JAMA Paper Points to Progress Empowering African Americans to Quit Smoking

Wisconsin Has Worst Smoking Disparity Between Blacks and Whites in Nation

African American familyAfrican Americans have been targeted for decades by tobacco companies and have suffered especially high health and economic burdens from smoking. However, according to an invited JAMA editorial by researchers from the Universities of Wisconsin and Kentucky, meaningful, recent progress has been made that should reduce those burdens.

That’s especially good news for Wisconsin, the state with the worst disparity in smoking rates between Black and White residents in the nation. In Wisconsin, 12% of White people smoke versus 30% of Black people, according to the Behavioral Risk Factor Surveillance System. The next closest state is New Mexico (14% for Whites versus 26% for Blacks). Among neighboring states, Iowa smoking rates among Whites and Blacks is the next biggest disparity (14% v. 21%, respectively). The national average is 13% for Whites and 16% for Blacks.

The researchers applauded a new study, also published in JAMA, of 500 African Americans that shows that active varenicline and culturally appropriate counseling produced a significantly higher quit rate than did placebo varenicline and counseling: 15.7% versus 6.5%, respectively after six months. Thus, treatment with varenicline more than doubled the long-term smoking abstinence rate.

“What’s especially exciting is that these treatments aren’t rare,” said Dr. Michael Fiore, co-author and director of the University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI). “They’re widely available. They’re covered by Medicaid and many insurance plans.”

“This shows the potential value and the absolute importance that clinicians attempt to intervene with all of their patients who smoke,” said co-author Dr. Tim Baker, associate UW-CTRI director.

Many of the participants in the study smoked relatively few cigarettes per day and the study showed that the varenicline treatment was effective with these individuals. This is significant because this smoking pattern is becoming increasingly common. Also, on average, African Americans tend not to smoke as heavily as White individuals, noted co-author Dr. Jessica Burris from the University of Kentucky. Research shows clinicians are less likely to intervene with light smokers; this study may encourage clinicians to help such individuals.

“This may play a role in why Black patients tend to have low use of medications we know can help them quit smoking,” Burris said. Unfortunately, cutting down to even one cigarette a day doesn’t dramatically reduce risks for serious health problems. “This is an incredible opportunity for clinicians to step up and help all patients quit. For African Americans in particular, prescribing varenicline and providing counseling that is sensitive to the unique experiences, strengths and stressors of the Black community is an effective approach.”

The researchers also pointed out that use of electronic health records (EHR) helps health systems proactively reach out to all patients who smoke, inviting them to treatment even if they don’t have an appointment. This has been shown to reduce health disparities.

Baker said the FDA’s plan to eliminate menthol flavored cigarettes and cigars has great potential for bolstering public health since 75 percent of African American adults smoke menthols, and 90 percent of Black children who start smoking do so with menthols. Meanwhile, just 25 percent of Whites who smoke use menthols.

“For too long, African Americans have been targeted by Big Tobacco,” Burris said, “and policy that could counter this hasn’t been enacted. African Americans have suffered needlessly. It’s encouraging to see new tools arise and old tools utilized more effectively, but much work needs to be done—by clinicians, lawmakers, researchers, and citizens across the country.”