Predictors of adherence to nicotine gum and counseling among African-American light smokers

J Gen Intern Med. 2010 Sep;25(9):969-76. doi: 10.1007/s11606-010-1386-x. Epub 2010 May 21.


Background: A high proportion of African-American smokers are light smokers, and they experience low smoking cessation rates and disproportionately high tobacco-related morbidity; yet no studies have examined tobacco treatment adherence in this group.

Objectives: To determine the predictors of adherence to nicotine gum and counseling among African-American light smokers (defined as smoking < or =10 cigarettes/day), and the effects of adherence on smoking cessation.

Design: Data were from a 2 x 2 randomized, placebo-controlled smoking cessation trial of nicotine gum (2 mg versus placebo) and counseling (motivational interviewing versus health education).

Participants: Seven hundred fifty-five African-American light smokers at a community-based clinic.

Measurements: Demographic and health-related information, smoking behaviors, psychosocial variables, adherence to nicotine gum and counseling, and cotinine-verified 7-day abstinence from smoking at week-26 follow-up.

Results: A logistic regression model showed that having a higher body mass index (OR = 1.03, 95% CI = 1.01 to 1.05), more quit attempts in the past year (OR = 1.04, 95% CI = 1.01 to 1.07), higher baseline exhaled carbon monoxide (OR = 1.22, 95% CI = 1.01 to 1.48), and higher perceived stress (OR = 1.12, 95% CI = 1.03 to 1.22) increased the likelihood of adherence to nicotine gum. Being a high school graduate was a predictor of adherence to counseling (OR = 1.58, 95% CI = 1.02 to 2.44). Surprisingly, being adherent to nicotine gum significantly reduced the odds of smoking cessation (OR = 0.50, CI = 0.28 to 0.87). On the other hand, adherence to counseling dramatically increased the likelihood of smoking cessation (OR = 3.32, CI = 1.36 to 8.08).

Conclusions: Individual risk factors may influence adherence to nicotine gum and counseling. Improving psychological interventions and promoting adherence to counseling may increase overall smoking cessation success among African-American light smokers.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Behavior Therapy*
  • Black or African American*
  • Body Mass Index
  • Chewing Gum
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Medication Adherence / ethnology*
  • Middle Aged
  • Nicotine / therapeutic use*
  • Nicotinic Agonists / therapeutic use*
  • Odds Ratio
  • Placebos
  • Smoking / ethnology
  • Smoking Cessation / ethnology*
  • Smoking Cessation / methods
  • Smoking Cessation / psychology
  • Smoking Prevention
  • Treatment Failure


  • Chewing Gum
  • Nicotinic Agonists
  • Placebos
  • Nicotine