Depressive symptoms and smoking cessation among inner-city African Americans using the nicotine patch

Abstract

This study examined the relationship between depressive symptoms and smoking cessation among a sample of inner-city African American smokers using the nicotine patch. Analyses were conducted on data from a previous randomized trial that tested the effects of culturally sensitive vs. standard self-help quitting materials. The study sample consisted of 498 African American smokers (mean age = 42.95, SD = 10.40; 60% female) recruited from a large hospital. Participants in both groups received 8 weeks of nicotine replacement therapy. Level of smoking, quit status, and depressive symptoms (Medical Outcomes Survey Short Depression Screen) were assessed at baseline, week 4 (mid-treatment), and 6-month follow-up. Analyses that controlled for randomization group generally did not support the hypothesis that baseline levels of depressive symptoms predict smoking at Week 4 or Month 6. Cross-sectional analyses at each time point indicated that depressive symptoms were positively associated with smoking level (both: beta = 0.24, p < .05). Changes (increases) in depressive symptoms from baseline to week 4 predicted higher smoking levels at follow-up (beta = 0.19, p < .05). Although the results indicated a significant association between depressive symptoms and level of smoking, they generally did not support the notion that depressive symptoms are associated with failure to quit.

Dimensions of depressive symptoms and smoking cessation

“…Depressive symptoms are associated with greater likelihood of smoking and poorer cessation outcomes at the population level (Anda et al, 1990). In clinical trials, higher levels of pretreatment depressive symptoms are associated with reduced odds of cessation (Anda et al, 1990;Brown et al, 2001;Cinciripini et al, 2003;Ginsberg, Hall, Reus, & Muñoz, 1995;Haas, Muñoz, Humfleet, Reus, & Hall, 2004;Hitsman et al, 1999;Killen, Fortmann, Davis, Strausberg, & Varady, 1999;Kinnunen, Doherty, Militello, & Garvey, 1996;Niaura et al, 2001;Rausch, Nichinson, Lamke, & Matloff, 1990;Swan et al, 2003), although this effect has not been replicated in some investigations (Catley, Ahluwalia, Resnicow, & Nazir, 2003;Catley et al, 2005;Vàzquez & Becoña, 1999). Many studies have shown that depressive symptoms, even at very low levels (e.g., Hamilton Rating Scale for Depression score >2; Niaura et al, 2001), predict poorer outcomes in smokers without current major depression (al 'Absi, Hatsukami, & Davis, 2005;al'Absi, Hatsukami, Davis, & Wittmers, 2004;Brown et al, 2001;Cinciripini et al, 2003;Ginsberg et al, 1995;Haas et al, 2004;Killen et al, 1999;Swan et al, 2003).…”

Predictors of Participation in a Smoking Cessation Program among Young Adult Smokers

“…Therefore, it is unclear what factors influence the likelihood that a young adult smoker would participate in a formal smoking cessation program. Prior research in older adults suggests a host of factors (e.g., demographic, smoking history, social, and psychological) may contribute to nonparticipation in smoking cessation programs (8)(9)(10)(11)(12). These factors include gender, race, education, smoking rate, and depressive symptoms.…”

“…The purpose of this study was to evaluate the predictors of participation in a smoking cessation program among young adult smokers. We evaluated variables shown to be important in older adult smoking cessation programs and those variables associated with young adult smoking (8)(9)(10)(11)(12)(13)(14).…”

A clinical trial to examine disparities in quitting between African-American and White adult smokers: Design, accrual, and baseline characteristics

“…Mechanisms underlying African American-White differences in quitting are also not well understood. Multiple factors, including demographic (e.g., socioeconomic status) [29, 33, 36, 37] and smoking characteristics (e.g., menthol, nicotine intake) [39–42], adherence and/or response to treatment (e.g., reductions in withdrawal, craving) [18, 17, 27, 31, 43], psychosocial (e.g., psychological distress, perceived and contextual disadvantage, stress) [44–46, 24, 47–53], and biological factors linked to nicotine metabolic inactivation (e.g., CYP2A6, 3hydroxycotinine/cotinine) [54–58] have been studied as they relate to cessation in African Americans and Whites, separately, but few studies have explored the relative importance of these factors in explaining African American-White differences in quitting.…”