Race and Medication Adherence Moderate Cessation Outcomes in Criminal Justice Smokers

Abstract

Introduction: Smokers in the criminal justice system represent some of the most disadvantaged smokers in the U.S., as they have high rates of smoking (70%-80%) and are primarily uninsured, with low access to medical interventions. Few studies have examined smoking-cessation interventions in racially diverse smokers, and none have examined these characteristics among individuals supervised in the community. The purpose of this study is to determine if four sessions of standard behavioral counseling for smoking cessation would differentially aid smoking cessation for African American versus non-Hispanic white smokers under community corrections supervision.

Design: An RCT.

Setting/participants: Five hundred smokers under community corrections supervision were recruited between 2009 and 2013 via flyers posted at the community corrections offices.

Intervention: All participants received 12 weeks of bupropion plus brief physician advice to quit smoking. Half of the participants received four sessions of 20-30 minutes of smoking-cessation counseling following tobacco treatment guidelines, whereas half received no additional counseling.

Main outcome measures: Generalized estimating equations were used to determine factors associated with smoking abstinence across time. Analyses were conducted in 2014.

Results: The end-of-treatment abstinence rate across groups was 9.4%, with no significant main effects indicating group differences. However, behavioral counseling had a differential effect on cessation: whites who received counseling had higher quit rates than whites who did not receive counseling. Conversely, African Americans who did not receive counseling had higher average cessation rates than African Americans who received counseling. Overall, medication-adherent African American smokers had higher abstinence rates relative to other smokers.

Conclusions: Racial disparities in smoking cessation are not evident among those who are adherent to medication. More research is needed to better understand the differential effect that behavioral counseling might have on treatment outcomes between white and African American smokers under community corrections supervision.

Figure 1

CONSORT Diagram.

Figure 2

Smoking cessation rates by race and treatment group across time.

Figure 3

Smoking cessation rates by treatment group, race, and medication adherence. *p<0.001.