Development of Culturally Tailored Content for Smoking Cessation and HIV Care Improvement among Latinx Adults: A Pilot Study

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PROJECT SUMMARY/ABSTRACT Racial/ethnic minority groups are disproportionately affected by HIV, people with HIV/AIDS (PWH) are at increased risk for smoking, and smoking presents a major health hazard to individuals with HIV and affects disease management. For example, cigarette smoking is a leading risk factor for HIV-related and non-HIV-related morbidity and mortality among PWH, even among those taking antiretroviral (ART) medications, and contributes to more life- years lost than HIV-related complications among those effectively treated with ART. Latinx/Hispanic adults (hereafter referred to as Latinx) with HIV who smoke are at high-risk for smoking-related health disparities and poorer response to HIV treatment. Latinx smokers with HIV experience more difficulty quitting, are less likely to use pharmacological support for smoking cessation, and are less likely to be a former smoker than non-Latinx White smokers with HIV. Challenges managing somatic perturbation related to stigma and discrimination experienced by Latinx smokers with HIV may contribute to quit difficulty and subsequently impact HIV disease management. Anxiety sensitivity (AS) is a core affective vulnerability factor implicated in internal distress that has emerged as a leading mechanistic target for behavioral health interventions, is related to smoking behavior and cessation, and has been implicated in HIV symptom distress severity. AS reduction improves anxiety, depression, and enhances quality of life among PWH, which can improve HIV-specific outcomes including ART adherence and treatment engagement. Smoking cessation treatment that specifically targets AS leads to better smoking outcomes among PWH. Yet, no work has leveraged the potential to target AS reduction to improve smoking cessation and HIV care outcomes in the context of an accessible, tailored intervention for Latinx smokers with HIV. The goal of the current proposal is to develop culturally tailored content for AS reduction, smoking cessation, and HIV disease management among three unique groups of Latinx smokers with HIV: Mexican Americans, Central Americans, and South Americans. To achieve this objective, our team will adapt our existing materials for AS reduction, smoking cessation, and HIV care engagement to incorporate unique cultural aspects for Mexican American smokers with HIV and then pilot these materials among 40 Mexican American smokers with HIV. Intervention content will then be refined and adapted to the unique cultural considerations for two additional subgroups of the Latinx population: (1) Central Americans and (2) South Americans, and subsequently piloted on Central Americans (N = 20) and South Americans (N = 20). Following completion of the proposed study, we will have developed culturally tailored content to improve smoking cessation and HIV care engagement/management among three unique subpopulations of the larger Latinx population that will have been informed and vetted by a strong team of researchers, community members who treat the target population, and the target population. Once refined, these materials will be ready for integration and testing within a smartphone-based application targeting improved outcomes. The proposed project is centrally relevant to public health because it can help guide the development of novel culturally tailored smoking cessation interventions and HIV care among Latinx smokers with HIV.