An addiction to cigarette smoking is truly difficult for HIV-positive people to break, according to a study comparing two smoking cessation strategies reported Wednesday, February 11, at the 16th Conference on Retroviruses and Opportunistic Infections (CROI) in Montreal. While no more than 10 percent of individuals participating in either strategy abstained from smoking for six months, study presenters Karen Tashima, MD, of Brown University in Providence, Rhode Island, and her colleagues found much higher success rates among Hispanics compared with other racial or ethnic groups.
According to background information provided by Tashima, about 47 to 70 percent of HIV-positive people in the United States smoke, compared with about 20 percent of the general U.S. population. Compounded by the fact that HIV-positive smokers appear to be at a significantly higher risk for conditions such as cancer, chronic lung problems and cardiovascular disease, many experts are eager to incorporate effective smoking cessation programs into HIV medical care.
Tashima’s group explored the effectiveness of two smoking cessation programs, both in conjunction with eight weeks of nicotine patch therapy. In the standard intervention program, 232 people received two three- to four-minute counseling sessions from their health care providers to discuss quitting and to review smoking cessation literature. In the Positive Paths program—a “motivationally enhanced” strategy—212 people participated in four 30-minute sessions to talk with trained counselors about setting goals, taking responsibility and making positive changes.
About 72 percent of the patients completed six months of the study. Sixty-two percent of the study completers were men, 52 percent were white, 18 percent were black, and 16 percent were Hispanic. On average, the study participants smoked about a pack of cigarettes a day.
Quit rates were based on self-reports of abstinence, confirmed using a lab test to check for the presence of nicotine.
When analyzing results involving all patients enrolled in the study—including those lost to follow-up—Tashima’s group reported that 9 percent of those enrolled in the study were smoke-free after six months. This includes 9 percent of those in the Positive Paths program and 10 percent of those in the standard intervention program. When looking only at those who actually completed all six months of the study, abstinence rates were somewhat higher: 12 percent in the Positive Paths program and 14 percent in the standard intervention program.
Interestingly, higher quit rates were seen among Hispanics: 19 percent overall, including 14 percent in the Positive Paths group and 24 percent in the standard intervention group. Quit rates were lowest among blacks: 5 percent overall, including 9 percent in the Positive Paths group and 0 percent in the standard intervention group. The overall difference between Hispanics and blacks was statistically significant, meaning it was too great to have occurred by change.
About one third of the study volunteers opted not to use the nicotine patch—not one of whom remained smoke-free within six months. In fact, using the patch and having a high motivation to quit and remain smoke-free were the strongest predictors of success in either program studied.