Tobacco use and attempts to quit smoking among injection drug users at high risk of HIV-infection in 2009, Baltimore, MD

Background: Heavy tobacco use is common among persons living with HIV/AIDS, particularly injection drug users (IDUs). While effective antiretroviral therapy (ART) has led to dramatically improved survival, tobacco-related disease burden is increasing. We sought to characterize tobacco smoking and cessation among participants of three on-going HIV cohort studies in Baltimore, MD. Methods: Cross-sectional survey of lung disease and risk factors completed in 2009. Results: Of 627 respondents, 85% currently smoke and 95% have ever smoked cigarettes. The median age is 50 years (IQR=45-55), 91% are African American and 29% are HIV-infected. 84% report past history, while 20% report past-month injection drug use. Recent IDUs were less likely to make a quit attempt in the past year (26% vs. 33%, p=0.30) and had a lower self-efficacy to quit (61% vs. 73%, p=0.009). 51% of HIV-infected respondents made at least one quit attempt since diagnosis; 39% discussed quitting smoking with a healthcare provider in the past year and 16% contacted a quitline. 35% of the HIV-infected attempting to quit used nicotine replacement therapy (NRT), which was elevated among those on ART (48% vs. 21%, p=0.07). HIV-infected quitters cited tapering off of cigarettes (71%) and abruptly quitting smoking (73%) as cessation strategies, and recent illness (47%) & concerns regarding smoking effects on other medications (61%) as leading smoking cessation motivations. Conclusions: Our results reflect strong motivation to quit smoking, yet under-utilization of evidence-based smoking cessation strategies. HIV care providers must assist their patients in quitting smoking by fully integrating nationally recommended clinical guidelines.