Factors That Explain Differences in Abstinence Between Black and White Smokers: A Prospective Intervention Study

Abstract

Background Black-white differences in smoking abstinence are not well understood. This trial sought to confirm previously reported differences in quitting between blacks and whites and to identify factors underlying this difference. Methods During enrollment, 224 black and 225 white low-income smokers were stratified on race and within race on age and sex to ensure balance on these factors known to impact abstinence. The intervention included varenicline for 12 weeks and six guideline-based smoking cessation counseling sessions. The primary endpoint was cotinine-verified 7-day point prevalence smoking abstinence at week 26. A priori socioeconomic, smoking, treatment process (eg, treatment utilization, side effects, withdrawal relief), psychosocial, and biological factors were assessed to investigate race differences in abstinence. Unadjusted odds ratios (OR) were used to compare abstinence between blacks and whites. Adjusted odds ratios from logistic regression models were used to examine predictors of abstinence. All statistical tests were two-sided. Results Blacks were less likely to achieve abstinence at week 26 (14.3% vs 24.4%, OR = 0.51, 95% confidence interval [CI] = 0.32 to 0.83, P = .007). Utilizing best subsets logistic regression, five factors associated with race jointly predicted abstinence: home ownership (yes/no, OR = 3.03, 95% CI = 1.72 to 5.35, P < .001), study visits completed (range = 0–6, OR = 2.81, 95% CI = 1.88 to 4.20, P < .001), income (household member/$1000, OR = 1.03, 95% CI = 1.01 to 1.06, P = .02), plasma cotinine (per 1 ng/mL, OR = 0.997, 95% CI = 0.994 to 0.999, P = .002), and neighborhood problems (range = 10–30, OR = 0.88, 95% CI = 0.81 to 0.96, P = .003). Conclusions The race difference in abstinence was fully explained by lack of home ownership, lower income, greater neighborhood problems, higher baseline cotinine, and higher visit completion, which were disproportionately represented among blacks. Findings illuminate factors that make it harder for blacks in the United States to quit smoking relative to whites and provide important areas for future studies to reduce tobacco-related health disparities.

Impact of early nausea on varenicline adherence and smoking cessation

“…) and PNAT (Fig. ) was explored by including additional covariates which have been found to impact abstinence outcomes . Of the baseline variables that were significant predictors of week 26 abstinence, plasma cotinine was available in both trials.…”

“…The study 1 sample was drawn from Quit2Live, a prospective cohort intervention study with a stratified recruitment based on race (African American, Caucasian), age (< 40, ≥ 40) and gender (male, female) (NCT01836276); these variables were included as covariates in this analysis . Quit2Live was designed to investigate differences in cessation rates between African Americans and Caucasians, and to understand the factors underlying such differences.…”

“…In Quit2Live, the primary end‐point was cotinine‐verified 7‐day point prevalence smoking abstinence at week 12 (end of varenicline treatment); secondary end‐points were cotinine‐verified 7‐day point prevalence smoking abstinence at weeks 4 and 26 . Abstinence was defined by recommended cut‐points of 15 ng/ml for salivary cotinine .…”

Association of frequency of perceived exposure to discrimination with tobacco withdrawal symptoms and smoking lapse behavior in African Americans

“…Discrimination-unequal or unfair treatment by individuals and/or social institutions on the basis of gender, race, ethnic or national origin, sexual orientation, social class or other factors-is disproportionately experienced by African Americans [5,6] and predicts risk of relapse during cessation attempts [7,8]. African American smokers who experience perceived discrimination more frequently are at greater risk of being a smoker [9], higher tobacco dependence severity [10] and greater motivation to smoke to enhance cognitive functioning and mood [10].…”

“…One study reported that associations between perceived frequency of discrimination and cigarette smoking status and smoking frequency were amplified among African Americans relative to Latinos [11]. More recently, a 2019 study demonstrated that African American low‐income smokers who reported a greater frequency of exposure to discrimination were less likely to achieve smoking abstinence at week 26 upon receiving interventions that included varenicline for 12 weeks and six guideline‐based smoking cessation counseling sessions relative to African Americans who reported experiencing discrimination less frequently [8]. Furthermore, a 2020 study tested the causal relationship between acute interpersonal discrimination and smoking motivation (i.e.…”