The association between lifetime polytobacco use and intention to quit among HIV-positive cigarette smokers

Background: This secondary analysis aims to describe, over time, the relationship between HIV disease progression and intention to quit cigarette smoking among current monocigarette users with and without a lifetime history of polytobacco use. Methods: Participants completed a baseline assessment at the time of HIV care initiation and four follow-up assessments (3, 6, 9, and 12-months). Assessments included biochemically verified smoking status and audio computer-assisted self-interviews assessing psychosocial, substance use, and clinical variables known to influence smoking behaviors. Using linear and generalized linear fixed-effects models, we modeled the covariance structure for the repeated outcome measures (intention to quit and 7-day point prevalence smoking abstinence) across the study time points and included a three-way interaction term to examine the effects of disease stage and tobacco product use. Results: Participants (N = 357) were 73.1% male, 67.3% black/African American, and had a mean (SD) age of 38.7 (10.6) years. At baseline, lifetime polytobacco users reported significantly worse HIV-related symptoms and burdens, illness perception, social support, and nicotine dependence. Intention to quit, but not smoking abstinence, was predicted by a three-way interaction between time from HIV care initiation, disease progression, and tobacco product use (p = .04). Overall, progressive HIV was associated with greater intention to quit smoking cigarettes. However, the relationship differed over time between the two tobacco product groups. Conclusion: Future studies should consider tailoring the timing of cessation interventions upon disease stage and lifetime history of polytobacco use.