Understanding Smoking Cessation Challenges among People Living with HIV: A Crossroads of Chronic Disease and Behavioral Health

ABSTRACTUnderstanding Smoking Cessation Challenges among People Living with HIV: A Crossroads of Chronic Disease and Behavioral Healthby Ngozi Genevieve Nwosisi Doctor of Philosophy in Public Health University of California, Irvine, 2021 Associate Professor David Timberlake, ChairSmoking prevalence among people living with HIV remains disproportionately higher than that of the general population (Diaz & Ferketich, 2018; Sigel et al., 2017). The prevalence of cigarette smoking in PLWH ranges between 47% and 65% (Pool et al., 2016). The extremely high smoking rate among PLWHA, coupled with the additional burden of HIV infection, should make smoking cessation a high priority among HIV/AIDS primary care and medical providers (Tesoriero et. al, 2008). Despite the recommendation to use 5A model, there are very low rates of 5A use among providers. To understand the barriers to smoking cessation among PLWH, the author interviewed 10 participants across two clinics in southern California. In Aim 1, the focus was to uncover unique challenges to the population that may prevent successful intervention strategies and derive targeted interventions for future use. Aim 2 addressed communication assessment from the view of the patient. A sample of the same patients from both aims was selected. While some patients trust providers’ authority in offering advice, others held strong beliefs regarding making decisions about their own health. Aim 3 identified key factors associated with 5A use using survey data from HIV providers in the U.S. 5A use did not differ by sex, provider age, type of outpatient practice, the volume of patients seen. Approximately 60% of surveyed attending physicians did not use 5A. While low numbers do not permit adequate comparison between the different categories of providers surveyed, all the physician assistants and 50% of the NPs used 5A. Providers who received formal training were two times as likely to adhere to 5A use with patients [p<0.001; C.I. 1.45- 4.43]. Implication: Providers should receive proper training regarding the implementation of 5A during a discussion with their patients. These discussions should occur with care and understanding for the patient’s specific needs to not be perceived as burdensome or paternalistic and lose the opportunity to make a lasting impact