AIDS and Behavior

, Volume 20, Issue 3, pp 622–632 | Cite as

Trends and Predictors of Cigarette Smoking Among HIV Seropositive and Seronegative Men: The Multicenter Aids Cohort Study

  • Wajiha Z. Akhtar-Khaleel
  • Robert L. Cook
  • Steven Shoptaw
  • Pamela Surkan
  • Ronald Stall
  • Rebecca J. Beyth
  • Linda A. Teplin
  • Michael Plankey
Original Paper


We measured the trend of cigarette smoking among HIV-seropositive and seronegative men over time from 1984 to 2012. Additionally, we examined the demographic correlates of smoking and smoking consumption. Six thousand and five hundred and seventy seven men who have sex with men (MSM) from the Multicenter AIDS Cohort Study (MACS) were asked detailed information about their smoking history since their visit. Prevalence of smoking and quantity smoked was calculated yearly from 1984 to 2012. Poisson regression with robust error variance was used to estimate prevalence ratios of smoking in univariate and multivariate models. In 2012, 11.8 and 36.9 % of men who were enrolled in the MACS before 2001 or during or after 2001 smoked cigarettes, respectively. In the multivariate analysis, black, non-Hispanic, lower education, enrollment wave, alcohol use, and marijuana use were positively associated with current smoking in MSM. HIV serostatus was not significant in the multivariate analysis. However, HIV variables, such as detectable viral load, were positively associated. Though cigarette smoking has declined over time, the prevalence still remains high among subgroups. There is still a need for tailored smoking cessation programs to decrease the risk of smoking in HIV-seropositive MSM.


Smoking Tobacco Detection of smoking HIV MSM 


Un análisis de hombres VIH-sero-positivo y -sero-negativo con fechas de nacimiento entre 1984 y 2012. Inclusivo, estudiamos la demografía relacionada entre fumando cigarrillos y la frecuencia de fumar cigarrillos. Se hizo entrevistas detalladas a 6.577 hombres del estudio Multicenter AIDS Cohort (MACS) que han tenido relaciones sexuales con otros hombres, sobre su frecuencia de fumar cigarrillos desde su última cita. Se calculó anual la frecuencia y cantidad de fumar desde el 1984 a 2012. Se usó la regresión de Poisson con un error de discrepancia conservativo para estimar la proporción de frecuencia de fumar en modelos univariante y multivariante. En 2012, de los hombres que estuvieron matriculados en el estudio de MACS antes del 2001 un 11,8 % fumaban cigarrillos y de los que matricularon en el 2001 o luego un 36,9 %. En el análisis multivariante, personas: africano-americano, anglo, baja nivel de educación, fecha de matriculación al MACS, uso del alcohol y mariguana muestrearon una correlación positiva dentro los hombres fumadores que han tenido relaciones sexuales con otros hombres. VIH-sero-estatus no estuvo significante en el análisis multivariante. Pero, los variables de VIH, como el carga viral, eran asociado positivamente. Aunque el consumo de cigarrillos ha bajado con tiempo, la presencia sigue predominante entre los grupos mencionados. Hay falta de programación que les pueda ayudar en eliminar el uso de cigarrillos para reducir el daño de salud entre hombres VIH-sero-positivo que mantienen relaciones sexuales con otros hombres.



We thank Tariq Syed for his help in translating our abstract. Steve Shoptaw's work was also supported by the Center for HIV Identification, Prevention, and Treatment (CHIPTS) NIMH Grant MH58107; the UCLA Center for AIDS Research (CFAR) NIH/NIAID AI028697; and the National Center for Advancing Translational Sciences through UCLA CSTI Grant UL1TR000124. Data in this manuscript were collected by the Multicenter AIDS Cohort Study (MACS) with centers at Baltimore (U01-AI35042): The Johns Hopkins University Bloomberg School of Public Health: Joseph B. Margolick (PI), Barbara Crain, Adrian Dobs, Homayoon Farzadegan, Joel Gallant, Lisette Johnson-Hill, Cynthia Munro, Michael W. Plankey, Ned Sacktor, James Shepard, Chloe Thio; Chicago (U01-AI35039): Feinberg School of Medicine, Northwestern University, and Cook County Bureau of Health Services: Steven M. Wolinsky (PI), John P. Phair, Sheila Badri, Maurice O’Gorman, David Ostrow, Frank Palella, Ann Ragin; Los Angeles (U01-AI35040): University of California, UCLA Schools of Public Health and Medicine: Roger Detels (PI), Otoniel Martínez-Maza (Co-PI), Aaron Aronow, Robert Bolan, Elizabeth Breen, Anthony Butch, Beth Jamieson, Eric N. Miller, John Oishi, Harry Vinters, Dorothy Wiley, Mallory Witt, Otto Yang, Stephen Young, Zuo Feng Zhang; Pittsburgh (U01-AI35041): University of Pittsburgh, Graduate School of Public Health: Charles R. Rinaldo (PI), Lawrence A. Kingsley (Co-PI), James T. Becker, Ross D. Cranston, Jeremy J. Martinson, John W. Mellors, Anthony J. Silvestre, Ronald D. Stall; and the Data Coordinating Center (UM1-AI35043): The Johns Hopkins University Bloomberg School of Public Health: Lisa P. Jacobson (PI), Alvaro Munoz (Co-PI), Alison, Abraham, Keri Althoff, Christopher Cox, Jennifer Deal, Gypsyamber D’Souza, Priya Duggal, Janet Schollenberger, Eric C. Seaberg, Sol Su, Pamela Surkan. The MACS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the National Cancer Institute (NCI). Targeted supplemental funding for specific projects was also provided by the National Heart, Lung, and Blood Institute (NHLBI), and the National Institute on Deafness and Communication Disorders (NIDCD). MACS data collection is also supported by UL1-TR000424 (JHU CTSA). Website located at The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH).


  1. 1.
    Skinner W. The prevalence and demographic predictors of illicit and licit drug use among lesbian and gay men. Am J Public Health. 1994;84:1307–10.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Skinner W, Otis M. Drug and alcohol use among lesbian and gay people in a southern US sample: epidemiological, comparative, and methodological findings from the Trilogy Project. J Homosex. 1996;30(59–91):18.Google Scholar
  3. 3.
    Royce R, Winkelstein W. HIV infection, cigarette smoking and CD4+ T-lymphocyte counts: preliminary results from the San Francisco Men’s Health Study. AIDS. 1990;4:327–33.CrossRefPubMedGoogle Scholar
  4. 4.
    Lifson A, Neuhaus J, Arribas JR, van den Berg-Wolf M, Labriola AM, Read TR. INSIGHT SMART Study Group: smoking-related health risks among person with HIV in the strategies for management of antiretroviral therapy clinical trial. Am J Public Health. 2010;100:1896–903.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Crothers K, Goulet JL, Rodriguez-Barradas MC, Gilbert CL, Oursler KA, Bidwell Goetz M, Crystal S, Leaf DA, Butt AA, Braithwaite RS, Peck R, Justice AC. Impact of cigarette smoking on mortality in HIV-positive and HIV-negative veterans. AIDS Educ Prev. 2009;21(Suppl 3):40–53.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Reynolds N. Cigarette smoking and HIV: more evidence for action. AIDS Educ Prev. 2009;21(3 suppl):106–21.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Hessol NA, Weber KM, D’Souze G, et al. Smoking cessation and recidivism in the women’s interagency human immunodeficiency virus study. Am J Prev Med. 2014;47(1):53–69.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Vijayaraghavan M, Penko J, Vittinghoff E, et al. Smoking behaviors in a community-based cohort of HIV-infected indigent adults. AIDS Behav. 2014;18:535–43.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Robinson WT, Brown MC, Moody-Thomas S, et al. Smoking and experiences with tobacco cessation among men who have sex with men: New Orleans, 2011. AIDS Behav. 2014;18(Suppl 3):325–32.Google Scholar
  10. 10.
    Ompand DC, Kingdom M, Kupprat S, et al. Smoking and HIV-related health issues among older HIV-positive gay, bisexual, and other men who have sext with men. Behav Med. 2014;40(99–107):19.Google Scholar
  11. 11.
    Lifson AR, Lando HA. Smoking and HIV: prevalence, health risks, and cessation strategies. Curr HIV/AIDS Rep. 2012;9:223–30.CrossRefPubMedGoogle Scholar
  12. 12.
    Tesoriero JM, Giervic SM, Carrascal A, Lavigne HE. Smoking among HIV-positive New Yorkers: prevalence, frequency, and opportunities for cessation. AIDS Behav. 2010;14:824–35.CrossRefPubMedGoogle Scholar
  13. 13.
    Worm SW, Bower M, Reiss P, et al. Non-AIDS defining cancers in the DAD study–time trends and predictors of survival: a cohort study. BMC Infect Dis. 2014;13:471.CrossRefGoogle Scholar
  14. 14.
    Crothers K, Goulet JL, Rodriguez-Barradas MC, et al. Decreased awareness of current smoking among health care providers of HIV-positive compared to HIV-negative veterans. J Gen Intern Med. 2007;22(6):749–54.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Centers for Disease Control and Prevention. Current cigarette smoking among adults—United States, 2005–2012. Morb Mortal Wkly Rep. 2014;63(02):29–34.Google Scholar
  16. 16.
    Mckirnan DJ, Tolou-Shams M, Turner L, et al. Elevated risk for tobacco use among men who have sex with men is mediated by demographic and psychosocial variables. Subst Use Misuse. 2006;41:1197–208.CrossRefPubMedGoogle Scholar
  17. 17.
    Kaslow R, Ostrow D, Detels R, et al. The Multicenter AIDS Cohort Study: rationale, organization, and selected characteristics of the participants. Am J Epidemiol. 1987;126(2):310–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Giorgi JV, Cheng H, Margolick JB, et al. Quality controls in the flow cytometric measurement of T-lymphocytes subsets: The Multicenter AIDS Cohort Study experience. Clin Immunol Immunopathol. 1990;55(2):173–86.CrossRefPubMedGoogle Scholar
  19. 19.
    Schenker E, Hultin L, Bauer K, et al. Evaluation of a dual-color flow cytometry immunophenotyping panel in a multicenter quality assurance program. Cytometry. 1993;14(3):307–17.CrossRefPubMedGoogle Scholar
  20. 20.
    Substance Abuse and Mental Health Services Administration (SAMHSA). Binge drinking: terminology and patterns of use. Accessed 15 Feb 2014.
  21. 21.
    Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Agaku IT, King BA, Dube SR. Current tobacco use among adults in the United States, 2005–2012. MMWR. 2014;63:29–34.PubMedGoogle Scholar
  23. 23.
    Lifson AR, Neuhaus J, Arribas JR, et al. Smoking-related health risks among persons with HIV in the strategies for management of antiretrovirals therapy clinical trial. Am J Public Health. 2010;100:1896–903.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Ryan H, Wortley PM, Easton A, et al. Smoking among lesbians, gays, and bisexuals: a review of the literature. Am J Prev Med. 2001;21:142–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Stall RD, Greenwood GL, Acree M, et al. Cigarette smoking among gays and bisexual men. Am J Public Health. 1999;89:1875–8.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Greenwood GL, Paul JP, Pollack JP, et al. Tobacco use and cessation among a household-based sample of US urban men who have sex with men. Am J Public Health. 2005;95:145–51.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Ward B, Dahlhamer JM, Galinsky A, et al. Sexual orientation and health among US adults: National health interview survey, 2013. National Health Statistics Report. 2013;77. Accessed 1 Sep 2014.
  28. 28.
    Pacek LR, Harrell PT, Martins SS. Cigarette smoking and drug use among a nationally representative sample of HIV-positive individuals. Am J Addict. 2014;23:582–90.CrossRefPubMedGoogle Scholar
  29. 29.
    CDC. State smoke-free laws for worksites, restaurants, and bars—United States, 2000–2010. MMWR. 2011;60(15):472–5.Google Scholar
  30. 30.
    Kabali C, Cheng DM, Brooks D, et al. Recent cigarette smoking and HIV disease progression: no evidence of an association. AIDS Care. 2011;23(8):947–56.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Wojna V, Robles L, Skolasky RL, et al. Associations of cigarette smoking with viral immune and cognitive function in human immunodeficiency virus-seropositive women. J Neurovirol. 2007;13(6):561–8.CrossRefPubMedGoogle Scholar
  32. 32.
    US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington DC. Accessed 1 Sep 2014.
  33. 33.
    Burkhalter JE, Springer CM, Chhabra R, et al. Tobacco use and readiness to quit smoking in low-income HIV-infected persons. Nicotine Tob Res. 2005;7(4):511–22.CrossRefPubMedGoogle Scholar
  34. 34.
    Reynolds NR, Neidig JL, Wewers ME. Illness representation and smoking behavior: a focus group study of HIV-positive men. J Assoc Nurses AIDS Care. 2004;15(4):37–47.CrossRefPubMedGoogle Scholar
  35. 35.
    Lloyd-Richardson EE, Stanton CA, Papandonatos GD, et al. HIV-positive smokers considering quitting: differences by race/ethnicity. Am J Health Behav. 2008;32(1):3–15.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Mamary EM, Bahrs D, Martinez S. Cigaretts smoking and the desire to quit among individuals living with HIV. AIDS Patient Care STDs. 2002;16(1):39–42.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Wajiha Z. Akhtar-Khaleel
    • 1
    • 8
  • Robert L. Cook
    • 1
  • Steven Shoptaw
    • 2
  • Pamela Surkan
    • 3
  • Ronald Stall
    • 4
  • Rebecca J. Beyth
    • 1
    • 5
  • Linda A. Teplin
    • 6
  • Michael Plankey
    • 7
  1. 1.Department of Epidemiology, College of Public Health and Health Professions and College of MedicineUniversity of FloridaGainesvilleUSA
  2. 2.David Geffen School of Medicine, Departments of Family Medicine and PsychiatryUniversity of California, Los AngelesLos AngelesUSA
  3. 3.Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Department of Behavioral and Community Health Sciences, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  5. 5.Malcom Randall VA Medical CenterGainesvilleUSA
  6. 6.Department of Psychiatry and Behavioral Sciences, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  7. 7.Division of Infectious Diseases, Department of MedicineGeorgetown University Medical CenterWashingtonUSA
  8. 8.Department of HealthHIV/AIDS, Hepatitis, STD, and TB AdministrationWashingtonUSA

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