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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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Calixte-Civil PF, Brandon TH. The Effect of Acute Interpersonal Racial Discrimination on Smoking Motivation and Behavior Among Black Smokers: an Experimental Study. J Racial Ethn Health Disparities 2020; 8:1511-1521. [PMID: 33215359 DOI: 10.1007/s40615-020-00914-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/12/2020] [Accepted: 10/27/2020] [Indexed: 12/20/2022]
Abstract
In comparison to White smokers, Black smokers are likely to report both more discrimination and less success in smoking cessation. No previous study has tested the causal relationship between an experience of racial discrimination and smoking variables associated with cessation. The goal of this study was to test the causal influence of interpersonal racial discrimination on smoking motivation (i.e., the urge to smoke cigarettes, cessation self-efficacy, and smoking behavior) using a controlled experimental design. We used a virtual ball-playing game to create a laboratory model of racial discrimination. A 2 × 2 between-subjects factorial design (inclusion/exclusion vs. ingroup/outgroup) was used to randomly assign participants to one of four groups: (1) included/ingroup, (2) included/outgroup, (3) excluded/ingroup (ostracism), and (4) excluded/outgroup (racial discrimination). Sixty-nine Black smokers were recruited from the community. Participants in the excluded conditions reported lower cessation self-efficacy than those in the included conditions. Participants in the outgroup conditions had reduced latency to smoke compared to those in the ingroup conditions. There were no main effects of social inclusion on cravings or latency to smoke and no statistically significant interactions for social inclusion × group membership. This laboratory simulation of racial discrimination shows a causal relationship between exclusion and low cessation self-efficacy, which contributes to a better understanding of influences upon smoking cessation attempts among Black smokers.
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Affiliation(s)
| | - Thomas H Brandon
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Health Outcomes and Behavior, Tobacco Research & Intervention Program, Moffitt Cancer Center & Research Institute, 4115 E. Fowler Avenue, Tampa, FL, 33617, USA
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Ruglass LM, Root JC, Dambreville N, Shevorykin A, Sheffer CE, Melara RD. Examining differences in attentional bias to smoking-related cues among black and white cigarette smokers: An event-related potential pilot study. Neurosci Lett 2020; 735:135241. [PMID: 32659312 PMCID: PMC8075105 DOI: 10.1016/j.neulet.2020.135241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 07/04/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
Black cigarette smokers experience higher craving, lower cessation rates, and increased health complications from tobacco use than Whites. We examined psychophysiological and behavioral differences in attentional bias to smoking cues between Black and White smokers. Thirty-one participants (Blacks, n = 20; MAge = 45 and Whites, n = 11, MAge = 47.64) discriminated line orientations while ignoring temporally flanking lines and smoking-related, positive-, negative-, and neutral-images as behavioral responses and event-related potentials (ERPs) were recorded. Results revealed a three-way interaction in reaction time among Group (White, Black), Congruity (congruent vs. incongruent flankers) and Cue (smoking-related, positive, negative) factors, F(2,58) = 3.63, p = .03, MSe = .001, η2 = .002. Smoking-related cues yielded the largest congruity effects in Whites, but the smallest congruity effects in Blacks. Random presentation of smoking-related cues (re: baseline) weakened P1 ERP amplitude (125 ms after stimulus onset) in Whites, but not Blacks (Cue x Group x Task, F(3,87) = 3.44, p < .05, MSe = 65.96, η2 = .01), suggesting an early sensory effect of smoking cues in Whites. The difference between Whites and Blacks in P2 amplitude (226 ms; amplitude weaker in Whites) was greatest to the smoking-related cues (Cue x Group, F(3,87) = 2.81, p < .05, MSe = 60.68, η2 = .01), indicating a stronger draw in attention from smoking cues in Whites. Findings suggest White and Black smokers respond differently to smoking-related cues during early sensory processing. Findings need to be replicated.
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Affiliation(s)
- Lesia M Ruglass
- Department of Psychology, The City College of New York, 160 Convent Avenue, NAC 7/120, NY, NY 10031, United States
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1300 York Avenue, NY, NY 10065, United States
| | - Naomi Dambreville
- Department of Psychology, The City College of New York, 160 Convent Avenue, NAC 7/120, NY, NY 10031, United States
| | - Alina Shevorykin
- Department of Psychology and Mental Health Counseling, Pace University, 861 Bedford Rd., Pleasantville, NY 10570, United States
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, United States
| | - Robert D Melara
- Department of Psychology, The City College of New York, 160 Convent Avenue, NAC 7/120, NY, NY 10031, United States
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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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Lepore SJ, Collins BN, Sosnowski DW. Self-efficacy as a pathway to long-term smoking cessation among low-income parents in the multilevel Kids Safe and Smokefree intervention. Drug Alcohol Depend 2019; 204:107496. [PMID: 31499240 PMCID: PMC6878184 DOI: 10.1016/j.drugalcdep.2019.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/20/2019] [Accepted: 05/31/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study investigated the effects of a multi-level smoking intervention on mediators of long-term abstinence in parental smokers, including smoking cessation self-efficacy, smoking urge coping, and perceived support to quit smoking. METHODS This is a secondary analysis of data from a randomized trial that recruited parental smokers from pediatric clinics in low-income communities (N = 327, 83% women, 83% African American, 79% below poverty level). Following clinical practice guidelines for tobacco intervention ("Ask, Advise, Refer" [AAR]), pediatricians asked all parents about child tobacco smoke exposure (TSE), advised about TSE harms and benefits of reducing TSE, and referred smokers to cessation resources. Eligible parents were then randomized to additional telephone-based smoking behavior counseling (AAR + counseling) or nutrition education (AAR + control). Bioverified 7-day point prevalence smoking abstinence and perceived counselor support were assessed at 12-month follow-up; cessation self-efficacy and urge coping were assessed at 3-month follow-up. RESULTS Relative to AAR + control, AAR + counseling was associated with higher self-efficacy, urge coping, and perceived support to quit (all p's<.001). Self-efficacy, but no other mediators, had a significant positive effect on 12-month bioverified smoking abstinence (p < .001). The indirect effect of intervention on 12-month abstinence via self-efficacy suggested mediation via this pathway (p = .002). CONCLUSION Results suggest that all putative treatment pathways were improved more by the multi-level AAR + counseling than the clinic-level AAR + control intervention. Further, self-efficacy at end-of-treatment prospectively predicted long-term cessation, suggesting that building of self-efficacy through treatment may be key to sustained cessation.
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Affiliation(s)
- Stephen J Lepore
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, 9th Floor Ritter Annex, Philadelphia, PA 19122, USA.
| | - Bradley N Collins
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, 9th Floor Ritter Annex, Philadelphia, PA 19122, USA.
| | - David W Sosnowski
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin St, Box 842018, Richmond, VA 23284, USA.
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Cruz TB, Rose SW, Lienemann BA, Byron MJ, Meissner HI, Baezconde-Garbanati L, Huang LL, Carroll DM, Soto C, Unger JB. Pro-tobacco marketing and anti-tobacco campaigns aimed at vulnerable populations: A review of the literature. Tob Induc Dis 2019; 17:68. [PMID: 31582956 PMCID: PMC6770621 DOI: 10.18332/tid/111397] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION We reviewed research literature on pro-tobacco marketing and anti-tobacco campaigns targeting eight vulnerable populations to determine key findings and research gaps. Results can inform tobacco policy and control efforts and the design of public education campaigns for these groups. METHODS Five journal databases in medicine, communication, and science, were used to identify 8875 peer-reviewed, original articles in English, published in the period 2004-2018. There were 144 articles that met inclusion criteria on pro-tobacco marketing or anti-tobacco campaigns aimed at eight US groups: women of reproductive age, racial/ethnic minority groups (African American, Hispanic/Latino, Asian/Pacific Islander and American Indian/Alaska Native), Lesbian/Gay/Bisexual/Transgender (LGBT) populations, groups with low socioeconomic status, rural/inner city residents, military/veterans, and people with mental health or medical co-morbidities. We summarized the number of articles for each population, type of tobacco, and pro-tobacco or anti-tobacco focus. Narrative summaries were organized by population and by pro-tobacco or anti-tobacco focus, with key strategies and gaps by group. RESULTS There were more studies on pro-tobacco marketing rather than anti-tobacco campaigns, and on cigarettes rather than other tobacco products. Major gaps included studies on Asian Americans, American Indian/Alaska Natives, pregnant women, LGBT populations, and those with mental health or medical co-morbidities. Gaps related to tobacco products were found for hookah, snus, and pipe/roll-your-own tobacco in the pro-tobacco studies, and for all products except cigarettes in anti-tobacco studies. Common tobacco industry methods used were tailoring of product and package design and messages that were used to reach and appeal to different sociodemographic groups. Studies varied by research design making it difficult to compare results. CONCLUSIONS We found major research gaps for specific groups and tobacco products. Public education campaigns need a stronger foundation in empirical studies focused on these populations. Research and practice would benefit from studies that permit comparisons across studies.
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Affiliation(s)
- Tess Boley Cruz
- Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Shyanika W Rose
- Truth Initiative Schroeder Institute, Washington, United States.,Center for Health Equity Transformation and Behavioral Science, University of Kentucky College of Medicine, Lexington, United States
| | - Brianna A Lienemann
- Keck School of Medicine, University of Southern California, Los Angeles, United States.,Moores Cancer Center, University of California San Diego, San Diego, United States
| | - M Justin Byron
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Helen I Meissner
- Office of Disease Prevention, National Institutes of Health, Bethesda, United States
| | | | - Li-Ling Huang
- Global Health and Health Security, Taipei Medical University, Taipei, Taiwan
| | - Dana M Carroll
- Masonic Cancer Center, University of Minnesota, Minneapolis, United States
| | - Claradina Soto
- Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Jennifer B Unger
- Keck School of Medicine, University of Southern California, Los Angeles, United States
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Robinson CD, Muench C, Brede E, Endrighi R, Szeto EH, Sells JR, Lammers JP, Okuyemi KS, Waters AJ. Effect of attentional retraining on cognition, craving, and smoking in African American smokers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:636-646. [PMID: 28627913 PMCID: PMC5546953 DOI: 10.1037/adb0000286] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
African American cigarette smokers have lower rates of cessation than Whites and live in communities with a higher number of tobacco advertisements. Exposure to smoking cues may promote smoking and undermine cessation. It may be possible to reduce attention to smoking cues ("attentional bias"). In this study, we investigated the effect of attentional retraining (AR) on attentional bias and smoking in African American smokers. Nontreatment- seeking African American smokers (N = 64) were randomly assigned to an AR or control condition. Participants were given a mobile device for 2 weeks and prompted to complete up to 3 AR (or control) trainings per day. Participants completed assessments of attentional bias, craving, and smoking both in the lab and in the field. Participants in the AR and control conditions completed an average of 29.07 AR (SD = 12.48) and 30.61 control training tasks (SD = 13.07), respectively. AR reduced attentional bias assessed in the laboratory, F(1, 126) = 9.20, p = .003, and field, F(1, 374) = 6.18, p = .01. This effect generalized to new stimuli, but not to new tasks. AR did not significantly reduce craving or biological measures of smoking. Smoking assessed on the mobile device declined over days in the AR group, F(1, 26) = 10.95, p = .003, but not in the control group, F(1, 27) = 0.02, p = .89. Two weeks of AR administered on a mobile device reduced attentional bias in African American smokers and had mixed effects on smoking. (PsycINFO Database Record
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Affiliation(s)
- Cendrine D Robinson
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | | | - Emily Brede
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Romano Endrighi
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Edwin H Szeto
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Joanna R Sells
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - John P Lammers
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Kolawole S Okuyemi
- Department of Family Medicine and Community Health, University of Minnesota
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
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Okuyemi KS, Reitzel LR, Fagan P. Interventions to Reduce Tobacco-Related Health Disparities. Nicotine Tob Res 2015; 17:887-91. [PMID: 26180213 PMCID: PMC4502764 DOI: 10.1093/ntr/ntv096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kolawole S Okuyemi
- Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN;
| | - Lorraine R Reitzel
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX
| | - Pebbles Fagan
- Cancer Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, HI
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