Smoking cessation among women with and at risk for HIV: Are they quitting?

Background: Cigarette smoking is an important risk factor for adverse health events in HIV-infected populations. While recent US population-wide surveys report annual sustained smoking cessation rates of 3.4-8.5%, prospective data are lacking on cessation rates for HIV-infected smokers. Objective: To determine the sustained tobacco cessation rate and predictors of cessation among women with or at risk for HIV infection. Design: Prospective cohort study. Participants: A total of 747 women (537 HIV-infected and 210 HIV-uninfected) who reported smoking at enrollment (1994-1995) in the Women's Interagency HIV Study (WIHS) and remained in follow-up after 10 years. The participants were mostly minority (61% non-Hispanic Blacks and 22% Hispanics) and low income (68% with reported annual incomes of less than or equal to $12,000). Measurements and main results: The primary outcome was defined as greater than 12 months continuous cessation at year 10. Multivariate logistic regression was used to identify independent baseline predictors of subsequent tobacco cessation. A total of 121 (16%) women reported tobacco cessation at year 10 (annual sustained cessation rate of 1.8%, 95% CI 1.6-2.1%). Annual sustained cessation rates were 1.8% among both HIV-positive and HIV-negative women (p=0.82). In multivariate analysis, the odds of tobacco cessation were significantly higher in women with more years of education (p trend=0.02) and of Hispanic origin (OR=1.87, 95% CI=1.4-2.9) compared to Black women. Cessation was significantly lower in current or former illicit drug users (OR=0.42 95% CI=0.24-0.74 and OR=0.65, 95% CI=0.49-0.86, respectively, p trend=0.03) and women reporting a higher number of cigarettes per day at baseline (p trend<0.001). Conclusions: HIV-infected and at-risk women in this cohort have lower smoking cessation rates than the general population. Given the high prevalence of smoking, the high risk of adverse health events from smoking, and low rates of cessation, it is imperative that we increase efforts and overcome barriers to help these women quit smoking.