To compare the utilization rate of a statewide tobacco quitline by African-American smokers to that of white smokers.
Design, Setting, and Subjects.
Observational study of 18 years of state quitline operation in California. Subjects were 61,096 African-American and 279,042 white smokers who called the quitline from August 1992 to December 2009. Data from six California Tobacco Surveys, 1993, 1996, 1999, 2002, 2005, and 2008 were also used.
Measure.
Callers' answers to the question how they heard about the quitline were grouped into four categories: media, health care providers, friends/family, and others.
Analysis.
The averaged annual quitline call volume for each ethnic group was divided by the total number of smokers in that group, based on California Tobacco Surveys, to produce the annual quitline utilization rate.
Results.
In five out of six periods of comparison, African-American smokers had a higher annual utilization rate than white smokers. The odds ratios [ORs] ranged from 1.44 to 2.40 (all p < .05). In the 1996 comparison, the OR was .90 (p < .05). The difference in utilization rates that is attributed to media, accounts for most of the difference in total utilization rates between the two ethnic groups.
Conclusions.
Within the context of California's comprehensive tobacco control program, which includes a strong media campaign, African-American smokers were significantly more likely to call the state quitline than white smokers were. Promoting the quitline as part of antismoking media campaigns can help reduce disparity in cessation service utilization. (Am J Health Promot 2011;25[5 Supplement]:S51–S58.)
USDHHS, Tobacco Use Among U.S. Racial/Ethnic Minority Groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A Report of the Surgeon General.Atlanta, Ga: US Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1998.
2.
Centers for Disease Control (CDC), Cigarette smoking among adults and trends in smoking cessation—United States, 2008. MMWR Morb Mortal Wkly Rep.2009;58:1227–1332.
3.
Centers for Disease Control (CDC), Vital signs: Current cigarette smoking among adults aged ≥18 years—United States, 2009. MMWR Morb Mortal Wkly Rep.2010;59:1135–1140.
4.
StewartSLCardinezCJRichardsonLC. Surveillance for cancers associated with tobacco use—United States, 1999–2004. MMWR Surveill Summ.2008;57:1–33.
5.
MaxWSungHYTuckerLYStarkB. The disproportionate cost of smoking for African Americans in California. Am J Public Health.2010;100:152–158.
6.
PetoRDarbySDeoH. Smoking, smoking cessation, and lung cancer in the UK since 1950: Combination of national statistics with two case-control studies. BMJ.2000;321:323–329.
7.
TaylorDHHasselbladVHenleySJ. (2002). Benefits of smoking cessation for longevity. Am J Public Health.2002;92:990–996.
8.
HuntWABarnettLWBranchLG. Relapse rates in addiction programs. J Clin Psychol.1971;27:455–456.
9.
HughesJRKeelyJNaudS. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction.2004;99:29–38.
10.
FioreMCJaenCRBakerTBTreating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline.Rockville, Md: US Dept of Health and Human Services, Public Health Service; 2008.
11.
BackingerCLThornton-BullockAMinerC. Building consumer demand for tobacco-cessation products and services: The National Tobacco Cessation Collaborative's consumer demand roundtable. Am J Prev Med.2010;38(3 suppl):S307–S311.
12.
GilpinEAEmerySLFarkasAJThe California Tobacco Control Program: A Decade of Progress, Results from the California Tobacco Surveys, 1990-1998.La Jolla, Calif: University of California, San Diego; 2001.
13.
ZhuS-HMelcerTSunJ. Smoking cessation with and without assistance: A population-based analysis. Am J Prev Med.2000;18:305–311.
14.
CokkinidesVEHalpernMTBarbeauEM. Racial and ethnic disparities in smoking-cessation interventions: Analysis of the 2005 National Health Interview Survey. Am J Prev Med.2008;34:404–412.
15.
FuSSShermanSEYanoEM. Ethnic disparities in the use of nicotine replacement therapy for smoking cessation in an equal access health care system. Am J Health Promot.2005;20:108–116.
16.
FioreMCCroyleRTCurrySJ. Preventing 3 million premature deaths and helping 5 million smokers quit: A national action plan for tobacco cessation. Am J Public Health.2004;4:205–210.
17.
LichtensteinEZhuS-HTedeschiGJ. Smoking cessation quitlines: An under-recognized intervention success story. Am Psychol.2010;65:252–261.
18.
ZhuS-HRosbrookBAndersonCM. The demographics of help-seeking for smoking cessation in California and the role of the California Smokers' Helpline. Tob Control.1995;4(suppl 1):S9–S15.
19.
GambleVN. Under the shadow of Tuskegee: African Americans and health care. Am J Public Health.1997;87:1773–1778.
20.
BoulwareLECooperLARatnerLE. Race and trust in the health care system. Public Health Rep.2003;118:358–365.
21.
WashingtonHMedical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present.New York, NY: Doubleday, Random House; 2007.
22.
RoeselerABurnsD. The quarter that changed the world. Tob Control.2010;19:i3–i15.
23.
StevensC. Designing an effective counteradvertising campaign—California. Cancer.1998;83(12 suppl):2736–2741.
PierceJPGoodmanJGilpinEABerryCTechnical Report on Analytic Methods and Approaches Used in the Tobacco Use in California, 1990-1991Report.Sacramento,Calif: California Dept of Health Services; 1992.
29.
Al-DelaimyWKMesserKPierceJPTechnical Report on Analytic Methods and Approaches Used in the 2005 California Tobacco Survey Analysis. Vol. 1: Data Collection Methodology.La Jolla, Calif: University of California, San Diego; 2007.
30.
Research Triangle Institute International (RTII), SUDAAN Language Manual, Release 10.0.Research Triangle Park, NC: Research Triangle Institute; 2008.
31.
SAS Institute Inc, SAS® 9.2 Language Reference: Concepts.Cary, NC: SAS Institute Inc; 2008.
32.
BoydNRSuttonCOrleansCT. Quit Today! A targeted communications campaign to increase use of the Cancer Information Service by African American smokers. Prev Med.1998;27:S50–S60.
KingACGoldbergJHSalmonJ. Identifying subgroups of U.S. adults at risk for prolonged television viewing to inform program development. Am J Prev Med.2010;38:17–26.
35.
ZhuS-HAndersonCM. Tobacco cessation and the African-American community. Paper presented at the State of Black California and Tobacco Use Conference; September 25, 2008; Los Angeles, Calif.
36.
DellJLWhitmanSShahAM. Smoking in 6 diverse Chicago communities, a population study. Am J Public Health.2005;95:1036–1042.
37.
NelsonDEPowell-GrinerETownMKovarMG. A comparison of national estimates from the National Health Interview Survey and the Behavioral Risk Factor Surveillance System. Am J Public Health.2003;93:1335–1341.
38.
LinkMWMokdadAHStackhouseHFFlowersNT. Race, ethnicity, and linguistic isolation as determinants of participation in public health surveillance surveys. Prev Chronic Dis.2006;3:1–12.
39.
BlumbergSJLukeJV. Coverage bias in traditional telephone surveys of low-income and young adults. Public Opin Q.2007;71:734–749.
40.
BlumbergSJLukeJVCynamonM. Telephone coverage and health survey estimates: Evaluating the need for concern about wireless substitution. Am J Public Health.2006;96:926–931.
41.
RabiusVMcAlisterAWiatrekD. Smoking cessation assistance for African Americans: Quitline utilization and effectiveness. Poster presented at: Society for research on nicotine and tobacco annual conference. February 25, 2010; Baltimore, MS.
42.
HalperinABushTYepassis-ZembrouPMcAfeeT. Differential quitline use, satisfaction and effectiveness: The African American experience. Paper presented at: National Conference on Tobacco or Health; May 5, 2005; Chicago, Ill.
43.
BalaMStrzeszynskiLCahillK. Mass media interventions for smoking cessation in adults. Cochrane Database Syst Rev.2008;1:CD004704, DOI: 10.1002/14651858.CD004704.pub2.
