Physical Activity, Cigarette Smoking, and Depression Among People with HIV

Nicholas J SantaBarbara^{1

2}, Melissa A St Hilaire³, Deborah J Konkle-Parker⁴, Warren Scott Comulada⁵, Jennifer Cantrell⁶, Amber D'Souza⁷, Robert Foronjy⁸, Susan L Koletar⁹, Matthew J Mimiaga¹⁰, Frank J Palella Jr¹¹, Daniel Merenstein¹², Anna A Rubtsova¹³, Sarath Raju¹⁴, Claudia A Martinez¹⁵, David B Hanna¹⁶, M Bradley Drummond¹⁷, Kathleen M Weber¹⁸, Richard Wang¹⁹, Kristine M Erlandson²⁰

Affiliations

¹ Athletic Training and Exercise Science, Merrimack College, North Andover, MA, USA. santabarbarn@merrimack.edu.
² Department of Athletic Training and Exercise Science, School of Nursing and Health Sciences, Merrimack College, North Andover, MA, 01845, USA. santabarbarn@merrimack.edu.
³ Computer and Data Sciences, Merrimack College, North Andover, MA, USA.
⁴ Schools of Nursing, Medicine and Population Health, University of Mississippi Medical Center, Jackson, MS, USA.
⁵ Department of Health Policy and Management, Geffen School of Medicine, Psychiatry and Biobehavioral Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
⁶ School of Global Public Health, Social and Behavioral Sciences, New York University, New York, NY, USA.
⁷ Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁸ Medicine, Downstate Health Sciences University, Brooklyn, NY, USA.
⁹ Infectious Diseases, The Ohio State University, Columbus, OH, USA.
¹⁰ Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
¹¹ Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹² Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA.
¹³ Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA.
¹⁴ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁵ Cardiovascular Medicine, University of Miami, Miami, FL, USA.
¹⁶ Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
¹⁷ Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁸ Hektoen Institute of Medicine, Chicago, IL, USA.
¹⁹ Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
²⁰ University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA.

PMID: 40299258
PMCID: PMC12351484
DOI: 10.1007/s10461-025-04727-6

Multicenter Study

Physical Activity, Cigarette Smoking, and Depression Among People with HIV

Nicholas J SantaBarbara et al. AIDS Behav. 2025 Sep.

. 2025 Sep;29(9):2701-2710.

doi: 10.1007/s10461-025-04727-6. Epub 2025 Apr 29.

Authors

Affiliations

¹ Athletic Training and Exercise Science, Merrimack College, North Andover, MA, USA. santabarbarn@merrimack.edu.
² Department of Athletic Training and Exercise Science, School of Nursing and Health Sciences, Merrimack College, North Andover, MA, 01845, USA. santabarbarn@merrimack.edu.
³ Computer and Data Sciences, Merrimack College, North Andover, MA, USA.
⁴ Schools of Nursing, Medicine and Population Health, University of Mississippi Medical Center, Jackson, MS, USA.
⁵ Department of Health Policy and Management, Geffen School of Medicine, Psychiatry and Biobehavioral Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
⁶ School of Global Public Health, Social and Behavioral Sciences, New York University, New York, NY, USA.
⁷ Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁸ Medicine, Downstate Health Sciences University, Brooklyn, NY, USA.
⁹ Infectious Diseases, The Ohio State University, Columbus, OH, USA.
¹⁰ Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
¹¹ Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹² Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA.
¹³ Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA.
¹⁴ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁵ Cardiovascular Medicine, University of Miami, Miami, FL, USA.
¹⁶ Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
¹⁷ Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁸ Hektoen Institute of Medicine, Chicago, IL, USA.
¹⁹ Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
²⁰ University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA.

PMID: 40299258
PMCID: PMC12351484
DOI: 10.1007/s10461-025-04727-6

Abstract

People with HIV (PWH) smoke cigarettes 2-3 times more and are 3 times more likely to have clinical depression relative to the general population. Physical activity (PA) can aid in smoking cessation and reduce depression in the general population; the role of PA for smoking cessation among PWH is unknown. Data collected between October 2021-September 2022 from the Multicenter AIDS Cohort Study (MACS)/Women Interagency HIV Study (WIHS) Combined Cohort Study (MWCCS) were analyzed using logistic regression and structural equation modeling to examine associations between cigarette smoking, PA and depression. Among adult PWH (n = 1584), 505 were insufficiently active (MET-min/week ≤ 500), 400 were currently smoking, and 420 had clinically significant depressive symptoms (CES-D ≥ 16). The odds of current smoking were significantly higher among PWH who were insufficiently active compared to sufficiently active, even after adjusting for age, sex, body mass index, race, ethnicity, substance use, and viral load (aOR = 1.40 [95% CI: 1.04-1.87], p = 0.03). Similarly, the odds of current smoking were significantly higher among PWH with more symptoms of depression in adjusted models (aOR = 1.57 [95% CI: 1.16-2.12], p = 0.003). When stratified by sex, the odds of current smoking remained significantly higher among female PWH, but not male PWH who were insufficiently active. The odds of current smoking also remained significantly higher among females but not males with more symptoms of depression. Structural equation modeling indicated that PA and depression have independent and direct effects on smoking among PWH. Physical inactivity and depression are associated with smoking, but longitudinal studies are needed to better understand directionality and causality.

Keywords: AIDS; Cigarette smoking; Depression; Exercise; HIV; Physical activity.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. Ethical Approval: This project was approved by the Executive Committee of the MWCCS and Institutional Review Board of Merrimack College; MWCCS was approved by Institutional Review Boards at all the participating institutions. This study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments of comparable ethical standards. Consent, Data, and Materials: Participants all signed informed consents allowing the use of their data for investigations sanctioned by the MWCCS Executive Committee.

Figures

**Figure 1.**
Associations between PA, depression and smoking

See this image and copyright information in PMC

References

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1. Frazier EL, et al. Trends in cigarette smoking among adults with HIV compared with the general adult population, United States - 2009–2014. Prev Med. 2018;111:231–234. - PubMed
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Physical Activity, Cigarette Smoking, and Depression Among People with HIV

Affiliations

Physical Activity, Cigarette Smoking, and Depression Among People with HIV

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous