Socioeconomics, Not Biology, Behind Blacks' Lower Smoking Quit Rates

By Anne Harding

February 05, 2019

NEW YORK (Reuters Health) - Socioeconomic factors largely explain why African Americans have a harder time quitting smoking than whites, new research shows.

Black smokers who owned a home were three times as likely as non-homeowners to succeed in kicking the habit, while income and neighborhood problems were also associated with abstinence, Dr. Nicole L. Nollen of the University of Kansas School of Medicine and her colleagues found.

"The difference is not due to biology or race differences in nicotine metabolism, it's due to socioeconomic factors largely," Nollen told Reuters Health in a telephone interview. "Individuals who are struggling to have their basic needs met on a daily or monthly basis, smoking is a stress relief for them. You're taking away their primary coping mechanism, which makes it hard."

Several studies have found that African American smokers are less likely to quit smoking than whites even though they make more attempts to quit, Nollen and her colleagues note in their January 18 report in the Journal of the National Cancer Institute. Recent research has also found that whites are more likely than blacks to quit smoking with varenicline.

In the new study, the researchers had 224 black and 225 white low-income smokers complete an intervention that included 12 weeks of varenicline and six smoking cessation counseling sessions.

At week 26, 24.4% of whites were abstinent from smoking versus 14.3% of black smokers (odds ratio 0.51), based on seven-day point prevalence smoking abstinence. Five race-associated factors predicted abstinence: home ownership (OR 3.03), study visits completed (OR 2.81), income (OR 1.03), plasma cotinine (per 1 nanogram/ml, OR 0.997) and neighborhood problems (OR=0.88).

African Americans completed more study visits than whites and were equally likely to adhere to the medication.

The findings should not be interpreted to mean that black patients should not be prescribed varenicline, Nollen said. "Varenicline is an effective therapy, it's probably considered the most effective smoking cessation therapy out there. It's still very much recommended for African Americans."

Physicians should understand, however, that black patients may need some extra support for quitting, including regular follow-up visits, she said.


J Natl Cancer Inst 2019.