The importance of reducing tobacco-associated health disparities between African Americans and Caucasians cannot be understated. Researchers suggest that interventions need to be targeted to specific racial/ethnic groups (i.e., cultural tailoring);however, the literature examining the efficacy of cultural tailoring is equivocal. The inconsistent findings may be related to methodological weaknesses of past research, such as confounding intervention intensity and contact, or failure to recognize the heterogeneity of African Americans. Moreover, no studies have considered individual-difference factors affecting responses to culturally specific interventions, such as level of acculturation and ethnic identity. The investigators'preliminary studies indicate that standard (i.e., not culturally specific) cognitive behavioral therapy (CBT) for smoking cessation can be successful among African Americans compared to health education. Therefore, the investigators propose to test the incremental efficacy of culturally specific CBT (CS-CBT), and to examine individual differences in intervention response.
The specific aims are: (1) To test the efficacy of a group-based, CS-CBT in African American smokers;and (2) to examine level of acculturation and ethnic identity as ethno-cultural predictors of smoking abstinence (exploratory). The investigators hypothesize main effects of (1) intervention type, such that the CS-CBT will produce greater abstinence rates compared to standard CBT;and (2) time, such that the greater abstinence rates in the CS-CBT condition will be maintained over time. No interactions are expected. The investigators also hypothesize that the intervention effects will be moderated by African American cultural factors (e.g., beliefs, values, and practices). Specifically, they hypothesize that lower acculturation levels and greater ethnic identity (i.e., a more traditional cultural orientation) will yield greater smoking abstinence rates among participants in the culturally specific condition, compared to the standard condition. The opposite association is hypothesized in the standard condition. The investigators will use a 2 (intervention type) x 4 (time) randomized design. Factor 1: intervention type (CS-CBT or standard CBT);factor 2: time (baseline, 3, 6, and 12 months). The former treatment represents the experimental condition and the latter will be an established control condition. All participants will receive transdermal nicotine patch therapy. The primary abstinence outcome will be 7-day point-prevalence abstinence (ppa);secondary outcomes will be 24- hour and 7-day ppa, and 28-day continuous abstinence. The investigators will also examine process outcomes, including utilization, study retention, and intervention evaluations. Answering the questions of (a) whether CS interventions lead to greater smoking abstinence compared to their traditional counterparts, and (b) for whom CS approaches are most beneficial will inform theories related to 'cultural sensitivity'and best practices for tobacco intervention among African Americans.
African American smokers suffer disproportionately from smoking-associated diseases and deaths. This study will test a culturally specific cognitive-behavioral intervention for tobacco cessation by comparing it to standard cognitive-behavioral therapy. This study will also examine whether level of acculturation and ethnic identity predict who responds to either type of intervention. Thus, the investigators will address important, yet unanswered, questions with the goal of reducing health disparities.