CIGARETTE SMOKING BEHAVIORS AMONG PEOPLE LIVING WITH HIV: ASSOCIATIONS WITH INDIVIDUAL- AND SOCIAL-LEVEL CHARACTERISTICS

INTRODUCTION: Smoking is endemic among people with HIV and associated with morbidity and mortality. Little research has been conducted among smokers with HIV. Research has focused on examining individual-level characteristics associated with smoking behaviors, with little examination of social-level factors. Aim 1 included a literature review concerning the intersection of HIV and smoking. Aims 2-4 explored individual- and social-level characteristics associated with current smoking (Aim 2), interest in quitting or cutting down (Aim 3), and lifetime quit attempts (Aim 4). METHODS: Data for Aims 2-4 came from a study designed to examine social environmental influences on HIV-positive current/former drug users’ health outcomes in Baltimore, Maryland. Logistic regression (Aims 2 and 4) and multinomial logistic regression (Aim 3) analyses were used to explore associations between covariates and outcomes. RESULTS: Aim 1: Literature concerning smoking among HIV-positive populations was reviewed. Topics included: morbidity, mortality, treatment and medication adherence outcomes; characteristics associated with smoking behaviors; evidence-based cessation interventions; findings from cessation interventions among smokers with HIV. Gaps in the literature and directions for future research were identified. Aim 2: Most participants (75%) were smokers. Drug use (aOR=2.82, 95% CI=1.55-5.13), 12-step program participation (aOR=1.74, 95% CI=1.02-2.96), and having a main Supporter who smokes (aOR=2.01, 95% CI=1.14-3.54) were associated with current smoking. Aim 3: Individuals who made lifetime quit attempts were more likely than those who had not to be interested in quitting (aRRR=3.50, 95% CI=1.39-8.30). Family encouragement to smoke was negatively associated with interest in cutting down (aRRR=0.09, 95% CI=0.01-0.86) and interest in quitting (aRRR=0.27, 95% CI=0.08-0.90). Aim 4: Older age (45-49: aOR=3.44, 95% CI=1.60-7.39; 54-65: aOR=2.74, 95% CI=1.22-6.17), non-Black race (aOR=3.61, 95% CI=1.23-10.62), and having a main Supporter who had used NRT or medications for cessation (aOR=2.40, 95% CI=1.24-4.63) were positively associated with an increased likelihood of lifetime use of NRT or medications for smoking cessation. CONCLUSIONS: Results corroborate research indicating that smoking is a significant public health problem among people with HIV. Results extend knowledge by suggesting that social- and individual-level characteristics are associated with smoking behaviors among people with HIV. Results have implications for cessation interventions among smokers with HIV

Substance Use Disorders and Adolescent Psychopathology

Adolescence is a vulnerable developmental stage where significant changes occur in a youth’s body, brain, environment and socialization, which may increase vulnerability to substance use, development of addiction, and psychiatric disorders. A co-occurrence of mental and behavioral disturbances with drug involvement in adolescence is common, as reflected in both a high risk for drug use in youth with mental illness and a high frequency of psychopathology among drug users. In this review we provide a broad and basic overview of some of the research evidence indicating a strong co-occurrence of drug use disorders (abuse and dependence) with externalizing and internalizing disorders, as well as a few other serious mental health conditions among adolescents. Increasing awareness and knowledge of the high probability of the co-occurrence of mental and behavioral disturbances with drug involvement informs the understanding of the etiology, course, and treatment of psychiatric problems among adolescents

Perceived risk of regular cannabis use in the United States from 2002 to 2012: Differences by sex, age, and race/ethnicity

Introduction: Cannabis is one of the most widely used psychoactive substances in the United States (U.S.). Perceived risk of use is associated with substance use; the recent debate surrounding medicalization and legalization of cannabis in the U.S. has the potential to impact perceived risk of use. Recent estimates are needed to assess temporal changes in, and identify correlates of, perceived risk of cannabis use. Methods: Utilizing data from the 2002–2012 survey years of the National Survey on Drug Use and Health, chi-squared statistics and logistic regression were used to describe temporal changes in perceived risk of regular cannabis use (i.e., once or twice a week), to explore correlates of perceived risk, and to report frequency of cannabis use. Results: Between 2002 and 2012, perceived great risk of regular cannabis use varied significantly overall (p < 0.001). The prevalence of past year non-daily (p < 0.001) and daily use varied significantly during this time (p < 0.001). Controlling for survey year and other confounders, characteristics associated with increased odds of perceived great risk of regular cannabis use included: female sex; Non-White race/ethnicity; age 50+; and family income of $20,000-49,999. Characteristics associated with decreased odds of perceived great risk included: ages 12–17 and 18–25; high school education or greater; total family income of$75,000+; past year non-daily and daily cannabis use; and survey years 2008–2012. Conclusions: Findings characterize trends of perceived risk of regular cannabis use, and past year non-daily and daily cannabis use. Longitudinal studies of the influence of legal status of cannabis at the state-level are needed

Cigarette smoking and drug use among a nationally representative sample of HIV-positive individuals

Background and Objectives: Among HIV-positive populations, the prevalence of cigarette smoking remains disproportionately high and is associated with significant morbidity and mortality. Little is known about this topic among HIV-positive persons in the general population. Methods: Data came from the 2005 to 2011 National Survey on Drug Use and Health (NSDUH) public use data files. Unadjusted and adjusted multinomial logistic regression analyses explored the associations between socio-demographic, drug and alcohol use, and drug and/or alcohol treatment characteristics with smoking status among HIV-positive individuals (n = 349). Results: More than 40% of the sample was current smokers. In adjusted analyses, females (aRRR = .11, 95% CI = .03–.41) and participants who had never been married (aRRR = .19, 95% CI = .05–.58), were more likely to be former smokers than never smokers. Females (aRRR = .37, 95% CI = .14–.96) and individuals older than age 35 (aRRR = .37, 95% CI = .16–.89) were less likely to be current smokers than never smokers. Conversely, previously married persons (aRRR = 5.72, 95% CI = 1.40–23.31), participants reporting binge drinking (aRRR = 5.96, 95% CI = 2.27–15.64), and lifetime drug or alcohol treatment (aRRR = 5.12, 95% CI = 2.09–12.55) were more likely to be current smokers than never smokers. Conclusions: Findings help confirm the high prevalence of smoking among HIV-positive persons suggesting the need for integrated substance use and smoking cessation treatment among HIV-positives. Scientific Significance: The present findings have implications for the development and implementation of targeted smoking cessation programs for HIV-positive smokers

Effects of Very Low Nicotine Content Cigarettes on Smoking Behavior and Biomarkers of Exposure in Menthol and Non-menthol Smokers.

IntroductionBecause 30% of cigarettes sold in the United States are characterized as menthol cigarettes, it is important to understand how menthol preference may affect the impact of a nicotine reduction policy.MethodsIn a recent trial, non-treatment-seeking smokers were randomly assigned to receive very low nicotine cigarettes (VLNC; 0.4 mg nicotine/g tobacco) or normal nicotine cigarettes (NNC; 15.5 mg/g) for 20 weeks. On the basis of preference, participants received menthol or non-menthol cigarettes. We conducted multivariable regression analyses to examine whether menthol preference moderated the effects of nicotine content on cigarettes per day (CPD), breath carbon monoxide (CO), urinary total nicotine equivalents (TNE), urinary 2-cyanoethylmercapturic acid (CEMA), and abstinence.ResultsAt baseline, menthol smokers (n = 346) reported smoking fewer CPD (14.9 vs. 19.2) and had lower TNE (52.8 vs. 71.6 nmol/mg) and CO (17.7 vs. 20.5 ppm) levels than non-menthol smokers (n = 406; ps &lt; .05). At week 20, significant interactions indicated that menthol smokers had smaller treatment effects than non-menthol smokers for CPD (-6.4 vs. -9.3), TNE (ratio of geometric means, 0.22 vs. 0.10) and CEMA (ratio, 0.56 vs. 0.37; ps &lt; .05), and trended toward a smaller treatment effect for CO (-4.5 vs. -7.3 ppm; p = .06). Odds ratios for abstinence at week 20 were 1.88 (95% confidence interval [CI] = 0.8 to 4.4) for menthol and 9.11 (95% CI = 3.3 to 25.2) for non-menthol VLNC smokers (p = .02) relative to the NNC condition.ConclusionsAlthough menthol smokers experienced reductions in smoking, toxicant exposure, and increases in quitting when using VLNC cigarettes, the magnitude of change was smaller than that observed for non-menthol smokers.ImplicationsResults of this analysis suggest that smokers of menthol cigarettes may respond to a nicotine reduction policy with smaller reductions in smoking rates and toxicant exposure than would smokers of non-menthol cigarettes

CIGARETTE SMOKING BEHAVIORS AMONG PEOPLE LIVING WITH HIV: ASSOCIATIONS WITH INDIVIDUAL- AND SOCIAL-LEVEL CHARACTERISTICS

INTRODUCTION: Smoking is endemic among people with HIV and associated with morbidity and mortality. Little research has been conducted among smokers with HIV. Research has focused on examining individual-level characteristics associated with smoking behaviors, with little examination of social-level factors. Aim 1 included a literature review concerning the intersection of HIV and smoking. Aims 2-4 explored individual- and social-level characteristics associated with current smoking (Aim 2), interest in quitting or cutting down (Aim 3), and lifetime quit attempts (Aim 4). METHODS: Data for Aims 2-4 came from a study designed to examine social environmental influences on HIV-positive current/former drug users’ health outcomes in Baltimore, Maryland. Logistic regression (Aims 2 and 4) and multinomial logistic regression (Aim 3) analyses were used to explore associations between covariates and outcomes. RESULTS: Aim 1: Literature concerning smoking among HIV-positive populations was reviewed. Topics included: morbidity, mortality, treatment and medication adherence outcomes; characteristics associated with smoking behaviors; evidence-based cessation interventions; findings from cessation interventions among smokers with HIV. Gaps in the literature and directions for future research were identified. Aim 2: Most participants (75%) were smokers. Drug use (aOR=2.82, 95% CI=1.55-5.13), 12-step program participation (aOR=1.74, 95% CI=1.02-2.96), and having a main Supporter who smokes (aOR=2.01, 95% CI=1.14-3.54) were associated with current smoking. Aim 3: Individuals who made lifetime quit attempts were more likely than those who had not to be interested in quitting (aRRR=3.50, 95% CI=1.39-8.30). Family encouragement to smoke was negatively associated with interest in cutting down (aRRR=0.09, 95% CI=0.01-0.86) and interest in quitting (aRRR=0.27, 95% CI=0.08-0.90). Aim 4: Older age (45-49: aOR=3.44, 95% CI=1.60-7.39; 54-65: aOR=2.74, 95% CI=1.22-6.17), non-Black race (aOR=3.61, 95% CI=1.23-10.62), and having a main Supporter who had used NRT or medications for cessation (aOR=2.40, 95% CI=1.24-4.63) were positively associated with an increased likelihood of lifetime use of NRT or medications for smoking cessation. CONCLUSIONS: Results corroborate research indicating that smoking is a significant public health problem among people with HIV. Results extend knowledge by suggesting that social- and individual-level characteristics are associated with smoking behaviors among people with HIV. Results have implications for cessation interventions among smokers with HIV