Randomized Controlled Trial of Group-Based Culturally Specific Cognitive Behavioral Therapy Among Af
Monday, August 15, 2016
Posted by: Natalia Gromov
Monica Webb Hooper, Ph.D, Michael H Antoni, Ph.D, Kolawole Okuyemi, M.D, Noella A Dietz, Ph.D and Ken Resnicow, Ph.D.
Randomized Controlled Trial of Group-Based Culturally Specific Cognitive Behavioral Therapy Among African American Smokers.
Nicotine Tob Res (2016)doi: 10.1093/ntr/ntw181First published online: July 15, 2016
This study tested the efficacy of group-based culturally specific cognitive-behavioral therapy (CBT) for smoking cessation among low-income African Americans. Participants (N=342; 63.8% male; M=49.5 years old; Mcigarettes/day=18) were randomly assigned to eight sessions of group-based culturally specific or standard CBT, plus 8-weeks of transdermal nicotine patches. Biochemically-verified 7-day point prevalence abstinence (ppa) was assessed at the end-of-therapy (i.e., CBT) (EOT), and 3-, 6-, and 12-month follow-ups. Primary outcomes were the longitudinal intervention effect over the 12-month follow-up period, and 7-day ppa at the 6-month follow-up. Secondary outcomes included 7-day ppa at the EOT and 12-month follow-up, and intervention ratings. Generalized linear mixed modeling (GLMM) tested the longitudinal effect and logistic regression tested effects at specific time points. GLMM demonstrated a longitudinal effect of intervention condition. Specifically, 7-day ppa was 2 times (p = .02) greater following culturally specific CBT versus standard CBT when tested across all time points. Analyses by time point found no significant difference at 6 or 12-months, yet culturally specific CBT was efficacious at the EOT (62.5% versus 51.5% abstinence, p = .05) and the 3-month follow-up (36.4% versus 22.9% abstinence, p = .007). Finally, intervention ratings in both conditions were high, with no significant differences. Culturally specific CBT had a positive longitudinal effect on smoking cessation compared to a standard approach; however, the effects were driven by short-term successes. We recommend the use of group-based culturally specific CBT in this population when possible, and future research on methods to prevent long-term relapse. Culturally specific interventions are one approach to address smoking-related health disparities, however, evidence for their efficacy in African Americans is equivocal. Moreover, the methodological limitations of the existing literature preclude an answer to this fundamental question. We found a positive longitudinal effect of culturally specific CBT versus standard CBT for smoking cessation across the follow-up period. Analyses by assessment point revealed that the overall effect was driven by early successes. Best practices for treating tobacco use in this population should attend to ethno-cultural factors, but when this is not possible, standard CBT is an alternative approach for facilitating long-term abstinence.