A comprehensive approach to secondary HIV prevention and care among positives

描述(由申请人提供)：患有慢性病、低收入的非洲裔美国人吸烟率高，与吸烟相关的发病率和死亡率存在差异。需要进行研究，以便为低收入AA制定更有力、更积极主动的烟草控制计划。需要信息来了解与烟草有关的交流对他们烟草使用的影响，以及艾滋病毒和药物使用可能在多大程度上影响他们戒烟的挑战。还需要进行研究，以确定减轻烟草使用对健康影响的沟通渠道。虽然新的电子媒体有望促进戒烟，但我们对临床招募的、大多是低收入的AA HIV+S的形成性研究表明，他们使用新媒体的比例远远低于其他人群。研究表明，社交网络可以对吸烟的开始和戒烟产生强大而持久的影响，这在一定程度上是通过人际交流影响亲密关系的行为规范。然而，很少有人注意到在低收入的AA或患有慢性病的亚群中确定影响烟草使用的网络和其他社会因素。也没有充分重视确定可行的社区组织作为向易受伤害的AAA发出戒烟信息的渠道。拟议的混合方法研究将从父母研究的筛查中招募目前吸烟、以前或现在吸毒、低收入、再生障碍性贫血、艾滋病毒+‘S(n=250)和艾滋病毒网络成员(n=250)。在第一阶段，我们将组织重点小组，探索研究人群中烟草的经济、社会和文化背景，以及艾滋病毒和毒品使用的特殊方面。就在第三阶段(调查管理)之前，我们将进行一项计算机管理的实验测试(第三阶段)，测试健康警告和烟草声明对烟草感知和行为的影响。这项研究对我们的多学科研究团队来说是一个合乎逻辑的科学进步，该团队由约翰霍普金斯大学公共卫生和医学院的研究人员组成，在低收入社区中进行基于社区的社会网络干预和艾滋病毒临床结果研究。该干预建立在我们团队成功的以社会网络为导向的预防干预和对艾滋病毒依从性干预的研究基础上。我们的初步研究表明，80%的曾经或现在吸毒、低收入的戒毒者目前吸烟，绝大多数人表示有戒烟的兴趣。 公共卫生相关性：虽然患有慢性病的低收入非裔美国人吸烟率很高，持续吸烟对健康的不利影响，但很少有针对他们的吸烟干预措施。拟议的试点研究将被用来测试一种基于理论的、为文化量身定做的吸烟干预措施的可行性和有效性，该干预措施代表着社会因素对艾滋病毒临床样本(其中75%目前吸烟)的护理标准的改进。

DESCRIPTION (provided by applicant): Chronically ill, low income African Americans (AAs) have high rates of smoking and disparities in smoking related morbidity and mortality. Research is needed to inform more powerful, proactive tobacco control programs for low income AAs. Information is needed to understand effects of tobacco related communications on their tobacco use, and the extent to which HIV and drug use may affect their challenges to quitting. Research is also needed to identify communication channels for mitigating health impacts on their tobacco use. While new electronic media hold promise for promoting cessation, our formative study on clinic recruited, mostly low income, AA HIV+s, suggests their new media use is much lower than other populations'. Research indicates social networks can have powerful, enduring effects on smoking initiation and cessation, in part through interpersonal communication affecting close ties' behavior norms. Yet little attention has been given to identifying network and other social factors affecting tobacco use among low income AAs, or subgroups with chronic conditions. Nor has there been adequate attention to identifying viable community organizations as channels for smoking cessation messages for vulnerable AAs. The proposed mixed methods study will recruit currently smoking, former or current drug using, low income, AA, HIV+'s (n=250) from among those screened for the parent study, and a sample of HIV- network members (n=250). In Phase I we will conduct focus groups to explore the economic, social and cultural context of tobacco in the study population, and aspects particular to HIV and drug use. Just prior to Phase III (survey administration), we will conduct a computer administered experimental test (Phase III) of health warnings and tobacco claims on tobacco perceptions and behaviors. The study represents a logical scientific advancement for our multi-disciplinary research team, comprised of researchers from the Johns Hopkins Schools of Public Health and Medicine in community-based social network intervention and HIV clinical outcomes research among low income communities. The intervention builds on our team's successful social network-oriented prevention interventions and research on HIV adherence intervention. Our preliminary research indicates >80% of former or current drug using, low income AAs currently smoke and the vast majority expressed interest in quitting. PUBLIC HEALTH RELEVANCE: While chronically ill, low income African Americans have high smoking rates and adverse health effects of continued smoking, few smoking interventions have been tailored to them. The proposed pilot study will be used to test the feasibility and efficacy o a theory-based, culturally tailored smoking intervention representing a social component enhancement over the standard of care among an HIV clinic sample of which 75% currently smoke cigarettes.