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Innovative Approaches to Smoking Cessation and Smoking Harm Reduction in People with HIV

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Guest Editor
Center for Alcohol & Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI 02912, USA
Interests: smoking cessation; smoking harm reduction; alternative nicotine delivery systems (ANDS); HIV/AIDS; cardiovascular risk reduction

Special Issue Information

Dear Colleagues,

Effective antiretroviral therapy has led to an increased lifespan for people with HIV (PWH) when they are diagnosed early and engaged in care. As a result, HIV has transitioned to a chronic illness, and non-AIDS-related medical conditions, such as lung cancer, have become a leading cause of morbidity and mortality. The increased risk for cancer is due in part to a high prevalence of traditional risk factors for cancer in this population—most notably tobacco use. Smoking prevalence is substantially higher in PWH compared with the general population and is associated with increased rates of  lung cancer and other malignancies. In fact, PWH lose more years due to smoking than to HIV infection itself. It has been estimated that at least 90% of lung cancers and 20% of all other cancers in PWH could be prevented by eliminating smoking.

Smoking cessation studies in PWH have demonstrated disappointing outcomes, with low quit rates, poor adherence to therapy, and a lack of sustained abstinence. While many smokers living with HIV express a willingness to quit and two-thirds are interested in or considering quitting when asked,  they are less likely to quit when compared to smokers in the general population, and few are able to achieve long-term abstinence.

This Special Issue of the International Journal of Environmental Research and Public Health titled “Innovative Approaches to Smoking Cessation and Smoking Harm Reduction in People with HIV” offers an opportunity to publish high-quality quantitative and qualitative research in this topical area. We welcome papers that describe innovative approaches to tobacco dependence in PWH, including smoking cessation research studies and tobacco harm reduction studies. Studies describing perceptions of harm, novel tobacco product use, the impact of use on health risk and health behaviors, and biomarkers are welcome.

Dr. Patricia A. Cioe
Guest Editor

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Keywords

  • HIV/AIDS
  • smoking cessation
  • smoking harm reduction
  • intervention research
  • e-cigarettes
  • health effects
  • biomarkers

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Published Papers (3 papers)

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Research

8 pages, 314 KiB  
Article
A Cross-Sectional Analysis of the Nicotine Metabolite Ratio and Its Association with Sociodemographic and Smoking Characteristics among People with HIV Who Smoke in South Africa
by Chukwudi Keke, Zane Wilson, Limakatso Lebina, Katlego Motlhaoleng, David Abrams, Ebrahim Variava, Nikhil Gupte, Raymond Niaura, Neil Martinson, Jonathan E. Golub and Jessica L. Elf
Int. J. Environ. Res. Public Health 2023, 20(6), 5090; https://doi.org/10.3390/ijerph20065090 - 14 Mar 2023
Cited by 1 | Viewed by 1765
Abstract
The nicotine metabolite ratio (NMR) is associated with race/ethnicity but has not been evaluated among smokers in the African region. We conducted a cross-sectional analysis of baseline data from a large randomized, controlled trial for smoking cessation among people with HIV (PWH) in [...] Read more.
The nicotine metabolite ratio (NMR) is associated with race/ethnicity but has not been evaluated among smokers in the African region. We conducted a cross-sectional analysis of baseline data from a large randomized, controlled trial for smoking cessation among people with HIV (PWH) in South Africa. Urine samples were analyzed for the NMR and evaluated as a binary variable using a cutoff value of the fourth quartile to determine the fastest metabolizers. The median NMR was 0.31 (IQR: 0.31, 0.32; range: 0.29, 0.57); the cut-point for fast metabolizers was ≥0.3174 ng/mL. A high NMR was not associated with the number of cigarettes per day (OR = 1.10, 95% CI: 0.71, 1.70, p = 0.66) but was associated with 40% lower odds of a quit attempt in the past year (OR = 0.69; 95% CI: 0.44, 1.07, p = 0.09) and alcohol use (OR = 0.59, 95% CI: 0.32, 1.06, p = 0.07). No association was seen with marijuana or HIV clinical characteristics. As we found only minimal variability in the NMR and minimal associations with intensity of smoking, NMR may be of limited clinical value in this population, although it may inform which individuals are less likely to make a quit attempt. Full article
12 pages, 625 KiB  
Article
Theoretically Guided Iterative Design of the Sense2Quit App for Tobacco Cessation in Persons Living with HIV
by Rebecca Schnall, Paul Trujillo, Gabriella Alvarez, Claudia L. Michaels, Maeve Brin, Ming-Chun Huang, Huan Chen, Wenyao Xu and Patricia A. Cioe
Int. J. Environ. Res. Public Health 2023, 20(5), 4219; https://doi.org/10.3390/ijerph20054219 - 27 Feb 2023
Cited by 2 | Viewed by 1752
Abstract
The use of mobile health (mHealth technology) can be an effective intervention when considering chronic illnesses. Qualitative research methods were used to identify specific content and features for a mobile app for smoking cessation amongst people living with HIV (PWH). We conducted five [...] Read more.
The use of mobile health (mHealth technology) can be an effective intervention when considering chronic illnesses. Qualitative research methods were used to identify specific content and features for a mobile app for smoking cessation amongst people living with HIV (PWH). We conducted five focus group sessions followed by two Design Sessions with PWH who were or are currently chronic cigarette smokers. The first five groups focused on the perceived barriers and facilitators to smoking cessation amongst PWH. The two Design Sessions leveraged the findings from the focus group sessions and were used to determine the optimal features and user interface of a mobile app to support smoking cessation amongst PWH. Thematic analysis was conducted using the Health Belief Model and Fogg’s Functional Triad. Seven themes emerged from our focus group sessions: history of smoking, triggers, consequences of quitting smoking, motivation to quit, messages to help quit, quitting strategies, and mental health-related challenges. Functional details of the app were identified during the Design Sessions and used to build a functional prototype. Full article
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7 pages, 301 KiB  
Article
Optimizing the Implementation of Tobacco Treatment for People with HIV: A Pilot Study
by Madeline G. Foster, Benjamin A. Toll, Emily Ware, Allison Ross Eckard, Katherine R. Sterba and Alana M. Rojewski
Int. J. Environ. Res. Public Health 2022, 19(19), 12896; https://doi.org/10.3390/ijerph191912896 - 8 Oct 2022
Cited by 3 | Viewed by 1452
Abstract
People with HIV (PWH) have higher rates of tobacco use compared to their societal counterparts and are disproportionately affected by tobacco-related morbidity and mortality. A needs assessment was conducted to assess provider beliefs and opinions on tobacco treatment barriers and treatment approaches. The [...] Read more.
People with HIV (PWH) have higher rates of tobacco use compared to their societal counterparts and are disproportionately affected by tobacco-related morbidity and mortality. A needs assessment was conducted to assess provider beliefs and opinions on tobacco treatment barriers and treatment approaches. The results highlighted a disconnect between the known importance of quitting smoking and barriers in linking patients to treatment, such as lack of patient interest and other patient issues being a higher priority. Using this assessment data, a treatment delivery approach, Proactive Outreach with Medication Opt-out for Tobacco Treatment Engagement (PrOMOTE), was devised and piloted. PrOMOTE consisted of an outpatient clinical pharmacist trained in tobacco treatment proactively contacting patients for counseling and to prescribe smoking cessation pharmacotherapy (varenicline or dual nicotine replacement therapy (NRT)) using an opt-out approach. The pilot was conducted with 10 PWH and patient reach and opt-out rates were evaluated. Of the 10 patients contacted, 7 were reached and none opted out of the pharmacotherapy prescription (varenicline = 6; NRT = 1). Providers know the importance of smoking cessation for PWH but encounter several barriers to implementing treatment. Using PrOMOTE methods to deliver tobacco treatment increased the reach and pharmacotherapy acceptance rate of PWH who smoke. Full article
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