A Pilot Trial Examining African American and White Responses to Algorithm-Guided Smoking Cessation Medication Selection in Persons Living with HIV

Abstract

Algorithm-based treatments (AT) may be an effective clinical tool to aid HIV clinicians in prescribing pharmacotherapy to increase smoking cessation among people living with HIV (PLWH). Initial results from AT indicated significant increases in abstinence self-efficacy and medication utilization and declines in cigarettes smoked per day across time. Given historical racial disparities, it is unclear if both African Americans and White smokers would benefit equally from this type of intervention. Thus, the aim of this study was to examine racial differences in response to AT guided smoking cessation for African American and White smokers living with HIV. One hundred PLWH smokers (n = 100) were randomized to receive either AT guided smoking cessation or Treatment as Usual (TAU) which consisted of instructing participants to talk to a provider about smoking cessation assistance when ready to make a quit attempt. Participants were African American (75%) and White (25%) and majority men (71%) who had never been married (56%). African Americans smoked fewer cigarettes and were more likely to smoke mentholated cigarettes compared to White smokers at baseline. African Americans increased their use of other tobacco products (cigars/cigarillos) over time relative to White smokers. A significant interaction between race and quit goal was observed, with White smokers who reported complete abstinence as their goal having higher quit rates, while African Americans who reported a goal other than complete abstinence demonstrating higher quit rates. The increased use of cigars/cigarillos during quit attempts as well as having a goal other than complete abstinence should be considered when applying algorithm based interventions for PLWH African American smokers.

Keywords: Behavior; HIV; Intervention; Smoking cessation.

Fig. 1

Algorithm-guided treatment for smoking cessation

Fig. 2

Interaction between treatment and race for abstinence self-efficacy (N = 100). Number of cigarettes smoked per day and menthol use were included as covariates. AT algorithm treatment; TAU treatment as usual

Fig. 3

Racial differences on use of other tobacco products across time (N = 100). Number of cigarettes smoked per day and menthol use were included as covariates. Wk Week

Fig. 4

Interaction between race and abstinence goal for quit status for CO ≤ 5 ppm. Number of cigarettes smoked per day and menthol use were included as covariates