African American Smokers' Intention to Use Pharmacotherapy for Cessation

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.