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

描述（由申请人提供）：虽然在高效抗逆转录病毒治疗（HAART）时代，艾滋病相关疾病导致的死亡率大幅下降，但其他疾病（例如，心血管疾病、肺部疾病和癌症）显著增加。因此，努力降低这些非艾滋病界定疾病的发病率和死亡率是一个重要的公共卫生优先事项。改善这一人群健康状况的一种方法是针对健康风险行为，如吸烟。现有证据表明，艾滋病毒/艾滋病感染者的吸烟率显著上升。此外，吸烟与许多艾滋病毒相关的不良后果有关。尽管有这些发现，但很少有人努力为这一人群提供戒烟治疗。还缺乏努力探索艾滋病毒疾病事件/阶段与吸烟之间的关系。因此，本项目的总体目标是前瞻性地探讨艾滋病毒疾病事件/阶段，艾滋病毒的影响，对吸烟的态度和吸烟行为之间的关系。HIV疾病事件/阶段（例如，HIV诊断时间、疾病进展和疾病稳定）将被评估为戒烟的潜在可教时刻。具体来说，我们将从一个大型的市中心艾滋病毒/艾滋病护理中心识别和招募新确诊的艾滋病毒吸烟者，该中心为种族/民族多样化、医疗贫困的人群提供服务。参与者将完成一项计算机管理的评估，旨在测量HIV的感知影响、对吸烟的态度以及研究入组时的当前吸烟行为。除了传统的自我报告措施，某些变量（例如，艾滋病毒的影响）将使用“内隐”认知心理测量进行评估，因为相当多的证据表明，外显和内隐测量都产生预测结果的独特信息。参与者将被随访一年，并要求每隔三个月完成一次随访计算机管理的评估。除了诊所管理的评估外，参与者还将完成每周简短的电话评估，这将使我们能够在随访的前三个月内仔细跟踪疾病和吸烟行为的感知影响的变化。研究人员还将进行病历审查，以记录疾病的时间和进展（例如，治疗失败，诊断为HIV或非HIV相关疾病）。这种设计将使我们能够仔细跟踪吸烟行为随时间的变化，并将这些变化与艾滋病毒疾病的过程和/或参与者对艾滋病毒的感知影响联系起来。通过确定干预的最佳时间点，研究结果将有可能最大限度地提高在资源有限的环境中提供的戒烟治疗的效率和效果。此外，研究结果将有助于确定应针对干预的具体结构，并将为未来针对感染艾滋病毒/艾滋病的吸烟者的戒烟干预措施的发展提供坚实的基础。 公共卫生相关性拟议的研究将提供关于社会经济地位低、种族/民族多样化人群中HIV疾病事件/阶段与吸烟行为之间关系的重要信息。具体而言，研究结果将确定潜在的可教的时刻，在艾滋病毒疾病的过程中停止干预，并将提供一个强大的基础，为未来的戒烟干预措施，针对这一人群的发展。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE 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.