Associations Between Multiple Forms of Discrimination and Tobacco Use Among People Living With HIV: The Mediating Role of Avoidance Coping

Crockett, Kaylee B.; Rice, Whitney S.; Turan, Bülent

doi:10.1097/qai.0000000000001636

Cited by 14 publications

(4 citation statements)

References 46 publications

(62 reference statements)

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“…23,25,51 Another maladaptive coping response to experienced stigma (avoidant coping) was also found to be indirectly associated with health risk behavior (tobacco use) among PLWH in a separate study. 52 Taken together, the results and extant literature imply a need to address the manifestations of these negative health and psychological effects of stigma, in addition to stigmareduction efforts. In particular, programs to increase social support may produce positive change in treatment selfefficacy, 36 and interventions to treat clinical as well as subclinical anxiety and depressive symptoms have the potential to reduce coping by substance use 53 and improve ART adherence.…”

Section: Discussionmentioning

confidence: 88%

A Mixed Methods Study of Anticipated and Experienced Stigma in Health Care Settings Among Women Living with HIV in the United States

Rice

Turan

Fletcher

et al. 2019

AIDS Patient Care and STDs

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Among places where people living with HIV experience and anticipate HIV-related stigma, stigma in health care settings may be particularly harmful. Utilizing an exploratory sequential mixed methods approach, we conducted interviews (n = 76) and questionnaires (N = 460) with older adult women living with HIV enrolled in the Women's Interagency HIV Study in Birmingham, AL; Jackson, MS; Atlanta, GA; and San Francisco, CA. Interviews addressed facilitators and barriers to HIV treatment adherence, including HIV-related stigma. Qualitative data were coded using thematic analysis. Questionnaires assessed self-reported antiretroviral therapy (ART) adherence and experienced and anticipated HIV-related stigma from various sources (i.e., health care personnel, family, partner, and community). Covariate-adjusted logistic regression analyses examined total and mediated effects of stigma on ART adherence. Interviewees described fears and experiences of stigma in health care settings; including privacy violations, disrespect for patient autonomy, and reproductive coercion; and how these influenced their adherence to HIV treatment recommendations. Experienced and anticipated HIV-related stigma in health care settings were associated with suboptimal (or <95%) ART adherence in separate models controlling for experienced or anticipated stigma, respectively, from other sources. When entered together, only anticipated stigma in health care settings was associated with suboptimal ART adherence, controlling for anticipated and experienced stigma from other sources. The effect of anticipated stigma in health care settings on suboptimal ART adherence may work through the pathways of lower adherence self-efficacy, higher depressive symptoms, and higher coping by substance use. These findings indicate that interventions should promote cultures of acceptance within health care settings and resilience-based strategies for women to combat stigma and promote life-sustaining behaviors.

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Section: Discussionmentioning

confidence: 88%

A Mixed Methods Study of Anticipated and Experienced Stigma in Health Care Settings Among Women Living with HIV in the United States

Rice

Turan

Fletcher

et al. 2019

AIDS Patient Care and STDs

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“…Among people with HIV/AIDS who smoke, those who identify as members of a racial minority group are at an elevated risk for negative health consequences of smoking and poorer HIV-related outcomes. Evidence suggests that Black adults with HIV, in particular, experience high rates of discrimination and stigma that lead to the onset and maintenance of maladaptive coping, including smoking [ 19 , 20 ]. Consistent with these data, Black adults with HIV are more likely to smoke [ 4 ], less likely to quit [ 4 , 21 - 24 ], and experience greater quit difficulty when attempting to quit than White smokers or smokers without HIV [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

An Integrated mHealth App for Smoking Cessation in Black Smokers With HIV: Protocol for a Randomized Controlled Trial

Bizier,

Jones,

Businelle

et al. 2024

JMIR Res Protoc

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Background Black adults who smoke and have HIV experience immense stressors (eg, racial discrimination and HIV stigma) that impede smoking cessation success and perpetuate smoking-related health disparities. These stressors also place Black adults who smoke and have HIV at an increased risk of elevated interoceptive stress (eg, anxiety and uncomfortable bodily sensations) and smoking to manage symptoms. In turn, this population is more likely to smoke to manage interoceptive stress, which contributes to worse HIV-related outcomes in this group. However, no specialized treatment exists to address smoking cessation, interoceptive stress, and HIV management for Black smokers with HIV. Objective This study aims to test a culturally adapted and novel mobile intervention that targets combustible cigarette smoking, HIV treatment engagement and adherence, and anxiety sensitivity (a proxy for difficulty and responsivity to interoceptive stress) among Black smokers with HIV (ie, Mobile Anxiety Sensitivity Program for Smoking and HIV [MASP+]). Various culturally tailored components of the app are being evaluated for their ability to help users quit smoking, manage physiological stress, and improve health care management. Methods This study is a pilot randomized controlled trial in which Black combustible cigarette smokers with HIV (N=72) are being recruited and randomly assigned to use either (1) the National Cancer Institute’s QuitGuide app or (2) MASP+. Study procedures include a web-based prescreener; active intervention period for 6 weeks; smartphone-based assessments, including daily app-based ecological momentary assessments for 6 weeks (4 ecological momentary assessments each day); a video-based qualitative interview using Zoom Video Communications software at week 6 for participants in all study conditions; and smartphone-based follow-up assessments at 0, 1, 2 (quit date), 3, 4, 5, 6, and 28 weeks postbaseline (26 weeks postquitting date). Results Primary outcomes include biochemically verified 7-day point prevalence of abstinence, HIV-related quality of life, use of antiretroviral therapy, and HIV care appointment adherence at 26 weeks postquitting date. Qualitative data are also being collected and assessed to obtain feedback that will guide further tailoring of app content and evaluation of efficacy. Conclusions The results of this study will determine whether the MASP+ app serves as a successful aid for combustible cigarette smoking cessation, HIV treatment engagement, and physiological stress outcomes among Black people with HIV infection. If successful, this study will provide evidence for the efficacy of a new means of addressing major mental and physical health difficulties for this high-risk population. If the results are promising, the data from this study will be used to update and tailor the MASP+ app for testing in a fully powered randomized controlled trial that will evaluate its efficacy in real-world behavioral health and social service settings. Trial Registration ClinicalTrials.gov NCT05709002; https://clinicaltrials.gov/study/NCT05709002 International Registered Report Identifier (IRRID) PRR1-10.2196/52090

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“…According to data from a national sample, PLWH are at twice the risk of having an income at or below the poverty threshold (16). Being a part of intersecting minority populations can lead to increased likelihood of mental health disorders and substance use, speci cally tobacco (15,17,18). A 2015 cross-sectional sampling of PLWH in D.C.…”

Section: Introductionmentioning

confidence: 99%

“…Prior research has described the ways in which stigma surrounding HIV has exacerbated smoking among PLWH (17), however limited research exists to combat smoking through speci cally targeting these underlying determinants (14,20). We developed and evaluated a tailored smoking cessation intervention for PLWH in the D.C. metropolitan area that integrates aspects of minority stress theory (18) utilizing counseling, pharmacotherapy, and mobile health (mHealth) methodologies.…”

Section: Introductionmentioning

confidence: 99%

A pilot randomized controlled trial of a tailored smoking cessation program for people living with HIV in the Washington, D.C. metropolitan area

Kierstead

Harvey

Sánchez

et al. 2020

Preprint

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ObjectiveMorbidity and mortality from smoking-related diseases among people living with HIV (PLWH) in the U.S. surpasses that due to HIV itself. Conventional smoking cessation treatments have not demonstrated strong efficacy among PLWH. We conducted a pilot randomized controlled trial (RCT) to evaluate a tailored smoking cessation intervention based on the minority stress model. We compared standard of care counseling (SOC) to a tailored intervention (TI) including one face-to-face counseling session incorporating cognitive behavioral therapy to build resilience, and 30 days of 2-way text messaging.ResultsThe primary outcome was smoking cessation. Secondary outcomes included cigarettes per day (CPD), exhaled carbon monoxide (CO), and cessation self-efficacy. A total of 25 participants were enrolled (TI:11, SOC:14), and 2 were lost to follow up. There were no significant differences in quit rates between study groups. However, there was a significantly greater decrease in CPD in the TI versus SOC (13.5 vs. 0.0, p-value:0.036). Additionally, self-efficacy increased in both groups (TI p-value:0.012, SOC p-value:0.049) and CO decreased in both groups (TI p-value:<0.001, SOC p-value:0.0488). This intervention shows promise to support smoking cessation among PLWH. A larger study is needed to fully evaluate the efficacy of this approach.Trial RegistrationRetrospectively registered (10/20/2020) NCT04594109

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Associations Between Multiple Forms of Discrimination and Tobacco Use Among People Living With HIV: The Mediating Role of Avoidance Coping

Abstract: Given the disparity in tobacco use in PLWH, behavioral scientists and interventionists should consider including content specific to coping with experiences of discrimination in tobacco prevention and cessation programs for PLWH.

Cited by 14 publications

References 46 publications

A Mixed Methods Study of Anticipated and Experienced Stigma in Health Care Settings Among Women Living with HIV in the United States

A Mixed Methods Study of Anticipated and Experienced Stigma in Health Care Settings Among Women Living with HIV in the United States

An Integrated mHealth App for Smoking Cessation in Black Smokers With HIV: Protocol for a Randomized Controlled Trial

A pilot randomized controlled trial of a tailored smoking cessation program for people living with HIV in the Washington, D.C. metropolitan area

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