Expert advice: Delivering health information to African American smokers who are not motivated to quit

Although African Americans suffer disproportionately from smoking related illnesses, few studies have examined ethnic differences in processing health and smoking information. This study examines ethnic differences in unmotivated smokers' preference for receiving counseling to quit smoking in an expert oriented style, and whether ethnicity and style of counseling predicts alliance with counselor, perceived influence on smoking, and treatment satisfaction. Participants were 255 community residents (57% male; 68% African American) in a randomized controlled trial comparing expert-oriented Health Education (HE) with patient-centered Motivational Interviewing. Compared to Whites, African American participants had a significantly higher preference for “being told what to do by an expert” (p < .031), although on average both African Americans (M = 2.84, SD = 1.13) and Whites (M = 3.18, SD = 1.) indicated only a moderate degree of preference for expert direction on a 5 point scale. Separate GLM analyses predicting therapeutic alliance and study satisfaction from ethnicity and treatment group revealed neither main effects nor any significant interactions. However, a GLM model predicting perceived influence of counseling on smoking behavior revealed a trend (p <.065) of treatment group favoring the impact of HE. Results of this study suggest that although African Americans may prefer more expert direction than Whites, this preference does not appear to negatively impact therapeutic alliance or satisfaction with more patient-centered counseling. Understanding the ways patients prefer processing information and the real impact on outcomes may help researchers and practitioners design and implement more effective strategies to promote smoking cessation.