Sustained-release bupropion and professional counseling seem to be an effective combination for lower-income African American adults who are trying to quit smoking, according to a study in the Journal of the American Medical Association.
Jasjit S. Ahluwalia, MD, MPH, and colleagues from the University of Kansas School of Medicine, conducted a clinical trial of smoking cessation in African Americans. While bupropion SR (an antidepressant medication) has been previously shown to be effective for smoking cessation, their study is the first to look at sustained-release bupropion (bupropion SR) use among low-income minorities.
According to background information in the article, the smoking rate for inner city African Americans is as high as 45%, compared with 25% for the general population. However, a higher number of African Americans are likely to attempt quitting more times in 1 year than white smokers, even though their success rate is 34% lower.
Community outreach efforts recruited 600 urban, low-income African American smokers for the study. The average age was 44 years, and the average number of cigarettes smoked was 17 per day. Women composed 70% of the group. At baseline, participants were randomly assigned to receive either placebo or 150 mg of bupropion SR. They were instructed to take one pill once a day for the first 3 days, and then twice a day for 7 weeks. All participants were told to keep taking the pills for 7 weeks, even if they failed to quit smoking.
At baseline, participants were interviewed and assessed by a counselor. Participants set a quit date and returned for another counseling session on that day. Face-to-face counseling continued 1 week after the quit date (week 1), week 3 and week 6. Counselors telephoned participants 3 days after quitting, at week 5, at week 7 and several times after the 7-week treatment period. All counselors were African American.
At weeks 6 and 26, participants returned to the health center for assessment. Study outcome was based on smoking cessation at 26 weeks. The authors defined cessation as "having smoked no cigarettes - not even a puff - for the previous 7 days." Researchers also judged the outcome on 7-day cessation at 6 weeks, continuous abstinence since quit day, and, for those who had relapses, a change in the number of cigarettes smoked. Self-reported cessation was verified through biochemical tests.
After 7 weeks of treatment, 36% of participants taking bupropion SR and 19 of participants taking placebo had not smoked. At 26 weeks, rates of quitting smoking were 21% in the bupropion SR group and 13.7% in the placebo group (JAMA, 2002;288:468-474).
"Translating this scientific finding to the population of African American smokers is critical to further decrease the prevalence of smoking and to reach the goals of Healthy People 2010. In addition, reductions in smoking will also aid in reducing the excess smoking - attributable morbidity and mortality that exists between African Americans and other segments of the population," the authors stated.
Editor's Note: This study was funded by a grant from the National Cancer Institute. Glaxo Smith Kline provided study medication, but played no role in the design or conduct of the study or the interpretation and analysis of data.
In an accompanying editorial, Neal L. Benowitz, MD, of San Francisco General Hospital, University of California, San Francisco, encouraged the development of studies on smoking cessation among racial and ethnic groups, such as the study by Ahluwalia and coauthors.
"During the past 18 years, a variety of nicotine replacement medications and bupropion have been developed and marketed to aid smoking cessation. As is the case for most clinical trials of new medications, clinical trials of these drugs have been performed primarily in white, middle class individuals. ...However, the genetic, sociocultural, and pharmacologic determinants of addictive smoking may differ by racial and ethnic group or economic status," Benowitz wrote.
"The findings of Ahluwalia and colleagues raise the issue of whether smoking cessation trials are needed in other minority populations...Eventually, race or ethnicity may be considered unimportant as new knowledge becomes available about how genetic and environmental factors influence response to treatment. Until then, for complex behavioral disorders such as tobacco addiction, which require both pharmacologic and behavioral therapies, clinical trials focused on minority groups are critical," he concluded (JAMA, 2002;288:497-499). This article was prepared by Health & Medicine Week editors from staff and other reports.
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