Sex Differences in Tobacco Use Among Persons Living With HIV/AIDS: A Systematic Review and Meta-Analysis

Abstract

Background Persons living with HIV/AIDS (PLWH) smoke at higher rates than other adults and experience HIV-related and non-HIV-related adverse smoking consequences. The current study conducted a systematic review to synthesize current knowledge about gender differences in smoking behaviors among PLWH. Methods Over three thousand abstracts from MEDLINE were reviewed and seventy-nine publications met all of the review inclusion criteria (i.e., reported data on smoking behaviors for PLWH by gender). Sufficient data were available to conduct a meta-analysis for one smoking variable: current smoking prevalence. Results Across studies (n=51), the meta-analytic prevalence of current smoking among female PLWH was 36.3% (95% CI=28.0%-45.4%) and male PLWH was 50.3% (95% CI=44.4%-56.2%; meta-analytic OR=1.78, 95% CI=1.29-2.45). When analyses were repeated just on United States (U.S.) studies (n=23), the prevalence of current smoking was not significantly different for female PLWH (55.1%, 95% CI=47.6%-62.5%) compared to male PLWH (55.5%, 95% CI=48.2%-62.5%; meta-analytic OR=1.04, 95% CI=0.86-1.26). Few studies reported data by gender for other smoking variables (e.g., quit attempts, non-cigarette tobacco product use) and results for many variables were mixed. Discussion Unlike the general U.S. population, there was no difference in smoking prevalence for female versus male PLWH (both >50%) indicating that HIV infection status was associated with a greater relative increase in smoking for women than men. More research is needed in all areas of smoking behavior of PLWH to understand similarities and differences by gender in order to provide the best interventions to reduce the high smoking prevalence for all genders.

Perceived risks and benefits of quitting smoking in a sample of adults living with HIV/AIDS

“…Fewer gender differences were found than in community samples (e.g., McKee et al, 2005) similar to a review of smoking and PLWH (Weinberger et al, 2017). Compared to male PLWH, female PLWH more highly endorsed risks of post-quit negative affect.…”

Association between smoking, and hospital readmission among inpatients with psychiatric illness at an academic inpatient psychiatric facility, 2000–2015

“…The observed difference continues to add to the growing evidence that tobacco use places a toll upon individuals with mental illness, accounting for 200,000 of the 443,000 tobacco-related annual deaths ( Schroeder & Morris, 2010 ). The results of 54.3% of males as current smokers compared to 39.7% of females as current smokers are consistent with smoking in the general population where men compared to women are more likely to report that they are current smokers ( Weinberger, Smith, Funk, Rabin, & Shuter, 2017 ). With the adjusted odds ratio of readmission within a year for females compared to males at 1.19, the females had a higher chance of 19% of being readmitted than males.…”

Changes in smoking patterns after HIV diagnosis or antiretroviral treatment initiation: a global systematic review and meta-analysis

“…Integration of tobacco use services in HIV programs and strengthening skills of HIV healthcare workers on strategies to help quitting tobacco consumption should be prioritized in this region as well as resources to be allocated for the task. On the other hand and concerning what specific interventions should be implemented for PLWH who smoke, a review of tested interventions came to the conclusion that interventions may be more effective when its components are tailored to the unique needs of the target population [14]. For instance, depression and co-dependency on other substances such as alcohol and illicit drugs should be adequately addressed as part of a smoking cessation program for PLWH [16,41].…”

“…Studies have reported that smoking tobacco is a highly prevalent behaviour among people living with HIV (PLWH), with an average of 16-28 cigarettes smoked per day among those who smoke, which is an indicator of high nicotine dependence [10,[12][13][14][15][16]. Furthermore, the prevalence of smoking among PLWH is at least 1.3 folds higher (range 40-74%) than in the general population (range 19-31%) [10,11,13,17,18].…”