A New Way To Help Black Smokers Quit

Jan Johnson smoked a dozen cigarettes a day for about two decades.

"I would go to bingo at least four times out of a week, and at bingo it was just the thing to do," she said.

When her apartment building went smoke free in 2018, she knew something would have to change. 

She saw a bulletin board for a research study testing whether a text messaging program could help people stop smoking and decided to sign up.

Each of the approximately 100 participants in the pilot study received six weeks of daily texts featuring encouraging video messages. The videos offered tips, such as, "Ask other smokers in your home to quit with you. Or if they aren’t ready, ask them to smoke outside."

But the texts weren’t one-size-fits-all messages like you’d find online at smokefree.gov.

For the study, there were also messages designed specifically for the African-American community. "We are a strong people. We’ve had to overcome many obstacles and fight hard to get what we want. And you will need this strength to be successful quitting smoking,” one said.

Case Western Reserve University researcher Monica Webb Hooper developed the text messaging program, infusing it with evidence-based strategies as well as messages and visuals that are culturally congruent.

"So for example, we talk about smoking rates in the African-American community. We talk about the relationship of the tobacco industry with African Americans and its roots that date back to slavery. We talk about the targeting of the tobacco industry for menthol cigarettes which are known to be more difficult to quit and contain greater rates of toxins and tars. We also talk about the cultural assets and strengths that would be relevant to this group, such as the emphasis on spirituality, religion, and the emphasis on family and community engagement," she said.

People receiving the culturally-specific texts were more engaged with the program and more likely to be smoke-free at their six week follow-up than those who got the standard texts from smokefree.gov, Hooper said.

Johnson credits the program for her success in quitting.

"I used to use oxygen when I sat up and laid down, but now I'm only on oxygen at night," she said.

Johnson still consults the videos when she needs a boost.

"They inoculated me, and definitely educated me, and I was like, I don't want to be like that. I remember the one with the lady that had to use a voice box. That one right there hit me below the belt," she said.

What Johnson doesn’t remember, though, is feeling like the videos were tailored toward black smokers.

"No, I didn't look at it like that. I know that the doctor was explaining 'in the black culture, this and that and the other,' but no, it just really didn't stick out," she said.

Not everyone is going to notice or want that kind of culturally-tailored approach, said Rasheeda Larkin, who works in community and government relations at the Cleveland Clinic.

"We have some shared experiences like other culturally similar groups but also very different experiences as well. So I might be the type of person who says, 'Oh was that something that's particularly for black people? I don't want that. Just give me the regular.'"

But Larkin also likes the idea of cultural specificity and says it could help broaden thinking and validate experiences, maybe even make people angry.

"It takes it to a different level, where they understand not only is this hurting you from a health care standpoint, but also how you are marketed to. Because of how you show up in the world: being a person of color, being a black woman, being a black man. It shows that they are directly targeting you. It's a full-on attack," she said.

The overall smoking rate in Cleveland is 29 percent. But in some heavily African-American neighborhoods, such as Kinsman and Central, as many as 40 percent of adults smoke, according to statistics from the U.S. Centers for Disease Control and Prevention.

That’s why it’s critical to find new ways to help more black smokers quit, Hooper said.

"This group tends to be less likely to quit smoking. This group also suffers disproportionately from a range of tobacco associated conditions, not only cancer, but heart disease, stroke, diabetes, infant mortality — all these things are related to tobacco use. So it is imperative that any health agenda include tobacco use," she said.

More research is needed, Hooper said, but ultimately, she’d love to have a free texting program, tailored to black smokers available on the National Cancer Institute’s website, where smoking cessation programs for pregnant women, teens, and other groups already exist.

That, she thinks, might help move the needle on smoking rates in the black community.