Contemplation of smoking cessation and quit attempts in human immunodeficiency virus–infected and uninfected veterans

ABSTRACT

Background: As antiretroviral treatments prolong life in human immunodeficiency virus (HIV)-infected patients, smoking cessation is now a top priority. However, studies of HIV-infected smokers have not been conducted with uninfected controls. In this study, researchers determined factors associated with contemplating smoking cessation and making a prior quit attempt among HIV-infected and uninfected smoking veterans. Methods: Between 2005 and 2007, 1,027 HIV-infected and 794 uninfected smokers were identified as part of the Veterans Aging Cohort Study (VACS). Stratifying by HIV status, adjusted odds ratios (AORs) were calculated using logistic regression to identify factors associated with contemplating smoking cessation and making a prior quit attempt. Results: Most participants (66 % of HIV-infected vs. 68 % of uninfected; P = .46) were contemplating cessation, and 56 % of both groups (P = .99) had attempted to quit in the last year. In stratified multivariable analyses, HIV-infected smokers with recent pulmonary disease diagnoses were more likely to have made a quit attempt (AOR = 4.93, 95 % confidence interval [CI] = 1.41–17.17). Both HIV-infected and uninfected patients with unhealthy alcohol use were less likely to be contemplating cessation (AOR = 0.66, 95 % CI = 0.49–0.90 and 0.71, 95 % CI = 0.50–1.00). HIV-infected smokers who reported unhealthy alcohol use were also less likely to have made a quit attempt in the last year (AOR = 0.68, 95 % CI = 0.51–0.91). Conclusions: Patient-level interest and motivation are not major barriers to smoking cessation among HIV-infected veterans. Targeting HIV-infected smokers with a recent pulmonary disease diagnosis may improve sustained smoking cessation. Unhealthy alcohol use appears to be a key modifiable risk factor. Smoking cessation rates may be improved by combining interventions for smoking and alcohol use for HIV-infected patients.

KEYWORDS:

• Smokers
• smoking cessation
• HIV
• veterans

Acknowledgment

We would like to acknowledge the Veterans Aging Cohort Study (VACS) support team.

Author contributions

Each co-author listed contributed significantly to the preparation, editing, and analysis of the manuscript.

Funding

Funding for this study was provided by the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health (NIH/NIAAA), grant 3U01AA13566 (Amy Justice, MD, Yale University, New Haven, CT) and the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH/NHLBI), grant R01HL090342 (Kristina Crothers, MD, University of Washington, Seattle, WA). The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.