{"doi":"10.1093/ntr/ntaf149","title":"Characteristics of Black Adults Who Never Achieved 24-Hours of Abstinence in a Smoking Cessation Trial: Implications for Improving Treatment Response","abstract":"INTRODUCTION: Maximizing early treatment response is an important strategy for long-term abstinence, yet little is known about individuals who never achieve any period of abstinence. Improving early treatment response is critical for Black adults who smoke (AWS) who bear a disproportionate share of tobacco-related mortality. METHODS: Secondary data analysis of a randomized clinical trial among Black AWS (N = 392) interested in quitting smoking. Participants received 18 weeks of pharmacotherapy and smoking cessation counseling. This investigation quantified the proportion of participants who never achieved 24-hour abstinence through week 2 (W2). Best subsets logistic regression identified baseline and non-baseline factors contributing to never achieving 24-hour abstinence. RESULTS: 135 participants (36.2%) did not achieve 24-hour abstinence by W2 despite good adherence with nicotine patch (73.9% had > 80% compliance). Of those, 56.4% and 47.8% still did not achieve 24-hour abstinence at W6 and W12, respectively. Baseline financial strain, higher baseline cotinine and smoking more CPD at W2 increased odds of never achieving 24-hour abstinence while greater cessation self-efficacy and more positive beliefs about study medication at W2 decreased odds of never achieving 24-hours abstinence. CONCLUSIONS: A substantial proportion of individuals who were motivated to quit smoking and received gold-standard treatment (i.e., pharmacotherapy and counseling) never achieved a period of 24 hours of abstinence. Findings highlight financial strain, nicotine dependence, early self-efficacy challenges, and medication experience as targets for improving abstinence among those at high risk for early treatment failure. By characterizing a subset within a larger population at-risk of continued smoking, the study presents opportunities to consider contributors to treatment success. IMPLICATIONS: Individuals who do not experience success with quitting early in treatment rarely go on to achieve long-term abstinence, yet the majority of interventions fail to address challenges among this high-risk subgroup. Findings suggest a need for interventions that consider the psychological impact of unmet social needs associated with financial strain, address low cessation self-efficacy, and early experiences with smoking cessation pharmacotherapy as approaches for bolstering treatment efficacy. Two possible evidence-based interventions for addressing these factors are discussed.","journal":"Nicotine & Tobacco Research","year":2025,"id":570702,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9226,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":324036,"name":"Lisa Sanderson Cox","orcid":"0000-0002-3345-4178","position":1,"is_corresponding":false},{"id":385060,"name":"Eleanor L.S. Leavens","orcid":"0000-0003-2948-2384","position":2,"is_corresponding":false},{"id":640202,"name":"Alexandra R. Brown","orcid":"0000-0002-1594-3269","position":3,"is_corresponding":false},{"id":366604,"name":"Matthew S. Mayo","orcid":"0000-0001-7264-1577","position":4,"is_corresponding":false},{"id":274696,"name":"Jasjit S. Ahluwalia","orcid":"0000-0003-1756-3646","position":5,"is_corresponding":false},{"id":274692,"name":"Nicole L. Nollen","orcid":"0000-0002-0943-0061","position":6,"is_corresponding":false},{"id":1476584,"name":"A. N. Sundar","orcid":null,"position":0,"is_corresponding":true}],"reference_count":45,"raw_metadata":null,"created_at":"2026-07-19T02:57:11.713851Z","pmid":"40693755","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}