Women, unmarried individuals, African Americans who smoke less likely to attempt quitting

In a cohort of smokers screened for lung cancer, women, unmarried individuals, African Americans and those with a low education level had a low likelihood of attempting to quit smoking, according to study results published in CHEST.

“This study brings clinicians’ attention to certain demographics that struggle more with tobacco cessation and highlights the deficit of prescribing practices for effective pharmacologic therapy for tobacco cessation,” Nina A. Thomas, MD, assistant professor of medicine at University of Colorado School of Medicine, told Healio. “It also presents a validated and easy-to-assess tool, the nicotine dependence measurement time to first cigarette (TTFC), to help guide a tailored and more successful approach to smoking cessation.”

For their study, Thomas and colleagues conducted a secondary analysis of the American College of Radiology Imaging Network arm of The National Lung Screening Trial. The researchers analyzed 7,369 active smokers screened for lung cancer that completed detailed smoking questionnaires to determine the factors linked to attempts of smoking cessation.

Researchers looked at variables related to patient demographics, smoking behaviors and tobacco treatment and stratified them into either stable users or quit attempters.

Tobacco treatment was divided into three different types: bupropion therapy, nicotine replacement therapy (NRT; patched, gum, inhaler or spray) and bupropion plus NRT. TTFC helped researchers measure patients’ nicotine dependence.

For each variable, researchers assessed its impact on an attempt to quit through the Cox proportional hazards ratios to understand which ones are associated with quit attempts.

Demographics, smoking behaviors

Of the total cohort, 4,380 patients were classified as stable users and 2,989 patients attempted quitting.

Compared with those who attempted to quit smoking, demographics associated with stable users included female sex (47.8% vs. 43.8%; P < .01), unmarried status (43.2% vs. 36.9%; P < .001), African American race (8.2% vs. 6.3%; P = .007) and an education less than the college level (47.7% vs. 42.3%; P < .001).

“It was illuminating that smoking cessation attempts were less within certain high-risk demographic groups, specifically women, Black, unmarried and less educated individuals, suggesting unidentified barriers to smoking cessation and revealing paths for further investigation to define and mitigate them,” Thomas told Healio.

In terms of smoking behaviors, those who attempted to quit had a smoking history of fewer mean pack-years (53.3 pack-years vs. 56 pack-years; P < .001), tried more different forms of tobacco (41% vs. 37.8%; P = .006) and had a higher likelihood of low dependence on nicotine (13.7% vs. 9.2%; P < .001) than stable users. Researchers observed no impact on smoking status when assessing the type of cigarette.

Those who attempted quitting had a higher percentage of lung cancer diagnoses (5.8% vs. 3.6%; P < .001) but lower mortality (5.7% vs. 8.7%; P < .001) compared with stable users.

Tobacco treatment

Within the total cohort, 73.4% never received pharmacologic tobacco treatment, which Thomas told Healio was surprising,

“The most surprising finding in this study is that, within a lung cancer screening trial, only one-quarter of the patients received pharmacologic therapy for tobacco cessation, despite significant evidence supporting its efficacy,” she said. “Tobacco cessation counseling is a key component of the lung cancer screening process.”

Of this percentage, those who attempted quitting had a greater likelihood of receiving each of the three pharmacologic treatment options compared with stable users (bupropion, 8% vs. 6.9%; P = .0162; NRT, 18% vs. 12.4%; P < .01; both, 5.6% vs. 3.9%; P < .01).

Based on dependence levels of those diagnosed with lung cancer, researchers found that low to medium dependence was linked to a 75% likelihood (HR = 1.75; 95% CI, 1.19-2.58) of attempting quitting, and high to very high dependence was linked to a 92% likelihood (HR = 1.92; 95% CI, 1.6-2.31).

Individuals receiving bupropion or NRT with low or medium dependence had similar likelihoods of attempting to quit and a higher likelihood than those not receiving treatment (bupropion, HR = 1.4; 95% CI, 1.09-1.81; NRT, HR = 1.44; 95% CI, 1.19-1.73).

Among those with high dependency receiving treatment, the greatest likelihood of attempting to quit was found in bupropion plus NRT treatment (HR = 2.07; 95% CI, 1.75-2.44). Although not as pronounced, patients with these characteristics receiving bupropion alone (HR = 1.72; 95% CI, 1.49-1.98) or receiving NRT alone (HR = 1.87; 95% CI, 1.68-2.09) were also more likely to attempt to quit smoking compared with patients not receiving treatment.

Women and unmarried individuals continued to have a low likelihood of attempting quitting regardless of dependence, whereas older individuals had a high likelihood of attempting smoking cessation.

“This study is only the starting line for further research into impactful and effective tobacco cessation in a high-risk population,” Thomas told Healio. “Future studies will focus on prospective investigation of tailored pharmacologic interventions using our nicotine dependence assessment tools, as well as qualitative analysis to identify the specific barriers within certain demographic groups.”

For more information:

Nina A. Thomas, MD, can be reached at nina.thomas@cuanschutz.edu.