Introduction
tobacco-related disease
About 1 of every 7 non-Hispanic Black adults in the United States smoke.Early abstinence is an important but overlooked target for intervention. More than two-thirds of individuals who smoke and do not achieve abstinence within 4 weeks of initiating pharmacotherapy do not achieve abstinence at later time points.Within tobacco dependence, existing studies suggest changing pharmacotherapy results in higher rates of abstinence for those who do not show initial treatment response.Prior studies have adapted pharmacotherapy only once and/or focused on adaptation distal to a failed quit attempt,This study is the first to examine if multiple pharmacotherapy adaptions proximal to a failed quit attempt (adapted therapy [ADT]) lead to higher rates of abstinence for Black adults who smoke compared with continuing with a single pharmacotherapy for the duration of treatment (usual care [UC]). While this treatment approach may benefit all adults who smoke, we focus on Black adults who smoke because they bear a disproportionate share of tobacco-related disease and have lower prevalence of pharmacotherapy supported sustained cessation relative to other racial or ethnic groups.