Distress, race/ethnicity and smoking cessation in treatment-seekers: Implications for disparity elimination

Monica Webb Hooper, Stephanie K. Kolar

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background and Aims: Distress is a modifiable risk factor for smoking maintenance. This study aimed to assess racial/ethnic differences in distress pre- and post-cognitive-behavioral therapy (CBT) for smoking cessation, and relations with abstinence. Design: Analyses of variance and logistic regressions were conducted. Setting: University-based smoking cessation laboratory in South Florida, USA. Participants: The sample comprised 234 treatment-seekers recruited from the community (18% white, 60% African American and 22% Hispanic). Intervention: All participants received eight sessions of group CBT plus 8weeks of transdermal nicotine patches (TNP). Measurements: Demographics and smoking history [baseline], perceived stress and depressive symptoms [baseline and end of therapy (EOT)], carbon monoxide-verified 7-day point prevalence abstinence (p.p.a.) at EOT, 3months post-CBT (primary outcome) and 6months (self-report). Findings: Compared with whites, African Americans reported greater baseline perceived stress (P=0.03) and depressive symptoms (P=0.06); no EOT differences were found. African Americans (P<0.001) and Hispanics (P<0.01) reported greater perceived stress reduction, and African Americans reported greater reductions in depressive symptoms (P<0.01). EOT-perceived stress (adjusted odds ratio (AOR)=0.93 (0.89-0.98)) and depressive symptoms [AOR=0.96 (0.93-0.99)] were associated inversely with 7-day p.p.a. at 3 months. Reductions in perceived stress [AOR=0.93 (0.89-0.98)] and depressive symptoms at the EOT [AOR=0.96 (0.93-0.99)] were associated with cessation, such that reduced distress increased the odds of abstinence. The interactions between race/ethnicity and distress on 7-day p.p.a. were not significant at any assessment point. Conclusions: Among smokers in Florida, USA, racial/ethnic differences in distress before starting cognitive-behavioral therapy for smoking cessation were eliminated at the end of treatment, driven by improvements among African Americans and Hispanics. High levels of distress were associated with reduced odds of abstinence through 6months across racial/ethnic groups.

Original languageEnglish (US)
Pages (from-to)1495-1504
Number of pages10
Issue number9
StatePublished - Sep 1 2015
Externally publishedYes


  • Depressive symptoms
  • Distress
  • Health disparities
  • Racial and ethnic
  • Smoking cessation
  • Stress

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health


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