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Hoang THL, Nguyen VM, Adermark L, Alvarez GG, Shelley D, Ng N. Factors Influencing Tobacco Smoking and Cessation Among People Living with HIV: A Systematic Review and Meta-analysis. AIDS Behav 2024; 28:1858-1881. [PMID: 38478323 PMCID: PMC11161546 DOI: 10.1007/s10461-024-04279-1] [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] [Accepted: 01/25/2024] [Indexed: 06/10/2024]
Abstract
Tobacco smoking is highly prevalent among people living with HIV (PLWH), yet there is a lack of data on smoking behaviours and effective treatments in this population. Understanding factors influencing tobacco smoking and cessation is crucial to guide the design of effective interventions. This systematic review and meta-analysis of studies conducted in both high-income (HICs) and low- and middle-income countries (LMICs) synthesised existing evidence on associated factors of smoking and cessation behaviour among PLWH. Male gender, substance use, and loneliness were positively associated with current smoking and negatively associated with smoking abstinence. The association of depression with current smoking and lower abstinence rates were observed only in HICs. The review did not identify randomised controlled trials conducted in LMICs. Findings indicate the need to integrate smoking cessation interventions with mental health and substance use services, provide greater social support, and address other comorbid conditions as part of a comprehensive approach to treating tobacco use in this population. Consistent support from health providers trained to provide advice and treatment options is also an important component of treatment for PLWH engaged in care, especially in LMICs.
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Affiliation(s)
- Thanh H L Hoang
- School of Public Health and Community Medicine, Institute for Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 18A, 41390, Gothenburg, Sweden.
| | - Van M Nguyen
- School of Public Health and Community Medicine, Institute for Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Louise Adermark
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gloria G Alvarez
- School of Global Public Health, New York University, New York, USA
| | - Donna Shelley
- School of Global Public Health, New York University, New York, USA
| | - Nawi Ng
- School of Public Health and Community Medicine, Institute for Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Obieche O, Lee M, Salehi N. Exploring attitudes towards smoking behaviour and cessation among hospitalised smokers via a socio-ecological framework: A scoping review. Addict Behav 2021; 122:107040. [PMID: 34246988 DOI: 10.1016/j.addbeh.2021.107040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/10/2021] [Accepted: 06/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Cigarette smoking is a leading cause of preventable mortality and disability. Smoke-free policies in healthcare settings have been implemented as a public health measure. This scoping review aims to explore attitudes on smokers' cessation in smoke-free healthcare settings using a socio-ecological framework. METHODS Four databases were searched for terms: smoking cessation, patient attitudes, and smoke-free policy. Of 420 studies, 17 met full inclusion criteria. RESULTS The review identified four socio-ecological aspects of smoking cessation in smoke-free healthcare settings: Intrapersonal factors (health literacy, health conditions, and self-efficacy), interpersonal factors (social support, peer pressure, and social responsibility), healthcare factors (perceived mixed messages, healthcare setting, clinical, psychosocial and health promotion supports), and societal factors (restrictions on smoking in a public place and social acceptability of smoking). Smoke-free policies effectively encouraged cessation in some patients but were ineffective in those that felt a loss of autonomy. Provision of smoke breaks within smoke-free policies was considered a mixed message. CONCLUSIONS Holistic strategies are required to interconnect the four socio-ecological dimensions for successful smoking cessation.
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Edwards S, Fitzgerald L, Mutch A, Dean JA, Ford P, Howard C, Watts P, Gartner C. Views and preferences of people living with HIV about smoking, quitting and use of nicotine products. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103349. [PMID: 34252787 DOI: 10.1016/j.drugpo.2021.103349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 10/20/2022]
Abstract
AIMS AND BACKGROUND People living with HIV (PLHIV) have a higher rate of smoking and experience a greater burden of tobacco-related disease than the general population. This study aimed to understand the role smoking plays in the lives of PLHIV, participants' views of traditionally available nicotine products (e.g., nicotine replacement therapy or NRT) and novel nicotine products (e.g., nicotine vaping products or NVPs) as both short-term quit aids and long-term substitutes for cigarettes. METHODS Semi-structured focus groups were conducted with PLHIV who smoked. Focus groups were transcribed and analysed using a combination of deductive and inductive thematic analysis. A brief questionnaire of nicotine product use and interest was also completed and the quantitative data presented using descriptive statistics. RESULTS Fifty-four participants took part in 11 focus groups. Participants' views of smoking, quitting and nicotine products were diverse. Commitment to smoking and interest in quitting were categorised into three groups across a smoking-quitting continuum: committed to smoking, ambivalent about smoking and reluctantly smoking. NRT was criticised for a range of side effects and primarily considered as a short-term cessation aid. NVPs generated debate. NVPs that closely resembled cigarettes were viewed as the most acceptable product and were considered to be more suitable than NRT for long-term use. DISCUSSION AND CONCLUSIONS Understanding the unique needs, goals and views of PLHIV related to smoking, quitting smoking and using nicotine products could inform development of novel and tailored smoking interventions for PLHIV. NVPs should be further examined as potential long-term substitutes for PLHIV who are ambivalent about smoking. However, traditional smoking cessation assistance (approved cessation aids and counselling) is likely to be most appropriate for PLHIV who are reluctantly smoking.
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Affiliation(s)
- Stephanie Edwards
- The University of Queensland, Faculty of Medicine, School of Public Health, The Public Health Building, Corner of Wyndham St and Herston Road, Herston QLD 4006, Australia
| | - Lisa Fitzgerald
- The University of Queensland, Faculty of Medicine, School of Public Health, The Public Health Building, Corner of Wyndham St and Herston Road, Herston QLD 4006, Australia
| | - Allyson Mutch
- The University of Queensland, Faculty of Medicine, School of Public Health, The Public Health Building, Corner of Wyndham St and Herston Road, Herston QLD 4006, Australia
| | - Judith A Dean
- The University of Queensland, Faculty of Medicine, School of Public Health, The Public Health Building, Corner of Wyndham St and Herston Road, Herston QLD 4006, Australia
| | - Pauline Ford
- The University of Queensland, Faculty of Health and Behavioural Sciences, School of Dentistry, Oral Health Centre, 288 Herston Road, Herston QLD 4006, Australia
| | - Chris Howard
- Queensland Positive People, 21 Manilla St, East Brisbane QLD 4169, Australia
| | - Peter Watts
- The University of Queensland, Faculty of Medicine, School of Public Health, The Public Health Building, Corner of Wyndham St and Herston Road, Herston QLD 4006, Australia; The University of Queensland, Faculty of Health and Behavioural Sciences, School of Dentistry, Oral Health Centre, 288 Herston Road, Herston QLD 4006, Australia; Queensland Positive People, 21 Manilla St, East Brisbane QLD 4169, Australia
| | - Coral Gartner
- The University of Queensland, Faculty of Medicine, School of Public Health, The Public Health Building, Corner of Wyndham St and Herston Road, Herston QLD 4006, Australia.
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Quinn MH, Bauer AM, Flitter A, Lubitz SF, Ashare RL, Thompson M, Leone F, Gross R, Schnoll R. Correlates of varenicline adherence among smokers with HIV and its association with smoking cessation. Addict Behav 2020; 102:106151. [PMID: 31783245 DOI: 10.1016/j.addbeh.2019.106151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION With medical advances, the life expectancy of people living with HIV/AIDS (PLWHA) has improved; however, tobacco use remains a prominent risk for mortality. Although studies have examined the efficacy of varenicline for treating smoking among PLWHA, the relationship between varenicline adherence and cessation and correlates of varenicline adherence remain under-studied. METHODS We conducted secondary analyses from a randomized placebo-controlled trial of varenicline for smoking among PLWHA, using data from participants who received varenicline (N = 89). The relationship between varenicline adherence (based on pill count) and end-of-treatment smoking cessation was assessed, as were correlates of varenicline adherence. RESULTS Those who were abstinent took an average of 137.1 pills (SD = 39.3), or 83% of pills prescribed, vs. 105.3 pills (SD = 64.1), or 64%, for those who were smoking (OR = 1.01, 95% CI: 1.001-1.021, p = 0.03); 52/89 (58%) participants were adherent based on taking ≥80% of pills. The quit rate for adherent participants was 35% (18/52) vs. 19% (7/37) for non-adherent participants. Adherent participants were older, smoked fewer cigarettes each day, started smoking at an older age, and had lower baseline creatinine vs. non-adherent participants (p < 0.05). There was a significant time-by-group interaction effect for anxiety (F[1,72] = 6.24, p = 0.02), depression (F[1,72] = 4.2, p = 0.04), and insomnia (F[1,72] = 7.73, p = 0.007), indicating that adherent participants had less depression, anxiety, and insomnia during the initial weeks of treatment, vs. non-adherent participants. CONCLUSIONS Our findings underscore the importance of varenicline adherence for determining cessation and highlight the role of early changes in anxiety, depression, and insomnia determining varenicline adherence.
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Affiliation(s)
| | - Anna-Marika Bauer
- Department of Psychiatry, University of Pennsylvania, PA, United States
| | - Alex Flitter
- Department of Psychiatry, University of Pennsylvania, PA, United States
| | - Su Fen Lubitz
- Department of Psychiatry, University of Pennsylvania, PA, United States
| | - Rebecca L Ashare
- Department of Psychiatry, University of Pennsylvania, PA, United States
| | - Morgan Thompson
- Department of Psychiatry, University of Pennsylvania, PA, United States
| | - Frank Leone
- Pulmonary, Allergy, & Critical Care Division, University of Pennsylvania, PA, United States
| | - Robert Gross
- Department of Medicine/Division of Infectious Diseases, University of Pennsylvania, PA, United States; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, PA, United States
| | - Robert Schnoll
- Department of Psychiatry, University of Pennsylvania, PA, United States.
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Nguyen AB, Zhao X, Hoffman L, Morse AL, Delahanty J. Nicotine and addiction beliefs and perceptions among the US-born and foreign-born populations. Prev Med 2018; 114:107-114. [PMID: 29958861 PMCID: PMC6370004 DOI: 10.1016/j.ypmed.2018.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/30/2018] [Accepted: 06/26/2018] [Indexed: 11/24/2022]
Abstract
Little is known about nicotine and addiction beliefs held by those who are foreign-born in the US and how these beliefs are associated with acculturation and race/ethnicity. This study attempts to address these research gaps. Data were analyzed from two cycles of the Health Information National Trends Survey, HINTS-FDA 2015 (n = 3738) and HINTS-FDA 2017 (n = 1736). HINTS-FDA is a tobacco-focused, cross-sectional, nationally representative survey of US non-institutionalized civilian adults aged 18 years or older. We first assessed associations between foreign-born status and beliefs about nicotine and addiction using weighted chi-square analyses. Then, using only the foreign-born sample, we examined the associations of nicotine and addiction beliefs with race/ethnicity and acculturation (i.e., English proficiency and U.S. tenure) using weighted multiple linear regression. Results showed that, compared to US-born respondents, foreign-born respondents were more likely to be concerned with being addicted to nicotine and to believe that low nicotine cigarettes would have much lower lung cancer risk than a typical cigarette. Among the foreign-born, NH-Black and Hispanic respondents were more likely to see low nicotine cigarettes as harmful and addictive compared to NH-White respondents. The relationship between acculturation and nicotine beliefs was complex with lower acculturation associated with elevated misperceived risk of nicotine and also ratings of addictiveness. Further research among key subpopulations may inform communication, education and dissemination strategies, especially among vulnerable populations.
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Affiliation(s)
- Anh B Nguyen
- Center for Tobacco Products (CTP), Food and Drug Administration, Silver Spring, MD, USA.
| | - Xiaoquan Zhao
- Center for Tobacco Products (CTP), Food and Drug Administration, Silver Spring, MD, USA; Department of Communication, George Mason University, Fairfax, VA, USA
| | - Leah Hoffman
- Center for Tobacco Products (CTP), Food and Drug Administration, Silver Spring, MD, USA
| | - Aura Lee Morse
- Center for Tobacco Products (CTP), Food and Drug Administration, Silver Spring, MD, USA
| | - Janine Delahanty
- Center for Tobacco Products (CTP), Food and Drug Administration, Silver Spring, MD, USA
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Shirley D, Thibodeau L, Catz SL, McCoy K, Jorenby DE, Safdar N, Sosman JM. Cessation-related information, motivation, and behavioral skills in smokers living with HIV. AIDS Care 2017; 30:131-139. [PMID: 28817951 DOI: 10.1080/09540121.2017.1367088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a need for new, targeted smoking cessation interventions for smokers living with HIV. The Information-Motivation-Behavioral Skills (IMB) model has been applied effectively to HIV-related health behaviors and was used in this qualitative study to elicit factors that could lead to the development of innovative and successful cessation interventions for this population. Twenty individuals who smoked from two clinics providing care to people living with HIV participated in open-ended interviews, responding to questions covering the domains of the IMB model, as applied to smokers living with HIV. Participants were enrolled from a larger survey cohort to recruit into groups based on the impact of HIV diagnosis on smoking as well as attempting to enroll a mix of demographics characteristics. Interviews were recorded, transcribed, coded and thematically analyzed using a grounded theory qualitative approach. Interviews continued until thematic saturation was reached. Major themes included: Presence of knowledge deficits regarding HIV-specific health risks of smoking; use of smoking for emotional regulation, where many reported close contacts who smoke and concern with the effect of cessation on their social networks; Use of smoking cessation aids or a telephone-based wellness intervention were acceptable to most. Providing HIV-specific information in cessation advice is of the utmost importance for clinicians caring for smokers living with HIV, as this theme was noted consistently as a potential motivator to quit. Innovative and effective interventions must account for the social aspect of smoking and address other methods of emotional regulation in this population.
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Affiliation(s)
- Daniel Shirley
- a Division of Infectious Diseases, Department of Medicine , University of Wisconsin School of Medicine & Public Health , Madison , WI , USA
| | - Laura Thibodeau
- b University of Wisconsin Hospital and Clinics , Madison , WI , USA
| | - Sheryl L Catz
- c Betty Irene Moore School of Nursing , University of California - Davis , Sacramento , CA , USA
| | - Katryna McCoy
- d School of Nursing and Health Studies, University of Washington - Bothell , Bothell , WA , USA
| | - Douglas E Jorenby
- e Department of Medicine , Center for Tobacco Research & Intervention, University of Wisconsin School of Medicine & Public Health , Madison , WI , USA
| | - Nasia Safdar
- a Division of Infectious Diseases, Department of Medicine , University of Wisconsin School of Medicine & Public Health , Madison , WI , USA.,f William S. Middleton Memorial Veterans Hospital , Madison , WI , USA
| | - James M Sosman
- a Division of Infectious Diseases, Department of Medicine , University of Wisconsin School of Medicine & Public Health , Madison , WI , USA
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Pacek LR, Cioe PA. Tobacco Use, Use Disorders, and Smoking Cessation Interventions in Persons Living With HIV. Curr HIV/AIDS Rep 2016; 12:413-20. [PMID: 26391516 DOI: 10.1007/s11904-015-0281-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cigarette smoking remains highly prevalent among persons living with human immunodeficiency virus (HIV), estimated to be 40-75 %, and is significantly higher than what is observed among the general population. Health risks of smoking in this population include cardiovascular disease; bacterial pneumonia, chronic obstructive pulmonary disease, and other respiratory conditions; lung cancer and other malignancies; adverse cognitive and neurological outcomes; low birth weight, preterm birth, and small-for-gestational-age infants; and overall mortality. Smokers with HIV now lose more life years to smoking than they do to the HIV itself. A majority of smokers living with HIV report being interested in cessation, and a significant proportion has made recent quit attempts. There is a general paucity of large, randomized controlled trials of smoking cessation interventions among smokers living with HIV, and among the existing research, cessation rates are suboptimal. Greater resources and effort should be allocated to developing and evaluating cessation treatment modalities for smokers living with HIV. Efforts to individualize and tailor treatments to address specific client needs and comorbidities are warranted. HIV care providers and other health professionals can play a key role in improving health among this population by regularly screening for smoking and promoting cessation.
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Affiliation(s)
- Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27707, USA. .,Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA.
| | - Patricia A Cioe
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02912, USA
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Vijayaraghavan M, Pierce JP. Interest in Smoking Cessation Related to a Smoke-Free Policy Among Homeless Adults. J Community Health 2016; 40:686-91. [PMID: 25559109 DOI: 10.1007/s10900-014-9985-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Homeless adults have among the highest rates of cigarette smoking. Few studies have explored the potential of smoke-free policies as facilitators of smoking cessation or harm reduction among sheltered homeless adults. We focused on clients of a homeless shelter in San Diego, California. The facility prohibited smoking indoors and outdoors within five blocks of the building, and permitted smoking during four smoking breaks during the day in designated smoking zones away from the building. Current and former smokers who were residents of the facility were interviewed on smoking behaviors and attitudes toward these policies. Of the 170 ever smokers, 75.3% were current smokers. The average daily cigarette consumption was 6.6 cigarettes per day (SD 4.3). More than half of the participants (57.8%) attempted to quit smoking in the past year. Of the current smokers, three-fourths agreed that the facility policies were associated with their reduced consumption, and about half agreed that the policies were associated with either making a quit attempt or getting ready to quit completely. Sixty percent agreed that further restrictions on smoking, beyond the current policies, would be associated with increased interest in quitting smoking completely. Less than 10% agreed that they were unhappy to stay in the facility because of the policies. Findings suggest that smoke-free policies may not influence occupancy rates in shelters serving clientele with high rates of cigarette smoking. Smoke-free policies in homeless service settings present an important and un-tapped opportunity to reduce smoking behaviors among homeless adults.
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Affiliation(s)
- Maya Vijayaraghavan
- Family Medicine and Public Health, Cancer Prevention and Control Division, Moores UCSD Cancer Center, University of California, San Diego, 3855 Health Sciences Drive, MC 0901, La Jolla, San Diego, CA, 92093-0901, USA,
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