Effect of Varenicline Added to Counseling on Smoking Cessation Among African American Daily Smokers

Abstract

Key PointsQuestionAmong African American individuals who are daily smokers, does the addition of varenicline to counseling improve rates of smoking cessation compared with counseling alone?FindingsIn this randomized clinical trial that included 500 African American adults, counseling plus 12 weeks of varenicline treatment, compared with counseling plus placebo, showed a statistically significant improvement in rates of 7-day point prevalence smoking abstinence at week 26 (15.7% vs 6.5%).MeaningThe findings support the use of varenicline added to counseling for promoting smoking cessation among African American adults who are daily smokers of all smoking levels.

Helping African American Individuals Quit Smoking

“…The findings reported by Cox et al demonstrating the effectiveness of varenicline among very light smokers has implications beyond Black individuals who smoke. Light daily smoking has become increasingly common over the past 2 decades in the smoking population in the US, with an estimated 25.0% of adult smokers in 2020 reporting smoking 1 to 9 cigarettes per day (increased from 16.4% of adult smokers in 2005) .…”

“…Several issues must be considered when interpreting the findings reported by Cox et al The abstinence rates observed no doubt reflect the effects of the fairly intense counseling that all participants received. It is also unclear whether payments given to study participants for session attendance might have increased overall smoking quit rates by encouraging high session attendance.…”

“…Importantly, the results reported by Cox et al do not prove that varenicline is more effective than other smoking cessation pharmacotherapies, such as nicotine replacement therapy (NRT), for Black individuals who want to quit smoking. But other findings, including some with diverse samples of study participants, have shown that varenicline tends to produce higher abstinence rates than other pharmacotherapies, such as NRT monotherapy (eg, the nicotine patch).…”

“…In this issue of JAMA , the rigorous randomized clinical trial reported by Cox and colleagues offers evidence that cigarette smoking by Black individuals can be addressed more successfully. The investigators enrolled 500 African American adults who were smokers, provided them with 6 sessions of culturally relevant individualized counseling, and randomized the study participants (in a 3:2 ratio) to receive varenicline (1 mg twice daily; n = 300) or placebo (n = 200) for 12 weeks.…”

“…This may be a factor in the low rates of use of smoking pharmacotherapy among Black patients . The study by Cox et al shows that treatment with varenicline also increased abstinence rates for individuals who smoked lightly (1-10 cigarettes/d; n = 260), with verified abstinence rates at the end of treatment week 12 of 22.1% for those assigned to receive varenicline and 8.5% for those assigned to receive placebo . Moreover, varenicline was well tolerated among these individuals, with no reports of serious adverse events.…”