Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
Nicotine Tob Res. 2021 Aug 4;23(8):1308-1317. doi: 10.1093/ntr/ntaa277.
Approximately one in four deaths among people living with HIV (PLWH) in the United States can be attributed to cigarette smoking. Using a nationally representative sample of PLWH, this study examines the prevalence, time-trends, and correlates of current cigarette smoking among PLWH compared to people without HIV.
Secondary analysis of population-based cross-sectional biobehavioral survey.
Data were pooled from the 1999-2016 National Health and Nutrition Examination Survey (NHANES). All adults (20-59 years) who self-reported their smoking status and were tested for HIV (HIV+ = 152; HIV- = 26 305) were included in the analysis. Prevalence with 95% confidence interval (95% CI), trend analysis by year and group (HIV+/HIV-), and multivariable logistic regression analyses were performed with the complex survey design adjustments.
Overall, 47.0% of PLWH were current smokers compared to 25.5% of those without HIV. From 1999 to 2016, the decline in smoking in PLWH was comparable to those without HIV (10.7% vs. 8.0%). PLWH smokers were more likely than PLWH nonsmokers to be substance users (adjusted odds ratio [aOR] = 17.52; 95% CI = 2.04 to 27.8). Compared to smokers without HIV, PLWH smokers were more likely to be older (1.10; 1.06 to 1.14), males (7.96; 2.50 to 25.40), non-Hispanic Black (10.45; 4.13 to 26.45), with depression (Patient Health Questionnaire-9 sum score ≥5) (3.79; 1.22 to 11.79), and less likely to be gay (0.02; 0.00 to 0.07).
Cigarette smoking among PLWH is a major public health problem in the United States. Targeted and tailored smoking cessation interventions that incorporate assessment and treatment of depression and co-occurring substance use are critical for PLWH, especially among those who are disproportionately affected by smoking and HIV (sexual minority).
This study offers important research implications in four areas:1. The decline in smoking among PLWH over 18 years has been modest, and half of PLWH are still smokers.2. More resources and efforts should be allocated to reduce cigarette smoking among PLWH.3. There is a critical need to develop and test culturally tailored smoking cessation interventions for minority subgroups who are most impacted by HIV infection and smoking (non-Hispanic Blacks and men who have sex with men)4. Smoking cessation interventions designed for PLWH should incorporate assessment and treatment of depression and substance use.
在美国，HIV 感染者（PLWH）中有四分之一的死亡可归因于吸烟。本研究使用具有全国代表性的 PLWH 样本，与没有 HIV 的人群相比，调查了 PLWH 中当前吸烟的流行率、时间趋势和相关因素。
基于人群的横断面生物行为调查的二次分析。
数据来自 1999-2016 年全国健康和营养调查（NHANES）。所有报告吸烟状况并接受 HIV 检测的成年人（20-59 岁）（HIV+ = 152；HIV- = 26305）均纳入分析。采用复杂调查设计调整，进行现患率（95%置信区间[95%CI]）、按年和组（HIV+/HIV-）的趋势分析以及多变量逻辑回归分析。
总体而言，47.0%的 PLWH 是当前吸烟者，而没有 HIV 的人这一比例为 25.5%。1999 年至 2016 年，PLWH 吸烟率的下降与没有 HIV 的人相似（10.7%比 8.0%）。与 PLWH 非吸烟者相比，PLWH 吸烟者更有可能是物质使用者（调整后的优势比[aOR] = 17.52；95%CI = 2.04 至 27.8）。与没有 HIV 的吸烟者相比，PLWH 吸烟者更有可能年龄较大（1.10；1.06 至 1.14）、男性（7.96；2.50 至 25.40）、非西班牙裔黑人（10.45；4.13 至 26.45）、患有抑郁症（患者健康问卷-9 总分≥5）（3.79；1.22 至 11.79），且同性恋的可能性较小（0.02；0.00 至 0.07）。
在美国，PLWH 的吸烟是一个重大的公共卫生问题。针对 PLWH 的有针对性和定制化的戒烟干预措施，结合对抑郁和共病物质使用的评估和治疗，对于 PLWH 至关重要，尤其是对那些受吸烟和 HIV 影响不成比例的人群（性少数群体）。
本研究在四个方面提供了重要的研究意义：1. 18 年来，PLWH 的吸烟率下降幅度不大，仍有一半的 PLWH 吸烟。2. 应投入更多资源和努力减少 PLWH 的吸烟行为。3. 迫切需要为受 HIV 感染和吸烟影响最大的少数亚组（非西班牙裔黑人以及男男性行为者）开发和测试针对少数民族的文化适应性戒烟干预措施。4. 为 PLWH 设计的戒烟干预措施应包括对抑郁和物质使用的评估和治疗。
