Journal of General Internal Medicine

, Volume 22, Issue 6, pp 749–754

Decreased Awareness of Current Smoking Among Health Care Providers of HIV-positive Compared to HIV-negative Veterans

Authors

  • Kristina Crothers
    • Pulmonary and Critical Care Medicine, Department of Internal MedicineYale University School of Medicine
  • Joseph L. Goulet
    • VA Connecticut Healthcare System, West Haven, and General Internal Medicine, Department of Internal MedicineYale University School of Medicine
  • Maria C. Rodriguez-Barradas
    • Medical Service, Infectious DiseasesMichael A. DeBakey VA Medical Center, and Baylor College of Medicine
  • Cynthia L. Gibert
    • Medical Service, Infectious DiseasesVA Medical Center, and George Washington University
  • Adeel A. Butt
    • Infectious Diseases, Department of Internal MedicineVA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine
  • R. Scott Braithwaite
    • VA Connecticut Healthcare System, West Haven, and General Internal Medicine, Department of Internal MedicineYale University School of Medicine
  • Robin Peck
    • Medical Service, Infectious DiseasesVA Medical Center, and George Washington University
    • VA Connecticut Healthcare System, West Haven, and General Internal Medicine, Department of Internal MedicineYale University School of Medicine
Original Article

DOI: 10.1007/s11606-007-0158-8

Cite this article as:
Crothers, K., Goulet, J.L., Rodriguez-Barradas, M.C. et al. J GEN INTERN MED (2007) 22: 749. doi:10.1007/s11606-007-0158-8

Abstract

BACKGROUND

Cigarette smoking is an important risk factor for morbidity and mortality in HIV-positive patients on combination antiretroviral therapy.

OBJECTIVE

To determine whether awareness of smoking differs between HIV and non-HIV providers, and to identify factors associated with failure to recognize current smoking.

DESIGN

Observational study.

PARTICIPANTS

801 HIV-positive and 602 HIV-negative patients, 72 HIV and 71 non-HIV providers enrolled in the Veterans Aging Cohort 5 Site Study.

MEASUREMENTS

Data sources included patient and provider questionnaires; electronic medical records; and the national administrative VA database. We calculated sensitivity, specificity, and measures of agreement between patient- and provider-reported smoking, and examined factors associated with failure to recognize current smoking using logistic regression.

RESULTS

Whereas most providers were correct when they identified a patient as a current smoker (specificity ≥90%), HIV providers missed current smoking more often (sensitivity 65% for HIV vs. 82% for non-HIV). Kappa scores for current smoking were significantly lower for HIV compared to non-HIV providers (0.55 vs. 0.75, p < .001). In models adjusted for age, gender, race, and other differences, patient HIV status and provider specialty in infectious diseases were independent predictors of a provider’s failure to recognize current smoking. Comorbid illnesses, cough/dyspnea, degree of immune competence and HIV viral suppression did not impact recognition of current smoking. Only 39% of HIV providers reported confidence in their ability to influence smoking cessation compared to 62% of non-HIV providers (p = .049).

CONCLUSIONS

Interventions to increase HIV provider awareness of current smoking and skills to influence smoking cessation are needed. Efforts should also target patient populations with smoking-related comorbid diseases who would especially benefit from smoking cessation.

KEY WORDS

tobaccodetection of smokingHIVsmoking cessation

Copyright information

© Society of General Internal Medicine 2007