title: Distress, race/ethnicity and smoking cessation in treatment-seekers: implications for disparity elimination.
abstract: OBJECTIVE
  Distress is a modifiable risk factor for smoking maintenance. This study aimed to assess racial/ethnic differences in distress pre- and post-cognitive-behavioral therapy (CBT) for smoking cessation, and relations with abstinence.
  
  
  METHODS
  Analyses of variance and logistic regressions were conducted.
  
  
  METHODS
  University-based smoking cessation laboratory in South Florida, USA.
  
  
  METHODS
  The sample comprised 234 treatment-seekers recruited from the community (18% white, 60% African American and 22% Hispanic).
  
  
  METHODS
  All participants received eight sessions of group CBT plus 8 weeks of transdermal nicotine patches (TNP).
  
  
  METHODS
  Demographics and smoking history [baseline], perceived stress and depressive symptoms [baseline and end of therapy (EOT)], carbon monoxide-verified 7-day point prevalence abstinence (p.p.a.) at EOT, 3 months post-CBT (primary outcome) and 6 months (self-report).
  
  
  RESULTS
  Compared with whites, African Americans reported greater baseline perceived stress (P = 0.03) and depressive symptoms (P = 0.06); no EOT differences were found. African Americans (P < 0.001) and Hispanics (P < 0.01) reported greater perceived stress reduction, and African Americans reported greater reductions in depressive symptoms (P < 0.01). EOT-perceived stress (adjusted odds ratio (AOR) = 0.93 (0.89-0.98)) and depressive symptoms [AOR = 0.96 (0.93-0.99)] were associated inversely with 7-day p.p.a. at 3 months. Reductions in perceived stress [AOR = 0.93 (0.89-0.98)] and depressive symptoms at the EOT [AOR = 0.96 (0.93-0.99)] were associated with cessation, such that reduced distress increased the odds of abstinence. The interactions between race/ethnicity and distress on 7-day p.p.a. were not significant at any assessment point.
  
  
  CONCLUSIONS
  Among smokers in Florida, USA, racial/ethnic differences in distress before starting cognitive-behavioral therapy for smoking cessation were eliminated at the end of treatment, driven by improvements among African Americans and Hispanics. High levels of distress were associated with reduced odds of abstinence through 6 months across racial/ethnic groups.
authors.affiliation: University of Miami, Sylvester Comprehensive Cancer Center, Coral Gables, FL, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Webb Hooper
authors.affiliation: University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL, USA.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Kolar
mesh_terms: D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000704:Analysis of Variance; D015928:Cognitive Behavioral Therapy; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D005431:Florida; D005500:Follow-Up Studies; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000523:psychology* / Q000706:statistics & numerical data; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000523:psychology*; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000628:therapy*; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data
keywords: Depressive symptoms; distress; health disparities; racial and ethnic; smoking cessation; stress