Cigarette Smokers are Less Likely to Have Undetectable Viral Loads: Results from Four HIV Clinics

BACKGROUND:

The prevalence of smoking among HIV-infected individuals is 2-3 times that of the general population, increasing the risk of smoking-related morbidity and mortality. We examined characteristics associated with smoking behavior among a large cohort of HIV-infected individuals in care in the United States.

METHODS:

A convenience sample of 2952 HIV-infected patients in the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) was assessed during routine clinic visits and was included. Multinomial logistic regression was used to examine the relationship between smoking status, depression/panic symptoms, alcohol/substance use, and demographic and clinical characteristics.

RESULTS:

Compared with never-smokers, current smokers were more likely to have moderate to severe depression (odds ratio [OR] 1.37), endorse current substance use (OR 14.09), and less likely to report low-risk alcohol use on the Alcohol Use Disorders Identification Test (AUDIT-C) (OR 0.73). Current smokers were less likely to have an undetectable viral load (OR 0.75), and more likely to have current substance abuse (OR 2.81) and moderate to severe depression (OR 1.50), relative to smokers who had quit smoking.

CONCLUSIONS:

HIV-infected smokers are less likely to have undetectable viral loads and frequently have psychosocial comorbidities including depression and substance abuse that impact antiretroviral therapy adherence and viral load suppression. To be effective, smoking-cessation interventions need to address the complex underlying concurrent risks in this population.

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By:   Cropsey KL1, Willig JH, Mugavero MJ, Crane HM, McCullumsmith C, Lawrence S, Raper JL, Mathews WC, Boswell S, Kitahata MM, Schumacher JE, Saag MS;CFAR Network of Integrated Clinical Systems.

• 1University of Alabama at Birmingham (KLC, JHW, MJM, CMcC, SL, JLR, JES, MSS), Birmingham, AL; University of Washington (HMC, MMK), Seattle, WA; University of California, San Diego (WCM), San Diego, CA; Fenway Community Health Center (SB), Boston, MA. 

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The Long-Term Effects of School Dropout & GED Attainment on Substance Use Disorders

BACKGROUND:

Epidemiologic research suggests that 14% of the population do not complete high school, and dropout has been linked to mental health conditions, substance use, chronic health problems, and criminal behavior. Few studies have assessed whether attainment of the general education development (GED) credential is protective from substance use.

PURPOSE:

To assess the long-term outcomes of school dropout and GED attainment on past year substance use disorders, age of onset, and current smoking status.

METHODS:

Longitudinal data were included for lifetime substance users who participated in the National Epidemiological Survey on Alcohol and Related Conditions (Waves I and II). Eligible participants (N=30,608) were classified as having completed high school, dropped out of high school and did not complete a GED, or completed GED at Wave I. Survey logistic regression analyses were used to determine whether high school graduation status was associated with substance use disorders and smoking at Wave II.

RESULTS:

Multivariate results suggest that participants who dropped out of high school (OR=1.53; p<.01) or attained a GED were more likely to have a past year marijuana use disorder (OR=1.62 p<.01) compared to high school graduates. High school dropouts were also more likely to be current smokers (OR=1.88; p<.05) than graduates.

CONCLUSIONS:

High school dropouts have higher long-term rates of marijuana use disorder and smoking in adulthood than graduates. Attainment of a GED does not appear to be protective from marijuana use disorders in adulthood.

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By:  Reingle Gonzalez JM1, Salas-Wright CP2, Connell NM3, Jetelina KK4, Clipper SJ5, Businelle MS6.

• 1Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Dallas, TX, USA. Electronic address: Jennifer.reingle@utsouthwestern.edu.
• 2School of Social Work, The University of Texas at Austin, Austin, TX, USA. Electronic address: salaswright@utexas.edu.
• 3Program in Criminology, School of Economic, Political and Policy Sciences, University of Texas at Dallas, Richardson, TX, USA. Electronic address: Nadine.connell@utdallas.edu.
• 4Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Dallas, TX, USA. Electronic address: Katelyn.kassarjian@utsouthwestern.edu.
• 5Program in Criminology, School of Economic, Political and Policy Sciences, University of Texas at Dallas, Richardson, TX, USA. Electronic address: Stephen.clipper@utdallas.edu.
• 6The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: Michael.Businelle@utsouthwestern.edu. 

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Dental Disease Patterns in Methamphetamine Users: Findings in a Large Urban Sample

BACKGROUND:

The authors used a large community sample of methamphetamine (MA) users to verify the patterns and severity of dental disease and establish a hierarchy of caries susceptibility by tooth type and tooth surface.

METHODS:

Using a stratified sampling approach, 571 MA users received comprehensive oral examinations and psychosocial assessments. Three calibrated dentists characterized dental and periodontal disease by using National Health and Nutrition Examination Survey protocols. The authors also collected data on substance use history and other attributes linked to dental disease.

RESULTS:

On all dental outcome measures, MA users evidenced high dental and periodontal disease, with older (≥ 30 years) and moderate or heavy MA users disproportionately affected. Women had higher rates of tooth loss and caries, as well as a greater prevalence of anterior caries. Current cigarette smokers were more likely to manifest 5 or more anterior surfaces with untreated caries and 3 or more teeth with root caries. Nearly 3% were edentulous, and a significant percentage (40%) indicated embarrassment with their dental appearance.

CONCLUSIONS:

MA users have high rates of dental and periodontal disease and manifest a dose-response relationship, with greater levels of MA use associated with higher rates of dental disease. Women and current cigarette smokers are affected disproportionately. The intraoral patterns and hierarchy of caries susceptibility in MA users are distinctive.

PRACTICAL IMPLICATIONS:

The prevalence and patterns of dental and periodontal disease could be used to alert dentists to possible covert MA use and to plan treatment. Concerns about dental appearance have potential as triggers for behavioral interventions.

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By:  Shetty V, Harrell L, Murphy DA, Vitero S, Gutierrez A, Belin TR, Dye BA, Spolsky VW.

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Motivation for Smoking Cessation among Drug-Using Smokers Under Methadone Maintenance Treatment in Vietnam

Smoking cessation treatment service is concerned to be a critical element in methadone maintenance treatment (MMT) in order to diminish the effect of smoke on health outcomes. To implement the smoking cessation services in Vietnam, we examined the stages of change to quit and determined associated factors among MMT patients.

We conducted a cross-sectional survey with 1016 MMT patients in five clinics in Hanoi and Nam Dinh province, of those, 932 (91.7 %) were ever-smokers. Patients were classified into four groups: “pre-contemplation,” “contemplation,” “preparation,” and “action and maintenance” by using the transtheoretical model. Multivariate logistic regression was applied to determine the associated factor for intention and action to quit smoking.

Overall, 96 % were not actively trying to quit or maintain abstinence. Age older than 45, HIV-positive status, and residence in Hanoi were negatively associated with intention to quit. Meanwhile, higher levels of nicotine dependence and number of years of smoking negatively associated with quitting and abstinence.

The study indicated the high rate of MMT smokers being in pre-contemplation stage but low proportion of quitting and maintaining abstinence. It emphasizes the importance of availability and accessibility of information about smoking cessation therapies and services. Integrating cessation programs into health-care services should be considered to provide tailored interventions for different patient groups.

Full article at: http://goo.gl/joc95H

By: Bach Xuan Tran^12*†, Long Hoang Nguyen^3†, Huyen Phuc Do⁴, Nhung Phuong Thi Nguyen⁵, Huong Thu Thi Phan⁶, Michael Dunne⁴ and Carl Latkin²

¹Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam

²Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

³School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam

⁴School of Public Health and Social Work, The Queensland University of Technology, Brisbane, Australia

⁵Hanoi University of Pharmacy, Hanoi, Vietnam

⁶Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam

  

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