About

Rebecca L. Ashare, Ph.D., is an Adjunct Associate Professor of Psychiatry and a Senior Fellow at the Center for Public Health Initiatives at the University of Pennsylvania. She is also an affiliated faculty member at the Palliative and Advance Illness Research Center and a Core Investigator at the Prevention Science and Community Engagement Core of the Penn Center for AIDS Research. Dr. Ashare's research focuses on translational science, medication development, and neurocognition as they relate to nicotine dependence. Her primary research interests include identifying risk factors for smoking relapse, with particular attention to cognitive control, decision-making, and stress, as well as evaluating novel treatments to improve abstinence rates. Her work leverages tools from psychology, neuropharmacology, and cognitive neuroscience to understand the mechanisms underlying smoking relapse and the efficacy of new interventions. Additionally, she conducts research on the intersection of smoking, HIV, and cognitive function, investigating whether HIV-infected smokers experience greater withdrawal-related cognitive deficits and exploring potential treatments targeting the cholinergic pathway to reduce inflammation and reverse neurocognitive deficits in this population.

Research topics

• Medicine
• Psychology
• Psychiatry
• Clinical psychology
• Internal medicine

Selected publications

• Cannabis stigma and symptom management considerations in cancer survivors: a mixed-methods exploration of patient perspectives

  Supportive Care in Cancer · 2026-03-13

  articleOpen accessSenior author

  PURPOSE: This study aims to assess for indications of stigma and attitudes toward cannabis among cancer survivors (CS) who use or consider the use of cannabis. METHODS: This study employed a convergent, parallel mixed methods design utilizing focus group and questionnaire data to assess the presence of stigma among a sample of CS (n = 23) who use (n = 10) and do not use (n = 13) cannabis to manage symptoms. CS were recruited from a multi-site observational study in the Northeast U.S. region that assesses cannabis use among oncology patients. RESULTS: A total of 23 CS participated in this study. In general, this sample appeared to have positive attitudes towards cannabis, as indicated by quantitative results, and most CS felt accepting or neutral about other CS using cannabis, irrespective of whether they used or not. Most CS did not indicate experiences of stigma for cannabis use, did not feel judged by their medical providers, and indicated a feeling of empowerment to do whatever was needed to feel better. However, several CS reported intentional nondisclosure to their providers. Many CS discussed the presence of opioid-related stigma, both perceived from society and internalized, which appeared to play an important role in their symptom-management decision-making. CONCLUSIONS: Findings from this study suggest that while cannabis stigma may not be commonplace for CS, some do experience it. Further, opioid stigma appears to be perceived and intertwined in the decision-making processes for CS in this sample.

  PublisherOA PDFDOI

• Leveraging the National Cancer Institute’s collaborative efforts to understand the benefits and harms of cannabis use among individuals with cancer

  JNCI Journal of the National Cancer Institute · 2026-02-24

  article

  Cannabis use for symptom management among patients with cancer has increased significantly in recent years, with many reporting benefits for pain, anxiety, sleep, nausea, appetite as well as other symptoms. However, rigorous prospective data on the potential benefits and harms of cannabis use in this population are lacking. This Commentary describes a United States National Cancer Institute (NCI)-led initiative addressing this research gap by supporting five prospective observational studies evaluating the benefits and harms of cannabis use among a large, heterogeneous samples of patients with cancer undergoing active systemic treatment. We provide an overview of each study, including cancer type, treatment modalities, inclusion/exclusion criteria, data collection methods, and both patient-reported and cancer-related outcomes.

  PublisherDOI

• Differences in Cognition and Smoking Abstinence Rates Among People With and Without HIV Who Smoke

  Nicotine & Tobacco Research · 2025-06-27 · 1 citations

  articleOpen accessSenior author

  INTRODUCTION: High rates of smoking among people with HIV (PWH) persist and may be due to HIV-associated neurocognitive disorders exacerbating abstinence-induced cognitive deficits, leading to higher risk of relapse. This study assessed differences in smoking abstinence rates and abstinence-induced cognitive deficits among PWH and people without (PWOH). METHODS: In this prospective observational design (NCT03169101), treatment-seeking adults completed two laboratory sessions during a pre-quit phase to assess cognition: once following 24h abstinence and once smoking-as-usual. Cognition was measured through response inhibition, working memory, and verbal memory tasks. All received standard smoking cessation treatment over 8 weeks (i.e., counseling, nicotine patch). Point-prevalence abstinence was assessed at end-of-treatment. RESULTS: Our sample included 210 participants (38.1% PWH; 61.9% PWOH), who were mostly male (59.5%) and Black/African-American (76.7%). No significant HIV status by abstinence condition interactions emerged for any cognitive outcome (all ps > .4). There were significant abstinence-induced deficits in response inhibition (p = .02), working memory response time (p = .005), and verbal memory (p=<.001). No significant differences emerged in abstinence rates between PWH and PWOH (31.2%, 32.3%, respectively; OR = 1.26, 95% CI: 0.67, 2.39, p = .48). CONCLUSION: Despite prior research suggesting differences in abstinence rates and cognition between PWH and PWOH who smoke, hypotheses were not supported. However, this is one of a few studies to directly compare people with and without HIV in a rigorously designed mechanistic smoking cessation study. Given that cognition does not appear to play a primary role in smoking among PWH, more work is needed to understand the mechanisms driving disproportionate smoking rates among PWH.

  PublisherOA PDFDOI

• Galantamine for 12 weeks does not improve neurocognition or immune activation in ART-suppressed people with HIV

  AIDS · 2025-11-27

  articleSenior authorCorresponding

  OBJECTIVE: People with HIV on ART are highly vulnerable to non-AIDS-related comorbidities, including HIV-associated neurocognitive disorders, which are linked to persistently activated monocytes/macrophages. Smoking is a major contributor to HIV-related comorbidities. However, nicotine alone has anti-inflammatory effects, mainly through α7-nicotinic receptor (nAChR) activation. Galantamine (GAL) is an FDA-approved pro-cognitive medication that increases endogenous acetylcholine and also directly potentiates the α7-nAChR. We hypothesized that GAL would improve neurocognition in PWH, both by direct pro-cognitive effects and by reducing inflammation. We also explored whether effects differed by smoking status. DESIGN/METHODS: Smoking and nonsmoking PWH/ART participated in a double-blind, randomized, placebo-controlled crossover study of 12 weeks of GAL treatment. Primary outcomes were composite neurocognitive test score; monocyte CD16, CD163 and CCR2, and CD8 T-cell CD38/HLA-DR; and plasma sCD16, sCD163 and CCL2. Plasma hsCRP and neurofilament light chain (NFL) were also measured. Exploratory analyses included plasma mediators by Luminex and monocyte transcriptome by RNAseq. RESULTS: Neurocognition did not differ between GAL and placebo treatment (adjusted standardized difference (95% CI) -0.02 (-0.2, 0.2); P = 0.82), with no difference by smoking status ( P = 0.51). Monocyte CCR2 expression was 15.2% (5, 25.1) greater with GAL than placebo ( P = 0.006). No differences were seen in monocyte CD16 ( P = 0.76) or CD163 ( P = 0.8), CD8 + T-cell CD38/HLA-DR ( P = 0.54), or plasma sCD163 ( P = 0.36), sCD14 ( P = 0.46), or CCL2 ( P = 0.34). NFL and hsCRP were not different, but several pro-inflammatory cytokines increased with GAL. Only modest effects were seen on monocyte gene expression. CONCLUSIONS: Galantamine for 12 weeks did not improve cognition or reduce inflammation in PWH/ART regardless of smoking status.

  PublisherDOI

• Witnessing for Black mental health: Formative steps for designing a community-based mental health education intervention

  2025-10-17

  articleOpen accessSenior author

  Objectives: Following the May 2022 racially motivated mass shooting in Buffalo, New York, mental health care was found to be the most frequently endorsed unmet need among local Black community members surveyed. In response, a community-university partnership formed in pursuit of developing culturally tailored mental health programming. To inform program development, the partnership conducted community-engaged research to understand diverse stakeholders’ relevant concerns, beliefs, and preferences. Methods: In Study 1, community health workers (n=13; 92% Black; 100% women; 23–78 years old, Mage=52) participated in one-on-one semi-structured interviews. In Study 2, community members (n=54; 100% Black; 63% women, 31% men, 6% gender not reported; 18–91 years old) participated in focus groups. In both studies, transcripts were coded using descriptive, semantic, realist thematic analysis. Member checks were conducted with organizational leadership, study participants, and broader members of the community. Results: Across both studies, participants described cultural (e.g., stigma) and material (e.g., insurance) barriers to care; systematic (e.g., poverty) and interpersonal (e.g., lack of social support) mental health risks; willingness to discuss mental health (e.g., increasing over time); and preferences for mental health education and services (e.g., provider authenticity). Individual study results and convergences and divergences across studies are detailed. Conclusions: Results informed the development of a pilot mental health education program, “Witnessing for Mental Health.” The community health worker–delivered program addresses participant-identified cultural, tangible, and systemic barriers to mental health care and leverages increasing community openness and interest in discussing mental health.

  PublisherDOI

• Differences in Cognition and Smoking Abstinence Rates Among People With and Without HIV

  Drug and Alcohol Dependence · 2025-02-01

  articleSenior author
  PublisherDOI

• The role of alternative reinforcers in smoking outcomes among people with and without HIV.

  Psychology of Addictive Behaviors · 2025-06-05

  articleOpen accessSenior author

  OBJECTIVE: People with HIV (PWH) smoke at higher rates than people without HIV (PWOH). Alternative reinforcers, or behaviors that replace (substitute reinforcers) or maintain (complementary reinforcers) smoking, are associated with smoking outcomes but have not been studied among PWH. This observational study assessed whether alternative reinforcers changed during a quit attempt among PWH and PWOH and whether the associations differed between groups. METHOD: The parent study included 274 participants (93 PWH and 181 PWOH) who sought treatment for smoking cessation in a 12-week program. The present analyses were limited to 173 (73 PWH and 100 PWOH) study completers. The primary outcomes were changes in substitute and complementary reinforcers at the end of treatment (EOT; week 12) measured using the Pleasant Events Schedule. We performed linear regressions in the overall sample and then stratified by HIV status for each alternative reinforcer. The time (baseline; week 0 vs. EOT) by smoking status at EOT (abstinent vs. nonabstinent) interaction was tested. RESULTS: = .04). CONCLUSIONS: Declines in complementary reinforcers were associated with smoking cessation outcomes among PWH. These findings partially support results from prior literature, suggesting that addressing complementary reinforcers during smoking cessation treatment may be crucial in improving quit rates among PWH. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

  PublisherDOI

• The State of the Evidence for Medical Cannabis as a Treatment for Pain-related Sleep Impairments: Integrating Social Determinants of Health into Research Design and Policy

  Current Sleep Medicine Reports · 2025-01-03

  articleSenior author
  PublisherDOI

• Sex-Specific Mediation of Pre-Quit Smoking Reduction: Secondary Analysis of a Randomized Controlled Trial Extending Varenicline Preloading

  Nicotine & Tobacco Research · 2025-05-02 · 1 citations

  articleOpen access

  INTRODUCTION: Relative to other pharmacotherapies for smoking cessation, varenicline has significantly greater efficacy in females; however, sex-specific mechanisms have not yet been investigated. We conducted a secondary analysis of ecological momentary assessment data to assess whether reductions in craving, negative affect, and smoking satisfaction/reward/aversion mediate effects of varenicline on next-day smoking to a greater degree in females (n = 179) relative to males (n = 141). AIMS AND METHODS: Data were from a 3-week medication manipulation period during the pre-quit phase of a double-blind randomized placebo-controlled trial investigating extended preloading (4 weeks) versus standard preloading of varenicline (1 week, preceded by 3 weeks of placebo, NCT03262662). Time-invariant multi-level moderated mediation models and time-varying mediation models were utilized. RESULTS: A significant time-varying indirect effect through craving that increased in magnitude over the pre-quit period was identified only in females. Exploratory analysis found that decreases in psychological reward and smoking satisfaction mediated the relationship between varenicline and reductions in craving only in females. Time-invariant multi-level models did not evidence a significant indirect effect through candidate mediators in males or females; the index of moderated mediation was not significant in any of the models. CONCLUSIONS: Our findings suggest that the efficacy of varenicline on reductions in pre-quit smoking in females operates through reductions in craving. Furthermore, reductions in craving may be due to decreases in positive subjective experiences of smoking. Augmenting craving coping strategies as well as reducing smoking reward and satisfaction may be a beneficial approach in females. IMPLICATIONS: This is the first study to investigate sex-specific mediation of varenicline on reductions in pre-quit smoking. Further investigation into varenicline-induced changes in smoking reinforcement and craving is warranted, particularly in females. For example, experimentally manipulating these mediators may inform them as mechanisms for smoking reduction.

  PublisherOA PDFDOI

• Ask the Experts: Community Engagement Studios to Inform Research on Cannabis Use in Cancer Symptom Management

  Drug and Alcohol Dependence · 2025-02-01

  articleSenior author
  PublisherDOI

Recent grants

• Targeting the Cholinergic Pathway in HIV-associated Inflammation and Cognitive Dysfunction

  NIH · $3.8M · 2017–2025

• NIH Grant F31DA024532

  NIH · $90k · 2010

• Understanding the Role of Cognitive Dysfunction in the Treatment of Nicotine Dependence among HIV-Infected Smokers

  NIH · $3.3M · 2016–2023

• Repurposing cholinesterase inhibitors for smoking cessation

  NIH · $746k · 2013–2018

Frequent coauthors

• Brooke Worster

  Thomas Jefferson University

  31 shared

• Robert A. Schnoll

  University of Pennsylvania

  31 shared

• Frank T. Leone

  University of Pennsylvania

  28 shared

• Rachel F. Tyndale

  Centre for Addiction and Mental Health

  27 shared

• Larry W. Hawk

  University at Buffalo, State University of New York

  23 shared

• Robert Gross

  22 shared

• Caryn Lerman

  USC Norris Comprehensive Cancer Center

  22 shared

• Salimah H. Meghani

  21 shared