PFI for Smoking and Analgesic Misuse among Older Adults with HIV and Chronic Pain

点击翻译按钮获取中文摘要

DESCRIPTION (provided by applicant): Tobacco smoking, chronic pain, and prescription analgesic misuse are all highly prevalent among older adults with HIV. The prevalence of smoking among persons with HIV is three times that observed in the general population, and older HIV+ smokers are particularly vulnerable to chronic pain and opioid misuse, in part due to complex nicotine-opioid interactions. Computer-based personalized feedback interventions (PFI) offer great promise as an approach to increasing motivation to quit smoking and reducing medication misuse because they are portable, adaptable, cost-effective, and can be delivered to a large number of patients by non- specialized care providers. Given that the vast majority of all smokers with HIV are not yet ready to quit smoking, research designed to increase motivation and confidence to quit smoking is both novel and consistent with the needs of the target population. The goal of the proposed study is to adapt and pilot test a brief, integrated, computer-based PFI for older adults with comorbid HIV and chronic pain aimed at increasing intentions to quit smoking and decreasing intentions to misuse prescription analgesic medications. Participants will include 76 older tobacco smokers with comorbid HIV and chronic pain, recruited from the Designated AIDS Center at SUNY Upstate Medical University. Participants will be randomized to either Active or Control PFI conditions. The Active PFI will include content relevant to interactions between chronic pain, tobacco smoking, and analgesic medication use/misuse in the context of HIV and aging. The Control PFI will include content relevant to the importance of exercise, nutrition, and medication adherence in the context of HIV and aging. We hypothesize that participants randomized to the Active PFI (relative to Control PFI) will evince: (1) a greater increase in motivation, confidence, and intention to quit smoking; (2); a greater decrease in positive attitudes and intentions toward the misuse of prescription analgesic medications; (3) a greater increase in knowledge regarding interrelations between pain, smoking, and analgesic medication use/misuse in the context of normative aging; and (4) a greater decrease in expectancies regarding the potential benefits of continued smoking and analgesic misuse in the context and course of both chronic pain and HIV. We also hypothesize that decreased positive expectancies for continued smoking and analgesic misuse in the context and course of both chronic pain and HIV will mediate the effects of the proposed intervention on respective smoking and prescription analgesic misuse outcomes. By adapting a brief and portable intervention for older smokers with HIV and chronic pain, our novel intervention strategy addresses a critical public health need in a population that has, to date, been underrepresented in research. We anticipate that a computer-based PFI will function as a "first line of defense" in HIV care settings, and the proposed study will be the first to target boh smoking and prescription analgesic misuse among older HIV+ individuals.