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Tedaldi E, Armon C, Li J, Mahnken J, Simoncini G, Palella F, Carlson K, Buchacz K. A Heavy Burden: Preexisting Physical and Psychiatric Comorbidities and Differential Increases Among Male and Female Participants After Initiating Antiretroviral Therapy in the HIV Outpatient Study, 2008-2018. AIDS Res Hum Retroviruses 2022; 38:519-529. [PMID: 35451335 DOI: 10.1089/aid.2021.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Attention to non-AIDS comorbidities is increasingly important in the HIV care and management in the United States. We sought to assess comorbidities before and after antiretroviral therapy (ART) initiation among persons with HIV (PWH). Using the 2008-2018 HIV Outpatient Study (HOPS) data, we assessed changes in prevalence of physical and psychiatric comorbidities, by sex, among participants initiating ART. Cox proportional hazards models were fit to investigate factors associated with the first documented occurrence of key comorbidities, adjusting for demographics and other covariates, including insurance type, CD4+ cell count, ART regimen, and smoking status. Among 1,236 participants who initiated ART (median age 36 years, CD4 cell count 375 cells/mm3), 79% were male, 66% non-white, 44% publicly insured, 53% ever smoked, 33% had substance use history, and 22% had body mass index ≥30 kg/m2. Among females, the percentages with at least one condition were: at ART start, 72% had a physical and 42% a psychiatric comorbidity, and after a median of 6.1 years of follow-up, these were 87% and 63%, respectively. Among males, the percentages with at least one condition were: at ART start, 61% had a physical and 32% a psychiatric comorbidity, and after a median of 4.6 years of follow-up, these were 82% and 53%, respectively. In multivariable Cox proportional hazards analyses, increasing age and higher viral loads (VL) were associated with most physical comorbidities, and being a current/former smoker and higher VL were associated with all psychiatric comorbidities analyzed. HOPS participants already had a substantial burden of physical and psychiatric comorbidities at the time of ART initiation. With advancing age, PWH who initiate ART experience a clinically significant increase in the burden of chronic non-HIV comorbidities that warrants continued surveillance, prevention, and treatment.
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Affiliation(s)
- Ellen Tedaldi
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Carl Armon
- Cerner Corporation, Kansas City, Missouri, USA
| | - Jun Li
- Division of HIV/AIDS Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Gina Simoncini
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Frank Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Kate Buchacz
- Division of HIV/AIDS Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Breger TL, Westreich D, Edmonds A, Edwards JK, Zalla LC, Cole SR, Ramirez C, Ofotokun I, Kassaye SG, Brown TT, Konkle-Parker D, Jones DL, D'Souza G, Cohen MH, Tien PC, Taylor TN, Anastos K, Adimora AA. A new smoking cessation 'cascade' among women with or at risk for HIV infection. AIDS 2022; 36:107-116. [PMID: 34586086 PMCID: PMC8819357 DOI: 10.1097/qad.0000000000003089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to define a smoking cessation 'cascade' among USA women with and without HIV and examine differences by sociodemographic characteristics. DESIGN An observational cohort study using data from smokers participating in the Women's Interagency HIV Study between 2014 and 2019. METHODS We followed 1165 women smokers with and without HIV from their first study visit in 2014 or 2015 until an attempt to quit smoking within approximately 3 years of follow-up, initial cessation (i.e. no restarting smoking within approximately 6 months of a quit attempt), and sustained cessation (i.e. no restarting smoking within approximately 12 months of a quit attempt). Using the Aalen-Johansen estimator, we estimated the cumulative probability of achieving each step, accounting for the competing risk of death. RESULTS Forty-five percent of smokers attempted to quit, 27% achieved initial cessation, and 14% achieved sustained cessation with no differences by HIV status. Women with some post-high school education were more likely to achieve each step than those with less education. Outcomes did not differ by race. Thirty-six percent [95% confidence interval (95% CI): 31-42] of uninsured women attempted to quit compared with 47% (95% CI: 44-50) with Medicaid and 49% (95% CI: 41-59) with private insurance. CONCLUSION To decrease smoking among USA women with and without HIV, targeted, multistage interventions, and increased insurance coverage are needed to address shortfalls along this cascade.
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Affiliation(s)
- Tiffany L. Breger
- Department of Medicine, University of North Carolina School of Medicine,Chapel Hill
| | - Daniel Westreich
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, at Chapel Hill, North Carolina
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, at Chapel Hill, North Carolina
| | - Jessie K. Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, at Chapel Hill, North Carolina
| | - Lauren C. Zalla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, at Chapel Hill, North Carolina
| | - Stephen R. Cole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, at Chapel Hill, North Carolina
| | - Catalina Ramirez
- Department of Medicine, University of North Carolina School of Medicine,Chapel Hill
| | - Igho Ofotokun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Seble G. Kassaye
- Department of Medicine, Georgetown University, Washington, District of Columbia
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Gypsyamber D'Souza
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital of Cook County Health and Hospitals System, Chicago, Illinois
| | - Phyllis C. Tien
- Department of Medicine, University of California San Francisco, and Department of Veterans Affairs, San Francisco, California
| | - Tonya N. Taylor
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Adaora A. Adimora
- Department of Medicine, University of North Carolina School of Medicine,Chapel Hill
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, at Chapel Hill, North Carolina
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Redding CA, Goldberg D, Weber KM, Yin HQ, Paiva AL, Burke-Miller J, Cohen MH, Rossi JS. Cross-validation of transtheoretical model smoking cessation measures in Chicago WIHS women smokers with and at risk for HIV. Transl Behav Med 2021; 10:457-468. [PMID: 30715533 DOI: 10.1093/tbm/ibz001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
People with and at risk for HIV have high rates of smoking, increasing their morbidity and mortality. Effective cessation interventions are needed for this group. Transtheoretical model (TTM)-tailored interventions have demonstrated efficacy, but measures need cross-validation in this population. TTM cessation measures were evaluated in women smokers with and at risk for HIV (N = 111) from Chicago Women's Interagency HIV Study (WIHS). Confirmatory factor analyses evaluated measurement models. MANOVAs examined relationships between constructs and stage subgroups. For decisional balance, the two-factor uncorrelated model was best (χ2(20) = 13.96; comparative fit index [CFI], 1.0; root mean square error of approximation [RMSEA] = .00), with good (pros α = .78) and fair (cons α = .55) four-item alphas. The one-factor temptations model (α = .90) showed reasonable fit (χ2(18) = 80.22; CFI = .89; RMSEA = .177). Processes of change subscales had fair to good two-item alphas (α = .49-.77) and fit a 10-factor fully correlated model (χ2(125) = 222.72; CFI = .88; RMSEA = .084). MANOVAs by stage of change replicated expected patterns for the pros, overall temptations, and two process subscales with medium-sized effects (η2 = .06-.18). Contrary to expectations, no differences by stage were found for cons or temptation negative affect subscales. The structures of these TTM measures replicated with good internal and external validity, except for the cons, which needs refinement. Negative affect temptations was structurally sound, but did not vary by stage group potentially reflecting this sample's moderate depression levels and/or their reliance on smoking to deal with negative affect. Results support the use of most TTM measures in research and tailored interventions to increase smoking cessation among women smokers with and at risk for HIV and highlight the importance of managing negative affect in cessation materials targeting this group.
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Affiliation(s)
- Colleen A Redding
- Cancer Prevention Research Center, Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - David Goldberg
- Department of Medicine, Cook County Health and Hospital System and Rush University, Chicago, IL, USA
| | - Kathleen M Weber
- The CORE Center at Cook County Health and Hospital System, Chicago, IL, USA
| | - Hui-Qing Yin
- Cancer Prevention Research Center, Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Andrea L Paiva
- Cancer Prevention Research Center, Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Jane Burke-Miller
- The CORE Center at Cook County Health and Hospital System, Chicago, IL, USA
| | - Mardge H Cohen
- Department of Medicine, Cook County Health and Hospital System and Rush University, Chicago, IL, USA.,The CORE Center at Cook County Health and Hospital System, Chicago, IL, USA
| | - Joseph S Rossi
- Cancer Prevention Research Center, Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
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Zyambo CM, Burkholder GA, Cropsey KL, Willig JH, Wilson CM, Gakumo CA, Westfall AO, Hendricks PS. Predictors of smoking cessation among people living with HIV receiving routine clinical care. AIDS Care 2019; 31:1353-1361. [PMID: 31117821 DOI: 10.1080/09540121.2019.1619659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
People living with HIV (PLWH) have a higher prevalence of smoking and are less likely to quit smoking than the general population. Few studies involving a large sample of PLWH receiving routine care have evaluated factors associated with smoking cessation. This retrospective longitudinal cohort study evaluated factors associated with smoking cessation among PLWH from 2007 to 2018. Of 1,714 PLWH smokers included in the study, 27.6% reported quitting smoking. Suppressed plasma HIV-1 RNA (<200 copies/ml) was significantly associated with an increased likelihood of smoking cessation (HRadjusted = 1.27, 95% CI [1.03, 1.58]); whereas age/10 year increments (HRadjusted = 0.12, 95% CI [0.04, 0.38]), greater length of care at the HIV clinic (HRadjusted = 0.97, 95% CI [0.94, 0.99]), lack of insurance (HRadjusted = 0.77, 95% CI [0.61, 0.99]) or having public insurance (HRadjusted = 0.74, 95% CI [0.55, 0.97)]), current substance use (HRadjusted = 0.66, 95% CI [0.43, 0.97]) and risk of developing alcohol use disorder (HRadjusted = 0.60, 95% CI [0.43, 0.84]) were associated with a reduced likelihood of quitting smoking. These findings underscore the importance of early smoking cessation intervention among PLWH. In addition, targeted smoking cessation intervention strategies are needed for groups at risk for being less likely to quit, including older patients, and those with alcohol and substance use disorders.
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Affiliation(s)
- Cosmas M Zyambo
- Department of Health Behavior, School of Public Health, University of Alabama , Birmingham , AL , USA.,Division of Infectious Diseases, School of Medicine, University of Alabama , Birmingham , AL , USA.,Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University , New Haven , CT , USA.,Department of Epidemiology, School of Public Health, University of Zambia , Lusaka , Zambia
| | - Greer A Burkholder
- Division of Infectious Diseases, School of Medicine, University of Alabama , Birmingham , AL , USA
| | - Karen L Cropsey
- Department of Psychiatry, School of Medicine, University of Alabama , Birmingham , AL , USA
| | - James H Willig
- Division of Infectious Diseases, School of Medicine, University of Alabama , Birmingham , AL , USA
| | - Craig M Wilson
- Department of Epidemiology, School of Public Health, University of Alabama , Birmingham , AL , USA
| | - C Ann Gakumo
- Department of Nursing, University of Massachusetts , Boston , MA , USA
| | - Andrew O Westfall
- Department of Biostatistics, School of Public Health, University of Alabama , Birmingham , AL , USA
| | - Peter S Hendricks
- Department of Health Behavior, School of Public Health, University of Alabama , Birmingham , AL , USA
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Li Y, Nouraie SM, Kessinger C, Weinman R, Huang L, Greenblatt RM, Kleerup E, Kingsley L, McMahon D, Fitzpatrick M, Morris A. Factors Associated With Progression of Lung Function Abnormalities in HIV-Infected Individuals. J Acquir Immune Defic Syndr 2018; 79:501-509. [PMID: 30142142 PMCID: PMC6203646 DOI: 10.1097/qai.0000000000001840] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND HIV is an independent risk factor for chronic obstructive pulmonary disease; however, baseline risk factors for lung function decline remain largely unknown in this population. METHODS HIV-infected participants in the Pittsburgh Lung HIV Cohort with at least 3 pulmonary function measurements between 2007 and 2016 were included. Pulmonary function testing including postbronchodilator (BD) spirometry and diffusion capacity for carbon monoxide (DLco) was performed every 18 months. We used a mixed-effect linear model to evaluate factors associated with pulmonary function testing and DLco decline and logistic regression models to evaluate factors associated with rapid FEV1 decline (defined as >80 mL per year) and any DLco decline. RESULTS Two hundred eighty-five HIV-infected participants were included. Median baseline CD4 cell count was 521 cells per micro liter, 61.9% had an undetectable HIV viral load at baseline, and 78.5% were receiving ART. Approximately 20% of participants met Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for a diagnosis of chronic obstructive pulmonary disease at baseline. Older age and baseline GOLD stage 1 compared with stage 0 were associated with faster decline in post-BD FEV1%, whereas female sex was associated with slower decline. Similarly, female sex was associated with slower decline in DLco%. HIV-related factors including CD4 cell count, viral load, and ART use were not significantly associated with pulmonary function decline. CONCLUSIONS Older age, male sex, and higher baseline GOLD stage were associated with more rapid post-BD FEV1% decline in HIV-infected individuals.
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Affiliation(s)
- Yijia Li
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Seyed Mehdi Nouraie
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Cathy Kessinger
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Renee Weinman
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Laurence Huang
- Department of Medicine, School of Medicine, University of California, San Francisco, CA
| | - Ruth M. Greenblatt
- Departments of Clinical Pharmacy, Epidemiology, Biostatistics and Medicine, University of California, San Francisco, CA
| | - Eric Kleerup
- Department of Medicine, University of California, Los Angeles, CA
| | - Lawrence Kingsley
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Deborah McMahon
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Meghan Fitzpatrick
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Alison Morris
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
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6
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Outcomes for a Public Hospital Tobacco Cessation Program: The Cook County Health and Hospitals System Experience. J Community Health 2018; 41:1130-1139. [PMID: 27393143 DOI: 10.1007/s10900-016-0215-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this study is to determine the rate and predictors of sustained smoking cessation for a cohort of smokers exposed to a guideline-based health education program delivered during routine clinical care at an urban public hospital. This is a retrospective analysis of 755 public hospital system patients who had at least two health educator contacts embedded in routine clinical care, with the latter contact 12-18 months after the baseline. The education occurred during visits to primary care, specialty clinics, urgent/episodic care, or during hospitalization. The assessment of smoking status is determined by the health educators as part of their routine assessment and recorded in the program's database. The primary outcomes are self-reported 12-month sustained smoking cessation at the 12-18 month contact and predictors of cessation. The cohort is predominantly minority smokers (African American 69 % and Latino 15 %) and uninsured (70 %) or on Medicaid (13 %). The sustained cessation rate was 9.3 %. Latino ethnicity, smoking 1-9 cigarettes/day at baseline, reporting smoke-free home, and additional educator contact in the year after the baseline were independent predictors of sustained cessation in the multivariate analysis. Smokers with multiple risks for poor cessation outcomes exposed to a guideline-based program of health education during routine healthcare encounters had sustained smoking cessation rates that compare favorably with published National Health Interview Study population cessation rates. An additional educator contact after the baseline was a predictor of cessation. The findings support development of cessation programs in which health educators are integrated into clinical care settings.
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Westreich D, Cates J, Cohen M, Weber KM, Seidman D, Cropsey K, Wright R, Milam J, Young MA, Mehta CC, Gustafson DR, Golub ET, Fischl MA, Adimora AA. Smoking, HIV, and risk of pregnancy loss. AIDS 2017; 31:553-560. [PMID: 27902507 PMCID: PMC5263172 DOI: 10.1097/qad.0000000000001342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/24/2016] [Accepted: 10/31/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Cigarette smoking during pregnancy increases risks of poor pregnancy outcomes including miscarriage and stillbirth (pregnancy loss), but the effect of smoking on pregnancy loss among HIV-infected women has not been explored. Here, investigated the impact of smoking on risk of pregnancy loss among HIV-positive and HIV-negative women, and estimated the potential impact of realistic smoking cessation interventions on risk of pregnancy loss among HIV-positive women. DESIGN We analyzed pregnancy outcomes in HIV-positive and HIV-negative participants in the Women's Interagency HIV Study between 1994 and 2014. METHODS We estimated effects of current smoking at or immediately before pregnancy on pregnancy loss; we controlled for confounding using regression approaches, and estimated potential impact of realistic smoking cessation interventions using a semiparametric g-formula approach. RESULTS Analysis examined 1033 pregnancies among 659 women. The effect of smoking on pregnancy loss differed dramatically by HIV status: adjusted for confounding, the risk difference comparing current smokers to current nonsmokers was 19.2% (95% confidence limit 10.9-27.5%) in HIV-positive women and 9.7% (95% confidence limit 0.0-19.4%) in HIV-negative women. These results were robust to sensitivity analyses. We estimated that we would need to offer a realistic smoking cessation intervention to 36 women to prevent one pregnancy loss. CONCLUSION Smoking is a highly prevalent exposure with important consequences for pregnancy in HIV-positive pregnant women in the United States, even in the presence of potent highly active antiretroviral therapy. This evidence supports greater efforts to promote smoking cessation interventions among HIV-positive women, especially those who desire to become pregnant.
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Affiliation(s)
- Daniel Westreich
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina
| | - Jordan Cates
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina
| | - Mardge Cohen
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County and Rush Medical College
| | - Kathleen M. Weber
- Hektoen Institute of Medicine/The CORE Center, Cook County Health & Hospital Systems, Chicago, Illinois
| | - Dominika Seidman
- Department of Obstetrics, Gynecology & Reproductive Health Services, University of California San Francisco, San Francisco, California
| | - Karen Cropsey
- Department of Psychiatry and Behavior Neurobiology, University of Alabama Birmingham, Birmingham, Alabama
| | - Rodney Wright
- Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Joel Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Mary A. Young
- Division of Infectious Diseases, Georgetown University, Washington, District of Columbia
| | - C. Christina Mehta
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | | | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Margaret A. Fischl
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Adaora A. Adimora
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina
- Department of Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
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Predictors of tobacco smoking abstinence among tuberculosis patients in South Africa. J Behav Med 2015; 38:472-82. [PMID: 25655663 DOI: 10.1007/s10865-015-9620-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
Abstract
This study examines predictors of smoking cessation in tuberculosis patients with high HIV co-infection rates in a South African primary care setting. Current smokers were randomly allocated to brief motivational interviewing (n = 205) or receipt of a brief message (n = 204). Multi-level logistic regression was performed to identify predictors of sustained 3- and 6-month abstinence and 7-day point prevalence abstinence (PPA) at 1 month, with the facility as a random effect. The intervention was ineffective among smokers with high nicotine-dependence at 1 month, but was effective for all smokers over longer periods. Higher baseline self-efficacy predicted the 1-month 7-day PPA, but not sustained abstinence. HIV-positive participants' odds of sustained abstinence were about three times higher than those of their HIV-negative counterparts. Results support a more intensive motivational intervention and/or coping skills' training to increase self-efficacy and abstinence rates. Tobacco cessation services can be introduced in tuberculosis services where high HIV co-infection rates occur.
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Pacek LR, Crum RM. A Review of the Literature Concerning HIV and Cigarette Smoking: Morbidity and Mortality, Associations with Individual- and Social-Level Characteristics, and Smoking Cessation Efforts. ADDICTION RESEARCH & THEORY 2015; 23:10-23. [PMID: 28529471 PMCID: PMC5436803 DOI: 10.3109/16066359.2014.920013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Cigarette smoking is endemic among many populations, but is especially prevalent among people living with HIV, and is consequently associated with a variety of types of morbidity as well as mortality. Despite this knowledge, relatively little research has been conducted among smokers living with HIV. Extant research has focused on examining individual-level characteristics associated with smoking behaviors, to the neglect of examining social-level factors. This manuscript represents a critical literature review of the intersecting research fields of HIV and cigarette smoking. Topics considered within this review include: morbidity, mortality, as well as treatment and medication adherence outcomes; individual- and social-level characteristics associated with various smoking behaviors; evidence-based smoking cessation interventions; and findings from cessation interventions among smokers living with HIV. Additionally, gaps in the existing literature, as well as directions for future research were identified and discussed.
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Affiliation(s)
- Lauren R. Pacek
- Johns Hopkins Bloomberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, Maryland
| | - Rosa M. Crum
- Johns Hopkins Bloomberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland
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Hessol NA, Weber KM, D'Souza G, Burton D, Young M, Milam J, Murchison L, Gandhi M, Cohen MH. Smoking cessation and recidivism in the Women's Interagency Human Immunodeficiency Virus Study. Am J Prev Med 2014; 47:53-69. [PMID: 24746376 PMCID: PMC4065848 DOI: 10.1016/j.amepre.2014.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 02/14/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Smoking increases the risk of morbidity and mortality and is particularly harmful to HIV-infected people. PURPOSE To explore smoking trends and longitudinal factors associated with smoking cessation and recidivism among participants in the Women's Interagency HIV Study. METHODS From 1994 through 2011, a total of 2,961 HIV-infected and 981 HIV-uninfected women were enrolled and underwent semi-annual interviews and specimen collection. Smoking prevalence was evaluated annually and risk factors associated with time to smoking cessation and recidivism were analyzed in 2013 using survival models. RESULTS The annual cigarette smoking prevalence declined from 57% in 1995 to 39% in 2011 (p-trend<0.0001). Among smokers, factors significantly associated with a longer time to smoking cessation included less education, alcohol use, having health insurance, >10-year smoking duration, self-reported poor health rating, and having hypertension. Pregnancy in the past 6 months was associated with a shorter time to cessation. Among HIV-infected women, additional risk factors for longer time to cessation included lower household income, use of crack/cocaine/heroin, CD4 cell count ≤200, and highly active antiretroviral therapy (HAART) use. Predictors of smoking recidivism included marijuana use, enrollment in 1994-1996, and not living in one's own place. Among HIV-infected women, enrollment in 2001-2002 and crack/cocaine/heroin use were associated with a shorter time to recidivism, whereas older age and HAART use were associated with a longer time to recidivism. CONCLUSIONS Despite declining rates of cigarette smoking, integrated interventions are needed to help women with and at risk for HIV infection to quit smoking and sustain cessation.
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Affiliation(s)
- Nancy A Hessol
- Department of Clinical Pharmacy , University of California, San Francisco.
| | - Kathleen M Weber
- CORE Center, Cook County Health and Hospital System and Rush University, Chicago, Illinois
| | - Gypsyamber D'Souza
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Dee Burton
- Department of Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn
| | - Mary Young
- Georgetown University School of Medicine, Washington DC
| | - Joel Milam
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lynn Murchison
- Division of Internal Medicine , Montefiore Medical Center, Bronx, New York
| | - Monica Gandhi
- Department of Medicine, University of California, San Francisco
| | - Mardge H Cohen
- CORE Center, Cook County Health and Hospital System and Rush University, Chicago, Illinois; Department of Medicine, Cook County Health and Hospital System and Rush University, Chicago, Illinois
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Fletcher FE, Vidrine DJ, Tami-Maury I, Danysh HE, King RM, Buchberg M, Arduino RC, Gritz ER. Cervical cancer screening adherence among HIV-positive female smokers from a comprehensive HIV clinic. AIDS Behav 2014; 18:544-54. [PMID: 23605155 DOI: 10.1007/s10461-013-0480-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HIV-positive women are at elevated risk for developing cervical cancer. While emerging research suggests that gynecologic health care is underutilized by HIV-positive women, factors associated with adherence to Pap testing, especially among HIV-positive female smokers are not well known. We utilized baseline data from a smoking cessation trial and electronic medical records to assess Pap smear screening prevalence and the associated characteristics among the HIV-positive female participants (n = 138). 46 % of the women had at least 1 Pap test in the year following study enrollment. Multiple logistic regression analysis indicated that younger age, African American race, hazardous drinking, increased number of cigarettes smoked per day, and smoking risk perception were associated with non-adherence to Pap smear screening. Cervical cancer screening was severely underutilized by women in this study. Findings underscore the importance of identifying predictors of non-adherence and addressing multiple risk factors and behavioral patterns among HIV-positive women who smoke.
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Affiliation(s)
- Faith E Fletcher
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, PO Box 301439, Unit 1330, Houston, TX, 77030-1439, USA,
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Cook RL, Zhu F, Belnap BH, Weber KM, Cole SR, Vlahov D, Cook JA, Hessol NA, Wilson TE, Plankey M, Howard AA, Sharp GB, Richardson JL, Cohen MH. Alcohol consumption trajectory patterns in adult women with HIV infection. AIDS Behav 2013; 17:1705-12. [PMID: 22836592 PMCID: PMC3534826 DOI: 10.1007/s10461-012-0270-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
HIV-infected women with excessive alcohol consumption are at risk for adverse health outcomes, but little is known about their long-term drinking trajectories. This analysis included longitudinal data, obtained from 1996 to 2006, from 2,791 women with HIV from the Women's Interagency HIV Study. Among these women, the proportion in each of five distinct drinking trajectories was: continued heavy drinking (3 %), reduction from heavy to non-heavy drinking (4 %), increase from non-heavy to heavy drinking (8 %), continued non-heavy drinking (36 %), and continued non-drinking (49 %). Depressive symptoms, other substance use (crack/cocaine, marijuana, and tobacco), co-infection with hepatitis C virus (HCV), and heavy drinking prior to enrollment were associated with trajectories involving future heavy drinking. In conclusion, many women with HIV change their drinking patterns over time. Clinicians and those providing alcohol-related interventions might target those with depression, current use of tobacco or illicit drugs, HCV infection, or a previous history of drinking problems.
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Affiliation(s)
- Robert L Cook
- Department of Epidemiology, University of Florida, PO Box 100231, Gainesville, FL 32610, USA.
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Zachary D, Gillani FS, Najfi N, Casarella R, Tashima K. Cardiovascular health of HIV-infected African-American women at the Miriam Hospital Immunology Center in Providence, RI. MEDICINE AND HEALTH, RHODE ISLAND 2012; 95:179-182. [PMID: 22866506 PMCID: PMC5448158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Crothers K, Tindle HA. Prevention of bacterial pneumonia in HIV infection: focus on smoking cessation. Expert Rev Anti Infect Ther 2012; 9:759-62. [PMID: 21810046 DOI: 10.1586/eri.11.67] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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HIV and Cardiovascular Disease: The Impact of Cigarette Smoking. CURRENT CARDIOVASCULAR RISK REPORTS 2011. [DOI: 10.1007/s12170-011-0197-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lung cancer incidence and mortality among HIV-infected and HIV-uninfected injection drug users. J Acquir Immune Defic Syndr 2011; 55:510-5. [PMID: 20838223 DOI: 10.1097/qai.0b013e3181f53783] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To examine the impact of HIV on lung cancer incidence and survival. DESIGN : Prospective study of 2495 HIV-infected and HIV-uninfected injection drug users in Baltimore, MD. METHODS Cancer data were obtained from the Maryland Cancer Registry. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer in 2 strata of packs of cigarettes smoked per day by HIV serostatus, and for mortality by HIV serostatus. RESULTS HIV-infected participants had twice the risk (HR = 2.3; 95% CI: 1.1 to 5.1) of lung cancer. There was no evidence of an interaction between HIV and packs of cigarettes smoked per day (P interaction = 0.18). Compared with participants who smoked <1.43 packs per day, among HIV-uninfected individuals lung cancer risk was 6 times greater (HR = 5.9; 95% CI: 2.1 to 17) and among HIV-infected individuals lung cancer risk was doubled (HR = 2.1; 95% CI: 0.63 to 6.8) in persons who smoked ≥1.43 per day. Additionally, HIV was associated with 4 times the risk of death (HR = 3.8; 95% CI: 0.92 to 15) in lung cancer cases. CONCLUSIONS HIV was associated with increased risk of lung cancer, after adjusting for smoking. However, no evidence was observed for synergistic effects of HIV and smoking. Further, HIV was associated with poorer lung cancer survival after accounting for cancer stage.
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