[Viva] Fwd: CATIE-News - Smoking cessation: Innovative group therapy-centered support found to double quit rate
Tami Starlight
tamistarlight at gmail.com
Fri Oct 19 11:29:11 PDT 2012
**
CATIE-News - Bite-sized HIV/AIDS news bulletins
CATIE-News - Smoking cessation: Innovative group therapy-centered
support found to double quit rate
Surveys have found that tobacco use is common among some HIV-positive
people. As much as 40% of some clinic populations have been found to smoke
cigarettes. In the time before potent combination anti-HIV therapy
(commonly called ART or HAART) became widely available, smoking cessation
was not a major concern for HIV-positive people and their health care
providers.
In the present era, researchers increasingly expect ART users to have
survival rates broadly similar to those of HIV-negative people. However,
there are increasing reports of shortened survival among some HIV-positive
people due to complications arising from cancers, co-infections and
cardiovascular disease<http://www.catie.ca/en/catienews/2012-10-16/cancers-liver-failure-and-other-problems-now-leading-causes-death-swiss-hiv-stu>.
Smoking tobacco elevates the risk for cancers, heart attack and other
complications, ultimately worsening quality of life and decreasing
lifespan. In one international study of more than 5,000 HIV-positive
people, researchers estimated that smoking tobacco was either directly or
indirectly responsible for 24% of the deaths that occurred over the long
term.
Help for quitting
Concerned about the harmful impact of smoking and trying to improve ways to
help HIV-positive people quit, researchers at the Albert Einstein College
of Medicine in the Bronx, New York, have been conducting studies related to
this issue. Their latest study was a randomized controlled trial comparing
an intensive group therapy*–*centered approach to standard advice about
quitting. All participants were offered nicotine replacement therapy.
Participants who received intensive group therapy*–*based support had
nearly double the quit rate after three months.
Furthermore, the researchers found that two factors—loneliness and
participants’ confidence in their ability to resist the urge to smoke—were
significantly associated with their ability to break free from smoking. The
results of this and other studies should encourage clinicians to refine
their tobacco-cessation programs for HIV-positive people.
Study details
Participants in the study were randomly assigned to either enter the
intensive program, called Positive Smoke Free (PSF), or receive brief
standard counselling. Within the PSF program, participants were divided
into small groups of six to eight people. Each group was led by two
facilitators, one was an HIV-positive peer and the other was a graduate
student of a psychology program. Both facilitators had training about
tobacco addiction.
Focus on PSF
PSF is an eight-session intervention based on the *Tobacco Dependence
Treatment Handbook*. The PSF program was created by making modifications to
the work in the handbook, so that the concerns of HIV-positive people could
be incorporated. These concerns, identified in pilot studies, included the
following:
- specific risks of smoking for HIV-positive people
- co-existing mental health and emotional issues
- substance use
- social isolation
- stress reduction
Each group had a weekly 90-minute session. Key issues covered in these
meetings including the following:
- reviewing the many health risks associated with exposure to tobacco
smoke
- dispelling myths about the alleged benefits of smoking
- exploring self-discipline and delaying instant gratification and their
impact on improved health
- understanding the importance of adherence
- understanding and enduring temporary discomfort in exchange for
long-term health
- assertive training to negotiate HIV care
- dealing with urges to skip medical appointments or doses of HIV
medications
- understanding the link between HIV, pain, tobacco use and quitting
- remaining free from tobacco over the long-term
Smoke-free status was confirmed by the evaluation of the exhaled air of
participants for carbon monoxide at several points throughout the study.
Of the 184 people who volunteered for the study, 147 made it through the
screening process and were randomly assigned to one of the following groups:
- 73 participants – PSF
- 72 participants – so-called standard therapy, consisting of a brochure
about quitting, brief advice (less than five minutes) about quitting and
free nicotine replacement therapy if they wished
The average profile at the time participants entered the study was as
follows:
- gender – 50% women, 49% men, 1% transgendered
- age – 48 years
- CD4+ count – 500 cells
- housing status – 90% had stable housing status
- employment – 89% were unemployed
HIV infection risk factors included the following:
- unprotected heterosexual sex – 58%
- unprotected sex between men – 15%
- injection drug use – 15%
- contaminated blood transfusion – 3%
Commonly used substances in the month prior to enrollment in the study
were as follows:
- marijuana – 42%
- cocaine – 29%
- heroin – 8%
Most people had been smokers for more than 30 years, consuming an average
of 12 cigarettes daily.
Results
Overall, 21 participants (15%) were able to quit after the three-month
program ended, distributed as follows:
- PSF – 19%
- standard therapy – 10%
Although the outcome of this study is highly promising and likely
clinically meaningful—nearly twice as many PSF participants quit—the
difference in quit rates did not reach statistical significance.
The study team assessed possible reasons that might have influenced people
to quit, including the following:
- group facilitators – a comparison of different group leaders did not
find any impact on outcomes
- prescribed medicines – although 40% of participants received nicotine
replacement therapy or other prescribed drugs, such as bupropion
(Wellbutrin, Zyban) and varenicline (Chantix, Champix), to help ease the
path to quitting, prescribed medicines on their own did not apparently
affect quit rates in this study
- race/ethnicity – people of Latino ethnicity were more likely to quit
- loneliness – people who were lonelier were less likely to quit
Improvements to the next clinical trial
The PSF program was clearly advantageous in helping people to quit.
Researchers found that quit rates were significantly greater among PSF
participants if they attended seven or more counselling sessions *and *also
received prescribed therapy to help them quit. Keeping people motivated in
any clinical trial is not easy, particularly in trials of smoking
cessation. Future trials should consider prescribed medicines for smoking
cessation as well as ways to maximize attendance at support group meetings.
Additional considerations include the following:
- race/ethnicity – Researchers are not certain why Latino participants
were more likely to quit smoking in the present study. They found that
Black people were less likely to quit and so more research is needed to
understand these issues concerning race and ethnicity.
- loneliness – Past research has found that loneliness is linked to an
increased risk for tobacco use. Perhaps this may be related to boredom and
stigmatization, which are also related to the use of tobacco. The social
aspects of the PSF program were the most appreciated part of the program by
participants. This finding may be useful for future studies.
The present study has produced highly promising results and shows that
smoking cessation is possible among HIV-positive people who are motivated
to quit. Perhaps future studies should be of a longer duration, both to
provide more social support for participants and to assess how long they
are able to remain smoke free.
*Resources:*
- *CATIE-News: Understanding Tobacco
Addiction*<http://www.catie.ca/en/catienews/2011-11-08/understanding-tobacco-addiction>
- Canadian Cancer Society: Smoking and
tobacco<http://www.cancer.ca/Canada-wide/Prevention/Smoking%20and%20tobacco.aspx?sc_lang=en>
- Canadian Lung Association: Smoking &
tobacco<http://lung.ca/protect-protegez/tobacco-tabagisme_e.php>
- Santé et services sociaux Québec: Tobacco and your
health<http://msss.gouv.qc.ca/sujets/santepub/tabac/index.php?tabac_et_votre_sante_en&PHPSESSID=d4c678bbe7b903338484656891c20464>
- CATIE: Up in Smoke - The ifs, ands or buts of butting
out<http://positiveside.ca/e/V6I4/Smoke_e.htm>
- CATIE Factsheet: HIV and Cardiovascular
disease<http://www.catie.ca/fact-sheets/other-health-conditions/hiv-and-cardiovascular-disease>
*—Sean R. Hosein*
REFERENCES:
1. Gong J, Hutter CM, Baron JA, et al. A pooled analysis of smoking and
colorectal cancer: timing of exposure and interactions with environmental
factors. *Cancer Epidemiology, Biomarkers & Prevention*. 2012; *in press*
.
2. Fabbiani M, Ciccarelli N, Tana M, et al. Cardiovascular risk factors
and carotid intima-media thickness are associated with lower cognitive
performance in HIV-infected patients. *HIV Medicine*. 2012; *in press*.
3. Shuter J, Bernstein SL, Moadel AB. Cigarette smoking behaviors and
beliefs in persons living with HIV/AIDS. *American Journal of Health
Behavior*. 2012 Jan;36(1):75-85.
4. Moadel AB, Bernstein SL, Mermelstein RJ, et al. A Randomized
Controlled Trial of a Tailored Group Smoking Cessation Intervention for
HIV-Infected Smokers. *Journal of Acquired Immune Deficiency
Syndromes.*2012 Oct 1;61(2):208-215.
5. Lifson AR, Neuhaus J, Arribas JR, et al. Smoking-related health risks
among persons with HIV in the Strategies for Management of Antiretroviral
Therapy clinical trial. *American Journal of Public Health.* 2010
Oct;100(10):1896-903.
6. Lauder W, Mummery K, Jones M, et al. A comparison of health
behaviours in lonely and non-lonely populations. *Psychology, Health,
and Medicine*. 2006 May;11(2):233-45.
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