Improving smoking abstinence outcomes in the African American community through extended treatment - PROJECT SUMMARY / ABSTRACT African American adults who smoke experience the highest rates of tobacco-attributable disease, cancer incidence and mortality in the United States. These striking negative health outcomes exist despite the fact that African Americans have similar smoking prevalence as Whites, yet smoke fewer cigarettes per day (cpd). To have an impact on the premature mortality of African Americans, effective treatment across the smoking continuum must be identified. Further, because smoking cessation rates tend to be lower for African American adults who smoke, it is necessary to find methods of increasing response to pharmacotherapy to better promote abstinence in this high-risk group. Extended treatment has been demonstrated to increase abstinence in White adults who smoke but has never been examined in African Americans, who might benefit from extended medication support for quitting and for reducing relapse. The primary objective of this study is to evaluate extended use of bupropion for tobacco treatment, with the goal of enhancing abstinence in African American daily smokers, including the full spectrum of light, moderate, and heavy smokers. Our specific aims are to 1) evaluate the efficacy of extended bupropion treatment to promote smoking cessation at end of treatment (Month 6), 2) examine medication adherence over the course of treatment and its impact on treatment outcomes, 3) evaluate change in negative affect, withdrawal, and craving across treatment conditions and their impact on treatment outcomes, 4) identify individual factors predicting smoking abstinence, and 5) characterize patterns of tobacco use and abstinence over the course of standard and extended treatment. These aims will be accomplished using a two-arm, randomized design to evaluate the efficacy of extended (6 months) bupropion treatment compared to standard (7 weeks) bupropion treatment. Baseline randomization will assign participants (N=400) to receive extended treatment (EXT; 26 weeks of bupropion, n=200) or standard treatment (ST; 7 weeks of bupropion, n=200). All participants will receive culturally relevant, individualized smoking cessation counseling, including support for medication adherence. This study is the first to examine the efficacy of extended bupropion treatment to increase abstinence among African American smokers, including the full spectrum of daily smoking level. It is the first to examine extended bupropion for all smokers, not only confirmed quitters, and among the first to examine patterns of quitting, lapse, and relapse among African American smokers. Findings will enrich our understanding of the interrelationship of key biological factors to smoking factors and treatment response. Success in increasing long-term abstinence rates would significantly impact clinical practice for treatment of this high-risk group. Increased treatment efficacy will have major impact on reducing tobacco-related disparities, morbidity, and mortality.
