Thursday, June 16, 2022

Counseling Plus Varenicline May Improve Smoking Cessation Among Black Adults

Black smokers may be more likely to stop smoking if prescribed varenicline in addition to counseling sessions, suggests a report published this week in JAMA.

“Black adults in the US have higher rates of smoking-related morbidity and mortality compared with White adults, despite having comparable smoking prevalence and smoking fewer cigarettes per day,” wrote Lisa Sanderson Cox, Ph.D., of the University of Kansas School of Medicine and colleagues. “Although they report greater interest in quitting, Black smokers are less likely than White smokers to be advised to quit or achieve sustained smoking abstinence and have been underrepresented in tobacco treatment research.”

Cox and colleagues conducted a randomized, double-blind, placebo-controlled trial with 500 participants aged 18 and older at a federally qualified health center in Kansas City, Missouri. Eligible participants identified as African American or Black, smoked at least one cigarette per day for at least 25 of the past 30 days, and were interested in stopping smoking.

Participants were randomly assigned to receive either 1 mg of varenicline twice daily (dosage was gradually increased from 0.5 mg to 1 mg during the first four days of treatment) or a placebo for 12 weeks, with 300 participants assigned to the varenicline group and 200 assigned to the placebo group. Additionally, participants received six cognitive-behavioral counseling sessions and the Kick It at Swope: Stop Smoking Guide, a culturally tailored educational guide used in previous studies with Black smokers. The participants completed assessments at weeks 4, 8, 12, 16, and 26 that asked about past-week tobacco use and adverse side effects. The researchers collected saliva and/or urine samples from the participants to confirm reports of smoking abstinence.

Participants who received varenicline were significantly more likely to be abstinent at week 26 compared with participants who received the placebo (15.7% vs 6.5%). Those who received varenicline were similarly significantly more likely to be abstinent after medication treatment ended at 12 weeks compared with the placebo group (18.7% vs 7%). Varenicline demonstrated significantly greater odds of abstinence for both participants who smoked between one and 10 cigarettes per day and participants who smoked more than 10 cigarettes per day. Adverse events reported by participants were similar in both groups, and no severe adverse events were reported by those receiving varenicline.

“For too long, Black individuals have been disproportionately recruited by the tobacco industry to replenish their customer base, have too infrequently received evidence-based cessation assistance during health care visits, have had especially great difficulty quitting smoking, and have experienced disproportionately high mortality rates due to smoking,” wrote Timothy Baker, Ph.D., of the Center for Tobacco Research and Intervention at the University of Wisconsin School of Medicine and Public Health and colleagues in an accompanying commentary. The authors added that the study by Cox and colleagues “offers evidence that cigarette smoking by Black individuals can be addressed more successfully.”

For related information, see the Psychiatric News article “Psychiatrists Hold Key for Helping Patients Quit Tobacco.”

(Image: iStock/AndreyPopov)

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