This study used a large population-based survey of U.S adults (≥18 years of age) to assess whether correlates of quit attempts among smokers vary by race/ethnicity. Our study found most correlates of quit attempts were similar across all racial/ethnic groups. We also observed that Hispanics and persons of multiple races were more likely to have made a quit attempt than whites. Although smoking prevalence continues to decline among all racial/ethnic groups, our findings, like those from earlier studies, show that disparities among racial/ethnic groups still exist in smoking-related behaviors including quit attempts with white smokers less likely to make a quit attempt than other racial/ethnic groups [2
]. Studies have shown however, that among those who make a quit attempt, whites are more likely to be successful than other racial/ethnic groups [34
Like previous studies [25
], we found for all racial/ethnic subgroups that younger age, having greater than high school education, smoking fewer cigarettes, smoking for fewer years, not smoking within the first 5 minutes after waking, living in a home where smoking was not allowed indoors, and receiving a doctor’s advice to quit were positively associated with having made a quit attempt in the past year. Some of these correlates are aspects of a person’s smoking pattern and their level of nicotine dependence (i.e.
, amount and duration of smoking and time to first cigarette). These correlates, as well as the relationship between younger age and increased quit attempts suggest that smokers who are younger and probably less nicotine dependent are the ones more likely to try to quit. Although young adult smokers are more likely to make a quit attempt than older adults, other studies have shown that they are less likely to use proven effective cessation treatments in their cessation attempts [5
]. Findings from recent studies on the relationship between menthol cigarettes and smoking cessation have been mixed and although some have found no relationship or a negative relationship, it is important to note that most of those studies have looked at successful quitting, few stratified the relationships by race/ethnicity, and only four [13
] have looked at the outcome of quit attempts. Alexander [19
] and Cubbin [20
] did not stratify by race/ethnicity and Alexander found no relationship with menthol and quitting while Cubbin found menthol smokers were not likely to quit. Levy et al.
found that menthol smokers are more likely to make a quit attempt [13
]. Levy et al
. also found that menthol smokers were less successful at long term cessation, similar to Trinidad et al.
]. We found that among whites, menthol users were less likely to make a quit attempt than non-menthol users. We also found that black menthol users were more likely to make a quit attempt than white menthol users. This may reflect the higher overall quit attempts among blacks vs
. whites and the fact that most blacks smoke menthol cigarettes. More research is needed on the relationship between menthol use and cessation as studies to date have yielded conflicting results.
Studies have shown that cessation counseling and use of cessation medications increase smoking cessation [25
]. Our study found that respondents who reported receiving doctor’s advice to quit (excluding Asian Americans/Pacific Islanders) were more likely to have made a quit attempt in the previous year than those who did not receive advice. Despite PHS clinical guidelines which recommend the delivery of effective cessation treatments for tobacco dependence at every clinical visit, disparities still exist in provider-delivered services [36
]. Lopez-Quintero et al
. found that about 16 million smokers had no recollection of receiving a physician’s advice to quit in the previous year [27
]. They and Franks et al
] also found that blacks and Hispanics are less likely than whites to receive counseling in how to quit and the likelihood that Hispanics received counseling was not related to the smoker’s English language proficiency. Another important barrier to receiving counseling and effective medications is that not all smokers visit a health care provider each year; young smokers and blacks and Hispanics are less likely to see a physician.
One population-based strategy for providing counseling and medications is a toll-free quitline. Since 2006, all states have had a free tobacco cessation quitline; these quitlines provide a variety of effective smoking cessation services including counseling and can be accessed by calling 1-800-QUIT NOW. Quitlines have the potential to reach large numbers of smokers across all racial/ethnic populations and in recent years more smokers are accessing this service for smoking cessation assistance [46
]. Quitlines are cost effective and they increase quit rates among callers by approximately 60% [25
]. More research is needed to confirm whether Asian Americans/Pacific Islanders may not be benefiting from physician’s advice to quit as other racial/ethnic groups especially in light of recent research that indicate that although Asian smokers who spoke one of three Asian languages were just as likely as whites to call the California quitline, Asian smokers who spoke English were less likely to call the California quitline [50
As evidence on the health effects of secondhand smoke continues to grow, the number of smoke-free laws and persons with voluntary rules aimed at protecting the family from secondhand smoke exposure in their home continues to grow. Although we did not find a relationship between workplace smoking policies and quit attempts in this study, laws that ban smoking indoors reduce opportunities to smoke and therefore reduce quantity of cigarettes consumed [51
]. Clean indoor air laws may also positively increase the voluntary establishment of non-smoking rules in homes [52
]. We found across all racial/ethnic groups that respondents living in a home in which smoking was not allowed indoors were more likely to have made a quit attempt than those who lived in homes where smoking was permitted (this relationship still persisted when persons who had already quit were excluded from the analysis to control for the possibility that the former smokers had changed their home smoking policy after they quit [data not shown]). Interestingly, a statistically significant interaction occurred between this variable and race/ethnicity and we observed that among those who did not have a smoke-free home Hispanics and Asian Americans/Pacific Islanders were no more likely to make a quit attempt than whites. Education campaigns encouraging the public in general to adopt smoke-free homes need to be implemented and advising smokers to adopt a smoke-free home should be included as part of cessation efforts by medical and public health practitioners [53
One of the strengths of this survey is that it uses a nationally representative sample of the U.S. population which included large numbers of smokers within six racial/ethnic groups in the U.S. The survey, however, has some limitations: first, the TUS-CPS data were self-reported and data on past year quit attempts was collected retrospectively. Although, self-reported current cigarette smoking has good validity [54
], reporting of quit attempts in the previous year depends on respondent’s recall of events and smokers may not accurately recall quit attempts of short duration [55
]. Second, we were unable to assess causal relationships given that this was a cross-sectional study. However, many of our results were consistent with previous studies. Third, sample sizes for Asian American/Pacific Islanders, American Indian/Alaska Natives and persons of multiple races were small (n = 284–386) and therefore additional studies using larger samples are need to further confirm findings among these populations. Fourth, this study only examined the probability of making a quit attempt in the past year and not whether the quit attempt was successful. Future analyses are needed to examine whether patterns of successful cessation vary by race/ethnicity. Fifth, these racial/ethnic groups are heterogeneous and therefore we do not have information on correlates of quit attempts among smaller racial/ethnic groups such as those among subgroups of AA/PI (Koreans, Chinese, Samoans etc
.). Sixth, questions on quit attempts in the past year differ slightly between current smokers who reported smoking on <12 days in the past 30 days and those who smoked ≥12 days in the past 30 days. In addition, non-white racial/ethnic groups are more likely to be light or infrequent smokers than whites [21
]. Although we included a measure of amount of smoking in our model (number of cigarettes smoked per day) we did not control for number of days smoked in the past 30 days as it was highly correlated with number of cigarettes smoked per day. To examine whether question wording and frequency of smoking might have influenced our results, we re-ran the logistic regression models stratified by frequency of smoking (smoked <12 days vs
. ≥12 days in the past 30 days) among current smokers (former smokers who quit in the past year were excluded). Because the numbers of smokers with each racial/ethnic group who reported smoking <12 days in the past 30 days was small the logistic regression model did not converge for this group. Among those who smoked ≥12 days in the past 30 days, the same variables that were statistically significant in our final logistic regression model for the entire populations were also significant among those who smoked ≥12 days in the past 30 days as were the interactions with race/ethnicity and doctor’s advice to quit and race/ethnicity and time to first cigarette and the race/ethnicity and menthol was borderline significant at p = 0.09. There was no longer an interaction with race/ethnicity and home smoking rules although home smoking rules was significant as a main effect in the model with those with home smoking rules more likely to make a quit attempt than those without home smoking rules. More research is needed on the effect of home smoking rules and the other correlates of quit attempts among infrequent smokers as this group is becoming a larger proportion of the population of smokers over time [57
More research is needed to assess the effect of physician’s advice to quit on the probability of having a quit attempt among Asian American/Pacific Islanders as this variable was not related to having made a quit attempt in this group as in the other racial/ethnic groups. Because most correlates of quit attempts do not appear to vary substantially across racial/ethnic groups in the United States, comprehensive tobacco control programs that implement broad-based policy interventions (i.e.
, smoke-free policies in public places, coverage for cessation treatment, increased price, mass media and pack labels, quitlines, etc
.) should be effective in increasing quit attempts among all population racial/ethnic subgroups [58