About

Seth Himelhoch, MD, MPH, is a Professor and Chair of the Department of Psychiatry and Behavioral Neuroscience at the University of Chicago. He leads a diverse team of clinicians and staff dedicated to creating a 'culture of health,' which emphasizes that everyone has the opportunity to live a healthier life and that communities must work together to ensure healthy choices are accessible. His role involves leveraging academic medicine to deliver cutting-edge clinical services, supported by robust community engagement, to educate and train future leaders in psychiatry. His work underscores the importance of community impact in advancing psychiatric care and education.

Research topics

• Family medicine
• Medicine
• Psychiatry
• Medical education
• Internal medicine
• Emergency medicine
• Psychology
• Medical emergency
• Nursing
• Clinical psychology

Selected publications

• Adult tobacco product use patterns across the urban–rural continuum: The longitudinal Population Assessment of Tobacco and Health (PATH) study, 2016–2023

  The Journal of Rural Health · 2026-03-01

  article

  PURPOSE: To determine the association between adult tobacco/nicotine product use over time and residence location (urban, suburban, town, rural), controlling for demographics. METHODS: Data from Waves 4-7 (2016-2023) of the Population Assessment of Tobacco and Health (PATH) study (N = 18,590 adults) were analyzed using survey-weighted logistic regression to evaluate location and time differences in likelihoods of current, daily, and established use of combustible tobacco, electronic nicotine delivery systems (ENDS), smokeless products, and poly use (≥2 products). FINDINGS: Compared to those residing in urban locations, suburban residents were less likely to report current (adjusted odds ratio (aOR) = 0.88), daily (aOR = 0.73), and established combustible products use (aOR = 0.77); town residents were more likely to use these products currently (aOR = 1.20) and daily (aOR = 1.42), and rural residents were more likely to use daily (aOR = 1.25) and report established use (aOR = 1.33). Rural residents had a lower likelihood of current ENDS use (aOR = 0.90), compared with those in urban locations. Compared with urban residents, current smokeless products use was more likely among rural residents (aOR = 1.63) and less likely among those in suburban locations (aOR = 0.74). Participants living in suburban (vs. urban) locations were less likely to use ≥2 products currently (aOR = 0.89) or daily (aOR = 0.79), while rural residents were more likely to engage in daily poly use (aOR = 1.39). Time was a significant factor in all models, with fluctuating patterns across waves. CONCLUSIONS: These findings highlight nuanced geographic differences in tobacco/nicotine product use patterns beyond simple urban-rural comparisons, informing efforts to eliminate tobacco/nicotine use disparities.

  PublisherDOI

• Tobacco marketing exposure and lifetime and current nicotine pouch use among US youth, 2022

  Preventive Medicine · 2025-05-30 · 3 citations

  article
  PublisherDOI

• Mediation Effects of Biobehavioral Factors in a Trial of Pharmacotherapy and Intensive Cessation Counseling for People with HIV Who Smoke Cigarettes in Nairobi, Kenya

  AIDS and Behavior · 2025-12-10

  articleOpen accessSenior author

  There is growing recognition of the important health risks of tobacco use in people with HIV (PWH). Multiple randomized controlled trials have tested cessation treatments in this population, but little is known about factors that mediate successful quitting. We conducted a randomized, placebo-controlled 2 × 2 factorial design trial of a behavioral intervention (Positively Smoke Free [PSF] one-on-one counseling) vs. brief advice to quit ± bupropion vs. placebo in PWH who smoked cigarettes in Nairobi, Kenya. Abstinence from cigarettes was assessed by self-report and exhaled carbon monoxide (ECO). We conducted pre-planned analyses of putative mediators of the effects of bupropion (i.e. craving, withdrawal, negative affect) and of PSF counseling (i.e. abstinence self-efficacy, decisional balance, and loneliness) at 12-weeks on biochemically-confirmed abstinence at 36-weeks. 269 participants were included in the final analytic cohort (mean age = 42.7 years, 70.3% male, smoking a mean of 10.6 cigarettes per day). The biochemically verified abstinence rate at 36-weeks was 24.2%. PSF counseling increased abstinence self-efficacy and reduced loneliness significantly more than brief advice to quit at 12-weeks. Mediation analyses suggested a mediating effect of change in self-efficacy at 12-weeks in the relationship of PSF to abstinence at 36-weeks. None of the putative mediators demonstrated a significant mediation effect of bupropion on quitting. These results indicate that self-efficacy was one mechanism through which PSF counseling, but not bupropion, increased smoking abstinence among PWH who smoked cigarettes in Nairobi, Kenya.Trial Registration: NCT02460900.

  PublisherOA PDFDOI

• Examining the Neural and Behavioral Impact of Accelerated Intermittent Theta Burst Stimulation (iTBS) in People with Opioid Use Disorder (OUD) Who Smoke Tobacco Cigarettes: A Pilot Study

  medRxiv · 2025-09-12

  preprintOpen access

  Abstract Novel therapies are needed to improve smoking cessation outcomes in people with opioid use disorder (OUD), as they are far more likely to smoke cigarettes (70-90%) compared to the general population (11.6%) and demonstrate poorer response to smoking cessation interventions. This pilot study was the first to explore the impact of a single day (four sessions) of accelerated intermittent theta burst stimulation (iTBS) (1800 pulses/session) versus sham iTBS on the left dorsolateral prefrontal cortex (L.dlPFC) in people with OUD who smoke tobacco cigarettes (n=8 received iTBS, n=7 received sham iTBS). Resting state functional connectivity (rsFC) was acquired at baseline and after the fourth session. Attentional bias for cigarette and opioid cues, and craving assessments were completed at baseline, and after the first and fourth sessions. Connectivity between the L.dlPFC seed and a cluster comprising the left anterior supramarginal gyrus (SMG) showed a significant group × time interaction, with planned comparisons showing a greater increase at follow-up with iTBS compared to sham iTBS ( t 12 =6.37, beta =0.40, p <0.001). Cigarette cue attentional bias showed a significant group × session interaction ( t 82 =2.34 , p =0.02), with planned comparisons revealing a decrease after iTBS and an increase after sham iTBS. No effect of iTBS was observed for opioid cue attentional bias. Cigarette craving decreased with both iTBS and sham iTBS but did not show a significant group × session interaction. These results are promising but need to be interpreted with caution, given the limited sample size and multiple comparisons. Future trials could examine the effects of increased doses of iTBS (e.g., more days of accelerated iTBS) to identify the dosing required to promote smoking cessation among individuals with OUD effectively.

  PublisherOA PDFDOI

• Integration of Tobacco-Cessation Interventions into Tuberculosis and HIV Care

  New England Journal of Medicine · 2025-11-15

  articleSenior author
  PublisherDOI

• A comparison of classifications for geographic location and their associations with tobacco use among US adults

  The Journal of Rural Health · 2025-06-01 · 1 citations

  articleOpen access

  PURPOSE: This study compared two classifications of rurality and their associations with cigarette, e-cigarette, and smokeless tobacco (SLT) use among a nationally representative sample of 31,196 US adults. METHODS: Data from Wave 1 of the Population Assessment of Tobacco and Health Study. Weighted descriptive statistics and multivariable logistic regressions assessed whether two classifications of rurality were differentially associated with past 30-day (P30D) cigarette, e-cigarette, or SLT use in separate models. Classifications were (1) the US Census Bureau's classification as urban/non-urban; and (2) the National Center for Education Statistic (NCES)'s classification as urban/suburban/town/rural. This study is reported in accordance with STROBE guidelines. FINDINGS: With the Census Bureau classification, 79.3% were in urban areas. With the NCES classification, 34.3% were in urban, 35.1% in suburban, 9.4% in town, and 21.1% in rural areas. With the Census Bureau classification, non-urban (vs. urban) residence was associated with reduced odds of e-cigarette use (AOR = 0.79; 95% CI = 0.70-0.88) and increased odds of SLT use (AOR = 2.32; 95% CI = 1.97-2.72). With the NCES classification with urban as reference, rural residence was associated with reduced odds of e-cigarette use (AOR = 0.77; 95% CI = 0.75-0.98); both town (AOR = 2.16; 95% CI = 1.69-2.78) and rural (AOR = 2.75; 95% CI = 2.16, 3.48) were associated with increased odds of SLT use. Location was not associated with cigarette use for either classification. CONCLUSIONS: Location was similarly associated with P30D e-cigarette and SLT use across both classifications in adjusted models. The use of classifications with more categories may be beneficial to understand nuanced location differences in tobacco use.

  PublisherOA PDFDOI

• Tobacco Marketing Exposure and Lifetime and Current Nicotine Pouch Use Among Us Youth, 2022

  SSRN Electronic Journal · 2025-01-01

  preprintOpen access
  PublisherDOI

• Efficacy of Smoking Cessation Interventions among People with HIV in Kenya

  NEJM Evidence · 2024-10-22 · 5 citations

  article1st authorCorresponding

  BACKGROUND: People with human immunodeficiency virus (HIV) smoke at much higher rates than the general population, resulting in higher risk for tobacco-related morbidity and mortality. The efficacy of smoking cessation interventions among people with HIV in lower-middle-income countries remains unclear. METHODS: We conducted a randomized, 2 × 2 factorial design trial based in Nairobi, Kenya, to evaluate the efficacy of bupropion versus placebo, and a culturally tailored behavioral cessation therapy, called Positively Smoke Free (PSF), versus standard of care for people with HIV who smoke. The primary outcome was 7-day point prevalence abstinence confirmed by exhaled carbon monoxide <7 ppm at 36 weeks. RESULTS: Between June 2020 and August 2023, 300 participants were randomly assigned. Most participants were men (71.4%) who were moderately dependent on nicotine (Fagerström Test of Cigarette Dependence, mean [SD]: 4.5 [2.3]; range: 0-10; higher scores represent greater physical dependence on nicotine); nearly all participants (99.7%) were taking antiretroviral medication. At 36 weeks, 31.3% of participants who received bupropion were abstinent from smoking, compared with 13.3% in the placebo group (odds ratio, 2.95; 95% confidence interval [CI], 1.64-5.32, P<0.001). Among participants randomized to receive PSF therapy, 29.5% were abstinent from smoking, compared with 14.9% in the standard of care group (odds ratio, 2.39; 95% CI, 1.34-4.25, P=0.003). The combination of bupropion+PSF was associated with increased abstinence compared with either bupropion (38.9% vs. 23.6%; odds ratio, 2.06; 95% CI, 1.00-4.23) or PSF (38.9% vs. 20.3%; odds ratio, 2.50; 95% CI, 1.20-5.24) alone. Participants randomized to receive bupropion were significantly more likely to report excessive sweating compared with placebo (50.7% vs. 37.6%; P=0.024). CONCLUSIONS: Both bupropion and PSF cessation counseling were effective in promoting abstinence from smoking at 36 weeks. The combined intervention was associated with higher abstinence rates than either therapy alone. (The National Cancer Institute provided support for this trial through grant R01CA225419.).

  PublisherDOI

• Nicotine Metabolite Ratio in People with HIV Who Smoke Cigarettes Receiving Pharmacologic and Behavioral Cessation Therapy

  Cancer Prevention Research · 2024-12-24 · 1 citations

  articleSenior author

  People with human immunodeficiency virus (HIV; PWH) smoke cigarettes at triple the rate of the general population in the United States. Efforts to increase quit rates in this group have met with limited success. The nicotine metabolite ratio (NMR) has shown promise as a phenotypic marker that may be useful in selecting the most appropriate cessation treatments for people who smoke cigarettes. We completed a randomized controlled trial of individual intensive counseling and/or varenicline treatment for PWH in the Baltimore area who smoke cigarettes, and we measured serum 3' hydroxycotinine and cotinine at baseline and calculated the ratio of these two values, i.e., the NMR, for each participant. Herein, we present summary statistics and measures of association, or lack thereof, of NMR values with a variety of behavioral parameters and clinical outcomes related to tobacco use and tobacco treatment. The NMR was calculated for 155 PWH who were currently using tobacco cigarettes. The mean age was 52.9 years, 62.3% male, 91.0% Black, and they smoked a mean of 10.6 cigarettes/day. The mean NMR was 0.43, similar to that reported from other PWH cohorts. We did not find any significant correlation between NMR and cigarettes/day, nicotine dependence, temptation to smoke, or nicotine withdrawal symptoms. We did not find that lower NMR was predictive of successful cessation, nor was it associated with varenicline intolerance in those who received varenicline. Prevention Relevance: People with HIV suffer disproportionately from lung, head and neck, and other tobacco-related cancers as a consequence of high smoking rates. There is an urgent need to mitigate this harm, and the use of the NMR to personalize tobacco treatment is an area of active interest.

  PublisherDOI

• Design and rationale of the Botswana Smoking Abstinence Reinforcement Trial: a protocol for a stepped-wedge cluster randomized trial

  Implementation Science Communications · 2024-05-08 · 1 citations

  articleOpen access

  BACKGROUND: With expanded and sustained availability of HIV treatment resulting in substantial improvements in life expectancy, the need to address modifiable risk factors associated with leading causes of death among people living with HIV/AIDS (PLWH), such as tobacco smoking, has increased. Tobacco use is highly prevalent among PLWH, especially in southern Africa, where HIV is heavily concentrated, and many people who smoke would like to quit but are unable to do so without assistance. SBIRT (Screening, Brief Intervention and Referral to Treatment) is a well-established evidence-based approach successful at supporting smoking cessation in a variety of settings. Varenicline is efficacious in supporting smoking cessation. We intend to assess the effectiveness of SBIRT and varenicline on smoking cessation among PLWH in Botswana and the effectiveness of our implementation. METHODS: BSMART (Botswana Smoking Abstinence Reinforcement Trial) is a stepped-wedge, cluster randomized, hybrid Type 2 effectiveness-implementation study guided by the RE-AIM framework, to evaluate the effectiveness and implementation of an SBIRT intervention consisting of the 5As compared to an enhanced standard of care. SBIRT will be delivered by trained lay health workers (LHWs), followed by referral to treatment with varenicline prescribed and monitored by trained nurse prescribers in a network of outpatient HIV care facilities. Seven hundred and fifty people living with HIV who smoke daily and have been receiving HIV care and treatment at one of 15 health facilities will be recruited if they are up to 18 years of age and willing to provide informed consent to participate in the study. DISCUSSION: BSMART tests a scalable approach to achieve and sustain smoking abstinence implemented in a sustainable way. Integrating an evidence-based approach such as SBIRT, into an HIV care system presents an important opportunity to establish and evaluate a modifiable cancer prevention strategy in a middle-income country (MIC) setting where both LHW and non-physician clinicians are widely used. The findings, including the preliminary cost-effectiveness, will provide evidence to guide the Botswanan government and similar countries as they strive to provide affordable smoking cessation support at scale. CLINICAL TRIAL REGISTRATION: NCT05694637 Registered on 7 December 2022 on clinicaltrials.gov, https://clinicaltrials.gov/search?locStr=Botswana&country=Botswana&cond=Smoking%20Cessation&intr=SBIRT.

  PublisherOA PDFDOI

Recent grants

• Increasing Motivation for Antiretroviral Therapy Initiation: A Pilot Intervention

  NIH · $664k · 2011–2015

• NIH Grant R34MH080630

  NIH · $650k · 2012

• NIH Grant K23DA019820

  NIH · $883k · 2011

• HEART to HAART: Smartphone Intervention to Improve HAART Adherence for Drug Users

  NIH · $702k · 2011–2015

Frequent coauthors

• Richard W. Goldberg

  Mental Illness Research, Education and Clinical Centers

  83 shared

• Deborah R. Medoff

  University of Maryland, Baltimore

  51 shared

• Lisa B. Dixon

  Columbia University

  50 shared

• Eric P. Slade

  Johns Hopkins University

  49 shared

• Julie Kreyenbuhl

  43 shared

• Wendy Potts

  University of Maryland, Baltimore

  40 shared

• Lisa B. Dixon

  New York State Psychiatric Institute

  36 shared

• Clayton H. Brown

  University of Maryland, Baltimore

  35 shared