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Excerpts from: Researchers focus on helping black smokers kick the habit

By ALAN BAVLEY The Kansas City Star  [07/24/02]
 
On Saturday, Kimberly Harris celebrates her third year smoke-free, thanks to counseling and the anti-smoking drug Zyban.

"I think it helped a lot," the 40-year-old Kansas City woman said of the pills she took for seven weeks. "I'd encourage other people to use it."

Harris was one of 600 adult black smokers who took part in a groundbreaking study by researchers at the University of Kansas Medical Center.

Their study, published today in The Journal of the American Medical Association, is the first to show that the popular drug Zyban is effective helping black smokers to quit.

"We dispelled the myth that poor people and African-American people don't want to quit smoking, and answered the question, `Can they quit?' " said Jasjit S. Ahluwalia, chairman of the department of preventive medicine and public health and lead researcher on the study.

In previous Zyban studies, more than 93 percent of the smokers were white, and most were from middle or upper income households.

The black population has largely been ignored, Ahluwalia said.

"We had to come up with educational materials and recruitment techniques to reach African Americans," he said.

Ahluwalia conducted his study at Swope Parkway Health Center from 1999 through 2000. Researchers gave recruits motivational counseling in person and over the phone. Half were chosen at random to receive Zyban; the rest were supplied with placebos.

Zyban, a prescription medication, can help reduce the urge to smoke. The drug also is prescribed as an antidepressant under the brand name Wellbutrin.

At the end of seven weeks of treatment, 36 percent of the subjects taking Zyban had quit smoking, compared with 19 percent who had taken the placebo.

When the researchers followed up on their subjects after six months, 21 percent of those who had taken Zyban still were not smoking; 13.7 percent of the placebo subjects were still tobacco-free.

A previous study of mostly white smokers found that 27 percent of smokers who took Zyban still abstained from tobacco after six months, compared to 16 percent who took a placebo.

The KU study was financed by a National Cancer Institute grant. GlaxoSmithKline, which manufactures Zyban, supplied the drug for the study. Ahluwalia also has served as a consultant to the company.

At the end of the study, researchers told participants what they had been taking. Harris had been taking the Zyban.

Harris said she had never thought about quitting until her son was diagnosed with asthma about four years ago.

"I realized I needed to do something differently," she said. "His health was more important than my smoking."

The KU study is a good model of how smoking research on members of minority groups ought to be conducted, said Neal L. Benowitz, a researcher at the University of California at San Francisco.

"Most researchers are educated whites. When they put together smoking interventions they do it in ways that make sense to them. That doesn't work with other groups," Benowitz said.

Smoking studies that focus on particular racial groups are essential, Benowitz said, because each group's experience with tobacco is different.

For example, African-American smokers, on average, smoke fewer cigarettes per day than do white smokers, but they metabolize the nicotine in tobacco more slowly, so it remains in their bodies longer.

The use of culturally sensitive educational materials and a staff of African-American counselors probably helped make the KU study a success, Benowitz said.

"The challenge next is to make effective treatment available when you don't have so many resources," Benowitz said.

The KU study should help persuade more insurance plans, and in particular state Medicaid programs, to pay for smoking cessation treatments, said John F. Banzhaf III, executive director of Action on Smoking and Health.

Politicians may not be strongly motivated to add smoking-cessation coverage to Medicaid, Banzhaf said.

"A lot of politicians look at it as a long-term savings," he said. "Behind that may be the question of pushing a bill that won't see a payoff until they're out of office."

A survey by the Centers for Disease Control and Prevention published in November found that Medicaid programs in 17 states, including Missouri, did not cover any kind of smoking cessation. Programs in Kansas included Zyban coverage.

The Missouri Medicaid program has not asked state legislators to finance smoking cessation, said Pam Victor, deputy director of the state Division of Medical Services, and legislators have not brought up the topic in budget hearings.

The $160 cost of seven weeks of Zyban treatment is inexpensive compared to the cost of treating the maladies caused by smoking, Ahluwalia said.

"This is probably one of the cheapest (health) interventions you can do. It's very cost-effective," Ahluwalia said. "Society should invest. If a poor person gets lung cancer you know who's paying for it. You are, the taxpayer."