Association between cigarette smoking and selected medical conditions among people at high risk of HIV

Background: Strong scientific evidence relates cigarette smoking to more than two dozen diseases and conditions, including heart disease, pulmonary disease and cancer. However, little is known of the added risk it has on a transient population at high risk of HIV.

Methods: Using data collected from a large multi-site sample that recruits unstably-housed people at high risk of HIV (N= 2,661) we conducted logistic-regression analysis in order to understand the risks of cigarette smoking in this population. We used cigarette smoking as the independent variable. Predictor variables (p 0.05 in bivariate analysis) were sociodemographic characteristics, alcohol and drug abuse, and existing health problems.

Results: Cigarette smoking was prevalent: 78% of clients were current smokers; 41% smoked more than one pack per day.

Logistic regression analysis showed that cigarette smoking was associated with being less educated (OR=0.8), unemployed (OR=0.7), abusing drugs (OR=3.0), having dental problems (OR=1.8), diabetes (OR=0.6), and hepatitis C (OR=1.6).

Conclusions: Even within a "high-need" population, cigarette smoking is associated with those most at need: the less educated, the unemployed, and people with drug problems. Consistent with other studies, results here suggest that it is associated with dental problems and diabetes. There was no relationship between smoking and being HIV positive, or with having an AIDS diagnosis. Of concern was the finding that incidence of hepatitis C is higher among cigarette smokers. Further studies should investigate the extent to which cigarette smoking influences susceptibility to hepatitis C infection and/or if their co-occurrence represents a health-risk-taking cluster.