BACKGROUND: A high proportion of African-American smokers are light smokers, and they experience low smoking cessation rates and disproportionately high tobacco-related morbidity; yet no studies have examined tobacco treatment adherence in this group. OBJECTIVES: To determine the predictors of adherence to nicotine gum and counseling among African-American light smokers (defined as smoking ≤10 cigarettes/day), and the effects of adherence on smoking cessation. DESIGN: Data were from a 2 × 2 randomized, placebo-controlled smoking cessation trial of nicotine gum (2 mg versus placebo) and counseling (motivational interviewing versus health education). PARTICIPANTS: Seven hundred fifty-five African-American light smokers at a community-based clinic. MEASUREMENTS: Demographic and health-related information, smoking behaviors, psychosocial variables, adherence to nicotine gum and counseling, and cotinine-verified 7-day abstinence from smoking at week-26 follow-up. RESULTS: A logistic regression model showed that having a higher body mass index (OR = 1.03, 95% CI = 1.01 to 1.05), more quit attempts in the past year (OR = 1.04, 95% CI = 1.01 to 1.07), higher baseline exhaled carbon monoxide (OR = 1.22, 95% CI = 1.01 to 1.48), and higher perceived stress (OR = 1.12, 95% CI = 1.03 to 1.22) increased the likelihood of adherence to nicotine gum. Being a high school graduate was a predictor of adherence to counseling (OR = 1.58, 95% CI = 1.02 to 2.44). Surprisingly, being adherent to nicotine gum significantly reduced the odds of smoking cessation (OR = 0.50, CI = 0.28 to 0.87). On the other hand, adherence to counseling dramatically increased the likelihood of smoking cessation (OR = 3.32, CI = 1.36 to 8.08). CONCLUSIONS: Individual risk factors may influence adherence to nicotine gum and counseling. Improving psychological interventions and promoting adherence to counseling may increase overall smoking cessation success among African-American light smokers.
Bibliographical noteFunding Information:
Acknowledgements: The authors would like to thank the personnel of the Kick It at Swope II Project for their efforts on the parent project from which data for the current analysis were derived. We are also grateful to the volunteers who participated in this research and to the management and staff of Swope Health Services for their partnership in the implementation of this parent project. The clinical trial from which data used for the current study was derived was supported by the National Cancer Institute at the National Institutes of Health (R01 CA091912). GlaxoSmithKline provided study medication but played no role in the design, conduct of the study, or interpretation and analysis of the data.
- African American
- nicotine gum
- smoking cessation