Project Exhale: Preliminary Evaluation of a Tailored Smoking Cessation Treatment for HIV-Positive African American Smokers

Abstract

This study examined the feasibility, acceptability, and outcomes of a culturally tailored smoking cessation intervention for HIV-positive African American male smokers. Eligible smokers were enrolled in a seven-session group-based treatment combined with nicotine patch. The mean age of participants was M=46 years. The majority were daily smokers (71%), smoked a mentholated brand (80%), and averaged 8.6 (standard deviation [SD]=8.1) cigarettes per day. Baseline nicotine dependency scores (M=5.8) indicated a moderate to high degree of physical dependence. Of the 31 participants enrolled, the majority completed treatment (≥3 sessions; 68%), 1-month follow-up (74%), and 3-month follow-up (87%) interviews. Program acceptability scores were strong. However, adherence to the patch was low, with 39% reporting daily patch use. The majority of participants (80%, n=24) made a quit attempt. Furthermore, over the course of the intervention, smoking urge, cigarettes smoked, nicotine dependence, withdrawal symptoms, and depression scores all significantly decreased. Follow-up quit rates at 1 and 3 months ranged from 6% to 24%, with treatment completers having better outcomes. This first of its kind intervention for HIV-positive African American male smokers was feasible, acceptable, and showed benefit for reducing smoking behaviors and depression scores. Smoking cessation outcomes were on par with other similar programs. A larger trial is needed to address limitations and to confirm benefits.

Outcomes of a Tailored Intervention for Cigarette Smoking Cessation Among Latinos Living With HIV/AIDS

“…Quit rates in both conditions were low, but consistent with the two previous randomized trials to-date with PLWH in which 6-month or longer outcomes yielded quit rates that ranged from 4% to 10% using different intervention approaches such as cell-phone counseling 20 and motivational interviewing. 20,22 Despite theoretical support and previous literature in the general population suggesting that tailored-counseling would yield better outcomes 17,[60][61][62][63] and that tailored videos and materials would better engage participants, 64,65 Aurora did not prove to have added benefit beyond that conferred by the ESC condition. Aurora consisted of significantly longer sessions and a greater number of in-person visits and calls, yet the increased intensity did not translate into better cessation outcomes in this study.…”

“…15 Poor abstinence rates among underserved groups, such as ethnic minorities and PLWH, may reflect limited referral to and/or use of effective smoking cessation treatments, differential outcomes when participating in recommended treatments, or higher rates of smoking relapse following periods of abstinence compared to the general population. [16][17][18][19] Despite high levels of interest in quitting, 11 only a small proportion of PLWH smokers who participate in clinical trials that include nicotine replacement therapy (NRT) sustain abstinence at 6 months, 20 compared to 20%-30% quit rates seen with similar treatments in the general population of smokers. 21 To date, only two adequately powered smoking cessation trials have been conducted with PLWH smokers, and abstinence outcomes at 6 months have not exceeded 12%.…”

Promotion of Tobacco Use Cessation for Lesbian, Gay, Bisexual, and Transgender People

“…45 In the United Kingdom, an LGBT-tailored cessation group program showed positive results generally comparable to national results (45% abstinent [intent-to-treat] at seventh week versus 53% nationally [of those setting a quit date]), 39 and this program was replicated in Zurich, Switzerland, showing a 29% quit rate at 6 months. 46 Evaluations of these programs suggest heterogeneity of efficacy with quit rates (range, 6% at 3 months 44 to 36% at 6 months 38 ) both above and below other group-based interventions in the general population (14%, 95% CI=12%–16%, at 6 months) 29 and highlight the feasibility of implementing smoking-cessation treatments at health centers and community organizations. These community-driven programs were conducted with diverse populations and across genders.…”

Smoking Cessation for People Living With HIV/AIDS: A Literature Review and Synthesis

“…Matthews et al 42 examined outcomes of PLWHA who underwent a seven-session, group-based intervention plus NRT. They found the intervention to be feasible and highly acceptable by participants.…”

“…11,36,40 Compliance with NRT tends to be poor across studies. 36,42 Further, it appears that psychological variables, including self-efficacy and motivation (decisional balance) around quitting, may mediate the relationship between NRT use and smoking abstinence. 55 Bupropion, a norepinephrine-dopamine reuptake inhibitor that is also used to treat depression, has similarly demonstrated efficacy across numerous smoking cessation trials in a number of different patient groups, 54 but no randomized trials have examined the efficacy of bupropion in PLWHA.…”