How do HIV-infected smokers react to cigarette price increases? Evidence from the APROCO-COPILOTE-ANRS CO8 Cohort

Behavioral cardiovascular risk factors in HIV-infected people in France: Diversity of profiles across groups requires an urgent and tailored preventive approach

BACKGROUND

Among people living with HIV, cardiovascular risk could be markedly reduced through lifestyle improvement. However, to date behavioral cardiovascular risk factors (other than tobacco smoking) have been poorly investigated among them. Additionally, although co-occurrence of risk factors might amplify the deleterious effects of each risk factor, little is known about such risk factors clustering in this population. We aimed to examine levels, determinants and clustering of the major behavioral cardiovascular risk factors in the French HIV-infected population, in order to better target individuals with high risk profiles.

METHODS

The ANRS-Vespa2 survey was conducted among a national representative sample of HIV-infected people followed at hospital in France in 2011. Frequency and co-occurrence of tobacco smoking, alcohol intake, low physical activity and obesity were assessed in the HIV-infected population, overall and in each of the distinctive socio-epidemiological group composing it (men who have sex with men, intravenous drug users, sub-Saharan African migrants, non-African heterosexuals). Individual characteristics associated with each of these indicators were investigated using multivariable Poisson regression models.

RESULTS

The 2537 participants (median time since HIV-diagnosis: 12 years) included 39.4% men who have sex with men, 11.0% intravenous drug users, 23.5% sub-Saharan African migrants and 26.1% non-African heterosexuals. Overall, 29.4% were regular smokers, 13.8% were heavy drinkers, 14.8% lacked physical activity and 8.6% were obese. Half of the participants reported at least one risk factor with co-occurrence observed in 13.8% of the sample. However, those figures varied markedly across the groups. Main risk factors profiles were 1) regular smoking, heavy drinking, low physical activity alone or combined among intravenous drug users and men who have sex with men, 2) obesity and low physical activity usually alone among sub-Saharan African migrant women, 3) occurrence of the four risk factors separately or sometimes combined among sub-Saharan African migrant men and non-African heterosexuals. These risk factors were correlated with lower socioeconomic status and poorer health status.

CONCLUSIONS

Those findings highlight the need to focus on all behavioral cardiovascular risk factors and co-occurrence (and not only on tobacco smoking) in HIV-infected people and to implement preventive approach tailored to the specific needs of the different socio-epidemiological groups.

[Interventions for smoking cessation among low socioeconomic status smokers: a literature review]

INTRODUCTION

In most western countries, smoking appears to be highly differentiated according to socio-economic level. Two systematic reviews published in 2014 showed that most of the recommended interventions for smoking cessation, particularly individual interventions, tend to increase social inequalities in health. An analysis of the most recent literature was carried out in order to provide policy makers and stakeholders with a set of evidence on the modalities of interventions to encourage and help disadvantaged smokers quit smoking.

METHODS

This review was based on articles published between January 2013 and April 2016. Only studies conducted in European countries or countries in stage 4 of the tobacco epidemic (USA, Canada, Australia, New Zealand) were included. Selected articles were double-screened.

RESULTS

Twenty-three studies were identified, including evaluation of media campaigns, face-to-face behavioural support, phone- and web-based support or awareness of passive smoking among children. Some interventions adapted to precarious populations have been shown to be effective.

CONCLUSIONS

Some characteristics would facilitate access and improve the support of disadvantaged groups, including a local intervention, a proactive approach and co-construction with targeted smokers.

Tobacco use cessation interventions for lesbian, gay, bisexual, transgender and queer youth and young adults: A scoping review

Smoking prevalence among LGBTQ + youth and young adults is alarmingly high compared to their non-LGBTQ + peers. The purpose of the scoping review was to assess the current state of smoking prevention and cessation intervention research for LGBTQ + youth and young adults, identify and describe these interventions and their effectiveness, and identify gaps in both practice and research.

A search for published literature was conducted in PubMed, Scopus, CINAHL, PsychInfo, and LGBT Life, as well as an in-depth search of the grey literature. All English articles published or written between January 2000 and February 2016 were extracted.

The search identified 24 records, of which 21 were included; 11 from peer reviewed sources and 10 from the grey literature. Of these 21, only one study targeted young adults and only one study had smoking prevention as an objective. Records were extracted into evidence tables using a modified PICO framework and a narrative synthesis was conducted. The evidence to date is drawn from methodologically weak studies; however, group cessation counselling demonstrates high quit rates and community-based programs have been implemented, although very little evidence of outcomes exist. Better-controlled research studies are needed and limited evidence exists to guide implementation of interventions for LGBTQ + youth and young adults.

This scoping review identified a large research gap in the area of prevention and cessation interventions for LGBTQ youth and young adults. There is a need for effective, community-informed, and engaged interventions specific to LGBTQ + youth and young adults for the prevention and cessation of tobacco.

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We conducted a scoping review on cessation programs for LGBTQ + young adults.

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A large research gap in the area of tobacco control for LGBTQ + young adults exists.

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Tobacco control interventions specific to LGBTQ + youth and young adults are needed.

Promotion of tobacco use cessation for lesbian, gay, bisexual, and transgender people: a systematic review

CONTEXT

Lesbian, gay, bisexual, and transgender (LGBT) people are at increased risk for the adverse effects of tobacco use, given their high prevalence of use, especially smoking. Evidence regarding cessation is limited. To determine if efficacious interventions are available and to aid the development of interventions, a systematic review was conducted of grey and peer-reviewed literature describing clinical, community, and policy interventions, as well as knowledge, attitudes, and behaviors regarding tobacco use cessation among LGBT people.

EVIDENCE ACQUISITION

Eight databases for articles from 1987 to April 23, 2014, were searched. In February-November 2013, authors and researchers were contacted to identify grey literature.

EVIDENCE SYNTHESIS

The search identified 57 records, of which 51 were included and 22 were from the grey literature; these were abstracted into evidence tables, and a narrative synthesis was conducted in October 2013-May 2014. Group cessation curricula tailored for LGBT populations were found feasible to implement and show evidence of effectiveness. Community interventions have been implemented by and for LGBT communities, although these interventions showed feasibility, no rigorous outcome evaluations exist. Clinical interventions show little difference between LGBT and heterosexual people. Focus groups suggest that care is needed in selecting the messaging used in media campaigns.

CONCLUSIONS

LGBT-serving organizations should implement existing evidence-based tobacco-dependence treatment and clinical systems to support treatment of tobacco use. A clear commitment from government and funders is needed to investigate whether sexual orientation and gender identity moderate the impacts of policy interventions, media campaigns, and clinical interventions.

Equity impact of population-level interventions and policies to reduce smoking in adults: a systematic review

BACKGROUND AND AIMS

There is strong evidence about which tobacco control policies reduce smoking. However, their equity impact is uncertain. The aim was to assess the effectiveness of population-level interventions/policies to reduce socioeconomic inequalities in adult smoking.

METHODS

Systematic review of studies of population-level interventions/policies reporting smoking-related outcomes in adults of lower compared to higher socioeconomic status (SES). References were screened and independently checked. Studies were quality assessed. Results are presented in a narrative synthesis. Equity impact was assessed as: positive (reduced inequality), neutral (no difference by SES), negative (increased inequality), mixed (equity impact varied) or unclear.

RESULTS

117 studies of 130 interventions/policies were included: smokefree (44); price/tax (27); mass media campaigns (30); advertising controls (9); cessation support (9); settings-based interventions (7); multiple policies (4). The distribution of equity effects was: 33 positive, 36 neutral, 38 negative, 6 mixed, 17 unclear. Most neutral equity studies benefited all SES groups. Fourteen price/tax studies were equity positive. Voluntary, regional and partial smokefree policies were more likely to be equity negative than national, comprehensive smokefree policies. Mass media campaigns had inconsistent equity effects. Cigarette marketing controls were equity positive or neutral. Targeted national smoking cessation services can be equity positive by achieving higher reach among low SES, compensating for lower quit rates.

CONCLUSIONS

Few studies have assessed the equity impact of tobacco control policy/interventions. Price/tax increases had the most consistent positive equity impact. More research is needed to strengthen the evidence-base for reducing smoking inequalities and to develop effective equity-orientated tobacco control strategies.

State-level tobacco environments and sexual orientation disparities in tobacco use and dependence in the USA

OBJECTIVE

To describe relationships between tobacco-related environments and disparities in smoking by sexual orientation.

METHODS

We examined three aspects of state-level tobacco environments, which were derived from the ImpacTeen State Level Tobacco Control Policy and Prevalence Database: (1) tobacco price and tax data and tobacco control funding; (2) tobacco control policies and (3) tobacco prevalence and norms data. This information was linked to individual-level data on sexual orientation, tobacco use and nicotine dependence in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N=34 653; 577 LGB respondents), a cross-sectional, nationally representative survey of adults in the USA.

RESULTS

Lesbian, gay and bisexual (LGB) adults in states with more restrictive tobacco environments were less likely to have ever smoked (AOR=0.78, 95% CI 0.62 to 1.00) and to currently smoke (AOR=0.77, 95% CI 0.60 to 0.99) than LGB adults in more permissive tobacco environments. Further, sexual orientation disparities in past and current smoking, as well as in current nicotine dependence, were lower in states with the most restrictive tobacco environments. Results were robust to adjustment for confounders at the individual and state levels.

CONCLUSIONS

Restrictive state-level tobacco environments are correlates of smoking behaviours among LGB adults in the USA; such environments could potentially reduce social inequalities in smoking based on sexual orientation.

Effects of smoking on non-AIDS-related morbidity in HIV-infected patients

Tobacco smoking has many adverse health consequences. Patients with human immunodeficiency virus (HIV) infection smoke at very high rates, and many of the comorbidities associated with smoking in the general population are more prevalent in this population. It is likely that a combination of higher smoking rates along with an altered response to cigarette smoke throughout the body in persons with HIV infection leads to increased rates of the known conditions related to smoking. Several AIDS-defining conditions associated with smoking have been reviewed elsewhere. This review aims to summarize the data on non-AIDS-related health consequences of smoking in the HIV-infected population and explore evidence for the potential compounding effects on chronic systemic inflammation due to HIV infection and smoking.

A systematic review of the aetiology of tobacco disparities for sexual minorities

OBJECTIVE

To conduct a systematic review of the literature examining risk factors/correlates of cigarette smoking among lesbian, gay and bisexual (ie, sexual minority) populations.

METHODS

Sets of terms relevant to sexual minority populations and cigarette smoking were used in a simultaneous search of 10 databases through EBSCOhost. The search was limited to the peer-reviewed literature up to January 2011, using no geographic or language limits. For inclusion, the paper was required to: (1) have been written in English, (2) have sexual minorities (defined by either attraction, behaviour, or identity) included in the study population and (3) have examined some form of magnitude of association for risk factors/correlates of any definition of cigarette smoking. A total of 386 abstracts were reviewed independently, with 26 papers meeting all inclusion criteria. Abstracts were reviewed and coded independently by authors JB and JGLL using nine codes derived from the inclusion/exclusion criteria.

RESULTS

Studies used various measures of sexual orientation and of smoking. Risk factors that could be considered unique to sexual minorities included internalised homophobia and reactions to disclosure of sexual orientation. Some studies also indicated common smoking risk factors experienced at higher rates among sexual minorities, including stress, depression, alcohol use and victimisation.

CONCLUSIONS

This review identified risks that were associated with sexual minority status and common to the general population but experienced at potentially higher rates by sexual minorities. Government and foundation funds should be directed towards research on the origins of this disparity.