Understanding Disparities in Quitting in African American and White Smokers

描述(由申请人提供)：吸烟方面的种族/民族差异有很好的记录；非洲裔美国人每天比白人吸烟更少，但吸烟导致的发病率和死亡率高得不成比例。在戒烟方面也存在着有据可查的差异，非裔美国人的戒烟率始终低于白人。然而，到目前为止，还没有进行足够有力的研究，根据种族分层，使用严格的研究设计来证实这一发现，或者理解非裔美国人相对于白人的戒烟率差异的机制。本申请的目标是1)描述接受varenicline治疗的AA和白人吸烟者在戒烟方面的差异，2)确定吸烟、心理社会、治疗过程和生物学因素，这些因素独立地解释非裔美国人和白人吸烟者经可替宁验证的7天戒烟与种族/民族之间的关系，以及3)根据吸烟水平检查varenicline的副作用概况。这些目标将通过一项前瞻性队列干预研究来实现，该研究根据种族、年龄(40岁)和性别对448名参与者(224名非裔美国人和224名白人)进行分层。所有参与者都将接受3个月的varenicline治疗，这是目前可用的最有效的戒烟药物，标准的教育材料，以及6次戒烟咨询。本研究具有创新性。这将是第一个已知的关于在AS中使用varenicline的研究，第一个研究varenicline在轻度吸烟者(&lt；10CPD)和大范围吸烟水平(3-20CPD)中的作用，第一个按种族分层的面对面研究，旨在前瞻性地比较AAS和白人的药物治疗，以及少数几个探索AA和白人吸烟者戒烟差异的机制之一。这些发现的影响将是相当大的，对治疗、临床实践和政策都有影响。将获得关于非裔美国人和白人在戒烟方面的差异的有意义的知识。这些发现有可能通过将该领域从对种族/民族的一般性关注转向对与非裔美国人和白人最相关的可改变的吸烟、心理社会和治疗过程因素的关注，从而改善烟草使用治疗。

DESCRIPTION (provided by applicant): Racial/ethnic differences in smoking are well documented; African Americans smoke fewer cigarettes per day than Whites but experience disproportionately greater smoking attributable morbidity and mortality. Well documented disparities also exist in smoking cessation with African Americans consistently quitting at lower rates than Whites. However, to-date, no adequately powered study, stratified on race, has been conducted to confirm this finding using a rigorous study design or to understand the mechanisms accounting for differential quit rates in African Americans relative to Whites. The objectives of this application are to 1) describe the differences in smoking cessation among AA and White smokers treated with varenicline, 2) identify the smoking, psychosocial, treatment process, and biological factors that independently explain the relationship between race/ethnicity and cotinine-verified 7-day abstinence in African American and White smokers, and 3) examine the side effect profile of varenicline by smoking level. These aims will be accomplished through a prospective cohort intervention study, stratified on race, age (< 40, > 40), and gender among 448 participants (224 African American, 224 White). All participants will receive 3 months of varenicline, the most effective of currently available smoking cessation medications, standard educational materials, and six sessions of smoking cessation counseling. This study is innovative. It will be the first known study to report on the use of varenicline in As, the first to examine varenicline in light smokers (<10 cpd) and among a wide range of smoking levels (3-20 cpd), the first head-to-head study, stratified on race, designed to prospectively compare pharmacotherapy in AAs versus Whites, and one of a few to explore mechanisms underlying disparities in quitting between AA and White smokers. The impact of these findings will be considerable, having ramifications for treatment, clinical practice, and policy. Significan knowledge will be gained about African American-White differences in quitting. Findings have the potential to improve tobacco use treatment by moving the field away from a generic focus on race/ethnicity toward a targeted focus on modifiable smoking, psychosocial, and treatment process factors most relevant to African Americans and to Whites.