Health education helps African American smokers quit

Jun 7 2006

The first clinical trial to focus on light smokers shows that African Americans are motivated to quit more by completing health education than by using nicotine gum.

Jasjit S. Ahluwalia, M.D., M.P.H., professor and researcher with the University of Minnesota Medical School and Cancer Center, and executive director of the University's Office of Clinical Research, led the research team on this study. The findings are published in the June issue of the journal Addiction.

"Our results highlight the positive impact that directed health education and advice-oriented counseling has on helping African American light smokers quit," Ahluwalia said. "We hope our study provides impetus for more studies that assess other intervention methods that may be successfully used to improve quit rates among African American light smokers."

Researchers defined light smokers as people who smoke 10 or less cigarettes a day.

Ahluwalia noted that while the prevalence of cigarette smoking has decreased in the United States over the past few decades, the number of people who maintain a low level of cigarette use, or light smokers, is increasing. He said this is particularly evident among teens, college students, women, and ethnic minority groups.

"The phenomenon of light smoking is not entirely understood," Ahluwalia said. "For some, light smoking is a transitional state leading to heavier smoking or cessation. For others, light smoking is a pattern of low cigarette use that is maintained for years."

Approximately 50 percent of African American smokers are light smokers. By contrast, Ahluwalia notes that African Americans experience a disproportionate share of tobacco-related illnesses, including higher rate of death. African Americans tend to smoke mentholated, higher tar and nicotine cigarettes. They also have a slower rate of nicotine metabolism; higher levels, per cigarette smoked, of cotinine, a compound present in those exposed to tobacco; and, greater difficulty quitting smoking compared to other ethnic groups, which may be contributing factors to the higher smoking-related illness and death rate.

The 26-week study focused on the effects of nicotine gum and counseling among African American light smokers, defined as people who smoke 10 or less cigarettes a day. The study included 755 African American light smokers. The average age of study participants was 45; 66 percent were women. The study found that quit rates for participants prescribed nicotine gum were no better than for participants given a placebo gum. But participants who received specific health education had double the quit rate over participants who received motivational counseling.

Ahluwalia and his colleagues randomly assigned the participants to one of four study groups: 2 mg nicotine gum plus advice-oriented health education, 2 mg nicotine gum plus motivational counseling, placebo gum plus health education, and placebo plus motivational counseling. When enrolled into the study, participants who smoked an average of seven cigarettes a day had cotinine levels approaching white smokers who smoke 20 cigarettes a day.

Participants prescribed gum received an eight-week supply of either nicotine or placebo gum and six counseling sessions during the 26 weeks of the study. A booklet specifically developed for African American light smokers was given to all participants, but used extensively for groups receiving health education. During the course of the study, biochemical measures were randomly taken to check for tobacco-related compounds serum cotinine and carbon monoxide, which, if present, indicated an individual was using tobacco products.

Quit rates for participants using nicotine gum were 14.2 percent compared to 11.1 percent for the placebo group. Participants receiving health education had a quit rate of 16.7 percent compared to 8.5 percent for other participants.