Reducing racial/ethnic tobacco cessation disparities via cognitive behavioral therapy: Design of a dualsite randomized controlled trial

Contemp Clin Trials. 2018 May:68:127-132. doi: 10.1016/j.cct.2018.03.017. Epub 2018 Apr 1.


Racial/ethnic disparities in tobacco cessation are such that U.S. minorities have greater difficulty quitting compared to White non-Hispanics. Group differences in distress (i.e., perceived stress and depressive symptoms) may contribute to cessation disparities. The allostasis model of health suggests that the toll of chronic stress experienced by racial/ethnic minorities may lead to dysregulation of the physiological stress system and drug use. Previous research suggests that group cognitive behavioral therapy (CBT) for tobacco cessation addresses distress as a modifiable mechanism and has the potential to reduce/eliminate disparities. The present study is a dualsite randomized controlled trial aimed at evaluating the efficacy of group CBT in eliminating racial/ethnic differences in smoking cessation and distress. The study utilizes a [2 (intervention: group CBT or group general health education [GHE]) × 3 (race/ethnicity: African American/Black, Hispanic, White)] factorial design by randomizing 225 adult smokers from the community. Both interventions provide eight counseling sessions and eight weeks of nicotine patch therapy. Assessments occur at the end-of-therapy, and at 3-, 6-, and 12-months. Generalized longitudinal mixed modeling will be used to test our primary abstinence outcome, biochemically-confirmed 7-day point prevalence abstinence at 12-months. We hypothesize that group CBT will reduce or eliminate racial/ethnic differences in perceived stress, depressive symptoms, and smoking cessation compared to group GHE. We also hypothesize that reductions in physiological distress, assessed by salivary cortisol, will mediate racial/ethnic group differences in smoking cessation, particularly among racial/ethnic minorities. This study has implications for eliminating disparities in psychosocial factors related to tobacco use and cessation.

Trial registration: Clinicaltrials.govNCT02511236. Registered on July 27, 2015.

Keywords: Cognitive behavioral therapy; Depressive symptoms; Disparities; Distress; Smoking cessation; Stress.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Black or African American* / psychology
  • Black or African American* / statistics & numerical data
  • Cognitive Behavioral Therapy / methods*
  • Female
  • Health Status Disparities
  • Hispanic or Latino* / psychology
  • Hispanic or Latino* / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Needs Assessment
  • Psychotherapy, Group / methods*
  • Stress, Psychological* / ethnology
  • Stress, Psychological* / psychology
  • Tobacco Use Cessation Devices*
  • Tobacco Use Cessation* / ethnology
  • Tobacco Use Cessation* / methods
  • Tobacco Use Cessation* / psychology
  • Tobacco Use Disorder* / ethnology
  • Tobacco Use Disorder* / therapy
  • United States
  • White People* / psychology
  • White People* / statistics & numerical data

Associated data