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Hooper MW, Lee DJ, Simmons VN, Brandon KO, Antoni MH, Asfar T, Koru-Sengul T, Brandon TH. Cognitive behavioral therapy versus general health education for smoking cessation: A randomized controlled trial among diverse treatment seekers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2024; 38:124-133. [PMID: 37141036 PMCID: PMC10624643 DOI: 10.1037/adb0000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Racial and ethnic disparities in smoking cessation persist. This randomized controlled trial compared the efficacy of group cognitive behavioral therapy (CBT) for cessation among African American/Black, Latino/Hispanic, and White adults. METHOD African American/Black (39%), Latino/Hispanic (29%), and White (32%) adults (N = 347) were randomly assigned to eight group sessions of CBT or general health education (GHE), both including nicotine patch therapy. Biochemically confirmed 7-day point prevalence abstinence (7-day ppa) was measured at the end-of-therapy, and at 3-, 6-, and 12-month follow-ups. Generalized linear mixed models and logistic regressions tested abstinence rates by condition, stratified by race and ethnicity, and interaction effects. RESULTS CBT led to greater abstinence than GHE across 12-months of follow-up (AOR = 1.84, 95% CI [1.59, 2.13]) overall [12-month follow-up: CBT = 54% vs. GHE = 38%] and within racial and ethnic groups [12-months: African American/Black (CBT = 52%, GHE = 29%), Latino/Hispanic (CBT = 57%, GHE = 47%), and White (CBT = 54%, GHE = 41%)]. African American participants were less likely than White participants to quit irrespective of condition, as were persons with lower education and income. Socioeconomic status indicators positively predicted abstinence among racial and ethnic minority participants, but not White participants. CONCLUSIONS Group CBT was efficacious compared with GHE. However, cessation patterns suggested that intensive group interventions were less beneficial over the longer term among lower socioeconomic African American and Latino individuals, compared with White participants. Tobacco interventions should target racial and ethnic and socioeconomic differences, via culturally specific approaches and other means. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Monica Webb Hooper
- Case Western Reserve University School of Medicine, Case Comprehensive Cancer Center, 11000 Euclid Ave, 44106, Cleveland, OH, United States
| | - David J. Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Miami, FL 33136
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136
| | | | | | - Michael H. Antoni
- Department of Psychology, University of Miami College of Arts and Sciences, PO Box 248185, Coral Gables, FL 33124
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136
| | - Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Miami, FL 33136
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Miami, FL 33136
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136
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Verma H, Javed Z, Hong JC, Mahajan S, Mszar R, Grandhi GR, Desai NR, Virani SS, Javed U, Valero-Elizondo J, Nasir K. The Impact of the Affordable Care Act on Disparities in Utilization of Cardiovascular Preventive Services by Socioeconomic Status. Popul Health Manag 2022; 25:669-676. [PMID: 36067118 DOI: 10.1089/pop.2021.0337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Disparities in cardiovascular outcomes are persistent in our society. The objective was to track the trends before and after the passage of the Affordable Care Act in socioeconomic status (SES) disparities in utilization of cardiovascular disease (CVD) preventive services among nonelderly adults aged 18-64 years. This study used the National Health Interview Survey (2011-2017) to compare utilization of blood pressure, cholesterol, glycemic screening, and diet and smoking cessation advice over time between groups stratified by SES and race using difference-in-difference analysis. This study also measured the differences over time in specific vulnerable population subgroups (Hispanic, low-income and uninsured vs. White, middle-high-income, and insured). The study population included 176,961 surveyed individuals (mean age 40 [±13] years; 51% female; 67.7% non-Hispanic White) between 2011 and 2017, translating to 194.8 million nonelderly US adults per year. Most individuals were from high-income SES (40.0%), followed by middle-income (28.1%), low-income (13.6%), and lowest income SES (18.3%). The proportion of CVD preventive services increased over all SES categories through the study period. The biggest relative changes were seen among low-income individuals. The difference in blood pressure checks, cholesterol checks, and smoking cessation advise between high- and lowest income groups showed a statistically significant decrease at 5.2%, 4.8%, and 11.2%, respectively, between 2011 and 2017. The findings demonstrate a trend in reduction of CVD preventive care disparities between SES groups. However, a gap still exists, and this study highlights the need for continuous improvement to eliminate SES disparities.
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Affiliation(s)
- Hannah Verma
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zulqarnain Javed
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA
| | - Jonathan C Hong
- Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, USA
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut, USA
| | - Reed Mszar
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut, USA
| | - Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Salim S Virani
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Umair Javed
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Javier Valero-Elizondo
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA.,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA.,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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