Race/ethnicity-based discrimination, depressive symptoms, and smoking-related variables among people with HIV participating in a randomized clinical trial for cigarette smoking cessation

ABSTRACT

People with HIV smoke cigarettes at a high prevalence, and it is important to identify modifiable variables related to smoking in this population. Race/ethnicity-based discrimination is common among people with HIV from minoritized racial and ethnic groups and results in significant adverse effects. The goal of this study was to examine the relationship between race/ethnicity-based discrimination, depression, and smoking-related variables among people with HIV who smoke. This was a secondary analysis of data from a prospective, randomized controlled smoking cessation trial for people with HIV. Participants were recruited from three HIV clinical care sites and randomly assigned to an HIV-tailored group therapy intervention or a control condition. Participants completed measures of demographics, smoking-related variables, race/ethnicity-based discrimination, and depressive symptoms at baseline and were followed up 3- and 6-months after study completion. Depressive symptoms had an indirect effect on the relationship between race/ethnicity-based discrimination and self-efficacy to quit smoking at 3-month follow-up. Depressive symptoms mediated the relationship between race/ethnicity-based discrimination and both nicotine dependence and self-efficacy to quit smoking at 6-month follow-up. Findings highlight the importance of considering race/ethnicity-based discrimination and depressive symptoms in the development and implementation of smoking cessation treatment interventions for people with HIV.

KEYWORDS:

• HIV/AIDS
• racial/ethnic discrimination
• cigarette smoking
• self-efficacy
• depression

Sustainable Development Goals:

• SDG 3: Good health and well-being
• SDG 10: Reduced inequalities

Acknowledgements

The authors acknowledge with gratitude the efforts of Daniela Morales, Carol Rosario, Eileen Dolce, Doreen McGuire, Sean Durant, Giovanna Calderon-Di-Francesca, Kimberly Bennett, Noreen Cabellon, Sujana Lalagari, Veronika Sanderova, Terri Nochetto, Augusto Paredes, and all of the smoking cessation counselors who assisted in the completion of the study. The authors also gratefully acknowledge the patients and staff of the HIV care clinics at Montefiore Medical Center, the Comprehensive Health Care Center, and Medstar Georgetown University Hospital.

Author contributions

JS and CS were involved in the conception and design of the study; SA was involved in analysis and interpretation of the data and the drafting of the paper; all authors (SA, JS, CS, AHW, and EKS) were involved in revising the manuscript critically for intellectual content and the final approval of the version to be published; all authors agree to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by award R01-DA036445 (JS) from the National Institutes of Health (NIH)/National Institutes on Drug Abuse (NIDA) and by the Einstein-Rockefeller-CUNY Center for AIDS Research (P30-AI124414) which is supported by the following NIH co-funding and participating institutes and centers: NIAID, NCI, NICHD, NHBL, NIDA, NIMH, NIA, FIC and OAR.