Tobacco use and readiness to quit smoking in low-income HIV-infected persons Jack E. Burkhalter, Carolyn M. Springer, Rosy Chhabra, Jamie S. Ostroff, Bruce D. Rapkin [Received 23 December 2003; accepted 17 December 2004] The study aim was to identify covariates of smoking status and readiness to quit that encompassed key sociodemographic and health status variables, health-related quality of life, drug use and unprotected sex, and tobacco use variables in a cohort of low-income persons living with HIV. We also examined the impact of HIV diagnosis on smoking cessation. The sample (N5428) was mostly male (59%) and Black (53%) or Hispanic (30%), and had a high school education or less (87%). Mean age was 40 years. Two-thirds of participants were current smokers, 19% former smokers, and 16% never smokers. Current smokers smoked a mean of 16 cigarettes/day for 22 years; 42% were in the precontemplation stage of readiness to quit smoking, 40% were contemplators, and 18% were in preparation. Most current smokers (81%) reported receiving medical advice to quit smoking. Multivariate logistic regression analyses indicated that current smokers, compared with former smokers, were more likely to use illicit drugs, perceive a lower health risk for continued smoking, and report less pain. Current smokers, compared with nonsmokers (former and never smokers), were more likely to report greater illicit drug use in their lifetime, current illicit drug use, and less pain. A multiple linear regression indicated that greater current illicit drug use, greater emotional distress, and a lower number of quit attempts were associated with lower stage of readiness to quit smoking. These findings confirm a high prevalence of smoking among HIV-infected persons and suggest a complex interplay among drug use, pain, and emotional distress that impact smoking status and, among smokers, readiness to quit. Tobacco control programs for HIV-infected persons should build motivation to quit smoking and address salient barriers to cessation—such as comorbid drug use, emotional distress, pain, and access to and coverage for treatment—and should educate smokers regarding the HIV-specific health benefits of cessation. Introduction Advances in medical treatment leading to greater life expectancy for persons infected with HIV (McNaghten, Hanson, Jones, Dworkin, & Ward, 1999) have increased interest in health protective behavior changes, such as smoking cessation (Collins et al., 2001; Gritz, Vidrine, Lazev, Amick, & Arduino, 2004; Niaura, Shadel, Morrow, Flanigan, & Abrams, 2000), which may reduce morbidity and mortality and improve quality of life in this popula- tion. The sociodemographic and risk profile for HIV disease encompasses population characteristics related to higher likelihood of tobacco use, such as lower socioeconomic status (Droomers, Schrijvers, & Mackenbach, 2002; Escobedo, Zhu, Giovino, & Eriksen, 1995; Pierce, Fiore, Novotny, Hatziandreu, & Davis, 1989), illicit substance use or abuse (Hughes, 1993; Kopstein, Crum, Celentano, & Martin, 2001), and being a gay or bisexual male (Arday, Edlin, Giovino, & Nelson, 1993; Burns et al., 1991; Royce & Winkelstein, 1990; Stall, Greenwood, Acree, Paul, & Coates, 1999). Recent studies have shown higher rates of smoking among HIV-infected persons than in the general population, currently estimated at 23.3% (Centers for Disease Control and Prevention [CDC], 2002). In a study using a nationally representative sample of persons infected with HIV, 51% were current tobacco smokers (Collins et al., 2001). A multicenter study examining pulmonary complications of HIV infection found ISSN 1462-2203 print/ISSN 1469-994X online # 2005 Society for Research on Nicotine and Tobacco DOI: 10.1080/14622200500186064 Jack E. Burkhalter, Ph.D., Carolyn M. Springer, Ph.D., Rosy Chhabra, Psy.D., Jamie S. Ostroff, Ph.D., Bruce D. Rapkin, Ph.D., Department of Psychiatry & Behavioral Sciences, Memorial Sloan- Kettering Cancer Center, New York, NY. Correspondence: Jack E. Burkhalter, Ph.D., Memorial Sloan- Kettering Cancer Center, Department of Psychiatry & Behavioral Sciences, 1275 York Avenue, New York, NY 10021, USA. Tel: +1 (212) 583-3013; Fax: +1 (212) 230-1953; E-mail: burkhalj@mskcc.org Nicotine & Tobacco Research Volume 7, Number 4 (August 2005) 511–522