Minority Health and Health Equity Archive
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Item Racial/Ethnic Disparities in the Use of Nicotine Replacement Therapy and Quit Ratios in Lifetime Smokers Ages 25 to 44 Years(2008) Fu, S. S.; Kodl, M. M.; Joseph, A. M.; Hatsukami, D. K.; Johnson, E. O.; Breslau, N.; Wu, B.; Bierut, L.Abstract available at publisher's web site.Item Sustained-Release Bupropion for Smoking Cessation in African Americans: A Randomized Controlled Trial(2002) Ahluwalia, J. S.Abstract available at publisher's web site.Item Genetic variability of smoking persistence in African Americans.(2011) Hamidovic, Ajna; Kasberger, John L; Young, Taylor R; Goodloe, Robert J; Redline, Susan; Buxbaum, Sarah G; Benowitz, Neal L; Bergen, Andrew W; Butler, Kenneth R; Franceschini, Nora; Gharib, Sina A; Hitsman, Brian; Levy, Daniel; Meng, Yan; Papanicolaou, George J; Preis, Sarah R; Spring, Bonnie; Styn, Mindi A; Tong, Elisa K; White, Wendy B; Wiggins, Kerri L; Jorgenson, EricTo date, most genetic association analyses of smoking behaviors have been conducted in populations of European ancestry and many of these studies focused on the phenotype that measures smoking quantity, that is, cigarettes per day. Additional association studies in diverse populations with different linkage disequilibrium patterns and an alternate phenotype, such as total tobacco exposure which accounts for intermittent periods of smoking cessation within a larger smoking period as measured in large cardiovascular risk studies, can aid the search for variants relevant to smoking behavior. For these reasons, we undertook an association analysis by using a genotyping array that includes 2,100 genes to analyze smoking persistence in unrelated African American participants from the Atherosclerosis Risk in Communities study. A locus located approximately 4 kb downstream from the 3'-UTR of the brain-derived neurotrophic factor (BDNF) significantly influenced smoking persistence. In addition, independent variants rs12915366 and rs12914385 in the cluster of genes encoding nicotinic acetylcholine receptor subunits (CHRNA5-CHRNA3-CHRNB4) on 15q25.1 were also associated with the phenotype in this sample of African American subjects. To our knowledge, this is the first study to more extensively evaluate the genome in the African American population, as a limited number of previous studies of smoking behavior in this population included evaluations of only single genomic regions.Item A Nationwide Analysis of US Racial/Ethnic Disparities in Smoking Behaviors, Smoking Cessation, and Cessation-Related Factors(2011) Trinidad, D. R.; Perez-Stable, E. J.; White, M. M.; Emery, S. L.; Messer, K.Objectives. We used nationally representative data to examine racial/ethnic disparities in smoking behaviors, smoking cessation, and factors associated with cessation among US adults. Methods. We analyzed data on adults aged 20 to 64 years from the 2003 Tobacco Use Supplement to the Current Population Survey, and we examined associations by fitting adjusted logistic regression models to the data. Results. Compared with non-Hispanic Whites, smaller proportions of African Americans, Asian Americans/Pacific Islanders, and Hispanics/Latinos had ever smoked. Significantly fewer African Americans reported long-term quitting. Racial/ethnic minorities were more likely to be light and intermittent smokers and less likely to smoke within 30 minutes of waking. Adjusted models revealed that racial/ethnic minorities were not less likely to receive advice from health professionals to quit smoking, but they were less likely to use nicotine replacement therapy. Conclusions. Specific needs and ideal program focuses for cessation may vary across racial/ethnic groups, such that approaches tailored by race/ethnicity might be optimal. Traditional conceptualizations of cigarette addiction and the quitting process may need to be revised for racial/ethnic minority smokers.Item Relationship between menthol cigarettes and smoking cessation among African American light smokers(2007) Okuyemi, Kolawole S.; Faseru, Babalola; Sanderson Cox, Lisa; Bronars, Carrie A.; Ahluwalia, Jasjit S.AIMS: To determine whether African American light smokers who smoked menthol cigarettes had lower cessation when treated with nicotine replacement therapy and counseling. DESIGN: Data were derived from a clinical trial that assessed the efficacy of 2 mg nicotine gum (versus placebo) and counseling (motivational interviewing counseling versus Health Education) for smoking cessation among African American light smokers (smoked < or = 10 cigarettes per day). PARTICIPANTS: The sample consisted of 755 African American light smokers. MEASUREMENTS: The primary outcome variable was verified 7-day point-prevalence smoking cessation at 26 weeks follow-up. Verification was by salivary cotinine. FINDINGS: Compared to non-menthol smokers, menthol smokers were younger and less confident to quit smoking (P = 0.023). At 26 weeks post-randomization, 7-day verified abstinence rate was significantly lower for menthol smokers (11.2% versus 18.8% for non-menthol, P = 0.015). CONCLUSIONS: Among African American light smokers, use of menthol cigarettes is associated with lower smoking cessation rates. Because the majority of African American smokers use menthol cigarettes, a better understanding of the mechanism for this lower quit rate is needed.Item Combining community participatory research with a randomized clinical trial: The protecting the hood against tobacco (PHAT) smoking cessation study(2010) Froelicher, Erika Sivarajan; Doolan, Daniel; Yerger, Valerie B.; McGruder, Carol O.; Malone, Ruth E.BACKGROUND: This article describes the process and results of a smoking cessation intervention randomized clinical trial (RCT) that was conducted as a community-based participatory research project. This RCT tested whether outcomes are improved by adding social justice and tobacco industry targeting messages to a smoking cessation program conducted among African American adults within a low-income community in San Francisco, California. This study provides lessons for future similar research projects that focus on urban low-income populations. METHODS: Participants were randomly allocated to receive a smoking-cessation program (control group [CG]) or CG care plus tobacco industry and media (IAM) messages. Primary interventions were behavioral. At intake, participants reporting severe withdrawal or smoking > or = 25 cigarettes daily were offered free nicotine replacement therapy. Baseline data were from an in-person interview. Outcome measures included self-reported smoking status; validation of quitting was by salivary cotinine assays. RESULTS: Of 87 participants providing baseline data, 31% (27) did not join the RCT. Proportions quitting in the CG and IAM group were 11.5% and 13.6% at 6 months and 5.3% and 15.8% at 12 months, respectively. CONCLUSION: African Americans in underserved inner-city neighborhoods can be recruited into RCTs with community participatory approaches. Differences between the CG and IAM in proportions who quit were 2.1% and 10.5% at 6 and 12 months, respectively. More than 3 years with adequate funding, high staffing ratios, and intense outreach and follow-up schedules are needed to achieve recruitment and study goals.Item Assessing the scientific accuracy, readability, and cultural appropriateness of a culturally targeted smoking cessation program for American Indians.(2009) Makosky Daley, Christine; Cowan, Paul; Nollen, Nicole L; Greiner, K Allen; Choi, Won SThis study assesses educational materials developed for the All Nations Breath of Life smoking cessation program (targeted for American Indians and Alaska Natives) for scientific accuracy, readability and other literacy factors, and cultural appropriateness. The authors used a scientific review panel of experts in smoking cessation representing epidemiology, medicine, and psychology; the suitability assessment of materials (SAM) and the simplified measure of gobbledygook (SMOG) reading grade level formulas; and review by Native program facilitators and pilot participants. Materials were scientifically accurate and culturally appropriate. The mean SAM score was 80% (superior rating), and the average reading grade level was 7.1 using the Fry formula (part of the SAM) and 8.4 using the SMOG formula (difference was not statistically significant). Based on this project, the SAM can be used in combination with scientific review and input from community members during formative research to assess and modify educational materials for a targeted population.Item A review of the efficacy of smoking-cessation pharmacotherapies in nonwhite populations.(2008) Robles, Gisela I; Singh-Franco, Devada; Ghin, Hoytin LeeBACKGROUND: Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in the United States. Research suggests that behavioral support strategies and pharmacotherapy can improve abstinence rates. However, both approaches, especially pharmacotherapy, have been understudied in nonwhite US populations. OBJECTIVE: The aim of this review was to evaluate the efficacy of smoking-cessation pharmacotherapy in nonwhite US populations. METHODS: Using search terms smoking cessation, nicotine replacement therapy, bupropion SR, varenicline, minority, ethnicity, African American, black, Hispanic, American Indian, and Alaska Native, a literature search was conducted to identify English-language studies that evaluated the use of smoking-cessation pharmacotherapies in nonwhite patients in MEDLINE (1966\2-December 2007), International Pharmaceutical Abstracts (1980\2-January 2008), Database of Abstracts of Reviews of Effectiveness (1990\2-December 2007), and EMBASE Drugs & Pharmacology (1991\2-third quarter 2007). RESULTS: Nine studies were identified and assessed. Six studies looked at smoking-cessation pharmacotherapy in black smokers, 1 in Hispanic smokers, 1 in Native American smokers, and 1 in white and nonwhite smokers. In black smokers (N = 410; mean cigarettes per day [cpd], 20.4) who received the nicotine patch versus placebo, the 30-day self-reported abstinence rates were 21.5% versus 13.7% (P = 0.03) at 10 weeks and 17.1% versus 11.7% (P = NS) at 6 months. In black smokers (N = 600; mean [SD] cpd, 16.1 [7.5]) who received sustained-release (SR) bupropion 150 mg BID versus placebo for 7 weeks, the 7-day biochemically verified abstinence rates at weeks 6 and 26 were 36.0% versus 19.0% (Delta, 17%; 95% CI, 9.7\2-24.4; P < 0.001) and 21.0% versus 13.7% (Delta, 7.3%; 95% CI, 1.0\2-13.7; P = 0.02). Predictors of smoking cessation included use of bupropion SR (abstinence rate, 41.5% vs 21.1%; P<0.001); smoking nonmentholated cigarettes (abstinence rate, 28.3% in mentholated smokers [n = 417] vs 41.5% in nonmentholated smokers [n = 118]; P = 0.006); not smoking within 30 minutes of awakening (abstinence rate, 26.4% [n = 420] in those who did vs 48.7% [n = 115] in those who did not; P < 0.001); and lower baseline salivary cotinine levels (256.8 [137.0] ng/mL in those who became abstinent vs 305.6 [143.4] ng/mL in those who remained smokers; P < 0.001). In black light (or=7 consecutive days (odds ratio, 0.20; 95% CI, 0.05-0.77; P = 0.02). CONCLUSIONS: Data from the studies in this review support the use of smoking-cessation pharmacotherapy (nicotine patch and bupropion SR) in nonwhite patients. Black patients, who smoked within 30 minutes of awakening, smoked mentholated cigarettes, and had high salivary cotinine levels may have difficulty quitting regardless of the number of cigarettes smoked per day; therefore, determining the type of cigarettes smoked (mentholated vs nonmentholated) and salivary cotinine levels may be helpful in assessing the severity of smoking addiction and guide pharmacotherapy (eg, starting at higher doses of nicotine-replacement therapy in a light smoker). Other than smoking-cessation behavioral studies, there is a lack of congruent smoking-cessation pharmacotherapy studies in American Indian/Alaska Native, Hispanic, and other ethnic populations.Item Lower quit rates among African American and Latino menthol cigarette smokers at a tobacco treatment clinic(2009) Gandhi, K. K.; Foulds, J.; Steinberg, M. B.; Lu, S.-E.; Williams, J. M.BACKGROUND: Lower rates of smoking cessation and higher rates of lung cancer in African American (AA) smokers may be linked to their preference for mentholated cigarettes. AIM: This study assessed the relationship between menthol smoking, race/ethnicity and smoking cessation among a diverse cohort of 1688 patients attending a specialist smoking cessation service. RESULTS: 46% of the patients smoked mentholated cigarettes, but significantly more AA (81%) and Latino (66%) patients than Whites (32%) smoked menthols. AA and Latino menthol smokers smoked significantly fewer cigarettes per day (CPD) than non-menthol smokers (15.7 vs. 20.3, for AA, and 17.0 vs. 22.1, for Latinos), with no differences among White menthol and non-menthol smokers. At 4-week follow up, AA, Latino and White non-menthol smokers had similar quit rates (54%, 50% and 50% respectively). In contrast, among menthol smokers, AAs and Latinos had lower quit rates (30% and 23% respectively) compared with Whites (43%, p < 0.001). AA and Latino menthol smokers had significantly lower odds of quitting [odds ratio (OR) = 0.34; 95% CI = 0.17, 0.69 for AA, and OR = 0.32; 95% CI = 0.16, 0.62 for Latinos] than their non-menthol counterparts. At 6-month follow up, a similar trend was observed for the race/ethnicity subgroups, with AA menthol smokers having half the odds of being abstinent compared with AA non-menthol smokers (OR = 0.48; 95% CI = 0.25, 0.9). CONCLUSIONS: Despite smoking fewer CPD, AA and Latino menthol smokers experience reduced success in quitting as compared with non-menthol smokers within the same ethnic/racial groups.Item Smoking Cessation and Stress Among Teenagers(2007) Falkin, Gregory P.; Fryer, Craig S.; Mahadeo, MadhuvantiThe authors describe the experience of quitting smoking, focusing on the obstacles youth struggle with, based on individual interviews and focus groups with 54 teenagers in New York City. A major obstacle was the belief that people should stop smoking forever. The youth had to cope with temptation, frequent and often intense urges or cravings for cigarettes, and lack of social support from their family and friends. The young participants not only had to cope with general life stresses without being able to use cigarettes to reduce tensions but also had to contend with new stressful situations, such as friends who put them down for not smoking. In addition, the teens had to give up things that were important to them, such as friendships, during their quit attempts. The study describes how quitting can be a much more stressful experience for youth than research typically acknowledges. The authors discuss public health implications.