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Health Care Decisionmaking

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Race and sex may play a role in a person's ability to give up smoking

Women make up half of current smokers, and several racial/ethnic groups not only have high rates of smoking (27 percent of blacks and 34 percent of American Indians/Alaska Natives), but they also have higher mortality rates than whites from smoking-related illness, such as cancer and cardiovascular disease. A recent commentary by researchers who developed the Public Health Service's Clinical Practice Guideline, Treating Tobacco Use and Dependence, suggests that differences in motivational and physical dependence factors related to a smoker's sex and race/ethnicity may influence the effectiveness of treatments for tobacco dependence. The guideline does not, however, identify different treatment approaches for these groups.

When Michael C. Fiore, M.D., M.P.H., of the Center for Tobacco Research and Intervention, University of Wisconsin Medical School, and his colleagues developed the guideline, they found no studies on the effectiveness of treatment based on sex or race/ethnicity. However, they believe that differences in tobacco motivation and dependence might require different treatments for different groups. For example, women have much higher rates of anxiety and depression than men, which have been linked to increased rates of smoking and difficulty in quitting. Also, women are more influenced by the social consequences and ritual of smoking than its pharmacological properties. Women have lower quit rates than men for some treatments but not others.

Quit rates are higher for whites than for blacks and Hispanics. Black smokers appear to be more dependent on tobacco than whites, that is, they are more likely to light up within the first 10 minutes after waking in the morning. Although black smokers smoke significantly fewer cigarettes, start smoking later than whites, and report more desire to quit, they have more difficulty quitting. Finally, it has been suggested that Hispanics, like American Indians, may use tobacco to cope with the stress of acculturation into white society. In conclusion, the authors note that it is difficult to draw firm conclusions about ethnic differences in tobacco dependence because so little research as been done on this topic. They recommend changes and directions for future clinical research to address the effects of sex and race on tobacco dependence and response to treatment.

See "Gender and racial/ethnic differences in tobacco-dependence treatment: A commentary and research recommendations," by Megan E. Piper, M.A., Brian J. Fox, J.D., Samuel K. Welsch, M.S., and others, in Nicotine & Tobacco Research 3, pp. 291-297, 2001.

Editor's Note: The evidence-based Public Heath Service guideline on smoking cessation was developed with support from the Robert Wood Johnson Foundation, the Agency for Healthcare Research and Quality (contract 290-98-0015), the Centers for Disease Control and Prevention, the National Institutes of Health, and the University of Wisconsin Medical School.

Copies of the PHS smoking cessation materials are available from the AHRQ Publications Clearinghouse. Contact the Clearinghouse at 1-800-358-9295 for more information.

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