The Influence of HIV Disease Events/Stages on Smoking Attitudes and Behaviors

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Abstract: While mortality attributable to AIDS-related diseases has decreased dramatically in the highly active antiretroviral therapy (HAART) era, the proportion of deaths attributable to other diseases (e.g., cardiovascular disease, pulmonary disease, and cancer) has markedly increased. Thus, efforts to reduce morbidity and mortality attributable to these non-AIDS defining diseases represent an important public health priority. One approach to improve health outcomes for this population is to target health-risk behaviors, such as cigarette smoking. Existing evidence indicates that smoking prevalence is significantly elevated among persons living with HIV/AIDS. In addition, smoking is associated with numerous HIV-related adverse outcomes. Despite these findings, few efforts have been made to deliver cessation treatment to this population. Also lacking are efforts to explore the relationship between HIV disease events/stages and smoking. Thus, the overarching goal of this project is to prospectively explore the relationship between HIV disease events/stages, perceived impact of HIV, attitudes about smoking, and smoking behaviors. HIV disease events/stages (e.g., time of HIV diagnosis, progressive disease, and stable disease) will be evaluated as potential teachable moments for smoking cessation. Specifically, we will identify and recruit newly HIV-diagnosed smokers from a large, inner city HIV/AIDS care center serving a racially/ethnically diverse, medically indigent population. Participants will complete a computer-administered assessment designed to measure perceived impact of HIV, attitudes about smoking, and current smoking behavior at the time of study enrollment. In addition to traditional self-report measures, certain variables (e.g., perceived impact of HIV) will be assessed using "implicit" cognitive psychological measures, as considerable evidence suggests that both explicit and implicit measures yield unique information that predicts outcome. Participants will be followed for one year and asked to complete follow-up computer- administered assessments at three-month intervals. In addition to clinic administered assessments, participants will complete brief weekly phone assessments that will allow us to carefully track changes in perceived impact of disease and smoking behavior for the first three months of follow-up. Research staff will also conduct medical record reviews to document the timing and progression of disease (e.g., treatment failure, diagnosis of an HIV- or non-HIV related disease). This design will enable us to carefully track changes in smoking behavior over time, and to link these changes to both the course of HIV-disease and/or to participants' perceived impact of HIV. By identifying optimal time points for intervention, findings will have the potential to maximize the efficiency and efficacy of cessation treatments delivered in resource-limited settings. In addition, findings will be instrumental in identifying specific constructs that should be targeted for intervention, and will provide a strong foundation for the development of future cessation interventions targeting smokers living with HIV/AIDS. Project Narrative The proposed study will provide important information about the relationship between HIV-disease events/stages and smoking behavior among a low socio-economic status, racially/ethnically diverse population. Specifically, findings will identify potential teachable moments for cessation interventions in the course of HIV-disease, and will provide a strong foundation for the development of future cessation interventions targeting this population.