Excess Cigarette Smoking Among HIV-Infected Adults in Care – Washington State 2009-2011

BACKGROUND:  Tobacco use continues to be a significant public health problem. Nationally, cigarette smoking among HIV-infected adults in care has been shown to be significantly more prevalent compared to the general population. However, Washington State (WA) specific estimates among the HIV-infected population are lacking. The Medical Monitoring Project (MMP) is a surveillance project designed to ascertain the experiences and needs of HIV-infected adults receiving HIV care. The project includes a patient interview and medical record abstraction. The purpose of this analysis was to estimate prevalence of cigarette smoking among the WA HIV-infected adult population in care and compare this estimate to the WA general adult population.

METHODS:  Data sources included WA combined 2009-2011 MMP patient interviews, and combined 2009 and 2010 Behavioral Risk Factor Surveillance System (BRFSS), a population-based telephone survey of WA residents 18 years and older. Participants were included in the analysis if they reported smoking status in the MMP interview. Current smoking was defined self-report of at least 100 cigarettes smoked in lifetime and currently smoked at least weekly at time of the interview. Bivariate analyses were used to estimate the weighted prevalence of current smoking among WA HIV-infected persons in care and in the WA general adult population. Prevalence ratios (PR) were used to compare differences in prevalence among the two populations. Statistical significance was calculated using two-proportion z tests.

RESULTS:  Approximately 36% (95% CI: 30-41) of WA HIV-infected persons in care reported current smoking. Among these, 68% (95% CI: 61-73) indicated that their provider offered help to quit smoking in the 12 months prior to interview. Prevalence of current smoking was highest among 18-34 year olds, those with less than a high school diploma, and income below the federal poverty level. While current smoking status in the WA general adult population followed the same trend as the HIV-infected population, prevalence of current smoking was significantly higher among HIV-infected persons. Unadjusted current smoking prevalence was 2.4 times higher among HIV-infected persons compared to the WA general adult population (p<0.01).

CONCLUSIONS:  Consistent with National MMP estimates, smoking prevalence is significantly higher among HIV-infected adults in care in WA compared to the WA general adult population. While providers appear to be discussing tobacco cessation with their patients, most continue to smoke, particularly among the younger, less educated and less wealthy. New tobacco cessation interventions and new ways of discussing tobacco use need to be developed and implemented to address this ongoing issue.