PublisherDOI

• A novel hierarchical framework elucidating regional differences in α-synuclein and tau co-pathology in military veterans with parkinsonism

  Journal of Neuropathology & Experimental Neurology · 2025-11-21

  article

  Neuropathologic features diagnostic of parkinsonian disorders infrequently occur in isolation; hyperphosphorylated tau (p-tau) and amyloid plaques are often observed in combination with α-synuclein deposition. Co-pathologies in neurodegenerative diseases are now recognized as the norm rather than an exception, but existing neuropathological assessment tools do not capture the complexity of concurrent co-pathologies. Characterization of this co-pathology is critical, as it has the potential to identify synergistic mechanisms. We developed a hierarchical cytoarchitectural classification system, which we applied to an autopsy series of military veterans with parkinsonism (n = 26), focusing on Lewy and neurofibrillary pathologies. We defined co-pathology as Type A (co-morbid), Type B (co-regional), Type C (co-cellular), or Type D (co-aggregate). The regional distributions of each co-pathology subtype were assessed using double-label immunohistochemistry in the frontal cortex, hippocampal formation, and midbrain. The frontal cortex demonstrated only subtypes A-C (no co-aggregates), whereas the midbrain and hippocampus showed all subtypes of copathology (A-D). In summary, we show marked differences in the prevalence and levels of mixed α-synuclein and tau pathology in this cohort. Our classification system has the potential to be applied broadly for the study of co-pathology in neurodegenerative disorders.

  PublisherDOI

• Analyzing Smoking Challenges in Bladder Cancer Patients From an Online Forum: A Contemporary Qualitative Study of Peer Support and Cessation Motivators

  UNC Libraries · 2025-06-26

  articleOpen access

  Background Motivators and barriers to smoking cessation among bladder cancer (BC) survivors remain largely understudied. A novel approach to exploring these challenges is through analyzing user discourse on internet forums, which offer valuable insights into patients&rsquo; lived experiences. Objective To qualitatively examine smoking cessation in former and current smokers with connections to BC using Reddit.MethodsAll posts on the subreddit &ldquo;r/stopsmoking&rdquo; was queried for &ldquo;bladder cancer&rdquo; and its MeSH terms. Threads with anecdotal experiences on BC and smoking were included for analysis. Grounded theory was used to inductively analyze the original posts. Two independent reviewers arranged original posts into individual excerpts to identified preliminary themes. These categories were refined to derive resultant concepts. Results 145 total discussions (17 BC original posts by former and current smokers and 128 reponses) were included. Grounded theory identified 4 themes: coping with BC, fluctuating motivators, resilience and determination amidst smoking relapse, emotional release. Three resultant concepts were formed: BC impacts quality of life, BC experience serves as a motivator for smoking cessation, and successful smoking cessation relies on a robust support network. Conclusions This study unveils BC experiences without judgment apprehension. The diagnosis of BC and patients&rsquo; shared experiences may serve as catalysts to quit smoking. These themes and concepts on BC&rsquo;s impact on smoking can assist clinicians to have tailored cessation discussions.

  PublisherDOI

• Wanting to be “accepted and heard”: Perspectives about cessation messages from LGBTQ+ individuals who dual use cigarettes and e-cigarettes

  UNC Libraries · 2025-10-13

  articleOpen access

  INTRODUCTION: Dual use of cigarettes and e-cigarettes is especially prevalent among lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) adults in the US. This is concerning as health risks of dual use may be as high or higher than exclusive smoking. We sought to learn about people who dual use and identify as LGBTQ+'s perspectives about dual use, quitting, and cessation ads. METHODS: Nineteen LGBTQ+ adults who dual use participated in virtual semi-structured interviews in North Carolina in 2022. We asked about perceptions of smoking and vaping in LGBTQ+ communities, their thoughts about quitting, and their opinions on four cessation ads. The ads advocated quitting one or both products. Transcripts were coded using ATLAS.ti and reviewed using a thematic content analysis approach. RESULTS: Participants described how within LGBTQ+ communities, smoking and vaping are common and accepted and are used to cope or to socialize. Most participants made past quit attempts. Many said they were not ready to quit both products, but some were open to quitting smoking. Some thought e-cigarettes may be as harmful as cigarettes, reducing their motivation to quit smoking cigarettes due to the lack of perceived health benefits. Participants sought cessation ads that explicitly address dual use and are representative and supportive. They disliked ads that felt stereotypical or patronizing. CONCLUSIONS: Dual use in LGBTQ+ communities appears driven by both internal and external pressures. Participants were generally open to quitting cigarettes, and LGBTQ+ smoking cessation may be best encouraged with authentic ads that explicitly address both products. IMPLICATIONS: These qualitative findings about smoking and vaping among LGBTQ+ individuals provide guidance for communication ad campaign design to help reduce the high dual use rates among LGBTQ+ young adults.

  PublisherDOI

• The Impact of the COVID-19 Pandemic on Tobacco Treatment Program Implementation at National Cancer Institute-Designated Cancer Centers

  UNC Libraries · 2025-04-18

  articleOpen access

  INTRODUCTION: The COVID-19 pandemic disrupted cancer screening and treatment delivery, but COVID-19's impact on tobacco cessation treatment for cancer patients who smoke has not been widely explored. AIMS AND METHODS: We conducted a sequential cross-sectional analysis of data collected from 34 National Cancer Institute (NCI)-designated cancer centers participating in NCI's Cancer Center Cessation Initiative (C3I), across three reporting periods: one prior to COVID-19 (January-June 2019) and two during the pandemic (January-June 2020, January-June 2021). Using McNemar's Test of Homogeneity, we assessed changes in services offered and implementation activities over time. RESULTS: The proportion of centers offering remote treatment services increased each year for Quitline referrals (56%, 68%, and 91%; p = .000), telephone counseling (59%, 79%, and 94%; p = .002), and referrals to Smokefree TXT (27%, 47%, and 56%; p = .006). Centers offering video-based counseling increased from 2020 to 2021 (18% to 59%; p = .006), Fewer than 10% of centers reported laying off tobacco treatment staff. Compared to early 2020, in 2021 C3I centers reported improvements in their ability to maintain staff and clinician morale, refer to external treatment services, train providers to deliver tobacco treatment, and modify clinical workflows. CONCLUSIONS: The COVID-19 pandemic necessitated a rapid transition to new telehealth program delivery of tobacco treatment for patients with cancer. C3I cancer centers adjusted rapidly to challenges presented by the pandemic, with improvements reported in staff morale and ability to train providers, refer patients to tobacco treatment, and modify clinical workflows. These factors enabled C3I centers to sustain evidence-based tobacco treatment implementation during and beyond the COVID-19 pandemic. IMPLICATIONS: This work describes how NCI-designated cancer centers participating in the Cancer Center Cessation Initiative (C3I) adapted to challenges to sustain evidence-based tobacco use treatment programs during the COVID-19 pandemic. This work offers a model for resilience and rapid transition to remote tobacco treatment services delivery and proposes a policy and research agenda for telehealth services as an approach to sustaining evidence-based tobacco treatment programs.

  PublisherDOI

• Perceptions of Prevention and Cessation Ads among US Youth Who Use Multiple Tobacco Products: A Qualitative Study

  Nicotine & Tobacco Research · 2025-09-20

  article

  INTRODUCTION: Around 30% of youth who use tobacco use multiple tobacco products (MTPs), yet little research has evaluated campaign ads to address youth MTP use. METHODS: We qualitatively examined how youth who use MTPs perceive tobacco prevention and cessation ads. Between February 2023 and January 2024, we held seven virtual focus groups with 30 US youth (ages 14-20 years) who reported using both e-cigarettes and a combustible tobacco product in the past 30 days. Participants were shown five static tobacco prevention and cessation ads that addressed single and MTPs. Participants were asked about their reactions to the ads, including whether they were effective or relatable, and suggested changes to the ads. We performed a thematic analysis. RESULTS: Participants were, on average, 18.7 years old. Most participants were female (73%), white (47%), and lesbian, gay, or bisexual (63%). Four central themes emerged: (1) Ads about MTPs were perceived as more effective than ads about single tobacco products because they were relevant and informative; (2) Participants recommended that MTP ads should specify "vaping and smoking" or "nicotine" to refer to MTPs rather than "tobacco"; (3) Participants described ads with youth vernacular as ineffective and unrelatable and exhibited message fatigue; and (4) Ads that featured shared health consequences of MTP use, especially with graphic, fear-arousing images, were perceived as most effective. CONCLUSIONS: Findings suggest ads about MTPs could be effective among youth who use MTPs. Promising MTP ads could specify "vaping and smoking" and highlight shared health effects across MTPs using graphic, fear-arousing images. IMPLICATIONS: Multiple tobacco product (MTP) use (ie the use of two or more tobacco products in the past 30 days) is a common pattern of tobacco use among youth, yet little research has developed or evaluated campaign ads addressing MTP use. We conducted a qualitative study to examine how youth who use MTPs perceive tobacco prevention and cessation ads. Findings suggest ads about MTPs could be effective, especially if they specify "vaping and smoking" and highlight shared health effects of MTPs using graphic, fear-arousing images.

  PublisherDOI

Frequent coauthors

• Leah M. Ranney

  RTI International

  98 shared

• Sarah D. Kowitt

  University of North Carolina at Chapel Hill

  67 shared

• Lisa Sanderson Cox

  University of Kansas Medical Center

  51 shared

• Jamie S. Ostroff

  Memorial Sloan Kettering Cancer Center

  51 shared

• Glen D. Morgan

  University of North Carolina at Chapel Hill

  50 shared

• Kristen L. Jarman

  50 shared

• Elyse Richelle Park

  Massachusetts General Hospital

  49 shared

• Robert A. Schnoll

  University of Pennsylvania

  49 shared

Labs

• Tobacco Prevention and Evaluation ProgramPI

Education

• M.D., Medicine

  University of North Carolina (UNC)

• Other, Public Health

  University of North Carolina (UNC)