Smoking cessation: Next steps for special populations research and innovative treatments.

Abstract

Objective:The current introductory article provides the rationale for the special section on understudied smokers and innovative treatments. This article proposes a definition of "special populations" of smokers, outlines a priori criteria by which to judge whether an intervention should be adapted for these smokers, and delineates a process by which cultural adaptation of an intervention can be achieved. Next steps for innovative, theory-based treatments with special populations and with general populations of smokers are discussed. Method: Special populations of smokers are defined as having (a) Ͼ10% higher smoking prevalence than the general population of smokers, (b) disproportionate tobacco-related health disparities, (c) less access to treatments, and (d) a lack of prospective, longitudinal treatment trials. Results: Cultural adaptation of evidenced-based treatments (EBTs) for underserved smokers should be applied more widely, outside the bounds of race and ethnicity, but also judiciously, following several a priori criteria. Cultural adaptation may be justified if the target population differs from the general population in (a) rates and patterns of smoking, (b) burden of tobacco-related health diseases, (c) predictors of smoking behavior, (d) risk factors for treatment failure, (e) protective factors that facilitate quitting, (f) treatment engagement, (g) treatment response, and (h) perceived social validity of the EBT. Once these criteria are met, four phases of cultural adaptation of an EBT for the target population are proposed. Innovative treatments need to be developed that use novel channels and linkages between channels; test novel theories or build on mechanisms research to more accurately pinpoint targets of change; and increase consumer demand for EBTs. Conclusion: The process of cultural adaptation should be thoughtfully conducted with a priori definitions and criteria as well as standardized processes. Coupled with innovative, theory-based treatments, these considerations could help to jump-start stalled smoking cessation rates. Decreasing the prevalence of smoking will take a multitarget, multichannel, multimethod approach at different levels of social strata: individuals (i.e., address smoker heterogeneity, develop innovative treatments), groups (i.e., target populations with higher than average smoking prevalence; eradicate disparities in treatment access, engagement, and effectiveness), cultural/societal level (i.e., increase frequency and effectiveness of mass media campaigns, create greater consumer demand for evidenced-based treatments [EBTs]), health care systems and insurers (i.e., increase counseling and reimbursement, reduce out-of-pocket costs to smokers who want to quit), and government (i.e., increase taxation, expand smoke-free laws, increase funding of state quit lines).Although all of these factors are critical to jump-starting stalled smoking cessation rates, in January 2009 the Journal of Consulting and Clinical Psychology initiated a call for papers focusing on the first t...

Changes in the profiles of smokers seeking cessation treatment and in its effectiveness in Galicia (Spain) 2001–10

“…Perhaps due to the high percentage of smokers with this problem in the 2006–2010 group, depression has lost its predictive value, so that number of cigarettes smoked becomes the variable with the greatest weight for explaining the results in the follow-ups. Given the notable increase in numbers of smokers with depressive antecedents who wish to give up smoking, we might suggest, in line with Borrelli’s [38] proposal, the need to adapt smoking cessation treatment for this type of smoker, modifying aspects such as the mechanisms necessary for bringing about change, the way of intervention or the intensity of the programme, with the goal of improving treatment effectiveness.…”

Comparison of secondhand smoke exposure in minority and nonminority children with asthma.

“…Latino families had lower home nicotine concentration than African American families, however, Latino caregivers in our study reported smoking approximately 12 cigarettes per day and over 40% reportedly had two or more smokers in the home. Given that previous work has indicated that some Latino subgroups, such as Puerto Ricans, may evidence increased risk (e.g., less social support, higher depressed mood) for smoking treatment failure compared to NLW families (Borrelli et al, 2011) these data may underscore the need for smoking cessation interventions in African American and Latino families (Borrelli, 2010). Previous successful caregiver smoking cessation interventions among Latino and racial/ethnic minority families have included motivational interviewing strategies (Borelli et al, 2010) and behavioral counseling (Hovell et al, 1994, 2000, 2002) that incorporate feedback regarding children's SHS exposure in the home.…”

Smoking abstinence-related expectancies among American Indians, African Americans, and women: Potential mechanisms of tobacco-related disparities.

“…There is some evidence that these special populations are likely to benefit from smoking cessation treatments targeted to their unique characteristics (Borrelli, 2010; Cox, Okuyemi, Choi, & Ahluwalia, 2011; Fiore et al, 2008). Because the mechanisms driving tobacco-related health disparities are poorly understood, however, there are scant data to inform such targeting.…”