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Advisory Committee Chair

Peter Hendricks

Advisory Committee Members

Craig Wilson

Karen Cropsy

James Wilig

Ann Gakumo

Greer Burkholder

Document Type

Dissertation

Date of Award

2018

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

People living with HIV (PLWH) are two to three times more likely to be current smokers, less likely to quit smoking and more likely to relapse than those in the general population. Although smoking status, prescription of smoking cessation medications (SCMs), smoking cessation and relapse has been explored in this population, few have investigated using a large sample of PLWH receiving routine HIV care. Using data from a large observational cohort of PLWH receiving routine care in Birmingham, we determined: 1) Factors associated with smoking status; 2) Factors associated with prescription of SCMs; 3) Predictors of smoking cessation and; 4) Predictors of smoking relapse. For the first paper, Using descriptive statistics and multinomial logistic regression, smoking was prevalent among our study population. Psychological factors were associated with current and former smokers. For the second paper, using descriptive statistics and a logistic regression model, there was a racial disparity in the prescription of SCMs with African Americans being prescribed less as compared to whites. Patients with psychological factors and suppressed plasma HIV-1 RNA (<200 copies/mL) were more likely to be prescribed SCMs. For the third paper, using descriptive statistics and Cox proportional hazard model, few (28%) quit smoking, patients without insurance, substance abuse, alcohol abuse were less likely to quit while patients with plasma HIV-1 RNA (<200 copies/mL) were more likely to quit smoking. For the fourth paper, using descriptive statistics and Cox proportional hazard model, more than half (51%) of the patients relapsed, patients with psychological factors were more likely to relapse. This dissertation underscores the need to increase pharmacological therapy to the African Americans. Having a successful engagement of mental health care may provide a difference not only on smoking cessation but also in reducing the relapse in these underserved populations.

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