Factors that Explain Differences in Abstinence between Black and White Smokers: A Prospective Intervention Study
Menée aux Etats-Unis auprès de 224 fumeurs afro-américains et de 225 fumeurs de type caucasien participant à une intervention pour la cessation tabagique comportant un traitement par varénicline et des sessions de conseils, cette étude identifie les facteurs socioéconomiques, biologiques, psychosociaux et comportementaux associés aux disparités ethniques dans l'abstinence tabagique
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 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 6 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 (e.g., treatment utilization, side effects, withdrawal relief), psychosocial, and biological factors were assessed to investigate race differences in abstinence. Unadjusted odds ratios 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% CI = 0.32-0.83, p=.007). Utilizing best subsets logistic regression, five factors associated with race jointly predicted abstinence; home ownership (yes/no, OR = 3.03, 95% CI = 1.72-5.35, p<.001), study visits completed (range 0-6, OR = 2.81, 95% CI = 1.88-4.20, p<.001), income (household member/$1000, OR = 1.03, 95% CI = 1.01-1.06, p=.02), plasma cotinine (per 1 ng/ml, OR = 0.997, 95% CI = 0.994-0.999, p=.002) and neighborhood problems (range 10-30, OR = 0.88, 95% CI = 0.81-0.96, 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.
Journal of the National Cancer Institute , résumé, 2018