Skip to main content

Advertisement

SpringerLink
Log in

Decreased Awareness of Current Smoking Among Health Care Providers of HIV-positive Compared to HIV-negative Veterans

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND

Cigarette smoking is an important risk factor for morbidity and mortality in HIV-positive patients on combination antiretroviral therapy.

OBJECTIVE

To determine whether awareness of smoking differs between HIV and non-HIV providers, and to identify factors associated with failure to recognize current smoking.

DESIGN

Observational study.

PARTICIPANTS

801 HIV-positive and 602 HIV-negative patients, 72 HIV and 71 non-HIV providers enrolled in the Veterans Aging Cohort 5 Site Study.

MEASUREMENTS

Data sources included patient and provider questionnaires; electronic medical records; and the national administrative VA database. We calculated sensitivity, specificity, and measures of agreement between patient- and provider-reported smoking, and examined factors associated with failure to recognize current smoking using logistic regression.

RESULTS

Whereas most providers were correct when they identified a patient as a current smoker (specificity ≥90%), HIV providers missed current smoking more often (sensitivity 65% for HIV vs. 82% for non-HIV). Kappa scores for current smoking were significantly lower for HIV compared to non-HIV providers (0.55 vs. 0.75, p < .001). In models adjusted for age, gender, race, and other differences, patient HIV status and provider specialty in infectious diseases were independent predictors of a provider’s failure to recognize current smoking. Comorbid illnesses, cough/dyspnea, degree of immune competence and HIV viral suppression did not impact recognition of current smoking. Only 39% of HIV providers reported confidence in their ability to influence smoking cessation compared to 62% of non-HIV providers (p = .049).

CONCLUSIONS

Interventions to increase HIV provider awareness of current smoking and skills to influence smoking cessation are needed. Efforts should also target patient populations with smoking-related comorbid diseases who would especially benefit from smoking cessation.

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. Patel N, Talwar A, Reichert VC, Brady T, Jain M, Kaplan MH. Tobacco and HIV. Clin Occup Environ Med. 2006;5(1):193–207, xi.

    PubMed  Google Scholar 

  2. Burns DN, Hillman D, Neaton JD, et al. Cigarette smoking, bacterial pneumonia, and other clinical outcomes in HIV-1 infection. Terry Beirn Community Programs for Clinical Research on AIDS. J Acquir Immune Defic Syndr Hum Retrovirol. 1996;13(4):374–83.

    PubMed  CAS  Google Scholar 

  3. Niaura R, Shadel WG, Morrow K, Tashima K, Flanigan T, Abrams DB. Human immunodeficiency virus infection, AIDS, and smoking cessation: the time is now. Clin Infect Dis. 2000;31(3):808–12.

    Article  PubMed  CAS  Google Scholar 

  4. 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 

  5. 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 

  6. Benard A, Tessier JF, Rambeloarisoa J, et al. HIV infection and tobacco smoking behaviour: prospects for prevention? ANRS CO3 Aquitaine Cohort, 2002. Int J Tuberc Lung Dis. 2006;10(4):378–83.

    PubMed  CAS  Google Scholar 

  7. Ezzati M, Lopez AD. Estimates of global mortality attributable to smoking in 2000. Lancet. 2003;362(9387):847–52.

    Article  PubMed  Google Scholar 

  8. 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  Google Scholar 

  9. 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  Google Scholar 

  10. Hirschtick RE, Glassroth J, Jordan MC, et al. Bacterial pneumonia in persons infected with the human immunodeficiency virus. Pulmonary Complications of HIV Infection Study Group. N Engl J Med. 1995;333(13):845–51.

    Article  PubMed  CAS  Google Scholar 

  11. Kohli R, Lo Y, Homel P, et al. Bacterial pneumonia, HIV therapy, and disease progression among HIV-infected women in the HIV epidemiologic research (HER) study. Clin Infect Dis. 2006;43(1):90–8.

    Article  PubMed  Google Scholar 

  12. Diaz PT, King MA, Pacht ER, et al. Increased susceptibility to pulmonary emphysema among HIV-seropositive smokers. Ann Intern Med. 2000;132(5):369–72.

    PubMed  CAS  Google Scholar 

  13. Crothers K, Butt AA, Gibert CL, Rodriguez-Barradas MC, Crystal S, Justice AC. Increased COPD among HIV-positive compared to HIV-negative veterans. Chest. 2006;130(5):1326–33.

    Article  PubMed  Google Scholar 

  14. Frisch M, Biggar RJ, Engels EA, Goedert JJ. Association of cancer with AIDS-related immunosuppression in adults. JAMA. 2001;285(13):1736–45.

    Article  PubMed  CAS  Google Scholar 

  15. Miguez-Burbano MJ, Burbano X, Ashkin D, et al. Impact of tobacco use on the development of opportunistic respiratory infections in HIV seropositive patients on antiretroviral therapy. Addict Biol. 2003;8(1):39–43.

    Article  PubMed  Google Scholar 

  16. Sudano I, Spieker LE, Noll G, Corti R, Weber R, Luscher TF. Cardiovascular disease in HIV infection. Am Heart J. 2006;151(6):1147–55.

    Article  PubMed  Google Scholar 

  17. Justice AC, Dombrowski E, Conigliaro J, et al. Veterans Aging Cohort Study (VACS): overview and description. Med Care. 2006;44(8 Suppl 2):S13–24.

    Article  PubMed  Google Scholar 

  18. Patrick DL, Cheadle A, Thompson DC, Diehr P, Koepsell T, Kinne S. The validity of self-reported smoking: a review and meta-analysis. Am J Public Health. 1994;84(7):1086–93.

    Article  PubMed  CAS  Google Scholar 

  19. Justice AC, Holmes W, Gifford AL, et al. Development and validation of a self-completed HIV symptom index. J Clin Epidemiol. 2001;54(Suppl 1):S77–90.

    Article  PubMed  Google Scholar 

  20. Justice AC, Lasky E, McGinnis KA, et al. Medical disease and alcohol use among veterans with human immunodeficiency infection: a comparison of disease measurement strategies. Med Care. 2006;44(8 Suppl 2):S52–60.

    Article  PubMed  Google Scholar 

  21. Fleiss JL. Statistical Methods for Rates and Proportions. 2nd ed. New York: John Wiley and Sons; 1981.

    Google Scholar 

  22. 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 

  23. Crum NF, Riffenburgh RH, Wegner S, et al. Comparisons of causes of death and mortality rates among HIV-infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. J Acquir Immune Defic Syndr. 2006;41(2):194–200.

    Article  PubMed  Google Scholar 

  24. Lewden C, Salmon D, Morlat P, et al. Causes of death among human immunodeficiency virus (HIV)-infected adults in the era of potent antiretroviral therapy: emerging role of hepatitis and cancers, persistent role of AIDS. Int J Epidemiol. 2005;34(1):121–30.

    Article  PubMed  Google Scholar 

  25. Krentz HB, Kliewer G, Gill MJ. Changing mortality rates and causes of death for HIV-infected individuals living in Southern Alberta, Canada from 1984 to 2003. HIV Med. 2005;6(2):99–106.

    Article  PubMed  CAS  Google Scholar 

  26. Braithwaite RS, Justice AC, Chang CC, et al. Estimating the proportion of patients infected with HIV who will die of comorbid diseases. Am J Med. 2005;118(8):890–8.

    Article  PubMed  Google Scholar 

  27. Cummins D, Trotter G, Moussa M, Turham G. Smoking cessation for clients who are HIV-positive. Nurs Stand. 2005;20(12):41–7.

    PubMed  Google Scholar 

  28. Vidrine DJ, Arduino RC, Lazev AB, Gritz ER. A randomized trial of a proactive cellular telephone intervention for smokers living with HIV/AIDS. AIDS. 2006;20(2):253–60.

    Article  PubMed  Google Scholar 

  29. Wewers ME, Neidig JL, Kihm KE. The feasibility of a nurse-managed, peer-led tobacco cessation intervention among HIV-positive smokers. J Assoc Nurses AIDS Care. 2000;11(6):37–44.

    Article  PubMed  CAS  Google Scholar 

  30. An LC, Zhu SH, Nelson DB, et al. Benefits of telephone care over primary care for smoking cessation: a randomized trial. Arch Intern Med. 2006;166(5):536–42.

    Article  PubMed  Google Scholar 

  31. Fultz SL, Goulet JL, Weissman S, et al. Differences between infectious diseases-certified physicians and general medicine-certified physicians in the level of comfort with providing primary care to patients. Clin Infect Dis. 2005;41(5):738–43.

    Article  PubMed  Google Scholar 

Download references

Acknkowledgments

This study was funded by: National Institutes of Health/National Center for Research Resources (K12 RR0117594-01) (KC); National Institute on Drug Abuse (K23 DA016175-01A1) (AAB); National Institute on Alcohol Abuse and Alcoholism (3U01 AA 13566), National Institute on Aging (K23 G00826), Robert Wood Johnson Generalist Faculty Scholar Award, the VHA Office of Research and Development, VHA Public Health Strategic Health Care Group, and an Inter-Agency Agreement between National Institute on Aging, National Institute of Mental Health, and the Veterans Health Administration (ACJ).

Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Kristina Crothers MD

  2. VA Connecticut Healthcare System, West Haven, and General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Joseph L. Goulet PhD, R. Scott Braithwaite MD & Amy C. Justice MD, PhD

  3. Medical Service, Infectious Diseases, Michael A. DeBakey VA Medical Center, and Baylor College of Medicine, Houston, TX, USA

    Maria C. Rodriguez-Barradas MD

  4. Medical Service, Infectious Diseases, VA Medical Center, and George Washington University, Washington, DC, USA

    Cynthia L. Gibert MD, MS & Robin Peck MD

  5. Infectious Diseases, Department of Internal Medicine, VA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Adeel A. Butt MD, MS

Authors
  1. Kristina Crothers MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph L. Goulet PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria C. Rodriguez-Barradas MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cynthia L. Gibert MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adeel A. Butt MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Scott Braithwaite MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Robin Peck MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Amy C. Justice MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amy C. Justice MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Crothers, K., Goulet, J.L., Rodriguez-Barradas, M.C. et al. Decreased Awareness of Current Smoking Among Health Care Providers of HIV-positive Compared to HIV-negative Veterans. J GEN INTERN MED 22, 749–754 (2007). https://doi.org/10.1007/s11606-007-0158-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-007-0158-8

KEY WORDS

Search

Navigation