Smoking Cessation in Black Adults: Differences by Sex and Age

Females have poorer smoking cessation outcomes than males, especially with nicotine replacement therapy (NRT)-aided attempts, perhaps due to ovarian hormones. In addition, Black adults experience higher rates of tobacco-related mortality and also experience important ovarian hormone differences. This is the first study to examine sex, age, and menopause differences in NRT-aided smoking cessation outcomes in an all-Black sample.

A secondary data analysis was conducted on non-Hispanic Black adults aged 18 + who smoked 5-30 cigarettes/day for at least 6 months. Participants were categorized by sex assigned at birth (female versus male) and age (< 45 versus ≥ 45 years) with females in the ≥ 45 age group restricted to those who were postmenopausal (defined as 1 year post menses per self-report). Smoking status 2 weeks post-quit date was assessed by cessation attempts, expired carbon monoxide-verified abstinence, and reduction in daily cigarettes. Statistical analyses utilized Mann-Whitney rank-sum tests, chi-square tests, and regression models controlling for baseline cigarettes/day.

Participants (n = 340; 55.9% female) were, on average 53.4 (standard deviation: ± 11.6) years old. At baseline, males smoked significantly more cigarettes/day than females (13.9 ± 7.7 versus 11.9 ± 6.3, respectively; p-value = .031). Among those < 45 years of age, males (n = 30) had a greater reduction in cigarettes/day 2 weeks post cessation than females (n = 52; 11.3 ± 6.1 versus 7.9 ± 5.3, respectively; p-value = .008), but this difference became null after adjusting for baseline cigarettes/day (p-value = .989). No other significant differences were identified.

After adjusting for baseline differences in smoking rate, no significant sex differences in smoking cessation outcomes were observed in this all-Black sample. Additional research is needed to replicate this observation.

Despite known racial disparities and sex-based differences in NRT efficacy, little is known about sex differences in cessation among Black people who smoke. While we did not observe any differences by sex in smoking cessation outcomes within this all-Black sample, our results suggest that sex differences in the baseline level of cigarettes/day may play a critical role in cessation outcomes. Further research should replicate these observations and examine potential implications for cessation among Black people who smoke.