Stanton Amelia M, Lee Jasper S, Wirtz Megan R, Andersen Lena S, Joska John, Safren Steven A, van Zyl-Smit Richard, O'Cleirigh Conall
Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 761, Boston, MA, 02114, USA.
The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02115, USA.
Int J Behav Med. 2021 Aug;28(4):417-430. doi: 10.1007/s12529-020-09951-z. Epub 2021 Jan 28.
Tobacco use is the leading cause of preventable death worldwide, and prevalence rates are high among people living with HIV (PLWH), particularly in men. Depression is also common among PLWH, especially among smokers, who may use tobacco to manage mood. Although HIV and depression have been linked to functional impairment and poor health-related quality of life (HRQOL), little research has examined the degree to which smoking impacts these relationships in low- and middle-income countries with high HIV burden.
Participants (N = 289) were people living with HIV (PLWH) who were being assessed for inclusion in a study targeting depression as a barrier to HIV medication adherence. Linear regression models measured the effect of gender on tobacco use (assessed by the WHO-ASSIST) and on each of the five HRQOL functional impairment domains (assessed by the SF-21). Separate multivariable regression models examined the relationships between habitual tobacco use, defined as daily, almost daily, or weekly use, and the HRQOL domains.
The prevalence of habitual tobacco use was 23.9% (48.1% among men, 15.5% among women). Habitual tobacco use was associated with decreased cognitive functioning for the whole sample (B = - 8.99, p < 0.05) and with lower levels of pain-related impairment for men (B = 18.1, p < 0.05). Although men reported more tobacco use (B = 8.50, p < 0.001), they reported less pain-related limitations than women (B = 8.70, p < 0.05).
In our sample, men reported higher rates of habitual tobacco use than women. Smoking was associated with cognitive impairment and with less pain-related impairment among men. Future smoking cessation treatments tailored to PLWH who have symptoms of depression may benefit from strategies that consider pain management as a pathway to habitual smoking and recognize that motivations for use may differ by gender.
烟草使用是全球可预防死亡的首要原因，在艾滋病毒感染者（PLWH）中流行率很高，尤其是男性。抑郁症在PLWH中也很常见，特别是在吸烟者中，他们可能用烟草来调节情绪。尽管艾滋病毒和抑郁症与功能障碍及健康相关生活质量（HRQOL）较差有关，但在艾滋病毒负担高的低收入和中等收入国家，很少有研究探讨吸烟对这些关系的影响程度。
参与者（N = 289）为艾滋病毒感染者（PLWH），他们正在接受评估，以纳入一项将抑郁症作为艾滋病毒药物依从性障碍的研究。线性回归模型测量了性别对烟草使用（由WHO-ASSIST评估）以及对五个HRQOL功能障碍领域中每个领域（由SF-21评估）的影响。单独的多变量回归模型研究了习惯性烟草使用（定义为每天、几乎每天或每周使用）与HRQOL领域之间的关系。
习惯性烟草使用的流行率为23.9%（男性为48.1%，女性为15.5%）。习惯性烟草使用与整个样本的认知功能下降相关（B = -8.99，p < 0.05），与男性较低的疼痛相关障碍水平相关（B = 18.1，p < 0.05）。尽管男性报告的烟草使用更多（B = 8.50，p < 0.001），但他们报告的疼痛相关限制比女性少（B = 8.70，p < 0.05）。
在我们的样本中，男性报告的习惯性烟草使用率高于女性。吸烟与认知障碍相关，且男性的疼痛相关障碍较少。未来针对有抑郁症症状的PLWH的戒烟治疗可能会受益于将疼痛管理视为习惯性吸烟途径并认识到使用动机可能因性别而异的策略。
