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Health Disparities Across Lung Cancer Continuum Among Asian Americans: A Systematic Review. J Immigr Minor Health 2021; 24:526-545. [PMID: 34156594 DOI: 10.1007/s10903-021-01212-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
The purpose of this systematic review is to synthesize lung cancer associated health disparities across the cancer continuum among Asian Americans. A systematic review design with the narrative method was used for conducting this study. Electronic literature databases, including PubMed, Google Scholar, and CINAHL, were searched. After applying filter information, inclusion and exclusion criteria, a total of 20 articles were included in the review. Findings related to lung cancer prevention, screening, incidence rates, diagnosis, treatment, survival rates, and mortality rates among Asian Americans were synthesized. Results showed the prevalence of smoking quit attempts in the past year was high among Asian Americans, although the prevalence of receiving advice to quit and using counseling and/or medication services was low among this population. Also, the smoking cessation rate among Asian Americans was the second lowest among all racial groups, although the abstinence rate was highest among this population. Compared with other races, Asian Americans are more likely to be diagnosed with lung cancer at a distant stage of disease, and they tend to be less likely to undergo surgery than other races in the United States. The incidence and mortality rates of lung cancer were low among Asian Americans compared with other races in the United States, while the survival rate of lung cancer was high among this population. Further research focusing on lung cancer associated health disparities in specific Asian American ethnic groups should be conducted. Culturally relevant programs that tackle cultural and genetic factors related to lung cancer risk as well as early screening, diagnosis and treatment in this vulnerable population are also necessary.
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Lei F, Lee E, Zheng Y. Trajectory of smoking behavior change among Chinese immigrant smokers. PLoS One 2021; 16:e0246280. [PMID: 33529228 PMCID: PMC7853480 DOI: 10.1371/journal.pone.0246280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The incidence and mortality rates of smoking-associated lung cancer are high among Chinese immigrant smokers. Coming from a country with different smoking policies, culture, and economic background than the U.S., Chinese smokers may change their smoking behaviors after immigrating to the U.S. OBJECTIVES This study aims to explore the trajectory of smoking behavior change among Chinese immigrant smokers migrating to the U.S. METHODS This qualitative study was guided by the Grounded theory. Semi-structured intensive individual interviews were conducted among 10 eligible participants. A purposive theoretical sampling method was used to recruit participants through a website. Individual interviews were conducted online, via telephone, or in-person in Mandarin. Data were transcribed verbatim in Mandarin, translated into English, and triangulated with follow-up interviews and dialogues among authors to enhance trustworthiness and consistency of the study. Process coding and content analysis were used to analyze data. RESULTS A total of 10 participants, 7 males and 3 females, were interviewed. Results showed the trajectory of smoking behavior change among Chinese immigrant smokers went through three phases: 1) Beginning to smoke, which included learning to smoke from others, trying to smoke and learning to smoke, and hiding their smoking behaviors from others; 2) maintaining smoking, which included setting boundary around smoking, smoking as a facilitator or barrier to social interaction, feeling pressures related to smoking behavior, and making others happy: Collective smoking and controlling smoking desire; and 3) changing smoking behaviors, which included experiencing life events that were triggers to changing smoking behavior, boredom as a reason for relapses, personal will as a key to quitting smoking, and quitting smoking for a loved one. Although some differences existed between male and female Chinese immigrant smokers' smoking behaviors, their trajectories of smoking behavior change were generally similar. DISCUSSION Findings from this study can help health care providers to extend their understanding toward smoking behavior change among Chinese immigrant smokers across different socio-cultural contexts.
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Affiliation(s)
- Fang Lei
- School of Nursing, University of California at Los Angeles, Los Angeles, California, United States of America
| | - Eunice Lee
- School of Nursing, University of California at Los Angeles, Los Angeles, California, United States of America
| | - Ying Zheng
- Department of Health Care Quality Improvement, Shenzhen Nanshan Medical Group Headquarter, Shenzhen, China
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Nollen NL, Ahluwalia JS, Sanderson Cox L, Okuyemi K, Lawrence D, Samuels L, Benowitz NL. Assessment of Racial Differences in Pharmacotherapy Efficacy for Smoking Cessation: Secondary Analysis of the EAGLES Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2032053. [PMID: 33464316 PMCID: PMC7816102 DOI: 10.1001/jamanetworkopen.2020.32053] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Understanding Black vs White differences in pharmacotherapy efficacy and the underlying reasons is critically important to reducing tobacco-related health disparities. OBJECTIVE To compare pharmacotherapy efficacy and examine variables to explain Black vs White differences in smoking abstinence. DESIGN, SETTING, AND PARTICIPANTS This study is a secondary analysis of the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) double-blind, placebo-controlled, randomized clinical trial, which took place at clinical trial centers, academic centers, and outpatient clinics in 29 states in the US. US Black and White smokers who smoked 10 or more cigarettes per day with and without psychiatric comorbidity were enrolled between November 2011 and January 2015. Data analysis was performed from July 2019 to January 2020. INTERVENTIONS Participants were randomized (1:1:1:1) in a double-blind, triple-dummy, placebo- and active-controlled (nicotine patch) trial of varenicline and bupropion for 12 weeks with follow-up through week 24. MAIN OUTCOMES AND MEASURES Biochemically verified continuous cigarette abstinence rate (CAR) from weeks 9 to 24. Baseline, postbaseline treatment, and safety characteristics were examined as variables to explain race differences in abstinence. RESULTS Of the 1065 Black smokers enrolled, 255 were randomized to receive varenicline, 259 received bupropion, 286 received nicotine replacement therapy (NRT [ie, nicotine patch]), and 265 received placebo. Among the 3044 White smokers enrolled, 778 were randomized to receive varenicline, 769 received bupropion, 738 received NRT, and 759 received placebo. Participants were predominantly female (614 Black [57.7%] and 1786 White [58.7%] women) and heavy smokers (mean [SD] cigarettes per day, 18.2 [7.9] for Black and 20.0 [7.5] for White smokers), with a mean (SD) age of 47.2 (11.2) years for Black and 46.5 (12.7) years for White participants. Treatment and race were associated with CAR for weeks 9 to 24. The CAR was 4.9% lower for Black vs White participants (odds ratio [OR], 0.53; 95% CI, 0.41-0.69; P < .001); differences were found across all treatments. Pooling psychiatric and nonpsychiatric cohorts, varenicline (OR, 2.63; 95% CI, 1.90-3.63; P < .001), bupropion (OR, 1.75; 95% CI, 1.25-2.46; P = .001), and NRT (OR, 1.52; 95% CI, 1.07-2.16; P = .02) had greater efficacy than placebo for White participants. Only varenicline (OR, 2.63; 95% CI, 1.26-5.48; P = .01) had greater efficacy than placebo for Black participants. Baseline, postbaseline, and safety characteristics differed by race, but these variables did not eliminate the association of race with CAR. Black participants had 49% reduced odds of CAR for weeks 9 to 24 compared with White participants in the adjusted model (OR, 0.51; 95% CI, 0.39-0.66; P < .001). CONCLUSIONS AND RELEVANCE Black and White smokers achieved the highest rate of abstinence while taking varenicline, suggesting that it is the best first-line therapy for these groups. However, Black smokers were less responsive to all therapies, including placebo. Understanding variables (eg, socioeconomic or biological) beyond those may lead to improved treatment outcomes for Black smokers. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01456936.
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Affiliation(s)
- Nicole L. Nollen
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Jasjit S. Ahluwalia
- Alpert Medical School, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Alpert Medical School, Department of Medicine, Brown University School of Public Health, Providence, Rhode Island
| | - Lisa Sanderson Cox
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Kolawole Okuyemi
- Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City
| | | | | | - Neal L. Benowitz
- Department of Medicine, Bioengineering, and Therapeutic Sciences, University of California, San Francisco
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Nollen NL, Mayo MS, Sanderson Cox L, Benowitz NL, Tyndale RF, Ellerbeck EF, Scheuermann TS, Ahluwalia JS. Factors That Explain Differences in Abstinence Between Black and White Smokers: A Prospective Intervention Study. J Natl Cancer Inst 2020; 111:1078-1087. [PMID: 30657926 DOI: 10.1093/jnci/djz001] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/03/2018] [Accepted: 01/02/2019] [Indexed: 01/07/2023] Open
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.
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Duffy SA, Ignacio RV, Kim HM, Geraci MC, Essenmacher CA, Hall SV, Chow A, Pfeiffer PN, Sherman SE, Bohnert KM, Zivin K, Barnett PG. Effectiveness of tobacco cessation pharmacotherapy in the Veterans Health Administration. Tob Control 2018; 28:540-547. [PMID: 30181383 DOI: 10.1136/tobaccocontrol-2018-054473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/30/2018] [Accepted: 08/07/2018] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In 2003, the Veterans Health Administration (VHA) implemented a directive that cessation pharmacotherapy be made available to all who use tobacco and are interested in quitting. Despite the efficacy of cessation pharmacotherapy shown in clinical trials, the generalisability of the results in real-world settings has been challenged. Hence, the specific aim of this study was to determine the effectiveness of cessation pharmacotherapies in the VHA. METHODS This retrospective cohort study used VHA's electronic medical record data to compare quit rates among those who use tobacco and who did vs. did not receive any type of cessation pharmacotherapy. Included were 589 862 Veterans identified as current tobacco users during fiscal year 2011 who had not received cessation pharmacotherapy in the prior 12 months. Following a 6-month period to assess treatment, quit rates among those who were treated versus untreated were compared during the 7-18 months (12 months) post-treatment follow-up period. The estimated treatment effect was calculated from a logistic regression model adjusting for inverse probability of treatment weights (IPTWs) and covariates. Marginal probabilities of quitting were also obtained among those treated versus untreated. RESULTS Adjusting for IPTWs and covariates, the odds of quitting were 24% higher among those treated versus untreated (OR=1.24, 95% CI 1.23 to 1.25, p<0.001). The marginal probabilities of quitting were 16.7% for the untreated versus 19.8% for the treated based on the weighted model. CONCLUSION The increased quit rates among Veterans treated support the effectiveness and continuation of the VHA tobacco cessation pharmacotherapy policy.
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Affiliation(s)
- Sonia A Duffy
- College of Nursing, Ohio State University, Columbus, Michigan, USA.,Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Rosalinda V Ignacio
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Hyungjin Myra Kim
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark C Geraci
- Pharmacy Benefits Management Services, Department of Veterans Affairs, Hines, Illinois, USA
| | - Carol A Essenmacher
- Department of Veterans Affairs, Battle Creek VA Medical Center, Battle Creek, Michigan, USA
| | - Stephanie V Hall
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Adam Chow
- Department of Veterans Affairs, Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Paul N Pfeiffer
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott E Sherman
- Department of Veterans Affairs, VA New York Harbor Healthcare System, New York, New York, USA.,Department of Population Health, NYU School of Medicine, New York University, New York, USA
| | - Kipling M Bohnert
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Kara Zivin
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul George Barnett
- Department of Veterans Affairs, Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
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Pharmacokinetic characterization of three novel 4-mg nicotine lozenges
. Int J Clin Pharmacol Ther 2018; 56:113-119. [PMID: 29350176 PMCID: PMC5822134 DOI: 10.5414/cp203097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Nicotine replacement therapy (NRT) increases the probability of smoking cessation. This study was conducted to determine if three prototype 4-mg nicotine lozenges produced locally in India were bioequivalent to a globally marketed reference product, Nicorette® 4-mg nicotine lozenge. MATERIALS AND METHODS Healthy adult smokers (N = 39) were treated with three prototype 4-mg nicotine lozenges in comparison with a reference 4-mg lozenge in this single-center, randomized, open-label, single-dose, 4-way crossover study. Pharmacokinetic sampling was obtained to test for bioequivalence using maximal plasma concentration (Cmax) and extent of absorption (AUC0-t). Secondarily, AUC;0-∞, time to maximal plasma concentration (tmax), half-life (T1/2), elimination rate constant (Kel), and safety of the prototype lozenges versus the reference lozenge were compared. RESULTS Each prototype 4-mg nicotine lozenge was found to be bioequivalent to the reference 4-mg nicotine lozenge based on the ratio of geometric means and 90% confidence intervals for Cmax, AUC0-t, and AUC;0-∞. Although tmax; was significantly longer for prototype III, all four lozenges achieved maximum plasma nicotine concentrations at a median of 1.5 hours. The safety profiles of the three prototype 4-mg lozenges did not differ from that of the 4-mg reference product. CONCLUSION Each prototype 4-mg nicotine lozenge was bioequivalent to the reference 4-mg nicotine lozenge and was well tolerated. Furthermore, as these bioequivalent prototypes differed in in-vitro dissolution profiles, these data suggest that performance from the in -vitro method deployed is not a firm predictor of pharmacokinetic behavior.
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Webb Hooper M, Dietz NA, Wilson JC. Smoking Urges During Treatment and Long-Term Cessation among Low-Income African Americans. Ethn Dis 2017; 27:395-402. [PMID: 29225440 DOI: 10.18865/ed.27.4.395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective The urge to smoke is a predictor of smoking relapse. Little research has focused on the impact of acute urges during treatment among African Americans. This study examined the relationship between smoking urges and long-term abstinence among treatment seekers. Design Longitudinal prospective investigation. Urges to smoke were assessed at the initial (session 1) and final (session 8) sessions among adult smokers (N=308) enrolled in a 4-week group intervention trial. Nicotine patch use was assessed over 30 days. Main Outcome Measures Biochemically verified 7-day point prevalence abstinence (7-day ppa) was assessed immediately post-intervention, and at 3-, 6-, and 12-month follow-ups. Hierarchical logistic regressions tested associations between session 1 and session 8 urges and 7-day ppa at each smoking status assessment. Results There was a significant overall decrease in smoking urges (M=29, SD=15 at session 1; M=17, SD=11 at session 8). After controlling for covariates, urges to smoke at session 1 were unrelated to 7-day ppa at any of the assessment points. However, session 8 urges were inversely associated with 7-day ppa post-intervention (AOR=.94, CI:.92-.97), at 3-months (AOR=.93, CI: .89-.97), 6-months (AOR=.93, CI: .90-.97), and 12-months (AOR=.96, CI: .96-.99). Nicotine patch use was positively associated with 7-day ppa at each assessment. Conclusions The most robust predictors of abstinence through 12-months post-intervention were decreased urges over the 4-week, 8-session group intervention and the frequency of nicotine patch use. Interventions aimed at addressing the needs of African American smokers should address urges and encourage nicotine replacement adherence to increase abstinence rates.
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Affiliation(s)
- Monica Webb Hooper
- Case Western Reserve University School of Medicine, Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Psychology, University of Miami, Coral Gables, Florida
| | - Noella A Dietz
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Joseph C Wilson
- Psychology Department, Binghamton University State University of New York, Binghamton, New York
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Patterson F, Zaslav DS, Kolman-Taddeo D, Cuesta H, Morrison M, Leone FT, Satti A. Smoking Cessation in Pulmonary Care Subjects: A Mixed Methods Analysis of Treatment-Seeking Participation and Preferences. Respir Care 2016; 62:179-192. [PMID: 27729398 DOI: 10.4187/respcare.04958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND African-American smokers experience disproportionate COPD morbidity. As a front-line COPD behavioral management strategy, smoking cessation is less prevalent among African-American smokers. Identifying barriers and predictors to smoking cessation in this population is important to bridging this disparity. METHODS In this study, the predictors of enrollment and attendance to a 3-session urban hospital smoking cessation program were examined. A retrospective chart review was conducted for all pulmonary clinic patients who smoked and were referred to the cessation program between June 2013 and May 2014. Demographic, smoking behavior, cardiopulmonary, and health status variables were extracted (N = 253). Second, a qualitative assessment of the beliefs and barriers for smoking cessation and physical activity were examined in a sub-sample of the population (n = 41). RESULTS One-hundred forty-seven of the pulmonary subjects (58%) enrolled in the cessation program, and 40 attended all sessions (16% of the total sample). Participants with COPD (odds ratio = 4.65, P = .030), or had a mother who had cancer (odds ratio = 4.49, P = .027), were more likely to attend the program. Qualitatively, pulmonary care patients who wanted to quit smoking and be more physically active cited: strong beliefs about the inability to engage in these behaviors, belief that quitting and increased activity might exacerbate poor health, and an inability to obtain pharmacotherapy as barriers to adopting these behaviors. CONCLUSIONS Smoking cessation program attendance in this sample of mostly African-American smokers was poor. Increased knowledge about cessation benefits and access to full-course pharmacotherapy, particularly in those without a COPD diagnosis and who do not have a maternal history of cancer, may be high-priority targets to promote cessation program uptake in this population. Increased knowledge and access to safe forms of physical activity may also be beneficial.
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Affiliation(s)
- Freda Patterson
- Center of Biomedical Research Excellence (COBRE) in Cardiovascular Health and the Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware.
| | - David S Zaslav
- Treatment Research Institute, Philadelphia, Pennsylvania
| | - Diana Kolman-Taddeo
- Temple University Lung Center, Temple University Health System, Ambulatory Care Center, Philadelphia, Pennsylvania
| | - Hillary Cuesta
- Department of Epidemiology and Biostatistics, College of Health Sciences, Temple University, Philadelphia, Pennsylvania
| | - Mary Morrison
- Department of Psychiatry and Behavioral Sciences, Temple University School of Medicine Episcopal Campus, Philadelphia, Pennsylvania
| | - Frank T Leone
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Aditi Satti
- Temple University Lung Center, Temple University Health System, Ambulatory Care Center, Philadelphia, Pennsylvania
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Kulak JA, Cornelius ME, Fong GT, Giovino GA. Differences in Quit Attempts and Cigarette Smoking Abstinence Between Whites and African Americans in the United States: Literature Review and Results From the International Tobacco Control US Survey. Nicotine Tob Res 2016; 18 Suppl 1:S79-87. [PMID: 26980868 PMCID: PMC5009448 DOI: 10.1093/ntr/ntv228] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/30/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION While cigarette smoking prevalence is declining among US adults, quit rates may differ between white and African American smokers. Here, we summarize the literature on smoking cessation behaviors in whites and African Americans across four study designs and report the findings of new analyses of International Tobacco Control (ITC) US Survey cohort data. METHODS We reviewed 32 publications containing 39 relevant analyses that compared quit attempts and abstinence between US whites and African Americans. Two additional longitudinal analyses were conducted on 821 white and 76 African American cigarette smokers from Waves 7 and 8 of the ITC US Survey (mean follow-up = 19 months). RESULTS Of 17 total analyses of quit attempts, nine (including the ITC US Survey) observed that African American smokers were more likely than whites to attempt to quit during a given year; seven found no differences. Whites were more likely than African Americans to be abstinent in five of six retrospective cohort analyses and in two of five considered community- and population-based cohort studies. Four of these 11 analyses, including one from the ITC US Survey, found no differences. CONCLUSIONS Of 11 population- or community-based analyses, all seven that found significant differences indicated that whites were more likely to quit than African Americans. These findings, combined with the similar results from population-based birth cohort analyses, support the conclusion that white smokers are more likely to quit than African American smokers. Efforts to encourage and support quitting among all tobacco users remain a priority. IMPLICATIONS This article provides a review of the literature on smoking cessation among African American and white smokers, and adds new analyses that compare quit attempts and abstinence between US African Americans and whites. Results demonstrate a clear distinction between the findings of cross-sectional and retrospective cohort studies with those of cohort studies. Reasons for these differences merit further study.
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Affiliation(s)
- Jessica A Kulak
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY;
| | - Monica E Cornelius
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Gary A Giovino
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
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Robinson CD, Pickworth WB, Heishman SJ, Wetter DW, Cinciripini PM, Li Y, Rowell B, Waters AJ. Black Cigarette Smokers Report More Attention to Smoking Cues Than White Smokers: Implications for Smoking Cessation. Nicotine Tob Res 2015; 17:1022-8. [PMID: 26180228 PMCID: PMC4838045 DOI: 10.1093/ntr/ntu263] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/27/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Black cigarette smokers have lower rates of smoking cessation compared with Whites. However, the mechanisms underlying these differences are not clear. Many Blacks live in communities saturated by tobacco advertisements. These cue-rich environments may undermine cessation attempts by provoking smoking. Moreover, attentional bias to smoking cues (attention capture by smoking cues) has been linked to lower cessation outcomes. Cessation attempts among Blacks may be compromised by attentional bias to smoking cues and a cue-rich environment. METHOD Attention to smoking cues in Black and White smokers was examined in 2 studies. In both studies, assessments were completed during 2 laboratory visits: a nonabstinent session and an abstinent session. In study 1, nontreatment-seeking smokers (99 Whites, 104 Blacks) completed the Subjective Attentional Bias Questionnaire (SABQ; a self-report measure of attention to cues) and the Smoking Stroop task (a reaction time measure of attentional bias to smoking cues). In study 2, 110 White and 74 Black treatment-seeking smokers completed these assessments and attempted to quit. RESULTS In study 1, Blacks reported higher ratings than Whites on the SABQ (p = .005). In study 2, Blacks also reported higher ratings than Whites on the SABQ (p = .003). In study 2, Blacks had lower biochemical-verified point prevalence abstinence than Whites, and the between-race difference in outcome was partially mediated by SABQ ratings. CONCLUSION Blacks reported greater attention to smoking cues than Whites, possibly due to between-race differences in environments. Greater attention to smoking cues may undermine cessation attempts.
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Affiliation(s)
- Cendrine D Robinson
- Department of Medical and Clinical Psychology, Uniformed Services, University of the Health Sciences, Bethesda, MD;
| | | | - Stephen J Heishman
- National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD
| | - David W Wetter
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Yisheng Li
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services, University of the Health Sciences, Bethesda, MD
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Barnoya J, Jin L, Hudmon KS, Schootman M. Nicotine replacement therapy, tobacco products, and electronic cigarettes in pharmacies in St. Louis, Missouri. J Am Pharm Assoc (2003) 2015; 55:405-12. [DOI: 10.1331/japha.2015.14230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Duffy SA, Ronis DL, Karvonen-Gutierrez CA, Ewing LA, Dalack GW, Smith PM, Carmody TP, Hicks T, Hermann C, Reeves P, Flanagan P. Effectiveness of the Tobacco Tactics Program in the Department of Veterans Affairs. Ann Behav Med 2014; 48:265-74. [DOI: 10.1007/s12160-014-9605-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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13
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Hartwell KJ, Lematty T, McRae-Clark AL, Gray KM, George MS, Brady KT. Resisting the urge to smoke and craving during a smoking quit attempt on varenicline: results from a pilot fMRI study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 39:92-8. [PMID: 23421569 DOI: 10.3109/00952990.2012.750665] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Varenicline has been shown to reduce cigarette craving during a quit attempt. OBJECTIVES Use BOLD fMRI to explore differences in smoking cue reactivity at baseline and after five weeks of varenicline smoking cessation treatment. METHODS Treatment-seeking nicotine-dependent adult smokers underwent BOLD fMRI scans with block presentation of visual smoking, neutral, and rest cues under two conditions: craving or resisting the urge to smoke at baseline and following 5 weeks of standard varenicline therapy. Data were analyzed using FMRI Expert Analysis Tool, version 5.98 of Functional Magnetic Imaging of the Brain Software Library focused on the smoking vs. neutral cue contrast at the individual and group level, Z>2.3 with cluster threshold p=0.05. RESULTS Twenty-one participants were scanned at baseline and 16 completed the study; 10 were abstinent at the 2(nd) session, confirmed with urinary cotinine. In the Crave Condition no significant differences were found between the abstinent and non-abstinent groups at either time point. During the baseline Resist Condition, the abstinent group compared to the non-abstinent group demonstrated activation in a distributed network involved in alertness, learning and memory. Additionally, within the abstinent group, increased activation of the superior frontal gyrus was found at baseline compared to week 5. CONCLUSION Successful smoking cessation with varenicline is associated with increased activation, prior to a quit attempt, in brain areas related to attentiveness and memory while resisting the urge to smoke Scientific Significance: Varenicline may exert effects by both reducing craving and enhancing resistance to smoking urges during cue-elicited craving.
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Affiliation(s)
- Karen J Hartwell
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
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Karvonen-Gutierrez CA, Ewing LA, Taylor NJ, Essenmacher CA, Duffy SA. Ethnicity predicts perceptions of smoking and smoking cessation among veterans. J Psychiatr Ment Health Nurs 2012; 19:203-10. [PMID: 22074190 DOI: 10.1111/j.1365-2850.2011.01757.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objective of this study was to determine if race/ethnicity predicts motivation to quit smoking and preferences for cessation services among smokers serviced by a primarily psychiatric Veterans Affairs hospital. A self-administered survey was given to a convenience sample of smokers (n=146) at the Battle Creek Veterans Affairs Medical Center. Univariate, bivariate and multivariate regression analyses were calculated to determine the association between race/ethnicity and motivation to quit smoking. Forty-two per cent of the sample was non-white. Non-white patients smoked significantly less cigarettes per day as compared with white patients (P=0.002). In the multivariate analyses, compared with whites, non-whites had 3.5 times greater odds of thinking that quitting smoking was extremely/very important to health (P= 0.01), 4.0 times greater odds of thinking of quitting using tobacco products in the next 30 days (P=0.004) and 3.4 times greater odds of being interested in receiving smoking cessation services (P=0.007). Yet, non-white patients were less likely to be interested in intensive nurse counselling and cessation medications. As the number of non-whites continues to increase in the military, novel strategies may be needed to capitalize on the high motivation to quit smoking and preference for non-traditional interventions among non-white smokers treated in Veterans Affairs hospitals.
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Affiliation(s)
- C A Karvonen-Gutierrez
- Research Health Science, Ann Arbor VA Center for Clinical Management Research, Health Services Research and Development, MI, USA
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Carpenter MJ, Ford ME, Cartmell K, Alberg AJ. Misperceptions of nicotine replacement therapy within racially and ethnically diverse smokers. J Natl Med Assoc 2012; 103:885-94. [PMID: 22364057 DOI: 10.1016/s0027-9684(15)30444-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Underuse of evidence-based treatment for smoking cessation, including use of nicotine replacement therapy (NRT), is widespread, particularly among minority smokers. This paper examines perceptions of NRT among and between racially and ethnically diverse groups of smokers. Nine focus groups were held among homogenous groups of African American, European American, and Hispanic smokers (N = 70). Specific themes included perceptions of: (a) the mechanism by which NRT works; (b) NRT development and regulation (ie, purpose and methods of clinical trials, Food and Drug Administration oversight, etc); (c) efficacy; (d) safety; and (e) overall cost effectiveness. Across all groups, there was a general lack of knowledge of NRT effects and its efficacy, with only moderate knowledge of the mechanism by which NRT works. Concerns about NRT safety were expressed in all groups, with particular apprehension about addictive potential and possible interactions with other medications. Among African American smokers in particular, there was strong suspicion of pharmaceutical industry and government oversight, which coincided with the consensus view that there are too many unknowns about NRT. Among Hispanic smokers, there was less suspicion of NRT but a strong cultural belief in personal responsibility for smoking cessation. Results highlight enduring misperceptions about NRT that likely undermine usage. More education about NRT is needed, not only about its efficacy and safety, but also with regard to its development and regulation. Health care professionals, many of whom are viewed as trustworthy sources of health information, have a particularly important role to promote wider use of proven cessation strategies.
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Affiliation(s)
- Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
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Buchanan TS, Berg CJ, Cox LS, Nazir N, Benowitz NL, Yu L, Yturralde O, Jacob P, Choi WS, Ahluwalia JS, Nollen NL. Adherence to varenicline among African American smokers: an exploratory analysis comparing plasma concentration, pill count, and self-report. Nicotine Tob Res 2012; 14:1083-91. [PMID: 22367976 DOI: 10.1093/ntr/ntr333] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Measuring adherence to smoking cessation pharmacotherapy is important to evaluating its effectiveness. Blood levels are considered the most accurate measure of adherence but are invasive and costly. Pill counts and self-report are more practical, but little is known about their relationship to blood levels. This study compared the validity of pill count and self-report against plasma varenicline concentration for measuring pharmacotherapy adherence. METHODS Data were obtained from a randomized pilot study of varenicline for smoking cessation among African American smokers. Adherence was measured on Day 12 via plasma varenicline concentration, pill count, 3-day recall, and a visual analogue scale (VAS; adherence was represented on a line with two extremes "no pills" and "all pills"). RESULTS The sample consisted of 55 African American moderate to heavy smokers (average 16.8 cigarettes/day, SD = 5.6) and 63.6% were female. Significant correlations (p < .05) were found between plasma varenicline concentration and pill count (r = .56), 3-day recall (r = .46), and VAS (r = .29). Using plasma varenicline concentration of 2.0 ng/ml as the cutpoint for adherence, pill count demonstrated the largest area under the receiver operating characteristic curve (AUC = 0.85, p = .01) and had 88% sensitivity (95% CI = 75.0-95.0) and 80% specificity (95% CI = 30.0-99.0) for detecting adherence. CONCLUSIONS Of 3 commonly used adherence measures, pill count was the most valid for identifying adherence in this sample of African American smokers. Pill count has been used across other health domains and could be incorporated into treatment to identify nonadherence, which, in turn, could maximize smoking cessation pharmacotherapy use and improve abstinence rates.
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Affiliation(s)
- Taneisha S Buchanan
- Department of Medicine and Center for Health Equity, University of Minnesota, Minneapolis, MN 55414, USA.
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Sheffer CE, Stitzer M, Landes R, Brackman SL, Munn T, Moore P. Socioeconomic disparities in community-based treatment of tobacco dependence. Am J Public Health 2012; 102:e8-16. [PMID: 22390525 DOI: 10.2105/ajph.2011.300519] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined socioeconomic disparities in a community-based tobacco dependence treatment program. METHODS We provided cognitive-behavioral treatment and nicotine patches to 2739 smokers. We examined treatment use, clinical and environmental, and treatment outcome differences by socioeconomic status (SES). We used logistic regressions to model end-of-treatment and 3- and 6-month treatment outcomes. RESULTS The probability of abstinence 3 months after treatment was 55% greater for the highest-SES than for the lowest-SES (adjusted odds ratio [AOR] = 1.55; 95% confidence interval [CI] = 1.03, 2.33) smokers and increased to 2.5 times greater for the highest-SES than for the lowest-SES smokers 6 months after treatment (AOR = 2.47; 95% CI = 1.62, 3.77). Lower-SES participants received less treatment content and had fewer resources and environmental supports to manage a greater number of clinical and environmental challenges to abstinence. CONCLUSIONS Targets for enhancing therapeutic approaches for lower socioeconomic groups should include efforts to ensure that lower-SES groups receive more treatment content, strategies to address specific clinical and environmental challenges associated with treatment outcomes for lower-SES smokers (i.e., higher dependence and stress levels and exposure to other smokers), and strategies to provide longer-term support.
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Affiliation(s)
- Christine E Sheffer
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
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Stuart-Shor EM, Berra KA, Kamau MW, Kumanyika SK. Behavioral strategies for cardiovascular risk reduction in diverse and underserved racial/ethnic groups. Circulation 2012; 125:171-84. [PMID: 22215892 PMCID: PMC3293182 DOI: 10.1161/circulationaha.110.968495] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Eileen M Stuart-Shor
- ANP, FAHA, FAAN, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125, USA.
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Carlsten C, Halperin A, Crouch J, Burke W. Personalized medicine and tobacco-related health disparities: is there a role for genetics? Ann Fam Med 2011; 9:366-71. [PMID: 21747109 PMCID: PMC3133585 DOI: 10.1370/afm.1244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Genetic testing has been proposed as a means to increase smoking cessation rates and thus reduce smoking prevalence. To understand how that might be practically possible, with appreciation of the current social context of tobacco use and dependence, we performed a contextual analysis of smoking-related genetics and smoking cessation. To provide added value, genetics would need to inform and improve existing interventions for smokers (including behavioral and pharmacological treatments). Pharmacogenetics offers the most promising potential, because it may improve the efficacy of medication-based smoking cessations strategies. All proven interventions for treating tobacco dependence, however, including simple cost-effective measures, such as quit lines and physician counseling, are underutilized. As tobacco use occurs disproportionately among disadvantaged populations, efforts to improve smokers' access to health care, and to the tools that are known to help them quit, represent the most promising approaches for reducing smoking prevalence within these groups. Similar considerations apply to other chronic diseases contributing to population-level health disparities. We conclude that although genetics offers increasing opportunities to tailor drug treatment, and may in some cases provide useful risk prediction, other methods of personalizing care are likely to yield greater benefit to populations experiencing health disparities related to tobacco use.
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Ryan KK, Garrett-Mayer E, Alberg AJ, Cartmell KB, Carpenter MJ. Predictors of cessation pharmacotherapy use among black and non-Hispanic white smokers. Nicotine Tob Res 2011; 13:646-52. [PMID: 21464200 DOI: 10.1093/ntr/ntr051] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Use of pharmacotherapy for smoking cessation improves quit rates, but these treatments are underutilized, particularly among Black smokers. Attitudes toward pharmacotherapy may differ between racial/ethnic minorities and Caucasian smokers. It was hypothesized that Black and non-Hispanic White smokers would differ in their attitudes toward pharmacotherapy and that the association between attitudes toward and actual use of pharmacotherapy would differ by race. METHODS The study consisted of a single, cross-sectional telephone-based survey of current smokers (N = 697), which examined the relationship between race, attitudes toward pharmacotherapy, and pharmacotherapy usage in a representative bi-racial sample (39% Black). RESULTS Black smokers were significantly less likely to report ever use of pharmacotherapy (23%) than Caucasians (39%; odds ratio [OR] = 0.46; 95% CI: 0.33-0.66). Compared with Caucasians, Blacks had significantly less favorable attitudes toward pharmacotherapy, including disbelief about efficacy (p = .03), addiction concerns (p = .03), harmfulness of pharmacotherapy (p = .008), and need for treatment of any kind to quit smoking (p = .004). In a multiple logistic regression, racial group (Caucasian is referent: OR = 0.55, p = .003), addiction concerns (OR = 0.80, p < .01), and need for treatment of any kind to quit smoking (OR = 1.52, p < .001) were predictive of pharmacotherapy use. CONCLUSIONS These findings replicate and build upon previous research demonstrating underutilization of pharmacotherapy and enduring misconceptions about pharmacotherapy, particularly among Black smokers. Regardless of racial group, misconceptions about pharmacotherapy are related to lower rates of use. Efforts to improve understanding about the efficacy and safety of these products are needed to boost utilization and impact cessation rates.
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Affiliation(s)
- Katherine K Ryan
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC 29425, USA
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D'Silva J, Schillo BA, Sandman NR, Leonard TL, Boyle RG. Evaluation of a Tailored Approach for Tobacco Dependence Treatment for American Indians. Am J Health Promot 2011; 25:S66-9. [DOI: 10.4278/ajhp.100611-quan-180] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Evaluate a tailored approach for tobacco dependence treatment for American Indians. Design. A single-group design evaluation of a culturally specific curriculum for tobacco dependence treatment was implemented. Baseline assessment, program utilization, and 90-day follow-up interview data were analyzed. Setting. Fond du Lac Reservation in rural Minnesota and Mashkiki Waakaaigan Pharmacy in Minneapolis, Minnesota. Subjects. American Indian adults (N = 317). Intervention. Four 1-hour individual or group sessions of behavioral counseling paired with pharmacotherapy. Measures. Demographic variables, program satisfaction, and tobacco use behaviors. Analysis. Descriptive statistics; for abstinence, a smoking = missing analysis was used, assuming all nonrespondents were still smoking. Results. Sixty-three percent of participants completed the program. The 90-day follow-up response rate was 47%. Of those who completed, 47% reported abstinence at the 90-day follow-up. Missing = smoking analysis yielded a 21.8% quit rate. Continuing smokers cut their daily smoking by half from 17 to eight cigarettes, 88% reported an increase in self-efficacy for their next quit, and 44% planned to quit within 30 days. Conclusion. Evidence-based tobacco dependence treatment programs tailored to be culturally specific have the potential to significantly affect the burden of tobacco-related disparities among American Indians. (Am J Health Promot 2011;25[5 Supplement]:S66-S69.)
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Affiliation(s)
- Joanne D'Silva
- Joanne D'Silva, MPH; Barbara A. Schillo, PhD; Theresa L. Leonard, MPH; and Raymond G. Boyle, PhD, MPH, are with ClearWay Minnesota, Minneapolis, Minnesota. Nathan R. Sandman, BASc, is with the Wiidookaawishin (Help Me) QUITPLAN Center, Fond du Lac Reservation, Cloquet, Minnesota
| | - Barbara A. Schillo
- Joanne D'Silva, MPH; Barbara A. Schillo, PhD; Theresa L. Leonard, MPH; and Raymond G. Boyle, PhD, MPH, are with ClearWay Minnesota, Minneapolis, Minnesota. Nathan R. Sandman, BASc, is with the Wiidookaawishin (Help Me) QUITPLAN Center, Fond du Lac Reservation, Cloquet, Minnesota
| | - Nathan R. Sandman
- Joanne D'Silva, MPH; Barbara A. Schillo, PhD; Theresa L. Leonard, MPH; and Raymond G. Boyle, PhD, MPH, are with ClearWay Minnesota, Minneapolis, Minnesota. Nathan R. Sandman, BASc, is with the Wiidookaawishin (Help Me) QUITPLAN Center, Fond du Lac Reservation, Cloquet, Minnesota
| | - Theresa L. Leonard
- Joanne D'Silva, MPH; Barbara A. Schillo, PhD; Theresa L. Leonard, MPH; and Raymond G. Boyle, PhD, MPH, are with ClearWay Minnesota, Minneapolis, Minnesota. Nathan R. Sandman, BASc, is with the Wiidookaawishin (Help Me) QUITPLAN Center, Fond du Lac Reservation, Cloquet, Minnesota
| | - Raymond G. Boyle
- Joanne D'Silva, MPH; Barbara A. Schillo, PhD; Theresa L. Leonard, MPH; and Raymond G. Boyle, PhD, MPH, are with ClearWay Minnesota, Minneapolis, Minnesota. Nathan R. Sandman, BASc, is with the Wiidookaawishin (Help Me) QUITPLAN Center, Fond du Lac Reservation, Cloquet, Minnesota
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Trinidad DR, Pérez-Stable EJ, White MM, Emery SL, Messer K. A nationwide analysis of US racial/ethnic disparities in smoking behaviors, smoking cessation, and cessation-related factors. Am J Public Health 2011; 101:699-706. [PMID: 21330593 DOI: 10.2105/ajph.2010.191668] [Citation(s) in RCA: 318] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Dennis R Trinidad
- School of Community and Global Health, Claremont Graduate University, Claremont, San Dimas, CA, USA.
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Smoking-cessation strategies for American Indians: should smoking-cessation treatment include a prescription for a complete home smoking ban? Am J Prev Med 2010; 39:S56-65. [PMID: 21074679 DOI: 10.1016/j.amepre.2010.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 08/13/2010] [Accepted: 08/24/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND The prevalence of cigarette smoking is particularly high among American Indian communities in the Upper Midwest. PURPOSE To evaluate the predictors of smoking cessation among a population-based sample of American Indians in the Upper Midwest during a quit attempt aided with nicotine replacement therapy (NRT). METHODS This study used the subsample of American Indian adults (n = 291, response rate = 55.4%) from a cohort study of smokers engaging in an aided NRT quit attempt. Eligible participants filled an NRT prescription between July 2005 and September 2006 through the Minnesota Health Care Programs (e.g., Medicaid). Administrative records and follow-up survey data were used to assess outcomes approximately 8 months after the NRT fill date. This analysis was conducted in 2009-2010. RESULTS Approximately 33% of American Indian respondents trying to quit smoking reported complete home smoking bans. Adoption of a complete home smoking ban and greater perceived advantages of NRT were cross-sectionally associated with 7-day smoking abstinence in univariate and multivariate analyses. Consistent with previous research, older age was a significant predictor of 7-day abstinence. Having a history of clinician-diagnosed anxiety in the past year was associated with decreased likelihood of 7-day abstinence in the unadjusted analysis, but not significant in multivariate analyses. CONCLUSIONS Results of this study suggest potential modifiable targets of interventions for future research to help American Indians quit smoking: (1) improved delivery of behavioral interventions to increase the intensity of smoking cessation treatment; (2) promotion and adoption of complete home smoking bans; and (3) education to increase awareness of the benefits of NRT.
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David SP, Mezuk B, Zandi PP, Strong D, Anthony JC, Niaura R, Uhl GR, Eaton WW. Sex differences in TTC12/ANKK1 haplotype associations with daily tobacco smoking in Black and White Americans. Nicotine Tob Res 2010; 12:251-62. [PMID: 20133381 DOI: 10.1093/ntr/ntp201] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The 11q23.1 genomic region has been associated with nicotine dependence in Black and White Americans. METHODS By conducting linkage disequilibrium analyses of 7 informative single nucleotide polymorphisms (SNPs) within the tetratricopeptide repeat domain 12 (TTC12)/ankyrin repeat and kinase containing 1 (ANKK1)/dopamine (D2) receptor gene cluster, we identified haplotype block structures in 270 Black and 368 White (n = 638) participants, from the Baltimore Epidemiologic Catchment Area cohort study, spanning the TTC12 and ANKK1 genes consisting of three SNPs (rs2303380-rs4938015-rs11604671). Informative haplotypes were examined for sex-specific associations with daily tobacco smoking initiation and cessation using longitudinal data from 1993-1994 and 2004-2005 interviews. RESULTS There was a Haplotype x Sex interaction such that Black men possessing the GTG haplotype who were smokers in 1993-2004 were more likely to have stopped smoking by 2004-2005 (55.6% GTG vs. 22.0% other haplotypes), while Black women were less likely to have quit smoking if they possessed the GTG (20.8%) versus other haplotypes (24.0%; p = .028). In Whites, the GTG haplotype (vs. other haplotypes) was associated with lifetime history of daily smoking (smoking initiation; odds ratio = 1.6; 95% CI = 1.1-2.4; p = .013). Moreover, there was a Haplotype x Sex interaction such that there was higher prevalence of smoking initiation with GTG (77.6%) versus other haplotypes (57.0%; p = .043). DISCUSSION In 2 different ethnic American populations, we observed man-woman variation in the influence of the rs2303380-rs4938015-rs11604671 GTG haplotype on smoking initiation and cessation. These results should be replicated in larger cohorts to establish the relationship among the rs2303380-rs4938015-rs11604671 haplotype block, sex, and smoking behavior.
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Affiliation(s)
- Sean P David
- Division of Family & Community Medicine, Department of Medicine, Center for Education in Family & Community Medicine, Stanford University School of Medicine, 1215 Welch Road, Modular G, Stanford, CA 94305-5408, USA.
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Solberg LI, Parker ED, Foldes SS, Walker PF. Disparities in tobacco cessation medication orders and fills among special populations. Nicotine Tob Res 2009; 12:144-51. [PMID: 20018945 DOI: 10.1093/ntr/ntp187] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is considerable interest in measuring and eliminating health care disparities among various special populations, but there is limited understanding of their extent, causes, or potential remedies. To improve this for tobacco cessation, we measured differences in the frequency of receiving and filling cessation medication prescriptions by race, ethnicity, age, language preference, health insurance, and pregnancy. METHODS The relevant variables for all patients of a Minnesota medical group aged 18 years and older with clinician visits were extracted from the electronic medical records of 1 large medical group from March 2006 to February 2007. This was combined with claims data from 1 insurance plan that covered most of these individuals. Order and fill rates for cessation medications were then adjusted for each of the other variables. RESULTS There were 32,733 current users of tobacco, 18,047 of whom had both health insurance and pharmacy claims data available. After adjustment, 15.4% overall had received an order for cessation medications during this year, but only 78% had filled it. Groups receiving fewer orders than their comparison groups were aged 18-34 years or older than 65 years, men, pregnant women, Asians and Hispanics, and those with non-English-language preference, on Medicaid, or with fewer visits. The same groups were less likely to fill that prescription, except patients with non-English preference or Medicaid. DISCUSSION There are disparities in both the receipt of cessation medication orders and the likelihood of filling them for some special populations. The causes are likely to be complex, but this information provides a starting point for learning to improve this problem.
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Affiliation(s)
- Leif I Solberg
- HealthPartners Research Foundation, P.O. Box 1524, MS 21111R, Minneapolis, MN 55440-1524, USA.
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Burgess DJ, Fu SS, Noorbaloochi S, Clothier BA, Ricards J, Widome R, van Ryn M. Employment, gender, and smoking cessation outcomes in low-income smokers using nicotine replacement therapy. Nicotine Tob Res 2009; 11:1439-47. [DOI: 10.1093/ntr/ntp158] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Schroeder SA. Strategies to reduce tobacco use the role of state research. Am J Prev Med 2008; 35:S519-21. [PMID: 19012847 DOI: 10.1016/j.amepre.2008.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 09/08/2008] [Accepted: 09/08/2008] [Indexed: 11/19/2022]
Affiliation(s)
- Steven A Schroeder
- University of California San Francisco Department of Medicine and the Smoking Cessation Leadership Center, San Francisco, California 94143-1211, USA.
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Schillo BA, D'Silva J. ClearWay Minnesota's research program investing in innovative tobacco control research to improve the health of Minnesotans. Am J Prev Med 2008; 35:S439-41. [PMID: 19012836 DOI: 10.1016/j.amepre.2008.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 09/08/2008] [Accepted: 09/08/2008] [Indexed: 11/28/2022]
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