Addressing Racial/Ethnic Tobacco Health Disparities Via Group Intervention

The importance of reducing tobacco-associated health disparities between cannot be
understated. Racial/ethnic minorities are less likely to quit, and tend to have elevated
stress and depressive symptoms, which may contribute to cessation disparities. Cognitive
behavioral therapy (CBT) for cessation addresses these concerns and has the potential to
reduce/eliminate disparities. Preliminary research found racial/ethnic differences in
baseline perceived stress and depressive symptoms. Following CBT, these differences were no
longer present. Moreover, compared to Whites, African Americans exhibited blunted
hypothalamic-pituitary-adrenal (HPA) axis functioning. This randomized controlled trial (RCT)
will be the first to test the impact of CBT on smoking cessation disparities. The specific
aims are to: (1) Examine the effects of CBT on perceived stress and depressive symptoms in a
racially/ethnically diverse sample; (2) test the efficacy of CBT for eliminating smoking
cessation disparities; and (3) examine physiological distress as an underlying mechanism for
the effects of CBT on racial/ethnic minority smokers (exploratory). It is hypothesized that
CBT will eliminate racial/ethnic differences in distress symptoms compared to the general
health education (GHE) control group. A condition and race/ethnicity interaction on 7-day
point prevalence abstinence (ppa) is also expected, with no racial/ethnic differences in
cessation in the CBT condition only. It is also hypothesized that HPA functioning will
mediate the effect of CBT on smoking cessation, particularly among racial/ethnic minorities.
This study has implications for eliminating disparities in psychosocial factors related to
cessation, and disparities in success. Addressing stress and depressive symptoms through CBT
may facilitate cessation, particularly among racial/ethnic minorities.