摘要：Objectives. We examined whether a proactive care smoking cessation intervention designed to overcome barriers to treatment would be especially effective at increasing cessation among African Americans receiving care in the Veterans Health Administration. Methods. We analyzed data from a randomized controlled trial, the Veterans Victory over Tobacco study, involving a population-based electronic registry of current smokers (702 African Americans, 1569 Whites) and assessed 6-month prolonged smoking abstinence at 1 year via a follow-up survey of all current smokers. We also examined candidate risk adjustors for the race effect on smoking abstinence. Results. The interaction between patient race and intervention condition (proactive care vs usual care) was not significant. Overall, African Americans had higher quit rates than Whites (13% vs 9%; P < .006) regardless of condition. Conclusions. African Americans quit at higher rates than Whites. These findings may be a result of the large number of veterans receiving smoking cessation services and the lack of racial differences in receipt of these services as well as racial differences in smoking history, self-efficacy, and motivation to quit that favor African Americans. Numerous studies have found that African American smokers are less likely than White smokers to quit successfully. 1–8 These disparities in quit rates exist despite the fact that African American smokers report stronger motivation and readiness to quit, are more likely to believe they will be able to quit successfully, 9–11 and are more likely to make quit attempts than Whites. 12,13 Evidence has suggested that an important contributor to racial differences in cessation rates is African Americans’ lower use of evidence-based cessation treatment. Specifically, African Americans are less likely to be screened for nicotine use, to receive cessation advice, and to be prescribed nicotine replacement treatment (NRT) than Whites. 3,6,8,13–17 African Americans are also less likely to believe that NRT and formal smoking cessation treatment are effective and have less favorable attitudes toward pharmacotherapy than Whites. 10,17 Taken together, this research has suggested that increasing the use of evidence-based cessation treatment among African Americans may be a promising way to reduce racial disparities in cessation. The Veterans Victory over Tobacco (Victory) study, a pragmatic randomized controlled trial, assessed the effects of a proactive-care smoking cessation intervention, designed to increase the reach of evidence-based cessation treatment, on smoking abstinence rates among a diverse population of smokers enrolled in the Veterans Health Administration. 18 In this intervention, smokers were identified through electronic medical records and offered the choice of telephone or face-to-face care for treatment of tobacco dependence. Main effects of this study, which have already been published, revealed a significant 2.6% absolute increase in population-level smoking cessation rates in the proactive-care condition over usual care. 19 This study is a secondary analysis of data from the Victory study to determine whether the effects of treatment differ by race and, secondarily, to explore baseline factors that might account for the association between race and smoking cessation. Our hypothesis was that a proactive, population-based tobacco cessation care model, with low barriers to access, would have greater benefit among African American smokers than White smokers because the former are less likely to have received prior pharmacotherapy or counseling. 3,6,8,13–17
