A comprehensive approach to secondary HIV prevention and care among positives

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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.