AIDS and Behavior

, Volume 20, Issue 8, pp 1713–1721 | Cite as

Long-Term Cigarette Smoking Trajectories Among HIV-Seropositive and Seronegative MSM in the Multicenter AIDS Cohort Study

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


To examine the association between demographic characteristics and long-term smoking trajectory group membership among HIV-seropositive and HIV-seronegative men who have sex with men (MSM). A cohort of 6552 MSM from the Multicenter AIDS Cohort Study were asked detailed information about their smoking history since their last follow-up. Group-based trajectory modeling was used to examine smoking behavior and identify trajectory group membership. Because participants enrolled after 2001 were more likely to be younger, HIV-seronegative, non-Hispanic black, and have a high school diploma or less, we also assessed time of enrollment in our analysis. Participants were grouped into 4 distinct smoking trajectory groups: persistent nonsmoker (n = 3737 [55.9 %]), persistent light smoker (n = 663 [11.0 %]), heavy smoker to nonsmoker (n = 531 [10.0 %]), and persistent heavy smoker (n = 1604 [23.1 %]). Compared with persistent nonsmokers, persistent heavy smokers were associated with being enrolled in 2001 and later (adjusted odds ratio [aOR] 2.35; 95 % CI 2.12–2.58), having a high school diploma or less (aOR 3.22; 95 % CI 3.05–3.39), and being HIV-seropositive (aOR 1.17; 95 % CI 1.01–1.34). These associations were statistically significant across all trajectory groups for time of enrollment and education but not for HIV serostatus. The overall decrease of smoking as shown by our trajectory groups is consistent with the national trend. Characteristics associated with smoking group trajectory membership should be considered in the development of targeted smoking cessation interventions among MSM and people living with HIV.


MACS Smoking Trajectories PLWH 



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-P I), 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.
    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(5):335–44.CrossRefPubMedGoogle Scholar
  2. 2.
    Crothers K, et al. Impact of cigarette smoking on mortality in HIV-positive and HIV-negative veterans. AIDS Educ Prev. 2009;21(3 Suppl):40–53.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Lifson AR, Lando HA. Smoking and HIV: prevalence, health risks, and cessation strategies. Curr HIV/AIDS Rep. 2012;9(3):223–30.CrossRefPubMedGoogle Scholar
  4. 4.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Tesoriero JM, et al. Smoking among HIV positive New Yorkers: prevalence, frequency, and opportunities for cessation. AIDS Behav. 2010;14(4):824–35.CrossRefPubMedGoogle Scholar
  6. 6.
    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(6):582–90.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Benard A, et al. Tobacco addiction and HIV infection: toward the implementation of cessation programs. ANRS CO3 Aquitaine Cohort. AIDS Patient Care STDS. 2007;21(7):458–68.CrossRefPubMedGoogle Scholar
  8. 8.
    Royce RA, Winkelstein W Jr. HIV infection, cigarette smoking and CD4 + T-lymphocyte counts: preliminary results from the San Francisco Men’s Health Study. AIDS. 1990;4(4):327–33.CrossRefPubMedGoogle Scholar
  9. 9.
    Stall RD, et al. Cigarette smoking among gay and bisexual men. Am J Public Health. 1999;89(12):1875–8.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Reynolds NR. Cigarette smoking and HIV: more evidence for action. AIDS Educ Prev. 2009;21(3 Suppl):106–21.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Agaku I, King B, Dube S. Current cigarette smoking among adults-United States, 2005–2012. MMWR Mortal Mortal Wkly Rep. 2014;63:29–34.Google Scholar
  12. 12.
    Justice AC. HIV and aging: time for a new paradigm. Curr HIV/AIDS Rep. 2010;7(2):69–76.CrossRefPubMedGoogle Scholar
  13. 13.
    Barbaro G, et al. An open-label, prospective, observational study of the incidence of coronary artery disease in patients with HIV infection receiving highly active antiretroviral therapy. Clin Ther. 2003;25(9):2405–18.CrossRefPubMedGoogle Scholar
  14. 14.
    Friis-Moller N, et al. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med. 2003;349(21):1993–2003.CrossRefPubMedGoogle Scholar
  15. 15.
    Petoumenos K, et al. Rates of cardiovascular disease following smoking cessation in patients with HIV infection: results from the D:A: D study(*). HIV Med. 2011;12(7):412–21.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kaslow RA, et al. Infection with the human immunodeficiency virus: clinical manifestations and their relationship to immune deficiency. A report from the Multicenter AIDS Cohort Study. Ann Intern Med. 1987;107(4):474–80.CrossRefPubMedGoogle Scholar
  17. 17.
    Dudley J, et al. The Multicenter AIDS Cohort Study: retention after 9 1/2 years. Am J Epidemiol. 1995;142(3):323–30.PubMedGoogle Scholar
  18. 18.
    Akhtar-Khaleel WZ, et al. Trends and predictors of cigarette smoking among HIV seropositive and seronegative men: the Multicenter AIDS Cohort Study. AIDS Behav. 2015. doi: 10.1007/s10461-015-1099-6. Google Scholar
  19. 19.
    Cook RL, et al. Alcohol consumption trajectory patterns in adult women with HIV infection. AIDS Behav. 2013;17(5):1705–12.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Lim SH, et al. Changes in stimulant drug use over time in the MACS: evidence for resilience against stimulant drug use among men who have sex with men. AIDS Behav. 2012;16(1):151–8.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Hedeker D, Gibbons R. Longitudinal data analysis. Hoboken: Wiley; 2006.Google Scholar
  22. 22.
    Nagin D. Group-based modeling of development. Cambridge: Harvard University Press; 2005.CrossRefGoogle Scholar
  23. 23.
    Shwarz G. Estimating the dimension of a model. Ann Stat. 1978;9(2):461–4.CrossRefGoogle Scholar
  24. 24.
    Audrain-McGovern J, et al. Identifying and characterizing adolescent smoking trajectories. Cancer Epidemiol Biomarkers Prev. 2004;13(12):2023–34.PubMedGoogle Scholar
  25. 25.
    Bernat DH, et al. Adolescent smoking trajectories: results from a population-based cohort study. J Adolesc Health. 2008;43(4):334–40.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Hampson SE, et al. Smoking trajectories across high school: sensation seeking and hookah use. Nicotine Tob Res. 2013;15(8):1400–8.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Lessov-Schlaggar CN, et al. Adolescent smoking trajectories and nicotine dependence. Nicotine Tob Res. 2008;10:341–51.CrossRefPubMedGoogle Scholar
  28. 28.
    Greenwood GL, 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
  29. 29.
    Herrick AL, et al. Adversity and syndemic production among men participating in the multicenter AIDS cohort study: a life-course approach. Am J Public Health. 2013;103(1):79–85.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Kurtz SP, et al. Resilience, syndemic factors, and serosorting behaviors among HIV-positive and HIV-negative substance-using MSM. AIDS Educ Prev. 2012;24(3):193–205.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Stall R, Friedman M, Catania J. Interacting epidemics and gay men’s health: a theory of syndemic production among urban gay men. In: Unequal opportunity: health disparities affecting gay and bisexual men in the United States. New York: Oxford University Press; 2008.Google Scholar
  32. 32.
    Fergus S, Zimmerman MA. Adolescent resilience: a framework for understanding healthy development in the face of risk. Annu Rev Public Health. 2005;26:399–419.CrossRefPubMedGoogle Scholar
  33. 33.
    Rabkin JG, et al. Resilience in adversity among long-term survivors of AIDS. Hosp Community Psychiatry. 1993;44(2):162–7.PubMedGoogle Scholar
  34. 34.
    Mills TC, et al. Distress and depression in men who have sex with men: the Urban Men’s Health Study. Am J Psychiatry. 2004;161(2):278–85.CrossRefPubMedGoogle Scholar
  35. 35.
    Stall R, et al. Alcohol use, drug use and alcohol-related problems among men who have sex with men: the Urban Men’s Health Study. Addiction. 2001;96(11):1589–601.CrossRefPubMedGoogle Scholar
  36. 36.
    Herrick AL, et al. Resilience as an untapped resource in behavioral intervention design for gay men. AIDS Behav. 2011;15(Suppl 1):S25–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Kent M, Davis M. The emergence of capacity-building programs and models of resilience. Handbook of adult resilience. New York: Guilford Press; 2010. p. 427–49.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Wajiha Z. Akhtar-Khaleel
    • 1
  • Robert L. Cook
    • 1
  • Steve Shoptaw
    • 2
  • Pamela J. Surkan
    • 3
  • Linda A. Teplin
    • 4
  • Ronald Stall
    • 5
  • Rebecca J. Beyth
    • 6
    • 7
  • Todd  M. Manini
    • 1
    • 8
  • Michael Plankey
    • 9
  1. 1.Department of Epidemiology, College of Public Health and Health Professions and College of MedicineUniversity of FloridaGainesvilleUSA
  2. 2.Departments of Family Medicine and Psychiatry, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUSA
  3. 3.Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Department of Psychiatry and Behavioral Sciences, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  5. 5.Department of Behavioral and Community Health Sciences, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  6. 6.Malcom Randall VA Medical CenterGainesvilleUSA
  7. 7.Department of Medicine, College of MedicineUniversity of FloridaGainesvilleUSA
  8. 8.Department of Aging & Geriatric Research, Institute on Aging, College of MedicineUniversity of FloridaGainesvilleUSA
  9. 9.Department of Medicine, Division of Infectious DiseasesGeorgetown University Medical CenterWashingtonUSA

Personalised recommendations