Characteristics of Black Adults who Never Achieved 24-hours of Abstinence in a Smoking Cessation Tri

Sundar AN, Cox LS, Leavens ELS, Brown A, Mayo MS, Ahluwalia JS, Nollen NL.
Characteristics of Black Adults who Never Achieved 24-hours of Abstinence in a Smoking Cessation Trial: Implications for Improving Treatment Response
Nicotine Tob Res. 2025 Jul 22:ntaf149. doi: 10.1093/ntr/ntaf149. Epub ahead of print. PMID: 40693755.

Introduction: Maximizing early treatment response is an important strategy for long-term abstinence, yet little is known about individuals who never achieve any period of abstinence. Improving early treatment response is critical for Black adults who smoke (AWS) who bear a disproportionate share of tobacco-related mortality.

Methods: Secondary data analysis of a randomized clinical trial among Black AWS (n = 392) interested in quitting smoking. Participants received 18 weeks of pharmacotherapy and smoking cessation counseling. This investigation quantified the proportion of participants who never achieved 24-hour abstinence through week 2 (W2). Best subsets logistic regression identified baseline and non-baseline factors contributing to never achieving 24-hour abstinence.

Results: 135 participants (36.2%) did not achieve 24-hour abstinence by W2 despite good adherence with nicotine patch (73.9% had ≥80% compliance). Of those, 56.4% and 47.8% still did not achieve 24-hour abstinence at W6 and W12, respectively. Baseline financial strain, higher baseline cotinine and smoking more CPD at W2 increased odds of never achieving 24-hour abstinence while greater cessation self-efficacy and more positive beliefs about study medication at W2 decreased odds of never achieving 24-hours abstinence.

Conclusions: A substantial proportion of individuals who were motivated to quit smoking and received gold-standard treatment (i.e., pharmacotherapy and counseling) never achieved a period of 24 hours of abstinence. Findings highlight financial strain, nicotine dependence, early self-efficacy challenges, and medication experience as targets for improving abstinence among those at high risk for early treatment failure. By characterizing a subset within a larger population at-risk of continued smoking, the study presents opportunities to consider contributors to treatment success.

Implications: Individuals who do not experience success with quitting early in treatment rarely go on to achieve long-term abstinence, yet the majority of interventions fail to address challenges among this high-risk subgroup. Findings suggest a need for interventions that consider the psychological impact of unmet social needs associated with financial strain, address low cessation self-efficacy, and early experiences with smoking cessation pharmacotherapy as approaches for bolstering treatment efficacy. Two possible evidence-based interventions for addressing these factors are discussed.