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Tobacco Use and Health-Related Quality of Life Among Individuals with Depression Who Are Receiving Treatment for HIV in Cape Town, South Africa

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A Correction to this article was published on 01 April 2021

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Abstract

Background

Tobacco use is the leading cause of preventable death worldwide, and prevalence rates are high among people living with HIV (PLWH), particularly in men. Depression is also common among PLWH, especially among smokers, who may use tobacco to manage mood. Although HIV and depression have been linked to functional impairment and poor health-related quality of life (HRQOL), little research has examined the degree to which smoking impacts these relationships in low- and middle-income countries with high HIV burden.

Method

Participants (N = 289) were people living with HIV (PLWH) who were being assessed for inclusion in a study targeting depression as a barrier to HIV medication adherence. Linear regression models measured the effect of gender on tobacco use (assessed by the WHO-ASSIST) and on each of the five HRQOL functional impairment domains (assessed by the SF-21). Separate multivariable regression models examined the relationships between habitual tobacco use, defined as daily, almost daily, or weekly use, and the HRQOL domains.

Results

The prevalence of habitual tobacco use was 23.9% (48.1% among men, 15.5% among women). Habitual tobacco use was associated with decreased cognitive functioning for the whole sample (B = − 8.99, p < 0.05) and with lower levels of pain-related impairment for men (B = 18.1, p < 0.05). Although men reported more tobacco use (B = 8.50, p < 0.001), they reported less pain-related limitations than women (B = 8.70, p < 0.05).

Conclusions

In our sample, men reported higher rates of habitual tobacco use than women. Smoking was associated with cognitive impairment and with less pain-related impairment among men. Future smoking cessation treatments tailored to PLWH who have symptoms of depression may benefit from strategies that consider pain management as a pathway to habitual smoking and recognize that motivations for use may differ by gender.

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Funding

Amelia M. Stanton was supported by a T32 training grant (5T32MH116140-02). Funding for this project came from the National Institute of Mental Health 5R01MH103770 (Safren, O’Cleirigh). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health, or any of the other funders.

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 761, Boston, MA, 02114, USA

    Amelia M. Stanton & Conall O’Cleirigh

  2. The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02115, USA

    Amelia M. Stanton & Conall O’Cleirigh

  3. Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA

    Amelia M. Stanton, Megan R. Wirtz & Conall O’Cleirigh

  4. Department of Psychology, The University of Miami, P.O. Box 248185, Coral Gables, FL, 33124, USA

    Jasper S. Lee & Steven A. Safren

  5. Department of Psychiatry, The University of Cape Town, Groote Schuur Drive, Observatory, Cape Town, 7925, South Africa

    Lena S. Andersen, John Joska & Richard van Zyl-Smit

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  1. Amelia M. Stanton
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Steven Safren receives royalties from Oxford University Press for treatment manuals on treating depression in chronic illness.

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The original article has been updated to include the missing reference “Joska JA, Andersen LS, Smith-Alvarez R, Magidson J, Lee JS, O’Cleirigh C, Safren SA. Nurse-delivered cognitive behavioral therapy for adherence and depression among people living with HIV (the Ziphamandla Study): protocol for a randomized controlled trial. JMIR Res Protoc. 2020;9(2):e14200” and the corresponding citation has been included near the sentence “Participants in the present study completed the baseline assessment of a trial to treat clinical depression and ultimately improve ART adherence.”

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Stanton, A.M., Lee, J.S., Wirtz, M.R. et al. Tobacco Use and Health-Related Quality of Life Among Individuals with Depression Who Are Receiving Treatment for HIV in Cape Town, South Africa. Int.J. Behav. Med. 28, 417–430 (2021). https://doi.org/10.1007/s12529-020-09951-z

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