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Distress, race/ethnicity and smoking cessation in treatment‐seekers: implications for disparity elimination
Author(s) -
Webb Hooper Monica,
Kolar Stephanie K.
Publication year - 2015
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12990
Subject(s) - smoking cessation , medicine , abstinence , demography , distress , odds ratio , ethnic group , psychiatry , clinical psychology , pathology , sociology , anthropology
Background and Aims Distress is a modifiable risk factor for smoking maintenance. This study aimed to assess racial/ethnic differences in distress pre‐ and post‐cognitive–behavioral therapy (CBT) for smoking cessation, and relations with abstinence. Design Analyses of variance and logistic regressions were conducted. Setting University‐based smoking cessation laboratory in South Florida, USA. Participants The sample comprised 234 treatment‐seekers recruited from the community (18% white, 60% African American and 22% Hispanic). Intervention All participants received eight sessions of group CBT plus 8 weeks of transdermal nicotine patches (TNP). Measurements Demographics and smoking history [baseline], perceived stress and depressive symptoms [baseline and end of therapy (EOT)], carbon monoxide‐verified 7‐day point prevalence abstinence (p.p.a.) at EOT, 3 months post‐CBT (primary outcome) and 6 months (self‐report). Findings Compared with whites, African Americans reported greater baseline perceived stress ( P = 0.03) and depressive symptoms ( P = 0.06); no EOT differences were found. African Americans ( P < 0.001) and Hispanics ( P < 0.01) reported greater perceived stress reduction, and African Americans reported greater reductions in depressive symptoms ( P < 0.01). EOT‐perceived stress (adjusted odds ratio (AOR) = 0.93 (0.89–0.98)) and depressive symptoms [AOR = 0.96 (0.93–0.99)] were associated inversely with 7‐day p.p.a. at 3 months. Reductions in perceived stress [AOR = 0.93 (0.89–0.98)] and depressive symptoms at the EOT [AOR = 0.96 (0.93–0.99)] were associated with cessation, such that reduced distress increased the odds of abstinence. The interactions between race/ethnicity and distress on 7‐day p.p.a. were not significant at any assessment point. Conclusions Among smokers in Florida, USA, racial/ethnic differences in distress before starting cognitive–behavioral therapy for smoking cessation were eliminated at the end of treatment, driven by improvements among African Americans and Hispanics. High levels of distress were associated with reduced odds of abstinence through 6 months across racial/ethnic groups.