Cigarette smoking in HIV-positive populations
Initial Award Abstract
There are higher smoking rates in HIV-positive populations than the general public. Cigarette smoking has been shown to increase the risks of HIV-related medical conditions. Thus, it is important to develop effective smoking treatments for this population. However, many HIV-positive individuals face psychological, physical, and interpersonal issues that are associated with smoking treatment failure in other populations. In a small pilot study, we found that HIV-positive smokers were less likely to quit smoking than a comparison group following 12-weeks of treatment. HIV-positive smokers also scored higher on measures of depression, anxiety, and anger. With the advent of better HIV treatments and a shift towards thinking of HIV disease as a chronic disease, effective smoking cessation treatments with this population are essential.
The specific aims of the proposed studies are: to identify the important treatment elements to emphasize in smoking cessation programs for this population; to identify perceived barriers to treatment, preferred treatment elements, and preferred treatment settings; and to use this information to develop effective smoking treatments for HIV-positive cigarette smokers. The proposed study will focus on the two major populations impacted by HIV disease, gay men and injection drug users. This research will tell us if HIV-positive smokers differ from HIV-negative smokers on a variety of issues known to influence success in quitting smoking (depression and poor mood, higher levels of stress) as well as issues which may influence success (less personal control over health-related problems, less optimism regarding the future, etc). Three studies will be conducted during this preliminary research. First, 65 HIV-positive and 65 HIV-negative gay male smokers will be interviewed and complete questionnaires on a variety of psychological and social factors known to be related to success in quitting smoking, including depression, stress, perceived control over health issues, and readiness or motivation to quit smoking. HIV-positive and HIV-negative smokers will be compared on these variables. In a second study, these procedures will be repeated with 65 HIV-positive and 65 HIV-negative injection drug-using smokers. In a third study, 36 HIV-positive current smokers and 36 HIV-positive former smokers, will participate in focus groups to identify other variables that may influence seeking treatment to quit smoking as well as the success of treatment. Information from this preliminary work will be examined to identify issues to emphasize when treating HIV-positive smokers.
The long-term goals of this line of work are to develop effective smoking cessation treatments for HIV-positive smokers. The current proposal is a first step that will provide descriptive information that can be used to adapt current treatment procedures and develop new strategies to treat nicotine dependence in this population.
This developmental research protocol responds directly to several TRDRP's research priorities. This work will identify smoking-related factors among a sector of California's population that has not been studied and will examine variables that may contribute to continued smoking in this population. From a treatment perspective, this preliminary research will provide valuable information that will be used to develop effective smoking cessation treatments for this population. |
Given the high smoking rates in HIV-positive populations and the negative effect of cigarette smoking on HIV-related medical conditions, it is important to develop effective smoking treatments for this population. The specific aims of the current project were: to identify the important treatment elements to emphasize in smoking cessation programs for this population; to identify perceived barriers to treatment, preferred treatment elements, and preferred treatment settings; and to use this information to develop effective smoking treatments for HIV-positive cigarette smokers. We successfully achieved these goals.
The first study compared 68 HIV-positive gay male smokers with 67 HIV-negative gay male smokers on measures of nicotine dependence, mood, history of depression, stress, and readiness to quit smoking. We found that HIV-positive and HIV-negative gay male smokers did not differ on measures of nicotine dependence, current mood, and stress. Both HIV-positive and HIV-negative gay men reported high rates of Major Depressive Disorders and high levels of negative mood, particularly in comparison to a sample of male smokers from the general community. Both depression and negative mood are related to smoking treatment failure. We also found that HIV-positive men were significantly more likely to be ready to quit smoking than the sample of HIV-negative men.
We completed focus groups with 92 current smokers and former smokers. Participants identified smoking as a method to deal with stress, and a method for coping with and preventing depression. Many felt that quitting would have no impact on HIV illness. Most HIV-positive smokers in this sample were unaware of specific relationships between smoking and HIV illness. Many report that medical professionals suggest quitting, but offer little support. Many felt that treatments need to be intensive, convenient, and low cost. |