摘要：Objectives. We examined disparities in smoking cessation rates between African Americans and Whites from 1990 through 2000. Methods. We performed an analysis of smoking cessation with data from the National Health Interview Surveys of 30660 African Americans and 209828 Whites, 18 to 64 years old, with adjustment for covariates in multiple logistic regression models. Results. Whites were significantly more likely than African Americans to be former smokers, and this disparity in the quit ratio persisted from 1990 through 2000. After adjustment for covariates, disparities were substantially reduced especially among women. Among former smokers, African Americans were significantly more likely than Whites to have quit successfully within the past 10 years. Conclusions. Statistical adjustment for covariates reduces African American–White disparities in quit ratios, and recent cessation patterns suggest possible future reductions in disparities. Previous studies in the United States have shown that tobacco consumption has generally decreased among all racial/ethnic groups. 1, 2 Although prevalence had been higher in African Americans than in Whites since at least 1965, 3 recent data indicate that the proportions of current smokers are now similar. 1 Among African Americans, smoking prevalence has not decreased uniformly across all demographic groups (e.g., gender, nativity, and region). 2, 4, 5 Rather than “racial/ethnic group,” the term “racially classified social group” (RCSG) was employed in this article to emphasize that “race-ethnicity” as self-reported by survey respondents is not viewed as a biological or genetic construct with implications of immutable group differences based on phenotypic observations such as skin color. The idea of human populations as social groups recognizes the social character of human evolution and diversity rather than the classifications upon which fixations of “race biology” are imputed. 6– 8 Since the mid-1980s, public health efforts have increasingly promoted cessation initiatives targeting African Americans. 9, 10 Epidemiological research on smoking cessation has revealed that African Americans are less likely than Whites to make successful quit attempts, 1, 11 although they are no less likely to want to quit. 10, 12, 13 A study of National Health Interview Survey (NHIS) data found increasing quit ratios from 1965 to 1991 for both African Americans and Whites as well as a persistent difference between these 2 groups. 14 Pierce et al., in an analysis of 1974–1985 NHIS data, found a greater disparity in the rate of change in smoking cessation between African American and White men than that of African American and White women. 15 In contrast, a longitudinal study during 1985–1995 of young adults (18–35 years old) in 4 cities by Kiefe et al. did not find an African American–White difference in cessation after control for socioeconomic status. 16 An analysis of the influence of gender and race/ethnicity on cessation (which did not control for socioeconomic status) concluded that the age of initiation could obscure differences in cessation behavior. 17 Intervention studies and clinical trials have observed different outcomes in the quitting behavior of African Americans and Whites. 18– 20 Some researchers have found effective pharmacological treatment targeting African Americans, 21 whereas others have suggested genetic explanations for these variations. 6, 22– 25 To our knowledge, ours is the first study to analyze differences in the quitting behavior of African American and White Americans during 1990–2000. Using NHIS data for 1990 to 2000, our study examined different measures of quitting behavior and explored differences between African Americans and Whites. One implication of this analysis is that it may foreshadow future rates of smoking-related diseases and health disparities. The results may also be useful in developing more effective policies and interventions targeting specific groups of smokers.
