NEW YORK (Reuters Health) - Adding the antidepressant bupropion (Zyban) to intensive counseling can help low-income African Americans in urban areas--who have high smoking rates--to kick the habit.

Previous studies have shown that bupropion can help people quit smoking, but such studies have only focused on whites and on those who are relatively well-off. The current findings indicate that bupropion is "effective for smoking cessation among African Americans," Dr. Jasjit S. Ahluwalia of the University of Kansas School of Medicine in Kansas City and his colleagues write in the July 24/31 issue of The Journal of the American Medical Association. While it would seem that smoking cessation tools would work the same for people regardless of race, the researchers point out that African Americans exhibit different smoking patterns than other groups, and as such, may respond differently to the same strategies. For example, around 45% of blacks living in urban areas smoke, while the rate of smoking in the general population is around 25%. African Americans also tend to smoke fewer cigarettes per day than whites, are more likely to smoke menthols, and may metabolize nicotine slower than whites. In the first trial to test the effectiveness of bupropion as an anti-smoking agent for African Americans, Ahluwalia and his colleagues found that 21% of those who were given a sustained release form of bupropion and a type of behavior therapy known as "motivational counseling" were cigarette-free 26 weeks after the study began. In contrast, slightly less than 14% of blacks who received an inactive placebo drug and the counseling remained non-smokers by the end of the study period. This is lower than the quit rate--27% to 35%--seen in other studies with bupropion, the authors note. Ahluwalia and his colleagues obtained their findings from 600 adults who smoked at least 10 cigarettes per day. Counseling consisted of periodic discussions with counselors designed to help smokers motivate themselves to quit. Study participants took either bupropion or placebo twice a day for 7 weeks. In an interview with Reuters Health, Ahluwalia explained that researchers are not sure how bupropion helps smokers quit. Previous studies have shown the drug acts on the chemicals serotonin, dopamine and norepinephrine, all of which can affect behavior and addiction. "But its mechanism of action has yet to be elucidated," Ahluwalia admitted. But this study demonstrates that the drug may help smokers quit for good; people are most likely to relapse within the first weeks after quitting, Ahluwalia said, and they become less likely to do so as time goes on. "So 6-month quit rates will not be too much different from 5-year quit rates," the researcher noted. In a related editorial, Dr. Neal L. Benowitz of the University of California, San Francisco, points out that the difference between those who took bupropion and those given placebo is, at slightly more than 7%, only a "modest" improvement. He adds that these findings may not be applicable to all blacks, because such intense behavioral counseling may not be available--particularly in the inner city. Furthermore, participants were mostly women, and all enrolled in the study through one community health center in Kansas City. Nevertheless, these results demonstrate the importance of this type of research, Benowitz notes. "Eventually, race or ethnicity may be considered unimportant as new knowledge becomes available about how genetic and environmental factors influence response to treatment," the editorialist writes. "Until then, for complex behavioral disorders such as tobacco addiction, which require both pharmacologic and behavioral therapies, clinical trials focused on minority groups are critical," Benowitz adds. Both Ahluwalia and Benowitz have acted as consultants for GlaxoSmithKline. Bupropion is manufactured by Glaxo Wellcome, Inc., which merged with SmithKline Beecham to form GlaxoSmithKline in late 2000.

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