Race and Nicotine Replacement Treatment Outcomes Among Low-Income Smokers

Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota 55417, USA.
American journal of preventive medicine (Impact Factor: 4.53). 01/2009; 35(6 Suppl):S442-8. DOI: 10.1016/j.amepre.2008.09.009
Source: PubMed


Prior research suggests that racial/ethnic minority smokers experience more difficulty with cessation than white smokers and access formal treatment less often. Minority smokers may respond differently to treatment interventions than white smokers. This prospective, observational cohort study compared long-term cessation outcomes among four racial/ethnic groups after an aided quit attempt using nicotine replacement therapy (NRT).
A random cohort of smokers (N=1782) who recently filled a prescription for NRT was selected, stratified by race, using Minnesota Health Care Programs (e.g., Medicaid) pharmacy claims databases between July 2005 and September 2006. The primary outcome was 7-day point prevalence abstinence, which was assessed about 8 months after the NRT index prescription fill date using a mixed-mode survey protocol.
The overall survey response was 58.2%. Overall, abstinence outcomes did not significantly vary by race. Unadjusted comparisons show that among survey respondents, at 8 months, 7-day point prevalence abstinence was 13.8% among whites, 13.6% among blacks, 14.1% among American Indians/Alaska Natives, and 20.7% among Asians (p=0.42). Similarly, the 30-day duration abstinence was 10.0% among whites, 11.5% among blacks, 8.9% among American Indians/Alaska Natives, and 18.3% among Asians (p=0.14). In multivariate analysis using propensity adjustment for potential confounding and response bias, there was no evidence that the effectiveness of NRT was lower for racial/ethnic minority smokers compared to white smokers.
These findings indicate that racial/ethnic minorities are as likely to quit smoking at a level similar to whites when using cessation treatment that includes NRT. Given documented disparities in the use of evidence-based cessation treatments such as NRT, interventions are sorely needed to improve access and utilization of these treatments in racial/ethnic minority groups.

Download full-text


Available from: Siamak Noorbaloochi
  • Source
    • "Biospecimen collection procedures—involving primarily phlebotomy for whole blood and buccal samples from those participants unable or unwilling to undergo phlebotomy—and DNA preparation and quantification are described elsewhere (Fu, Kodl, et al., 2008; Mezuk et al., 2008). Separate consent forms were used for the survey, the collection of blood samples, and collection of buccal samples (Mezuk et al.). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The 11q23.1 genomic region has been associated with nicotine dependence in Black and White Americans. 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. 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). 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.
    Full-text · Article · Mar 2010 · Nicotine & Tobacco Research
  • [Show abstract] [Hide abstract]
    ABSTRACT: Evaluate a tailored approach for tobacco dependence treatment for American Indians. 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. Fond du Lac Reservation in rural Minnesota and Mashkiki Waakaaigan Pharmacy in Minneapolis, Minnesota. American Indian adults (N = 317). Four 1-hour individual or group sessions of behavioral counseling paired with pharmacotherapy. Demographic variables, program satisfaction, and tobacco use behaviors. Descriptive statistics; for abstinence, a smoking = missing analysis was used, assuming all nonrespondents were still smoking. 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. 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.
    No preview · Article · Apr 2011 · American journal of health promotion: AJHP
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: agents administered during hospi- talization at a tertiary care acade- mic medical center. The retrospec- tive analysis was conducted over 1 year. A total of 416 allergies were reported among 300 patients; more than 1 allergy was reported by more than one-fourth of study patients (82/300 (27.3%)). Only 36.3% (151/416) of allergies reported were accompanied by a reaction description (95% confi- dence interval (CI), 31.7% to
    Preview · Article ·
Show more