Abstract
Smoking cessation has proven to be a challenge for HIV-positive smokers. Patient and provider characteristics may provide barriers to smoking cessation. We aimed to identify characteristics associated with interest in cessation as well as characterize use of, current interest in, and provider recommendations for smoking cessation modalities. Data came from 275 HIV-positive smokers recruited online. Half (49.1%) of the sample was interested in quitting; daily smoking was associated with decreased likelihood of interest in cessation, whereas making a lifetime quit attempt, receiving encouragement to quit from an HIV care provider, and greater frequency of discussions regarding cessation with HIV care providers were associated with increased likelihood of interest in cessation. Nicotine replacement therapy was the most commonly used (42.9%), generated the most interest (59.1%), and was the most commonly clinician-recommended (70.7%) cessation modality. Findings emphasize the importance of the healthcare provider-patient relationship for smoking cessation promotion in HIV-positive smokers.
Keywords: smoking, cessation, HIV, comorbidity, Amazon Mechanical Turk
Introduction
Cigarette smoking is highly prevalent (40%−75%) among persons living with HIV (PLWH) (Mdodo et al., 2015; Pacek, Harrell, & Martins, 2014; Pacek, Latkin, Crum, Stuart, & Knowlton, 2014a). Among PLWH, smoking is associated with poor health (Freiberg et al., 2010; Madeddu et al., 2013; Vandenhende et al., 2015), poor adherence to and decreased effectiveness of antiretroviral therapy, and poor HIV treatment outcomes (Feldman et al., 2006; O’Cleirigh et al., 2015; Shuter & Bernstein, 2008). Smokers with HIV lose more life years to smoking than to HIV (Helleberg et al., 2013).
Most (63%−74%) HIV-positive smokers are interested in quitting (Mamary, Bahrs, & Martinez, 2002; Pacek, Latkin, Crum, Stuart, & Knowlton, 2014b). However, characteristics of HIV care providers may impede cessation. Compared to non-HIV care providers, they are less likely to assess patients’ smoking status or interest in quitting (Duval et al., 2008; Tesoriero, Gieryic, Carrascal, & Lavigne, 2010), which may stem from beliefs that patients lack interest in quitting (Horvath, Eastman, Prosser, Goodroad, & Worthington, 2012; Tesoriero et al., 2010), limited smoking cessation training (Konfino, Mejia, & Basombrio, 2012; Shuter, Salmo, et al., 2012), and limited confidence in their ability to impact smoking behavior (Crothers et al., 2007). Healthcare providers represent a critical link to smoking cessation interventions—particularly for PLWH, who routinely have contact with healthcare providers. Two studies suggest that HIV-positive smokers are more likely to attempt cessation following HIV diagnosis if a healthcare provider implements a cessation intervention (Berg et al., 2014) and experiencing a physician-delivered smoking status assessment increases readiness to quit (Amiya et al., 2011). Beyond this, little is known about how patient-provider interactions impact interest in quitting smoking among PLWH.
We explored the influence of sociodemographics, substance use, and interaction with healthcare providers on interest in quitting smoking. We also characterized lifetime use of and interest in smoking modalities and characterize the modalities recommended by HIV care providers.
Methods
Data Source
Data were from an online survey—advertised/conducted on Amazon Mechanical Turk (MTurk). To participate, individuals registered on MTurk were required to have a ≥95% approval rating from prior MTurk tasks, be ≥18 years old, and reside in the United States. Participants completed a screening questionnaire to determine eligibility, including: lifetime HIV diagnosis; having smoked ≥100 lifetime cigarettes; and having smoked ≥one cigarette within the past month. Eligible participants were given a code to access the survey, hosted by Qualtrics (Provo, UT). The survey was active from March 16-May 14, 2015. Participation was voluntary and anonymous. The Johns Hopkins University Institutional Review Board approved this study.
Measures
Sociodemographic characteristics
Sociodemographic variables included sex, age, race, income, marital status, and education.
HIV characteristics
We assessed participants’ age at and length of time since HIV diagnosis. Participants reported current use of antiretroviral therapy (yes/no).
Smoking characteristics
We assessed participants’ CPD , days smoked within the past month, and past month daily smoking. Participants reported age at smoking initiation, number of years of smoking, and lifetime cessation attempt(s). Summing participants’ time to first cigarette (TTFC) upon waking (<5 minutes=3, 5–30 minutes=2, 31–60 minutes=1, >60 minutes=0) and CPD (≤10=0; 11–20=1; 21–30=2; ≥31=3) produced the Heaviness of Smoking Index (HSI; (Heatherton, Kozlowski, Frecker, Rickert, & Robinson, 1989).
Interest in and reasons for smoking cessation
Participants reported current interest in quitting smoking (yes/no). Individuals who responded “yes” were shown a list of 26 “reasons why someone might want to quit smoking completely.” Participants selected all that applied and their most important reason.
Lifetime use of and interest in smoking cessation modalities
Participants reported lifetime use of various smoking cessation modalities. Individuals interested in quitting reported interest in using cessation modalities. Types of NRT were assessed individually; an NRT variable included nicotine patch/gum/lozenge/inhaler/nasal spray.
Interactions with HIV care providers
Participants reported whether their HIV care provider had ever encouraged them to quit smoking and whether they had suggested specific cessation modalities. Participants responding yes to the latter reported all suggested modalities. Participants reported how often they discussed smoking cessation with their providers (“never-rarely;” “sometimes;” “often-always”).
Statistical Analysis
The sample included 275 individuals. Chi-square (χ2) and t-tests described differences between groups based on interest in quitting smoking. Logistic regression analyses calculated adjusted odds ratios and 95% confidence intervals for associations between sample characteristics and interest in quitting smoking. Analyses were conducted using STATA SE statistical software version 12.0 (StataCorp, 2011).
Results
Sociodemographic and smoking characteristics
Half (49.1%) were interested in quitting smoking. Individuals interested in quitting were less likely to be daily smokers, χ2 (1, N=275)=8.23, p=0.004, and more likely to have made a quit attempt, χ2 (1, N=275)=54.85, p<0.001, compared to those not interested in quitting. Participant characteristics are found in Table 1.
Table 1.
Characteristics of HIV-positive current cigarette smokers, stratified by current interest in quitting smoking (n=275)
| Characteristic | Total Sample n=275 | Not Interested in Quitting n=136 |
Interested in Quitting n=139 |
p-value |
|---|---|---|---|---|
| Sociodemographics | ||||
| Female | 94 (34.2) | 44 (32.4) | 50 (36.0) | 0.527 |
| Age – mean (SD) | 29.4 (7.3) | 28.6 (5.8) | 30.2 (8.4) | 0.070 |
| Caucasian | 206 (74.9) | 108 (79.4) | 98 (70.5) | 0.225 |
| ≥$25,000* | 201 (74.7) | 100 (76.3) | 101 (73.2) | 0.553 |
| Not married | 213 (77.5) | 108 (79.4) | 105 (75.5) | 0.442 |
| ≥4-year degree | 100 (36.4) | 44 (32.4) | 56 (40.3) | 0.171 |
| Illicit drug use | 199 (72.4) | 101 (74.3) | 98 (70.5) | 0.486 |
| Taking ARVs | 201 (73.1) | 102 (75.0) | 99 (71.2) | 0.480 |
| Length of HIV diagnosis – mean (SD) | 5.8 (4.6) | 5.6 (4.2) | 6.0 (5.0) | 0.504 |
| Smoking characteristics | ||||
| CPD – mean (SD) | 8.1 (9.7) | 9 (12.0) | 7.2 (6.5) | 0.127 |
| Daily smoking | 106 (38.5) | 64 (47.1) | 42 (30.2) | 0.004 |
| HIS | ||||
| Low | 185 (67.3) | 92 (67.6) | 93 (66.9) | 0.896 |
| Moderate-High | 90 (32.7) | 44 (32.4) | 46 (33.1) | |
| Other tobacco use | 194 (70.5) | 89 (65.4) | 105 (75.5) | 0.066 |
| Lifetime quit attempt | 189 (68.7) | 65 (47.8) | 124 (89.2) | <0.001 |
| Interactions with HIV care provider | ||||
| Provider encouraged you to quit* | 228 (84.8) | 102 (77.3) | 126 (92.0) | 0.001 |
| Provider suggested specific ways to quit* | 181 (67.3) | 79 (59.8) | 102 (74.4) | 0.011 |
| Frequency of discussions about cessation * | ||||
| Never-rarely | 115 (42.8) | 68 (51.5) | 47 (34.3) | 0.002 |
| Sometimes | 88 (32.7) | 43 (32.6) | 45 (32.8) | |
| Often-always | 66 (24.5) | 21 (15.9) | 45 (32.8) | |
Note: Values represent n (%) unless otherwise indicated. Bolded text indicates statistically significant differences
n=269 for these variables
Reasons for wanting to quit
The most common reasons for wanting to quit smoking were to: be healthier (66.9%); live longer (59.5%); and feel better (57.1%) (Table 2). The most common “most important” reasons for wanting to quit smoking were to: be healthier (19.5%); live longer (14.3%); and avoid complications related to their HIV diagnosis (13.5%).
Table 2.
Reasons for wanting to quit smoking among HIV-positive cigarette smokers currently interested in quitting (n=133)
| Reasons for wanting to quit | Select all that apply n(%) |
Most important reason n(%) |
|---|---|---|
| To be healthier | 89 (66.9) | 26 (19.5) |
| To live longer | 79 (59.4) | 19 (14.3) |
| To feel better | 76 (57.1) | 8 (6.0) |
| I can feel the negative health effects of smoking | 74 (55.6) | 6 (4.5) |
| To have better breath | 67 (50.4) | 2 (1.5) |
| My doctor told me to quit | 66 (49.6) | 3 (2.3) |
| To save the money I spend on cigarettes | 64 (48.1) | 4 (3.0) |
| Cigarettes have become too expensive | 61 (45.9) | 7 (5.3) |
| To smell better | 59 (44.4) | 3 (2.3) |
| So that I would no longer be controlled by my addiction to cigarettes | 58 (43.6) | 3 (2.3) |
| To avoid health complications related to my diagnosis with HIV | 56 (42.1) | 18 (13.5) |
| To prove that I am strong enough to do it | 53 (39.8) | 1 (0.7) |
| To feel more in control | 50 (37.6) | 1 (0.7) |
| Because I would like myself better if I quit | 49 (36.8) | 2 (1.5) |
| Someone I know died because of smoking | 48 (36.1) | 7 (5.3) |
| To show myself that I can quit if I really want to | 47 (35.3) | 3 (2.3) |
| Smoking does not fit who I want to be | 42 (31.6) | 1 (0.8) |
| To look more attractive | 42 (31.6) | 1 (0.8) |
| Someone I know got sick because of smoking | 40 (30.1) | 4 (3.0) |
| To make my family/friends happy | 38 (28.6) | 2 (1.5) |
| To prove to myself that I’m not addicted to cigarettes | 34 (25.6) | 0 (0) |
| Smoking is becoming less socially acceptable | 33 (24.8) | 1 (0.8) |
| I don’t want to set a bad example for children | 31 (23.3) | 6 (4.5) |
| My significant other gave me an ultimatum | 27 (20.3) | 5 (3.8) |
| To get praise from people that I’m close to | 16 (12.0) | 0 (0) |
| Other | 3 (2.3) | 0 (0) |
Lifetime use of, interest in, and suggested smoking cessation modalities
Forty-three percent reported lifetime use of NRT (Table 3). Additionally, 29.1% of the sample attempted to quit by going cold turkey, and 18.9% used behavioral methods. Use of bupropion (4.7%) and varenicline (3.6%) was low. Additionally, 15.6% of the sample used e-cigarettes while making a quit attempt. Among individuals interested in quitting, interest in using behavioral methods (59.8%), NRT (59.1%), and going cold turkey (56.1%) were high. Interest in bupropion (26.3%) and varenicline (27.0%) were among the lowest. Forty-four percent of those interested in quitting reported interest in using e-cigarettes.
Table 3.
Lifetime use of, interest in, and recommended smoking cessation modalities among HIV-positive cigarette smokers
| Smoking cessation modality | Lifetime use among smokers with HIV (n=275) n (%) |
Interest among individuals currently interested in quitting (n=139)a n (%) |
Modalities recommended by providers (n=181) n (%) |
|---|---|---|---|
| Nicotine replacement therapyb | 118 (42.9) | 81 (59.1) | 128 (70.7) |
| Nicotine patch | 72 (26.2) | 57 (41.6) | 105 (58.0) |
| Nicotine gum | 76 (27.6) | 58 (42.3) | 86 (47.5) |
| Nicotine lozenge | 21 (7.6) | 40 (29.2) | 35 (19.3) |
| Nicotine inhaler | 13 (4.7) | 36 (26.3) | 31 (17.1) |
| Nicotine nasal spray | 7 (2.5) | 34 (24.8) | 21 (11.6) |
| Bupropion | 13 (4.7) | 36 (26.3) | 44 (24.3) |
| Varenicline | 10 (3.6) | 37 (27.0) | 37 (20.4) |
| Other medications | 0 (0) | 35 (25.5) | 2 (1.1) |
| Counseling | 14 (5.1) | 50 (36.5) | 63 (34.8) |
| Quit line | 9 (3.3) | 31 (22.6) | 29 (16.0) |
| Behavioral methods | 52 (18.9) | 82 (59.8) | 58 (32.0) |
| Herbal/alternative methods | 7 (2.5) | 57 (41.6) | 15 (8.3) |
| Switching to other tobacco products | 14 (5.1) | 35 (25.5) | 13 (7.2) |
| Cold turkey | 80 (29.1) | 78 (56.9) | 50 (27.6) |
| Electronic cigarettes | 43 (15.6) | 61 (44.5) | 35 (19.3) |
| Group therapy | 4 (1.4) | 56 (40.9) | 23 (14.4) |
Data only available for n=137 of 139 individuals interested in quitting
Includes nicotine patch, gum, lozenge, inhaler, and nasal spray; categories are not mutually exclusive
Interactions with HIV care providers
A greater proportion of persons interested in quitting reported that their HIV care provider had encouraged them to quit smoking, χ2 (1, N=275)=11.24, p=0.001 and had suggested specific cessation modalities, χ2 (1, N=275)=6.51, p=0.011. Participants interested in quitting were more likely to discuss smoking cessation “often-always” with their provider, χ2 (2, N=275)=12.52, p=0.002. Additionally, 65.8% reported that their provider has suggested at least one cessation modality: NRT (70.7%), counseling (34.8%), and behavioral methods (32.0%) were most frequently recommended.
Logistic regression analyses
Daily smokers were 51% less likely (95% CI=0.27–0.89) than non-daily smokers to be interested in cessation (Table 4). Participants who had made past quit attempt(s) were more likely to be interested in quitting (aOR=10.50, 95% CI=5.21–21.14). Individuals whose HIV care provider had encouraged them to quit smoking (aOR=4.02, 95% CI=1.62–9.97) and discussed smoking cessation “sometimes-always” (aOR=2.25, 95% CI=1.03–4.89) were more likely to be interested in quitting.
Table 4.
Logistic regression analyses examining associations between sample characteristics and current interest in quitting among HIV-positive cigarette smokers (n=275)
| OR (95% CI) | aORa (95% CI) | |
|---|---|---|
| Age | ||
| 18–25 | 1.0 | 1.0 |
| 26–34 | 0.78 (0.45–1.34) | 0.65 (0.33–1.26) |
| 35+ | 1.80 (0.87–3.71) | 1.33 (0.55–3.34) |
| ≥College education | 1.41 (0.86–2.31) | 1.62 (0.87–3.00) |
| Daily smoking | 0.49 (0.30–0.80) | 0.49 (0.27–0.89) |
| Lifetime quit attempt(s) | 9.02 (4.80–17.00) | 10.50 (5.21–21.14) |
| Provider encouragement to quit | 3.37 (1.61–7.05) | 4.02 (1.62–9.97) |
| Frequency of cessation discussions | ||
| Never-rarely | 1.0 | 1.0 |
| Sometimes | 1.51 (0.86–2.65) | 0.71 (0.35–1.42) |
| Often-always | 3.10 (1.64–5.86) | 2.25 (1.03–4.89) |
Note: Bold text indicates statistically significant findings
Model is adjusted for all variables in the table
Discussion
Participants whose providers had encouraged them to quit were more likely to be interested in quitting than those whose providers had not (Berg et al., 2014). Moreover, discussing smoking cessation “often-always” during healthcare visits doubled the likelihood of interest in quitting versus having discussions “never-rarely.” This highlights the crucial role that healthcare providers play in promoting cessation. Some HIV-positive smokers (42%−65%) attempt cessation following diagnosis with HIV (Benard et al., 2007; Burkhalter, Springer, Chhabra, Ostroff, & Rapkin, 2005); time of diagnosis may be a window during which patients are willing to modify smoking behaviors. Findings emphasize the need for consistent smoking cessation intervention by healthcare providers.
NRT was the most commonly used (Pacek, Latkin, et al., 2014a), garnered the greatest interest (Shapiro, Tshabangu, Golub, & Martinson, 2011; Shuter, Bernstein, & Moadel, 2012), and was the most commonly recommended modality by healthcare providers. However, only 43% of the sample used NRT during a quit attempt. Relatively low use may be due to misinformation regarding nicotine’s role in smoking-related morbidity among PLWH (Pacek, Rass, & Johnson, 2017) and misconceptions regarding NRT’s safety (Mooney, Babb, Jensen, & Hatsukami, 2005). Use of pill-based pharmacotherapies was uncommon (Pacek, Latkin, et al., 2014a); we observed lower interest in using and provider recommendations to use bupropion (Pacek, Latkin, et al., 2014b; Shuter, Bernstein, et al., 2012) and varenicline.
Although e-cigarettes are not currently an approved treatment for smoking cessation, 15.6% of participants used and 44% were interested in using e-cigarettes for cessation. Notably, 19.3% of participants whose provider had recommended cessation modalities had recommended e-cigarettes. Though proven cessation modalities should be promoted among PLWH, the tobacco control community should not discourage patients disinterested in such methods from switching to sole use of e-cigarettes, particularly when taking a harm reduction approach.
In terms of limitations, data were collected via self-report, and the cross-sectional design does not allow us to determine causality. Generalizability may be limited due to the online nature of the sample. Nevertheless, this study represents one of the first examinations of specific smoking cessation modalities recommended by HIV care providers (Konfino et al., 2012; Shuter, Bernstein, et al., 2012) and associations between provider characteristics and interest in cessation among PLWH.
This study provides a detailed examination of lifetime use of, interest in, and provider recommendations for smoking cessation modalities. Findings emphasize the importance of the healthcare provider-patient relationship for smoking cessation in PLWH. Findings highlight the need for consistent discussion of and encouragement regarding smoking cessation during healthcare visits, and cessation intervention training for clinicians.
Acknowledgments
Funding: This study was funded by NIH grants T32 AI007392, T32 DA07209, and R01 DA032363.
Footnotes
Conflict of Interest: The authors have no conflicts of interest to declare.
References
- Amiya RM, Poudel KC, Poudel-Tandukar K, Kobayashi J, Pandey BD, & Jimba M (2011). Physicians are a key to encouraging cessation of smoking among people living with HIV/AIDS: a cross-sectional study in the Kathmandu Valley, Nepal. BMC Public Health, 11 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Benard A, Bonnet F, Tessier J, Fossoux H, Dupon M, Mercie P, . . . Aquitaine G. D. E. C. D. S. E. (2007). Tobacco addiction and HIV infection: toward the implementation of cessation programs. ANRS CO3 Aquitaine Cohort. AIDS Patient Care STDS, 21(7), 458–468 [DOI] [PubMed] [Google Scholar]
- Berg CJ, Nehl EJ, Wang X, Ding Y, He N, Johnson BA, & Wong FY (2014). Healthcare provider intervention on smoking and quit attempts among HIV-positive versus HIV-negative MSM smokers in Chengdu, China. AIDS Care, 26(9), 1201–1207. doi: 10.1080/09540121.2014.892565 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Burkhalter JE, Springer CM, Chhabra R, Ostroff JS, & Rapkin BD (2005). Tobacco use and readiness to quit smoking in low-income HIV-infected persons. Nicotine Tob Res, 7(4), 511–522 [DOI] [PubMed] [Google Scholar]
- Crothers K, Goulet JL, Rodriguez-Barradas MC, Gibert CL, Butt AA, Braithwaite RS, . . . Justice AC (2007). Decreased awareness of current smoking among health care providers of HIV-positive compared to HIV-negative veterans. J Gen Intern Med, 22(6), 749–754 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Duval X, Baron G, Garelik D, Villes V, Dupre T, Leport C, . . . Group E. S. (2008). Living with HIV, antiretroviral treatment experience and tobacco smoking: results from a multisite cross-sectional study. Antivir Ther, 13(3), 389–397 [PMC free article] [PubMed] [Google Scholar]
- Feldman JG, Minkoff H, Schneider MF, Gange SJ, Cohen M, Watts DH, . . . Anastos K (2006). Association of cigarette smoking with HIV prognosis among women in the HAART era: a report from the women’s interagency HIV study. Am J Public Health, 96(6), 1060–1065. doi: 10.2105/AJPH.2005.062745 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Freiberg MS, McGinnis KA, Kraemer K, Samet JH, Conigliaro J, Curtis Ellison R, . . . Team V. P. (2010). The association between alcohol consumption and prevalent cardiovascular diseases among HIV-infected and HIV-uninfected men. J Acquir Immune Defic Syndr, 53(2), 247–253. doi: 10.1097/QAI.0b013e3181c6c4b7 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Heatherton TF, Kozlowski LT, Frecker RC, Rickert W, & Robinson J (1989). Measuring the heaviness of smoking: using self-reported time to first cigarette of the day and number of cigarettes smoked per day. British Journal of Addiction, 84, 791–800 [DOI] [PubMed] [Google Scholar]
- Helleberg M, Afzal S, Kronborg G, Larsen CS, Pedersen G, Pedersen C, . . . Obel N (2013). Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study. Clin Infect Dis, 56(5), 727–734. doi: 10.1093/cid/cis933 [DOI] [PubMed] [Google Scholar]
- Horvath KJ, Eastman M, Prosser R, Goodroad B, & Worthington L (2012). Addressing smoking during medical visits: patients with human immunodeficiency virus. Am J Prev Med, 43(5 Suppl 3), S214–221. doi: 10.1016/j.amepre.2012.07.032 [DOI] [PubMed] [Google Scholar]
- Konfino J, Mejia R, & Basombrio A (2012). Tobacco cessation strategies among infectious disease specialists who treat people with HIV in Buenos Aires. Revista Argentina de Salud Publica, 3(12), 23–27 [Google Scholar]
- Madeddu G, Fois AG, Calia GM, Babudieri S, Soddu V, Becciu F, . . . Mura MS (2013). Chronic obstructive pulmonary disease: an emerging comorbidity in HIV-infected patients in the HAART era? Infection, 41(2), 347–353 [DOI] [PubMed] [Google Scholar]
- Mamary EM, Bahrs D, & Martinez S (2002). Cigarette smoking and desire to quit among individuals living with HIV. AIDS Patient Care STDS, 16, 39–42 [DOI] [PubMed] [Google Scholar]
- Mdodo R, Frazier EL, Dube SR, Mattson CL, Sutton MY, Brooks JT, & Skarbinski J (2015). Cigarette smoking prevalence among adults with HIV compared with the general adult population in the United States: cross-sectional surveys. Ann Intern Med, 162(5), 335–344. doi: 10.7326/M14-0954 [DOI] [PubMed] [Google Scholar]
- Mooney M, Babb D, Jensen J, & Hatsukami D (2005). Interventions to increase use of nicotine gum: a randomized, controlled, single-blind trial. Nicotine Tob Res, 7(4), 565–579. doi: 10.1080/14622200500185637 [DOI] [PubMed] [Google Scholar]
- O’Cleirigh C, Valentine SE, Pinkston M, Herman D, Bedoya CA, Gordon JR, & Safren SA (2015). The unique challenges facing HIV-positive patients who smoke cigarettes: HIV viremia, ART adherence, engagement in HIV care, and concurrent substance use. AIDS Behav, 19(1), 178–185. doi: 10.1007/s10461-014-0762-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pacek LR, Harrell PT, & Martins SS (2014). Cigarette smoking and drug use among a nationally representative sample of HIV-positive individuals. Am J Addict, 23(6), 582–590. doi: 10.1111/j.1521-0391.2014.12145.x [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pacek LR, Latkin C, Crum RM, Stuart EA, & Knowlton AR (2014a). Current cigarette smoking among HIV-positive current and former drug users: associations with individual and social characteristics. AIDS Behav, 18(7), 1368–1377. doi: 10.1007/s10461-013-0663-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pacek LR, Latkin C, Crum RM, Stuart EA, & Knowlton AR (2014b). Interest in quitting and lifetime quit attempts among smokers living with HIV infection. Drug Alcohol Depend, 138, 220–224. doi: 10.1016/j.drugalcdep.2014.02.008 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pacek LR, Rass O, & Johnson MW (2017). Knowledge about nicotine among HIV-positive smokers: implications for tobacco regulatory science policy. Addict Behav, 65, 81–86 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shapiro AE, Tshabangu N, Golub JE, & Martinson NA (2011). Intention to quit smoking among human immunodeficiency virus infected adults in Johannesburg, South America. Int J Tuberc Lung Dis, 15(1), 140–142 [PMC free article] [PubMed] [Google Scholar]
- Shuter J, & Bernstein SL (2008). Cigarette smoking is an independent predictor of nonadherence in HIV-infected individuals receiving highly active antiretroviral therapy. Nicotine Tob Res, 10(4), 731–736. doi: 10.1080/14622200801908190 [DOI] [PubMed] [Google Scholar]
- Shuter J, Bernstein SL, & Moadel AB (2012). Cigarette smoking behaviors and beliefs in persons living with HIV/AIDS. Am J Public Health, 36(1), 75–85 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shuter J, Salmo LN, Shuter AD, Nivasch EC, Fazzari M, & Moadel AB (2012). Provider beliefs and practices relating to tobacco use in patients living with HIV/AIDS: a national survey. AIDS Behav, 16(2), 288–294. doi: 10.1007/s10461-011-9891-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
- StataCorp. (2011). Stata Statistical Software: Release 12. College Station, TX: StataCorp, LP. [Google Scholar]
- Tesoriero JM, Gieryic SM, Carrascal A, & Lavigne HE (2010). Smoking among HIV positive New Yorkers: prevalence, frequency, and opportunities for cessation. AIDS Behav, 14(4), 824–835. doi: 10.1007/s10461-008-9449-2 [DOI] [PubMed] [Google Scholar]
- Vandenhende MA, Roussillon C, Henard S, Morlat P, Oksenhendler E, Aumaitre H, . . . group, A. E. M. s. (2015). Cancer-Related Causes of Death among HIV-Infected Patients in France in 2010: Evolution since 2000. PLoS One, 10(6), e0129550. doi: 10.1371/journal.pone.0129550 [DOI] [PMC free article] [PubMed] [Google Scholar]