Skip to main content

Advertisement

SpringerLink
Log in

Smoking Behaviors in a Community-Based Cohort of HIV-Infected Indigent Adults

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

We conducted a longitudinal study of a community-based cohort of HIV-infected indigent adults to examine smoking behaviors and factors associated with quitting. We assessed “hardcore” smoking behaviors associated with a low probability of quitting. Of the 296 participants, 218 were current smokers (73.6 %). The prevalence of “hardcore” smoking was high: 59.6 % smoked ≥15 cigarettes per day, and 67.3 % were daily smokers. During the study interval, 20.6 % made at least one quit attempt. Of these, 53.3 % were abstinent at 6 months. The successful quit rate over 2 years was 4.6 %. Illegal substance use (adjusted odds ratio, AOR 0.2, 95 % CI 0.1–0.6) and smoking within 30 min of waking (AOR 0.2, 95 % CI 0.1–0.7) were associated with lower likelihood of making a quit attempt. Interventions that reduce nicotine dependence prior to smoking cessation and those that are integrated with substance use treatment may be effective for this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention. Vital signs: current cigarette smoking among adults age ≥18 years—United States, 2005–2010. MMWR. 2011;60:1207–12.

    Google Scholar 

  2. Mamary EM, Bahrs D, Martinez S. Cigarette smoking and the desire to quit among individuals living with HIV. AIDS Patient Care STDS. 2002;16(1):39–42.

    Article  PubMed  Google Scholar 

  3. Tesoriero JM, Gieryic SM, Carrascal A, Lavigne HE. Smoking among HIV positive New Yorkers: prevalence, frequency, and opportunities for cessation. AIDS Behav. 2010;14(4):824–35.

    Article  PubMed  Google Scholar 

  4. Burkhalter JE, Springer CM, Chhabra R, Ostroff JS, Rapkin BD. Tobacco use and readiness to quit smoking in low-income HIV-infected persons. Nicotine Tob Res. 2005;7(4):511–22.

    Article  PubMed  Google Scholar 

  5. Palella FJ Jr, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338(13):853–60.

    Article  PubMed  Google Scholar 

  6. Palella FJ Jr, Baker RK, Moorman AC, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006;43(1):27–34.

    Article  CAS  PubMed  Google Scholar 

  7. Clifford GM, Polesel J, Rickenbach M, et al. Cancer risk in the Swiss HIV Cohort Study: associations with immunodeficiency, smoking, and highly active antiretroviral therapy. J Natl Cancer Inst. 2005;97(6):425–32.

    Article  PubMed  Google Scholar 

  8. Neumann T, Woiwoid T, Neumann A, et al. Cardiovascular risk factors and probability for cardiovascular events in HIV-infected patients: part I. Differences due to the acquisition of HIV-infection. Eur J Med Res. 2003;8(6):229–35.

    CAS  PubMed  Google Scholar 

  9. Madeddu G, Fois AG, Calia GM, et al. Chronic obstructive pulmonary disease: An emerging comorbidity in HIV-infected patients in the HAART era? Infection. 2013;41(2):347–53.

    Article  CAS  PubMed  Google Scholar 

  10. Crothers K, Griffith TA, McGinnis KA, et al. The impact of cigarette smoking on mortality, quality of life, and comorbid illness among HIV-positive veterans. J Gen Intern Med. 2005;20(12):1142–5.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Helleberg M, Afzal S, Kronborg G, et al. Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study. Clin Infect Dis. 2012;56(5):727–34.

    Article  PubMed  Google Scholar 

  12. Shuter J, Bernstein SL. Cigarette smoking is an independent predictor of nonadherence in HIV-infected individuals receiving highly active antiretroviral therapy. Nicotine Tob Res. 2008;10(4):731–6.

    Article  CAS  PubMed  Google Scholar 

  13. King RM, Vidrine DJ, Danysh HE, et al. Factors associated with nonadherence to antiretroviral therapy in HIV-positive smokers. AIDS Patient Care STDS. 2012;26(8):479–85.

    Article  PubMed  Google Scholar 

  14. Feldman JG, Minkoff H, Schneider MF, et al. Association of cigarette smoking with HIV prognosis among women in the HAART era: a report from the women’s interagency HIV study. Am J Public Health. 2006;96(6):1060–5.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Gritz ER, Vidrine DJ, Lazev AB, Amick BC 3rd, Arduino RC. Smoking behavior in a low-income multiethnic HIV/AIDS population. Nicotine Tob Res. 2004;6(1):71–7.

    Article  PubMed  Google Scholar 

  16. Lloyd-Richardson EE, Stanton CA, Papandonatos GD, et al. HIV-positive smokers considering quitting: differences by race/ethnicity. Am J Health Behav. 2008;32(1):3–15.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Nahvi S, Cooperman NA. Review: the need for smoking cessation among HIV-positive smokers. AIDS Educ Prev. 2009;21(3 Suppl):14–27.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Bing EG, Burnam MA, Longshore D, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8.

    Article  CAS  PubMed  Google Scholar 

  19. Schroeder SA, Morris CD. Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse problems. Annu Rev Public Health. 2010;31:297–314; 1p following 314.

    Google Scholar 

  20. Okuyemi KS, Caldwell AR, Thomas JL, et al. Homelessness and smoking cessation: insights from focus groups. Nicotine Tob Res. 2006;8(2):287–96.

    Article  PubMed  Google Scholar 

  21. Okuyemi KS, Goldade K, Whembolua GL, et al. Smoking characteristics and comorbidities in the power to quit randomized clinical trial for homeless smokers. Nicotine Tob Res. 2013;15(1):22–8.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Ip DT, Cohen JE, Bondy SJ, et al. Do components of current ‘hardcore smoker’ definitions predict quitting behaviour? Addiction. 2012;107(2):434–40.

    Article  PubMed  Google Scholar 

  23. Emery S, Gilpin EA, Ake C, Farkas AJ, Pierce JP. Characterizing and identifying “hard-core” smokers: implications for further reducing smoking prevalence. Am J Public Health. 2000;90(3):387–94.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Costa ML, Cohen JE, Chaiton MO, Ip D, McDonald P, Ferrence R. “Hardcore” definitions and their application to a population-based sample of smokers. Nicotine Tob Res. 2010;12(8):860–4.

    Article  PubMed  Google Scholar 

  25. Robertson MJ, Clark RA, Charlebois ED, et al. HIV seroprevalence among homeless and marginally housed adults in San Francisco. Am J Public Health. 2004;94(7):1207–17.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Miaskowski C, Penko JM, Guzman D, Mattson JE, Bangsberg DR, Kushel MB. Occurrence and characteristics of chronic pain in a community-based cohort of indigent adults living with HIV infection. J Pain. 2011;12(9):1004–16.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Hansen L, Penko J, Guzman D, Bangsberg DR, Miaskowski C, Kushel MB. Aberrant behaviors with prescription opioids and problem drug use history in a community-based cohort of HIV-infected individuals. J Pain Symptom Manage. 2011;42(6):893–902.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Kozlowski LT, Porter CQ, Orleans CT, Pope MA, Heatherton T. Predicting smoking cessation with self-reported measures of nicotine dependence: FTQ, FTND, and HSI. Drug Alcohol Depend. 1994;34(3):211–6.

    Article  CAS  PubMed  Google Scholar 

  29. Velicer WF, Prochaska JO. A comparison of four self-report smoking cessation outcome measures. Addict Behav. 2004;29(1):51–60.

    Article  PubMed  Google Scholar 

  30. Hughes JR, Carpenter MJ, Naud S. Do point prevalence and prolonged abstinence measures produce similar results in smoking cessation studies? A systematic review. Nicotine Tob Res. 2010;12(7):756–62.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Hughes JR, Keely JP, Niaura RS, Ossip-Klein DJ, Richmond RL, Swan GE. Measures of abstinence in clinical trials: issues and recommendations. Nicotine Tob Res. 2003;5(1):13–25.

    PubMed  Google Scholar 

  32. Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Arch Gen Psychiatry. 1981;38(4):381–9.

    Article  CAS  PubMed  Google Scholar 

  33. National Institute on Alcohol Abuse and Alcoholism. Helping patients who drink too much: a clinicians’ guide, 2005. Washington, DC. http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf. Accessed 1 Apr 2013.

  34. Beck A, Steer R, Brown G. Manual for beck depression inventory-II. San Antonio: Psychological Corporation; 1996.

    Google Scholar 

  35. Lindson N, Aveyard P, Ingram JT, et al. Rapid reduction versus abrupt quitting for smokers who want to stop soon: a randomised controlled non-inferiority trial. Trials. 2009;10:69.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Tsai J, Rosenheck RA. Smoking among chronically homeless adults: prevalence and correlates. Psychiatr Serv. 2012;63(6):569–76.

    Article  PubMed  Google Scholar 

  37. StataCorp. Stata Statistical Software: Release 11. College Station, TX: StataCorp LP; 2009.

  38. Centers for Disease Control and Prevention. Cigarette smoking among adults and trends in smoking cessation—United States, 2008. MMWR. 2009;58:1227–32.

    Google Scholar 

  39. Hughes JR. The hardening hypothesis: is the ability to quit decreasing due to increasing nicotine dependence? A review and commentary. Drug Alcohol Depend. 2011;117(2–3):111–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Augustson E, Marcus S. Use of the current population survey to characterize subpopulations of continued smokers: a national perspective on the “hardcore” smoker phenomenon. Nicotine Tob Res. 2004;6(4):621–9.

    Article  PubMed  Google Scholar 

  41. Baggett TP, Rigotti NA. Cigarette smoking and advice to quit in a national sample of homeless adults. Am J Prev Med. 2010;39(2):164–72.

    Article  PubMed  Google Scholar 

  42. Hyland A, Borland R, Li Q, et al. Individual-level predictors of cessation behaviours among participants in the International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006;15 Suppl 3:iii83–94.

    Google Scholar 

  43. Vangeli E, Stapleton J, Smit ES, Borland R, West R. Predictors of attempts to stop smoking and their success in adult general population samples: a systematic review. Addiction. 2011;106(12):2110–21.

    Article  PubMed  Google Scholar 

  44. Hughes JR, Carpenter MJ. The feasibility of smoking reduction: an update. Addiction. 2005;100(8):1074–89.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Carpenter MJ, Alberg AJ, Gray KM, Saladin ME. Motivating the unmotivated for health behavior change: a randomized trial of cessation induction for smokers. Clin Trials. 2010;7(2):157–66.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Farkas AJ. When does cigarette fading increase the likelihood of future cessation? Ann Behav Med. 1999;21(1):71–6.

    Article  CAS  PubMed  Google Scholar 

  47. Connor SE, Cook RL, Herbert MI, Neal SM, Williams JT. Smoking cessation in a homeless population: there is a will, but is there a way? J Gen Intern Med. 2002;17(5):369–72.

    PubMed Central  PubMed  Google Scholar 

  48. Arnsten JH, Reid K, Bierer M, Rigotti N. Smoking behavior and interest in quitting among homeless smokers. Addict Behav. 2004;29(6):1155–61.

    Article  PubMed  Google Scholar 

  49. Benard A, Bonnet F, Tessier JF, et al. Tobacco addiction and HIV infection: toward the implementation of cessation programs. ANRS CO3 Aquitaine Cohort. AIDS Patient Care STDS. 2007;21(7):458–68.

    Article  PubMed  Google Scholar 

  50. Borrelli B, Mermelstein R. Goal setting and behavior change in a smoking cessation program. Cogn Ther Res. 1994;18:69–83.

    Article  Google Scholar 

  51. Gregor K, Borrelli B. Barriers to quitting smoking among medically ill smokers. J Behav Med. 2011;35(5):484–91.

    Article  PubMed  Google Scholar 

  52. Farkas AJ, Pierce JP, Zhu SH, et al. Addiction versus stages of change models in predicting smoking cessation. Addiction. 1996;91(9):1271–80; discussion 1281–1292.

    Article  CAS  PubMed  Google Scholar 

  53. Pierce JP, Farkas AJ, Gilpin EA. Beyond stages of change: the quitting continuum measures progress towards successful smoking cessation. Addiction. 1998;93(2):277–86.

    Article  CAS  PubMed  Google Scholar 

  54. Carpenter MJ, Hughes JR, Gray KM, Wahlquist AE, Saladin ME, Alberg AJ. Nicotine therapy sampling to induce quit attempts among smokers unmotivated to quit: a randomized clinical trial. Arch Intern Med. 2011;171(21):1901–7.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Hymowitz N, Sexton M, Ockene J, Grandits G. Baseline factors associated with smoking cessation and relapse. MRFIT Research Group. Prev Med. 1991;20(5):590–601.

    Article  CAS  PubMed  Google Scholar 

  56. Kassel JD, Stroud LR, Paronis CA. Smoking, stress, and negative affect: correlation, causation, and context across stages of smoking. Psychol Bull. 2003;129(2):270–304.

    Article  PubMed  Google Scholar 

  57. Kalman D, Morissette SB, George TP. Co-morbidity of smoking in patients with psychiatric and substance use disorders. Am J Addict. 2005;14(2):106–23.

    Article  PubMed Central  PubMed  Google Scholar 

  58. Crothers K, Goulet JL, Rodriguez-Barradas MC, et al. Decreased awareness of current smoking among health care providers of HIV-positive compared to HIV-negative veterans. J Gen Intern Med. 2007;22(6):749–54.

    Article  PubMed Central  PubMed  Google Scholar 

  59. Shuter J, Salmo LN, Shuter AD, Nivasch EC, Fazzari M, Moadel AB. Provider beliefs and practices relating to tobacco use in patients living with HIV/AIDS: a national survey. AIDS Behav. 2012;16(2):288–94.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank the research assistants for conducting the participant interviews. We would also like to thank the participants for their contribution to this study. We would like to thank John P. Pierce, PhD for his feedback on an earlier draft of the manuscript. This study was funded by a Grant from the National Institute of Drug Abuse R01DA022550, and a Grant from the National Institute of Mental Health R01MH54907. The Tenderloin Center for Clinical Research was supported by the University of California, San Francisco (UCSF), Clinical and Translational Institute Grant, NIH/NCRR UCSF-CTSI UL1 RR024131. The funders had no role in the design or conduct of the study or the preparation of the manuscript. Dr. Vijayaraghavan is supported by a Post-Doctoral Grant from the Cancer Prevention and Control Division, Moores UCSD Cancer Center, University of California, San Diego. Drs. Kushel and Vijayaraghavan had full access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Moores UCSD Cancer Center, University of California, San Diego, 3855 Health Science Drive, MC 0901, La Jolla, CA, 92093-0901, USA

    Maya Vijayaraghavan

  2. University of California, San Francisco, San Francisco, CA, USA

    Joanne Penko, Eric Vittinghoff & Margot B. Kushel

  3. UCSF Department of Epidemiology and Biostatistics, San Francisco, CA, USA

    Eric Vittinghoff

  4. Massachusetts General Hospital Center for Global Health, Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, and Harvard School of Public Health, Boston, MA, USA

    David R. Bangsberg

  5. Department of Physiological Nursing, UCSF, San Francisco, CA, USA

    Christine Miaskowski

  6. Division of General Internal Medicine, San Francisco General Hospital, San Francisco, CA, USA

    Margot B. Kushel

Authors
  1. Maya Vijayaraghavan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joanne Penko
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric Vittinghoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David R. Bangsberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christine Miaskowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Margot B. Kushel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maya Vijayaraghavan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vijayaraghavan, M., Penko, J., Vittinghoff, E. et al. Smoking Behaviors in a Community-Based Cohort of HIV-Infected Indigent Adults. AIDS Behav 18, 535–543 (2014). https://doi.org/10.1007/s10461-013-0576-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-013-0576-z

Keywords

Search

Navigation