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Smoking is the cause of over $100 billion in health care costs annually and accounts for approximately 443,000 deaths each year.1 Although the prevalence of smoking among African Americans is very similar to that of whites (currently 21% for both groups),2 African Americans experience a greater risk for tobacco-related morbidity and mortality.3,4 Studies also indicate that although African Americans have more quit attempts in a given year when compared to whites,5,6 they are much less likely to succeed in quitting.7,8 Although many biopsychosocial factors likely contribute to lower quitting success among African American smokers, one reason may be lower use of pharmacotherapy to aid in cessation attempts. Although pharmacotherapy has been shown to increase cessation success,9 there is evidence that pharmacotherapy is generally underused across all racial groups.10,11 However, studies of nicotine replacement use indicate that African Americans have even lower use rates (10–20%) when compared to those of whites (29–34%).6,10,12–18 In general, reasons for underuse include cost, lack of knowledge regarding efficacy,19 concerns about safety, and a perceived lack of access.20 However, whether similar or different reasons account for underuse by African Americans has not received much attention. One qualitative study examined several ethnic minorities’ attitudes and beliefs about pharmacotherapy.21 Results revealed that, similar to findings from previous studies of mostly white smokers, African American smokers (n = 26) were aware of the existence of cessation pharmacotherapy but were not knowledgeable regarding the specific benefits for cessation, such as reduced cravings and withdrawal symptoms. In addition, many smokers were skeptical of the effectiveness of all forms of cessation pharmacotherapy and were particularly reluctant to accept a medication in pill form. African American participants also reported believing that the side effects of all cessation aids would likely be worse than the health effects of smoking. The generalizability of these qualitative results to most African American smokers is unknown. Furthermore, Fu and colleagues21 did not determine which beliefs among those identified would be most significant in influencing participant decision making about the use of pharmacotherapy. Given the importance of increasing cessation among African American smokers and the dearth of research in this area, there is a need to extend this qualitative work to address these limitations.

The double-blind placebo-controlled design is commonly considered the gold standard in research methodology; however, subject expectation bias could subvert blinding.The primary aim of this study was to examine the impact of expectation bias. Specifically, we examined perceived treatment assignment on smoking cessation outcome rates among participants enrolled in a clinical trial of bupropion (150 mg SR, BID).Analyses were conducted on data collected during "Kick It at Swope," a double-blind, placebo-controlled, randomized trial of 600 African-American smokers. Chi-square and multiple logistic regression analyses were used to examine the impact of perception of assignment on treatment effect and cotinine-verified smoking abstinence rates.Participants were predominantly middle-aged (mean 44.7, SD 11.2), African-American women (68.6%), who smoked 19 CPD (SD = 8.1). Most had completed at least a high school education or GED (51.6%), and 55% had a monthly family income$1,800.At week 6 (end of treatment) and week 26 (end of study), participants were asked to report their perceived treatment group assignment. Self-reported abstinence (weeks 6 and 26) was confirmed using CO and cotinine biochemical verification.After adjusting for actual treatment assignment, age and baseline cotinine, participants who perceived being assigned to bupropion vs. placebo were more likely to be abstinent at weeks 6 (OR = 2.07, 95% CI: 1.29 to 3.33, p = 0.002) and 26 (OR = 1.85, 95% CI: 1.05 to 3.24, p = 0.032).Results support previous research that expectation bias associated with judgment of treatment assignment is a strong predictor of outcome and confirms this relationship in a smoking cessation trial using bupropion SR among African-American smokers.

African Americans bear a disproportionate health burden from smoking but are less likely than other populations to engage in cessation treatment. Intervening on adult nonsmokers residing with a smoker might represent an innovative approach to motivate smokers to engage in smoking behavior change. Twelve focus groups were conducted with African American smokers (four groups, n = 27), nonsmokers (four groups, n = 26) and pairs of cohabitating smokers and nonsmokers (four groups, n = 22) to assess attitudes and/or beliefs regarding engaging a nonsmoker in the home in smoking behavior change efforts. Participants ( N = 75) were middle-aged (45.1 ±3.7 years) females (68.0%) with 11.8 ±1.5 years of education. Smokers smoked 14.9 ±11.3 cigarettes per day, made 3.0 ±4.4 quit attempts in the past year, and are interested in receiving cessation assistance from a nonsmoker in their home. African American nonsmokers living with a smoker may be an appropriate target group to motivate smoking behavior change in the smoker. Suggestions for future research considerations are provided.

Objective. To create, implement, and evaluate a pharmacy course on motivational interviewing. Design. A 3-hour elective course was created to train doctor of pharmacy (PharmD) students in brief patient-centered motivational interviewing counseling strategies that have proven effective with the types of health issues most commonly addressed in pharmacy settings. Students were assisted in developing their skills through required readings, interactive lectures, in-class demonstrations and practice sessions, out of class skills practice, one-on-one supervision provided by doctoral level clinical health psychology students, and written reflections on each class session. Assessment. Students demonstrated significant improvement in motivational interviewing skills and a high level of motivation for and confidence in using these skills in their future practice. Students overall assessment of the course and supervision process was highly positive. Conclusion. This patient-centered counseling skills course was feas...

Studies indicate a positive association between social support and smoking cessation. However, clinic-based interventions designed to increase social support have had limited success. Most studies have relied on only the smoker's perceptions of support received while few have assessed the support provider's report of support delivered. Understanding supportive interactions between support providers and recipients may assist in developing effective support interventions for cessation. The current investigation examined the perceptions of smoking-specific support provided by the spouse of a partner who smokes and was seen for a nicotine dependence consultation. Specifically, we examined spouse reported willingness to help their spouse quit, interest in learning ways to help their spouse quit, and characteristics associated with the provision of smoking-specific supportive behaviors (as assessed via the Support Provided Measure, SPM), in the 2-weeks prior to the consultation. The current investigation also examined the concurrent validity of the SPM with a validated measure of support provided to a smoker, the Partner Interaction Questionnaire (PIQ), accounting for social desirability bias and smoker readiness to change. The sample comprised 84 adult cigarette smokers seen for a clinical smoking cessation intervention and their spouses (N = 84). Results indicate that a high percentage of spouses are willing to help their partner who smokes and interested in learning way to help. As expected, spouses who were females and had never smoked had higher scores on the SPM than males or current smokers. The SPM was significantly correlated with the PIQ positive (r = 0.50, p < 0.01) and negative (r = 0.44, p

The purpose of the current study was to examine the interrelationships between autonomous regulation (AR) and locus of control (LOC) and their prediction of Antiretroviral Therapy (ART) adherence among 189 HIV+ patients. Path analyses revealed that neither AR nor LOC directly predicted adherence although AR was indirectly related when mediated by self-efficacy. AR was positively related to internal and doctors LOC, but not related to chance or others LOC. Overall, results support Self-determination Theory's conceptualization of AR and indicate that AR may be a more robust predictor of medication adherence than LOC variables.

OBJECTIVES To examine social support needs of obese and overweight African American women for weight loss. METHODS Focus groups were conducted with overweight and obese African American women. Data were analyzed using standard grounded theory text analysis. RESULTS Our middle-aged (45.7 years; SD = 12.6) women (N = 66) were interested in receiving support from others focused on the health benefits of weight loss. Behaviors perceived as supportive include co-participating in exercise, providing nutrition education, using positive reinforcements, and avoiding criticism. CONCLUSIONS African American women are interested in a program designed to increase social support for their weight loss.