Racial disparities and factors associated with prescription for smoking cessation medications among smokers receiving routine clinical care for HIV

ABSTRACT

Factors associated with prescription of smoking cessation medication (SCM), including the impact of race, have not been well described among a large population of people living with HIV (PLWH) engaged in routine clinical care. Our study investigated whether there are racial differences between African-American and White PLWH regarding SCM prescription and sought to identify other factors associated with these prescriptions at a large HIV clinic in the Southeastern United States. Among 1899 smokers, 38.8% of those prescribed SCMs were African-American and 61.2% were White. Factors associated with lower odds of SCM prescription included African-American race (AOR, 0.63 [95% CI: 0.47, 0.84]) or transferring care from another HIV provider during the study period (AOR, 0.63 [95% CI: 0.43, 0.91]). Whereas major depression (AOR, 1.54 [95% CI: 1.10, 2.15]), anxiety symptoms (AOR, 1.43 [95% CI: 1.05, 1.94]), and heavy smoking (>20 cigarettes/day) (OR, 3.50 [95% CI: 2.11, 5.98]) were associated with increased likelihood of SCM prescription. There were racial disparities in the prescription of SCM in African Americans with HIV. These findings underscore the need to increase pharmacotherapy use among African Americans to improve smoking cessation outcomes across racial groups among PLWH.

KEYWORDS:

• HIV
• smoking cessation medication
• racial disparities
• psychological factors

Acknowledgements

The authors gratefully acknowledge the staff of the University of Alabama at Birmingham’s Research and Informatics Service Center for their valuable assistance with data retrieval, with special thanks to Suneetha Thogaripolly, Anuj Kapil, and Mohit Varshney. We thank the UAB 1917 Clinic Cohort staff and management for their assistance with this project (https://www.uab.edu/medicine/1917cliniccohort/).

Disclosure statement

Greer A. Burkholder has received research support from Bristol-Myers Squibb and Amgen, Inc and has consultant for Definicare, LLC and Medscape. James H. Willighas received research support from the Bristol-MyersSquibb, Pfizer, Tibotec Therapeutics, and Definicare, LLC, and has consulted forBristol-Myers Squibb and Gilead Sciences. Andrew O. Westfall has consulted for Definicare, LLC.

Additional information

Funding

This work was supported by the UAB Center for AIDS Research (P30-AI27767), CNICS (1R24AI067039-1); UAB Sparkman Center for Global Health and NIH Fogarty Global Health Equity Scholar (TW010540).