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Cancer Control Research

5R03CA126418-02
Webb, Monica S.
GROUP-BASED COGNITIVE-BEHAVIORAL THERAPY AMONG AFRICAN SMOKERS: AN EFFICACY TEST

Abstract

DESCRIPTION (provided by applicant): Tobacco smoking is the leading cause of preventable death and disease in the United States. Tobacco use claims the lives of over 176,000 Americans due to cancer each year. Compared to Caucasians, African American smokers suffer disproportionately from smoking-related illnesses. Few studies have tested the efficacy of smoking cessation treatments with representative samples of African Americans. A recent meta- analysis suggested that group counseling is among the most efficacious treatments for this population; yet, this conclusion was based on only two studies. The current application will test of the feasibility and efficacy of an established cognitive-behavioral smoking intervention among African American adults. Identifying whether this treatment is also beneficial for African Americans has theoretical and applied implications that transcend this project. The specific aims of the study will be (1) to examine the feasibility of conducting an intensive group cognitive behavioral intervention plus nicotine replacement in a sample of African American smokers, (2) to test the efficacy of the intervention, and (3) to begin exploratory analyses of predictors of successful smoking cessation (nicotine dependence, smoking outcome expectancies, health locus of control, cessation self-efficacy, and treatment utilization). To accomplish this, 80 smokers will be randomized to receive either a two-week group cognitive behavioral smoking intervention plus nicotine patch therapy (NPT), or a two-week health education intervention plus nicotine patch therapy. The group treatment will be based on an efficacious cognitive behavioral treatment (CBT) that includes education on tobacco addiction, the time-course of nicotine withdrawal, positive reinforcement, self-monitoring, identification of high-risk situations, coping skills training, and contingency contracting. The health education intervention (HE), a time and attention matched control condition, will present didactic information on a variety of health topics other than smoking cessation. Our primary outcomes will be point-prevalence abstinence, both 24-hour and 7- day, and 28-day continuous abstinence. Participants will be assessed post treatment (two weeks), and at three and six months post treatment. Thus, we will use a 2 (intervention) x 3 (time) design. It is hypothesized that the CBT plus NPT condition will demonstrate greater smoking cessation at each assessment compared to the HE plus NPT condition. It is also expected that baseline nicotine dependence, positive smoking outcome expectancies, and external health locus of control will be negatively associated with smoking cessation success. Intervention utilization will be positively associated with smoking cessation. The long term objective of this work is to advance the field by informing the development of smoking cessation treatments for African American smokers. This has important public health implications related to reducing smoking-related health disparities.


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