Abstract
HIV stigma and future orientations impact the health of adolescents and young adults living with HIV (AYALWH); however, little is known about how these factors may impact tobacco use, and thereby long-term health status. This study examined associations between internalized HIV stigma, future orientations, and smoking behavior using a cross sectional survey of AYALWH ages 18 to 29 (N = 109). Greater levels of stigma were associated with increased odds of smoking, and greater future orientations were associated with a reduced odds of smoking. The interaction was significant, illustrating that stigma was significantly associated with an increased odds of smoking among AYALWH who reported low levels of future orientations, but not for those with high levels of future orientations. Findings underscore the importance of understanding how HIV stigma may undermine future aspirations of AYALWH. Interventions that target HIV stigma and future orientations may be critical for tobacco prevention and cessation.
Resumen
El estigma asociado con el VIH y orientación futura de adolescentes y adultos jóvenes viviendo con VIH (AYALWH) impacta la salud de estos; sin embargo, se conoce poco sobre cómo estos factores pueden impactar el uso de tabaco y, por lo tanto, el estado de salud a largo plazo. Este estudio examinó las asociaciones entre el estigma internalizado hacia el VIH, las orientaciones futuras, y hábitos de fumar mediante una encuesta transversal con AYALWH entre las edades de 18 a 29 años (N = 109). Niveles elevados de estigma fueron asociado con mayores probabilidades de fumar, y mayores orientaciones futuras se asociaron con menores probabilidades de fumar. La interacción entre variables fue significativa, demostrando que el estigma se asoció significativamente con un aumento de las probabilidades de fumar entre AYALWH que reportaron niveles bajos de orientaciones futuras, pero no para aquellos con niveles altos de orientaciones futuras. Los hallazgos resaltan la importancia de comprender cómo el estigma hacia el VIH puede socavar las aspiraciones futuras de los AYALWH. Intervenciones dirigidas al estigma hacia el VIH y las orientaciones futuras pueden ser críticas para la prevención y abandono del tabaco.
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References
Mdodo R, et al. Cigarette smoking prevalence among adults with HIV compared with the general adult population in the United States: cross-sectional surveys. Ann Intern Med. 2015;162:335–44.
Marshall MM, et al. Tobacco use and nicotine dependence among HIV-infected and uninfected injection drug users. Addict Behav. 2011;36(1):61–7.
Lifson AR, et al. Smoking-related health risks among persons with HIV in the Strategies for Management of Antiretroviral Therapy clinical trial. Am J Public Health. 2010;100(10):1896–903.
Helleberg M, et al. Risk of cancer among HIV-infected individuals compared to the background population: impact of smoking and HIV. AIDS. 2014;28(10):1499–508.
Helleberg M, et al. Smoking and life expectancy among HIV-infected individuals on antiretroviral therapy in Europe and North America. AIDS. 2015;29(2):221.
Gamarel KE, et al. Tobacco use and sustained viral suppression among youth living with HIV. AIDS Behav. 2018. (In press).
Gamarel KE, et al. Prevalence and correlates of substance use among youth living with HIV in clinical settings. Drug Alcohol Depend. 2016;1(169):11–8.
Gamarel KE, et al. Smoking, internalized heterosexism, and HIV disease management among male couples. AIDS care. 2015;27(5):649–54.
Martinez J, Chakraborty R, Committee on pediatric AIDS. Psychosocial support for youth living with HIV. Pediatrics. 2014;133:558–62.
Kadivar H, et al. Psychosocial profile of HIV-infected adolescents in a Southern US urban cohort. AIDS Care. 2006;18(6):544–9.
Udell W, Donenberg G, Emerson E. Parents matter in HIV-risk among probation youth. J Fam Psychol. 2011;25(5):785.
Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160.
Earnshaw VA, et al. HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav. 2013;17(5):1785–95.
Logie C, Gadalla T. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care. 2009;21(6):742–53.
Rendina HJ, Millar BM, Parsons JT. Situational HIV stigma and stimulant use: a day-level autoregressive cross-lagged path model among HIV-positive gay and bisexual men. Addict Behav. 2018;83:109–15.
Rendina HJ, Millar BM, Parsons JT. The critical role of internalized HIV-related stigma in the daily negative affective experiences of HIV-positive gay and bisexual men. J Affect Disord. 2018;227:289–97.
Lee RS, Kochman A, Sikkema KJ. Internalized stigma among people living with HIV-AIDS. AIDS Behav. 2002;6(4):309–19.
Rosario M, Schrimshaw EW, Hunter J. Cigarette smoking as a coping strategy: negative implications for subsequent psychological distress among lesbian, gay, and bisexual youths. J Pediatr Psychol. 2010;36(7):731–42.
Ayyagari P, Sindelar JL. The impact of job stress on smoking and quitting: evidence from the HRS. BE J Econom Anal Policy. 2010. https://doi.org/10.2202/1935-1682.2259.
Siqueira LM, Rolnitzky LM, Rickert VI. Smoking cessation in adolescents: the role of nicotine dependence, stress, and coping methods. Arch Pediatr Adolesc Med. 2001;155(4):489–95.
Sussman S, et al. Relations of coping effort, coping strategies, perceived stress, and cigarette smoking among adolescents. Int J Addict. 1993;28(7):599–612.
Bauremeister JA. How statewide LGB policies go from “under our skin” to “into our hearts”: fatherhood aspirations and psychological well-being among emerging adult sexual minority men. J Youth Adolesc. 2014;43(8):1295–305.
Johnson SRL, Blum RW, Cheng TL. Future orientation: a construct with implications for adolescent health and wellbeing. Int J Adolesc Med Health. 2014;26(4):459–68.
McCabe KM, Barnett D. The relation between familial factors and the future orientation of urban, African American sixth graders. J Child Family Studies. 2000;9(4):491–508.
Chen P, Vazsonyi AT. Future orientation, impulsivity, and problem behaviors: a longitudinal moderation model. Dev Psychol. 2011;47(6):1633.
Cabrera P, Auslander W, Polgar M. Future orientation of adolescents in foster care: relationship to trauma, mental health, and HIV risk behaviors. J Child Adolesc Trauma. 2009;2(4):271–86.
Wills TA, Sandy JM, Yaeger AM. Time perspective and early-onset substance use: a model based on stress—coping theory. Psychol Addict Behav. 2001;15(2):118.
Nurmi JE, Poole ME, Kalakoski V. Age differences in adolescent future-oriented goals, concerns, and related temporal extension in different sociocultural contexts. J Youth Adolesc. 1994;23(4):471–87.
Bolland JM. Hopelessness and risk behaviour among adolescents living in high-poverty inner-city neighbourhoods. J Adolesc. 2003;26:145–58.
Griffin KW, et al. Low perceived chances for success in life and binge drinking among inner-city minority youth. J Adolesc Health. 2004;34:501–7.
Lin X, et al. Social ecological factors associated with future orientation of children affected by parental HIV infection and AIDS. J Health Psychol. 2016;2(7):1404–14.
Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001;24(6):518–29.
Whitaker DK, Miller KS, Clark LF. Reconceptualizing adolescent sexual behavior: beyond did they or didn’t they? Fam Plann Perspect. 2000;32(3):111–7.
Derogatis LR. BSI brief symptom inventory: administration, scoring, and procedures manual. Bloomington: PsychCorp; 1993.
Aiken LS, West SG. Multiple regression: testing and interpreting interactions. Newbury Park, CA: Sage; 1991.
Earnshaw VA, Kidman RC, Violari A. Stigma, Depression, and substance use problems among perinatally HIV-infected youth in South Africa. AIDS Behav. 2018;22:3892–6.
Earnshaw VA, et al. Stigma and racial/ethnic HIV disparities: moving toward resilience. Am Psychol. 2015;68(4):225–36.
Zullig KJ, et al. Relationship between perceived life satisfaction and adolescents’ substance abuse. J Adolesc Health. 2001;29:279–88.
Homel R, Burns A. Environmental quality and the well-being of children. Soc Indic Res. 1989;21:133–58.
Sastre MTM, Ferriere G. Family ‘‘decline’’ and the subjective well-being of adolescents. Soc Indic Res. 2000;49:69–82.
Mowen JC. The 3M model of motivation and personality: theory and empirical applications to consumer behavior. Belin: Springer Science & Business Media; 2000.
Fergus S, Zimmerman M. Adolescent resilience: a framework for understanding healthy development in the face of risk. Ann Rev Public Health. 2005;26:399–419.
Newcomb M, Bentler P, Collins C. Alcohol use and dissatisfaction with life and self. J Drug Issues. 1986;63:479–94.
Oyserman D, Fisher O. Social stigma and health: an identity-based motivation perspective. Oxford handbook of stigma, discrimination, and health. 2017; p. 317.
Harris PR, et al. Self-affirmation reduces smokers’ defensiveness to graphic on-pack cigarette warning labels. Health Psychol. 2007;26(4):437.
Oyserman D, Terry K, Bybee D. A possible selves intervention to enhance school involvement. J Adolesc. 2002;25:313–26.
Acknowledgements
This work was supported by the University of Michigan Roger Cancer Center Outreach & Health Disparities grant (PI: Gamarel). We are indebted to the W’SUP team at Wayne State University and the young people who participated in this study.
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Gamarel, K.E., Finer, Z., Resnicow, K. et al. Associations Between Internalized HIV Stigma and Tobacco Smoking Among Adolescents and Young Adults Living with HIV: The Moderating Role of Future Orientations. AIDS Behav 24, 165–172 (2020). https://doi.org/10.1007/s10461-019-02567-9
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DOI: https://doi.org/10.1007/s10461-019-02567-9