A comprehensive approach to secondary HIV prevention and care among positives

描述（由申请人提供）：慢性疾病，低收入的非裔美国人（AAs）的吸烟率高，吸烟相关的发病率和死亡率存在差异。需要进行研究，为低收入aa提供更有力、更主动的烟草控制规划。需要提供信息，以了解与烟草有关的宣传对其烟草使用的影响，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，确定沟通渠道，以减轻烟草使用对健康的影响。虽然新的电子媒体有望促进戒烟，但我们对诊所招募的主要是低收入的AA HIV+s的形成性研究表明，他们的新媒体使用率远低于其他人群。研究表明，社交网络可以对开始吸烟和戒烟产生强大而持久的影响，部分是通过人际交往影响亲密关系的行为规范。然而，很少有人注意查明影响低收入aa或慢性疾病亚群体烟草使用的网络和其他社会因素。也没有充分注意确定可行的社区组织作为向脆弱的辅助人员传递戒烟信息的渠道。拟议的混合方法研究将从父母研究筛选的人群中招募目前吸烟、曾经或正在吸毒、低收入、嗜酒者、艾滋病毒阳性者（n=250）和艾滋病毒网络成员（n=250）。在第一阶段，我们将开展焦点小组，探讨烟草在研究人群中的经济、社会和文化背景，以及艾滋病毒和药物使用的具体方面。就在第三阶段（调查管理）之前，我们将进行一个计算机管理的实验测试（第三阶段），对烟草认知和行为的健康警告和烟草声明进行测试。这项研究代表了我们由约翰霍普金斯大学公共卫生和医学学院的研究人员组成的多学科研究团队在低收入社区社区社会网络干预和艾滋病毒临床结果研究方面的一个合乎逻辑的科学进步。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艾滋病毒依从性干预研究的基础上。我们的初步研究表明，80%的曾经或正在吸毒的低收入asa目前仍在吸烟，绝大多数表示有戒烟的兴趣。

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.