Abstract
The prevalence of cigarette smoking among HIV+ individuals is greater than that found in the general population. However, factors related to smoking within this population are not well understood. This study examined the associations between smoking and demographic, medical, substance use, and psychosocial factors in a clinic-based sample of HIV+ men and women. Two hundred twelve participants completed self-report measures of tobacco use, HIV-related symptoms, viral load, CD4, alcohol and illicit drug use, depression, and social support. Multinomial logistic regression (MLR) analyses modeled the independent associations of the cross-sectional set of predictors with smoking status. Results indicated that 74% of the sample smoked at least one cigarette per day; using standard definitions, 23% of the sample were light smokers, 22% were moderate smokers, and 29% smoked heavily. Smoking was associated with more HIV-related symptoms, greater alcohol and marijuana use, and less social support. Light smoking was related to minority race/ethnicity and less income; moderate smoking was associated with less education; and heavy smoking was related to less education and younger age. Viral load, CD4 count, and depression were not associated with smoking status. Psychosocial interventions targeting this population should consider the relationships between biopsychosocial factors and smoking behavior.
Similar content being viewed by others
Notes
When the 26 participants who identified themselves as Asian, Native American, or other were excluded from the analyses, the pattern of results did not differ.
References
Alferi, S. M., Carver, C. S., Antoni, M. H., Weiss, S., & Durán, R. E. (2001). An exploratory study of social support, distress, and life disruption among low-income Hispanic women under treatment for early stage breast cancer. Health Psychology, 20, 41–46.
Arcavi, L., & Benowitz, N. L. (2004). Cigarette smoking and infection. Archives of Internal Medicine, 164(20), 2206–2216.
Barnes, P., & Schiller, J. S. (2006). Early release of selected estimates based on data from the January–June 2006. National Health Interview Survey. National Center for Health Statistics. http://www.cdc.gov/nchs/nhis.htm.
Beck, J., & Slade, G. (1996). Epidemiology of periodontal disease. Current Opinion in Periodontology, 3, 3–9.
Belsley, D. A., Kuh, E., & Welsch, R. E. (1980). Regression diagnostics: Identifying influential data and sources of collinearity. New York: John Wiley & Sons.
Bing, E. G., Hays, R. D., Jacobsen, L. P., Chen, B., Gange, S. J., Kass, N. E., et al. (2000). Health-related quality of life among people with HIV disease: Results from the Multicenter AIDS Cohort Study. Quality of Life Research, 9, 55–63.
Breslau, N., Kilbey, M., & Andreski, P. (1991). Nicotine dependence, major depression, and anxiety in young adults. Archives of General Psychiatry, 48, 1069–1074.
Brenner, M. H., Curbow, B., & Legro, M. W. (1995). The proximal-dostal continuum of multiple health outcome measures: The case of cataract surgery. Medical Care, 33(4), AS236–AS244.
Brown, C., Madden, P. A. F., Palenchar, D. F., & Cooper-Patrick, L. (2000). The association between depressive symptoms and cigarette smoking in an urban primary care sample. International Journal of Psychiatry in Medicine, 30, 15–26.
Burkhalter, J. E., Springer, C. M., Chhabra, R., Ostroff, J S., & Rapkin, B. D. (2005). Tobacco use and readiness to quit smoking in low-income HIV-infected persons. Nicotine and Tobacco Research, 7(4), 511–522.
Burns, D. N., Hillman, D., Neaton, J. D., Sherer, R., Mitchell, T., Capps, L., et al. (1996). Cigarette smoking, bacterial pneumonia, and other clinical outcomes in HIV-1 infection. Terry Beirn community programs for clinical research on AIDS. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 13, 374–383.
Centers for Disease Control, Prevention. (2005). Cigarette smoking among adults—United States, 2004. Morbidity and Mortality Weekly Report, 44, 1121–1124.
Chander, G., Lau, B., & Moore, R. D. (2006). Hazardous alcohol use: A risk factor for non-adherence and lack of suppression in HIV infection. Journal of Acquired Immune Deficiency Syndromes, 43(4), 411–417.
Collins, R. L., Kanouse, D. E., Gifford, A. L., Senterfitt, J. W., Schuster, M. A., McCaffrey, D. F., et al. (2001). Changes in health-promoting behavior following diagnosis with HIV: Prevalence and correlates in a national probability sample. Health Psychology, 20(5), 351–360.
Costello, C., & Devins, G. (1989). Screening for depression among women attending their family physicians. Canadian Journal of Behavioural Science, 21, 434–451.
Covey, L. S., Glassman, A. H., & Stetner, F. (1998). Cigarette smoking and major depression. Journal of Addictive Diseases, 17, 35–46.
Crothers, K., Griffith, T. A., McGinnis, K. A., Rodriguez-Barradas, M. C., Leaf, D. A., Weissman, S., et al. (2005). The impact of cigarette smoking on mortality, quality of life, and comorbid illness among HIV-positive veterans. Journal of General Internal Medicine, 20, 1142–1145.
Diaz, P. T., King, M. A., Pacht, E. R., Wewers, M. D., Gadek, J. E., Nagaraja, H. N., et al. (2000). Increased susceptibility to pulmonary emphysema among HIV-seropositive smokers. Annals of Internal Medicine, 132, 369–372.
Dierker, L., Lloyd-Richardson, E., Stolar, M., Flay, B., Tiffany, S., Collins, L., et al. (2006). The proximal association between smoking and alcohol use among first year college students. Drug and Alcohol Dependence, 81, 1–9.
Dixon, D., Kilbourn, K., Cruess, S., Klimas, N., Fletcher, M. A., Ironson, G., et al. (2001). Social support mediates the relationship between loneliness and Human Herpesvirus-Type 6 (HHV-6) antibody titers in HIV+ gay men following Hurricane Andrew. Journal of Applied Social Psychology, 31, 1111–1132.
Droomers, M., Schrijvers, T. M., & Mackenbach, J. P. (2002). Why do lower educated people continue smoking? Explanations from the longitudinal GLOBE study. Health Psychology, 21, 263–272.
Fein, G., Biggins, C. A., & MacKay, S. (1995). Alcohol abuse and HIV infection have additive effects on frontal cortex function as measured by auditory evoked potential P3A latency. Biological Psychiatry, 37, 183–195.
Feldman, J. G., Minkoff, H., Schneider, M. F., Gange, S. J., Cohen, M., Watts, H., et al. (2006). Association of cigarette smoking with HIV prognosis among women in the HAART era: A report from the women’s interagency HIV study. American Journal of Public Health, 96, 1060–1065.
Furler, M. D., Einarson, T. R., Millson, M., Walmsley, S., & Bendayan, R. (2004). Medicinal and recreational marijuana use by patients infected with HIV. AIDS Patient Care and STDs, 18(4), 215–228.
Furberg, H., Sullivan, P. F., Maes, H., Prescott, C. A., Lerman, C., Bulik, C., et al. (2005). The types of regular cigarette smokers: A latent class analysis. Nicotine and Tobacco Research, 7(3), 351–360.
Galvan, F. H., Bing, E. G., Fleishman, J. A., London, A. S., Caetano, R., Burnam, M. A., et al. (2002). The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: Results from the HIV cost and services utilization study. Journal of Studies on Alcohol, 63, 179–186.
Gostin, V., & Webber, D. W. (1998). The AIDS Litigation Project: HIV/AIDS in the courts in the 1990s, Part 2. AIDS Public Policy Journal, 13, 1–19.
Greenwood, G. L., Paul, J. P., Pollack, L. M., Binson, D., Catania, J. A., Chang, J., et al. (2005). Tobacco use and cessation among a household-based sample of US urban men who have sex with men. American Journal of Public Health, 95, 145–151.
Gritz, E. R., Vidrine, D. J., Lazev, A. B., Amick, B. C. III, & Arduino, R. C. (2004). Smoking behavior in a low-income multiethnic HIV/AIDS population. Nicotine and Tobacco Research, 6, 71–77.
Haiman, C. A., Stram, D. O., Wilkens, L. R., Pike, M. C., Kolonel, L. N., Henderson, B. E., et al. (2006). Ethnic and racial differences in the smoking-related risk of lung cancer. New England Journal of Medicine, 354, 333–342.
Halloran, J. (2006). Increasing survival with HIV: Impact on nursing care. AACN Clinical Issues, 17(1), 8–17.
Hammond, D. (2005). Smoking behaviour among young adults: Beyond youth prevention. Tobacco Control, 14, 181–185.
Hays, R. D., Cunningham, W. E., Sherbourne, C. D., Wilson, I. B., Wu, A. W., Cleary, P. D., et al. (2000). Health-related quality of life in patients with human immunodeficiency virus infection in the United States: Results from the HIV cost and services utilization study. American Journal of Medicine, 108, 714–722.
Hoffman, J. H., Welte, J. W., & Barnes, G. M. (2001). Co-occurrence of alcohol and cigarette use among adolescents. Addictive Behaviors, 26, 63–78.
House, J. S. (1987). Social support and social structure. Sociological Forum, 2, 135–146.
House J. S., Umberson, D., & Landis, K. R. (1988). Structures and processes of social support. Annual Review of Sociology, 14, 293–318.
Ickovics, J. R., Hamburger, M. E., Vlahov, D., Schoenbaum, E., Schuman, P., Boland, R. J., et al. (2001). Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: Longitudinal analysis from the HIV Epidemiology Research Study. Journal of the American Medical Association, 285, 1466–1474.
Justice, A. C., Holmes, W., Gifford, A. L., Rabeneck, L., Zackin, R., Sinclair, G., et al. (2001). Development and validation of a self-completed HIV symptom index. Journal of Clinical Epidemiology, 54, S77–S90.
Kalichman, S. C., Sikkema, K. J., & Somlai, A. (1995). Assessing persons with human immunodeficiency virus (HIV) infection using the Beck Depression Inventory: Disease processes and other potential confounds. Journal of Personality Assessment, 64(1), 86–100.
Kaplan, G. A., Wilson, T. W., Cohen, R. D., Kauhanen, J., Wu, M., & Salonen, J. T. (1994). Social functioning and overall mortality: Prospective evidence from the Kuopio ischemic heart disease risk factor study. Epidemiology, 5, 495–500.
Leserman, J., Jackson, E. D., Petitto, J. M., Golden, R. N., Silva, S. G., Perkins, D. O., et al. (1999). Progression to AIDS: The effects of stress, depressive symptoms, and social support. Psychosomatic Medicine, 61, 397–406.
Leserman, J., Petitto, J. M., Golden, R. N., Gaynes, B. N., Gu, H., Perkins, D. O., et al. (2000). Impact of stressful life events, depression, social support, coping, and cortisol on progression to AIDS. American Journal of Psychiatry, 157, 1221–1228.
Lewis, M. A., & Rook, K. S. (1999). Social control in personal relationships: Impact on health behaviors and psychological distress. Health Psychology, 18, 63–71.
Lohse, N., Hansen, A. B., Pedersen, G., Kronborg, G., Gerstoft, J., Sorensen, H. T., Vaeth, M., & Obel N. (2007). Survival of persons with and without HIV infection in Denmark, 1995–2005. Annals of Internal Medicine, 146, 87–95.
Lucas, G. M., Griswold, M., Gebo, K. A., Keruly, J., Chaisson, R. E., & Moore, R. D. (2006). Illicit drug use and HIV-1 disease progression: A longitudinal study in the era of highly antiretroviral therapy. American Journal of Epidemiology, 136, 412–420.
Lyketsos, C. G., Hoover, D. R., Guccione, M., Dew, M. A., Wesch, J. E., Bing, E. G., et al. (1996). Changes in depressive symptoms as AIDS develops. The Multicenter AIDS Cohort Study. The American Journal of Psychiatry, 153, 1430–1437.
Mamary, E. M., Bahrs, D., & Martinez, S. (2002). Cigarette smoking and the desire to quit among individuals living with HIV. AIDS Patient Care and STDs, 16, 39–42.
May, S., & West, R. (2000). Do social support interventions (“buddy systems”) aid smoking cessation? A review. Tobacco Control, 9, 415–422.
Metersky, M., Colt, H., Olson, L., & Shanks, T. (1995). AIDS-related spontaneous pneumothorax: Risk factors and treatment. Chest, 108, 946–951.
Miguez-Burbano, M. J., Ashkin, D., Rodríguez, A., Duncan, R., Pitchenik, A., Quintero, N., et al. (2005). Increased risk of Pneumocystis carinii and community-acquired pneumonia with tobacco use in HIV disease. International Journal of Infectious Diseases, 9, 208–217.
Moolchan, E. T., Robinson, M. L., Ernst, M., Cadet, J. L., Pickworth, W. B., Heishman, S. J., et al. (2005). Pediatrics, 115, e407–e414.
Moskowitz, J. Y. (2003). Positive affect predicts lower risk of AIDS mortality. Psychosomatic Medicine, 65, 620–626.
Murphy, D. A., Kelly, J. A., Brasfield, T., Koob, J., Bahr, R., & St. Lawrence, J. (1991). Predictors of depression among persons with HIV infection [abstract]. International Conference on AIDS, 7, 457.
Neiman, R. B., Fleming, J., Coker, R. J., Harris, J. R. W., & Mitchell, D. M. (1993). The effect of cigarette smoking on the development of AIDS in HIV-1-seropositive individuals. AIDS, 7, 705–710.
Niaura, R., Shadel, W. G., Morrow, K., Flanigan, T., & Abrams, D. B. (1999). Smoking among HIV-positive persons. Annals of Behavioral Medicine, 21(Suppl), S116.
Niaura, R., Shadel, W. G., Morrow, K., Tashima, K., Flanigan, T., & Abrams, D. B. (2000). Human immunodeficiency virus infection, AIDS, and smoking cessation: The time is now. Clinical Infectious Diseases, 31, 808–812.
Novotny, T. E., Warner, K. E., Kendrick, J. S., & Remington, P. L. (1988). Smoking by blacks and whites: Socioeconomic and demographic differences. American Journal of Public Health, 78, 1187–1189.
Okuyemi, K. S., Ahluwalia, J. S., Banks, R., Harris, K. J., Moiser, M. C., Nazir, N., et al. (2004). Differences in smoking and quitting experiences by levels of smoking among African Americans. Ethnicity and Disease, 14, 127–133.
Okuyemi, K. S., Harris, K. J., Scheibmeir, M., Choi, M., Powell, J., & Ahluwalia, J. S. (2002). Light smokers: Issues and recommendations. Nicotine and Tobacco Research, 4, S103–S112.
Palacio, H., Hilton, J., Canchola, A., & Greenspan, D. (1997). Effect of cigarette smoking on HIV related oral lesions. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 14, 338–342.
Patel, N., Talwar, A., Reichert, V. C., Brady, T., Jain, M., & Kaplan, M. H. (2006). Tobacco and HIV. Clinics in Occupational and Environmental Medicine, 5, 193–207.
Patten, C. A., Martin, J. E., & Owen, N. (1996). Can psychiatric and chemical dependency treatment units be smoke free? Journal of Substance Abuse Treatment, 13, 107–118.
Patton, L. L., McKaig, R. G., Strauss, R. P., & Eron, J. J., Jr. (1998). Oral manifestations of HIV in a southeast USA population. Oral Diseases, 4, 164–169.
Pence, B. W., Miller, W. C., Whetten, K., Eron, J. J., & Gaynes, B. N. (2006). Prevalence of DSM-IV-defined mood, anxiety, and substance use disorders in an HIV clinic in the Southeastern United States. Journal of Acquired Immune Deficiency Syndromes, 42, 298–306.
Prentiss, D., Power, R., Balmas, G., Tzuang, G., & Israelski, D. M. (2004). Patterns of marijuana use among patients with HIV/AIDS followed in a public health care setting. Journal of Acquired Immune Deficiency Syndrome, 53, 38–45.
Quattrocki, E., Baird, A., & Yurgelun-Todd, D. (2000). Biological aspects of the link between smoking and depression. Harvard Review of Psychiatry, 8, 99–110.
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 333–339.
Reynolds, N. R., Neidig, J. L., & Wewers, M. E. (2004). Illness representation and smoking behavior: Focus group study of HIV-positive men. Journal of the Association of Nurses in AIDS Care, 15, 37–47.
Royce, R. A., & Winkelstein, W., Jr. (1990). HIV infection, cigarette smoking and CD4+ T-lymphocyte counts: Preliminary results from the San Francisco Men’s Health Study. AIDS, 4, 327–333.
Ryan, H., Wortley, P. M., Easton, A., Pederson, L. L., & Greenwood, G. L. (2001). Smoking among lesbians, gays and bisexuals: A review of the literature. American Journal of Preventive Medicine, 21, 142–149.
Slovinec D’Angelo, M. E., Reid, R. D., Hotz, S., Irvine, J., Segal, R. J., Blanchard, C. M., et al. (2005). Is stress management training a useful addition to physician advice and nicotine replacement therapy during smoking cessation in women? Results of a randomized trial. American Journal of Health Promotion, 20, 127–134.
Spano, J., Massiani, M., Bentata, M., Rixe, O., Friard, S., Bossi, P., et al. (2004). Lung cancer in patients with HIV infection and review of the literature. Medical Oncology, 21, 109–115.
Stall, R. D., Greenwood, G. L., Acree, M., Paul, J., & Coates, T. J. (1999). Cigarette smoking among gay and bisexual men. American Journal of Public Health, 89, 1875–1878.
Stellman, S. D., Chen, Y., Muscat, J. E., et al. (2003). Lung cancer risk in white and black Americans. Annals of Epidemiology, 13, 294–302.
Strine, T. W., Okoro, C. A., Chapman, D. P., Balluz, L. S., Ford, E. S., Ajani, U. A., et al. (2005). Health-related quality of life and health risk behaviors among smokers. American Journal of Preventive Medicine, 28, 182–187.
Tate, D. C., Van Den Berg, J. J., Hansen, N. B., Kochman, A., & Sikkema, K. J. (2006). Race, social support, and coping strategies among HIV-positive gay and bisexual men. Culture, Health, and Sexuality, 8, 235–249.
Theorell, T., Blomkvist, V., Jonsson, H., Schulman, S., Berntorp, E., & Stigendal, L. (1995). Social support and the development of immune function in human immunodeficiency virus infection. Psychosomatic Medicine, 57, 32–36.
Turner, J., Page-Shafer, K., Chin, D. P., Osmond, D., Mossar, M., Markstein, L., et al. (2001). Adverse impact of cigarette smoking on dimensions of health-related quality of life in persons with HIV infection. AIDS Patient Care and STDs, 15, 615–624.
Turner, R. J., Wheaton, B., & Lloyd, D. A. (1995). The epidemiology of social stress. American Sociological Review, 60, 104–125.
U.S. Department of Health and Human Services. (1998). Tobacco use among U.S. racial/ethnic minority groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A report of the surgeon general. Atlanta, GA: U.S. Department of Health and Human Services, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
Vanable, P. A., Carey, M. P., Carey, K. B., & Maisto, S. P. (2003). Smoking among psychiatric outpatients: Relationship to substance use, diagnosis, and illness severity. Psychology of Addictive Behaviors, 17, 259–265.
Vanable, P. A., Carey, M. P., Blair, D. C., & Littlewood, R. A. (2006). Impact of HIV-related stigma on health behaviors and psychosocial adjustment among HIV-positive men and women. AIDS and Behavior, 10, 473–482.
Vidrine, D. J., Amick, B. C., Gritz, E. R., & Arduino, R. C. (2006). Assessing a conceptual framework of health-related quality of life in a HIV/AIDS population. Quality of Life Research, 14, 923–933.
Volpp, K. G., Gurmankin, L. A., Asch, D. A., Berlin, J. A., Murphy, J. J., Gomez, A., et al. (2006). A randomized trial of financial incentives for smoking cessation. Cancer Epidemiology, Biomarkers and Prevention, 15, 12–18.
Waddell, E. N., & Messeri, P. A. (2006). Social support, disclosure, and use of antiretroviral therapy. AIDS and Behavior, 10, 263–272.
Weissman, M.M., Sholomskas, D., Pottenger, M., Prusoff, B.A., & Locke, B. Z. (1977). Assessing depressive symptoms in five psychiatric populations: A validation study. American Journal of Epidemiology, 106, 203–213.
Wetzels, J. J. L., Kremers, S. P. J., Vitória, P. D., & de Vries, H. (2003). The alcohol-tobacco relationship: a prospective study among adolescents in six European countries. Addiction, 98, 1755–1763.
Wewers, M. D., Diaz, P. T., Wewers, M. E., Loew, M. P., Nagarage, H. N., & Clanton, T. L. (1998). Cigarette smoking in HIV infection induces a suppressive inflammatory environment in the lung. American Journal of Respiratory and Critical Care Medicine, 158(Pt. 1), 1543–1549.
Wewers, M. E., Neidig, J. L., & Kihm, K. E. (2000). The feasibility of a nurse-managed, peer-led, tobacco cessation intervention among HIV-positive smokers. Journal of the Association of Nurses in AIDS Care, 11, 37–44.
White, H. R., Nagin, D., Replogle, E., & Stouthamer-Loeber, M. (2004). Racial differences in trajectories of cigarette use. Drug and Alcohol Dependence, 76, 219–227.
Wilson, I. B., & Cleary, P. D. (1995). Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. The Journal of the American Medical Association, 273, 59–65.
Zvolensky, M. J., Feldner, M. T., Leen-Feldner, E. W., Gibson, L. E., Abrams, K., et al. (2005). Acute nicotine withdrawal symptoms and anxious responding to bodily sensations: A test of incremental predictive validity among young adult regular smokers. Behaviour Research and Therapy, 43, 1683–1700.
Acknowledgments
This work was supported by the National Institute of Mental Health Grant R21-MH65865. The authors thank the staff at University Hospital for their support of this work. Special thanks are extended to Missy Albert, Linda Bartlett, Jennifer Brown, Mary Beth Cavalieri, Kelley Flood, Rae Littlewood, Lois Needham, Paul Preczewski, Pamela Wickham, Judy Rees, Craig Withers, and Jennifer Wuilliez for their assistance.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Webb, M.S., Vanable, P.A., Carey, M.P. et al. Cigarette Smoking among HIV+ Men and Women: Examining Health, Substance Use, and Psychosocial Correlates across the Smoking Spectrum. J Behav Med 30, 371–383 (2007). https://doi.org/10.1007/s10865-007-9112-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10865-007-9112-9