A smoking-cessation intervention delivered through mobile phones to HIV/AIDS-positive smokers increased cessation rates compared to standard care, according to research published online in Clinical Infectious Diseases.
A team of researchers led by Ellen R. Gritz, Ph.D., professor and chair of the Department of Behavioral Science at The University of Texas MD Anderson Cancer Center, designed and tested the efficacy of a smoking intervention comparing usual care – brief advice to quit smoking, self-help materials, and instructions on how to obtain nicotine patches – with telephone smoking-cessation counseling delivered through cell phones.
“Individuals living with HIV/AIDS have an alarmingly high prevalence of smoking compared to the general population,” said Gritz. “This study developed and evaluated a unique intervention that was intended to help this vulnerable population achieve and maintain abstinence from smoking.”
Researchers recruited 474 HIV-positive smokers from the Thomas Street Health Center, a Harris Health System HIV clinic, serving a predominantly low socioeconomic and uninsured population. In the study, participants were randomized into two groups – usual care or cell phone-delivered treatment.
Both groups received smoking-cessation materials with expert advice on quitting and tips specifically addressing concerns of HIV-positive smokers. Both groups also received instructions on how to obtain nicotine replacement therapy through the clinic. The cell phone group received the additional support of behavioral counseling and access to a smoking cessation support line.
The telephone counseling was designed to address issues specific to people living with HIV/AIDS and served to help reduce perceived barriers associated with quitting and staying abstinent. Smoking status was assessed at three, six and 12 months. Overall, individuals in the cell phone group were approximately 2.5 times more likely to quit smoking compared to individuals who received the usual care intervention.
The study found the treatment effect was strongest at the three-month follow-up, when approximately 16 percent of participants in the cell phone group were abstinent compared to 5 percent in the usual care group. However, by the 12-month follow-up, the proportion of participants who reported refraining from smoking in both groups ranged between 6 to 7 percent.
The findings also showed that 67 percent of participants had high depressive symptoms, 31 percent were participating in harmful drinking, and 40 percent used illicit drugs at least 30 days before enrolling in the study. “These co-morbidities may in part explain the high smoking relapse rates that were observed,” said Damon Vidrine, Dr.PH., assistant professor in the Department of Behavioral Science at MD Anderson and senior author on the paper.
“It is extremely important for individuals living with HIV/AIDS to stop using tobacco,” said Gritz. “The health consequences of smoking in the general population are severe, and even more so in this population group as they are at increased risk to develop cancer, cardiovascular and pulmonary diseases, and other HIV/AIDS- related complications.”
This is one of the first randomized controlled trials to investigate a smoking cessation intervention targeting the HIV/AIDS population. “Our findings suggest the need for additional research targeted toward this group that focuses on long-term smoking abstinence and relapse prevention,” said Gritz.
Co-authors with Gritz are Michelle Cororve Fingeret, Ph.D., Irene Tami-Maury, Dr.PH., Heather Danysh, Faith Fletcher, Ph.D. and Damon Vidrine, Dr.PH., all of MD Anderson’s Department of Behavioral Science; Rachel Marks King, M.P.H., of MD Anderson’s Department of Integrative Health Services; and Roberto Arduino, M.D., of The University of Texas Health Science Center at Houston Medical School.
This research was funded by a grant from the National Cancer Institute (R01CA097893).