TUESDAY, July 23, 2002 (HealthDayNews) -- Low-income blacks who smoke can get nearly the same help quitting from a popular cessation drug as whites do, a new study has found.
Earlier studies of the drug, bupropion, tested the treatment in relatively well-off whites, not struggling minorities. While the biological effects of the chemical might be the same between ethnic groups, experts have wondered if socioeconomic factors that shape smoking habits might also influence the drug?s effectiveness.
Blacks, for example, have historically been more likely to smoke than whites -- although that has changed in recent years -- but their patterns of tobacco use are different. They smoke menthol cigarettes far more often, for example, which may lead them to inhale deeper, and they prefer brands that are higher in nicotine and tar. Yet, while they tend to smoke fewer cigarettes each day than whites and try to quit just as often, they're generally less successful -- suggesting they?re more tightly addicted to nicotine.
Blacks are also more prone than whites to lung cancer, for which smoking is the leading cause in this country. Also, poor people are more likely to be obese, diabetic and have other conditions that compound the damage of smoking.
Even so, the new study found urban blacks who took bupropion were significantly more likely than those who got dummy pills to be smoke-free six months later.
"This should dispel all myths that urban people, poor people, are not interested and not able to quit smoking. It's patronizing to believe that, and it's a myth," says lead author Dr. Jasjit S. Ahluwalia, chairman of the department of preventive medicine and public health at the University of Kansas Medical Center in Kansas City. The study appears in tomorrow's Journal of the American Medical Association.
Abstinence rates on the drug were lower than those achieved in wealthier whites in two previous trials. However, Ahluwalia says, the figures were "right on target" considering other factors, such as poverty, that might make it harder for inner city volunteers to concentrate on quitting.
Bupropion is sold as Zyban by GlaxoSmithKline, which provided the drugs for the study. It is also marketed as Wellbutrin for depression.
Ahluwalia's group compared the combination of slow-release Zyban and periodic 15-minute sessions of motivational counseling -- as opposed to conventional hourlong encounters -- and placebo pills plus counseling in 600 men and women living in urban Kansas City.
The drug therapy lasted seven weeks, during which time the volunteers received two tablets a day. At the end of that period, 36 percent of those who took Zyban had quit smoking, compared with 19 percent in the other group. By 26 weeks, the number still abstaining had dropped in each arm, to 21 percent and 13.7 percent, respectively.
Still, Ahluwalia says, such a decline was predictable, and the drug is clearly effective at reducing smoking among inner city blacks.
The U.S. government recommended in 2000 that anyone who would like to quit smoking be offered treatments to help them do so. In recent years, a growing list of states has added smoking cessation therapies to what their Medicaid low-income health insurance programs cover.
Dr. Neal Benowitz, a tobacco control expert at the University of California, San Francisco, says the latest study has implications for clinical research. While scientists probably do not need to conduct racially and ethnically specific trials to evaluate the effectiveness of treatments like cancer chemotherapy and antibiotics, behavioral interventions may demand such studies.
"With smoking cessation, mental illness, asthma, those are all [conditions] where there really are very strong social components to disease and to their treatment," says Benowitz, author of an editorial accompanying the study.
Scott Leischow, chief of tobacco control research at the National Cancer Institute, calls the new work important and reassuring.
"We can't assume that a medication will work for everybody. The fact that [Zyban's] efficacy is high in African-Americans assures us that we should be providing this medication regularly and consistently to African-American smokers," he says.
Leischow acknowledges the long-term abstinence rate of the people in the study who took the drug wasn't awe-inspiring.
"When you see a 21 percent quit rate, that means that a lot of people just aren't making it," he says. "It speaks to how addictive nicotine is, and to the need for other treatments."
What To Do
For more on smoking and blacks, try BlackHealthCare. For more on the drug, visit Zyban. You can find other strategies to give up smoking at QuitNet.
