Dr. Stephanie Marhefka and students curb smoking in people living with HIV through video groups

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Tobacco use among people living with HIV (PLWH) is a public health problem, according to USF College of Public Health’s Dr. Stephanie Marhefka, an associate professor of community and family health.

“People living with HIV are more likely to die due to non-HIV causes than due to HIV-related complications,” she said.

Her research, “Meeting Our Patients ‘Where They Are’: Video-Group Smoking Cessation for People Living With HIV” published in the Journal of The Association of Nurses in AIDS Care,  examines how video-conferencing groups may be the answer to curb the smoking habit for PLWH–a habit Marhefka cautions is extremely dangerous for this population.

“Tobacco related illness represents the number one cause of death among people living with HIV,” she said. “People living with HIV are more likely to smoke than the general population and much less likely to quit.”

While many tobacco cessation interventions have focused on the general population of people attempting tobacco cessation, trials specifically among PLWH have not had long-term success, Marhefka notes, and research suggests a main barrier to in-person program engagement for PLWH is the challenge of attendance.

According to Marhefka, PLWH may not attend in-person counseling sessions due to lack of transportation, living in areas where there is a lack of personnel to deliver HIV-specific cessation programs, or difficulty getting to the cessation program due to other commitments, such as childcare.

She and her colleagues—including recent USF College of Public Health graduate, Dr. Elizabeth Lockhart, and PhD students DeAnne Turner and Shanda Vereen—piloted the web-based program called Positively Smoke Free Video-Group (PSF-VG), to test the acceptability of the program and evaluate factors impacting adoption.

“PSF was developed by Dr. Jonathan Shuter and colleagues at Albert Einstein College of Medicine in NYC and originally tested in in-person groups, but attendance was not as high as would be preferred, primarily due to difficulty traveling to the clinic for the groups,” she said. “Dr. Shuter reached out to me because I was the first researcher to use video-conferencing groups to deliver programs to people living with HIV. He thought video-groups would reduce barriers to participation.”

Tw0 trained facilitators—both tobacco cessation specialists and former smokers, and one a PLWH– delivered eight sessions over six weeks.

“Participants really appreciate that both facilitators are former smokers and they can relate to the challenges participants experience when trying to quit,” she said. “Also, the peer facilitator—who is living with HIV—can relate to many of the HIV-specific burdens participants experience in their everyday lives.”

Stephanie Marhefka, PhD. (Photo courtesy of Stephanie Marhefka)

Marhefka said a master’s level mental health professional facilitating the groups means there is also expertise regarding the science of psychology and behavioral change.

“Those are important ingredients in PSF too,” she said.

Overall, they found that participants responded positively to the video-conferencing groups which led to reduced smoking frequency and lower overall cigarette use.

“Group video-conferencing is great because we can literally meet people ‘where they are.’ We can connect people who would otherwise be unable to connect due to geographic, financial, mobility, and even some mental health limitations,” she said. “We’ve had participants from Florida, California, New York, Tennessee, Texas, etc. Participants come from metropolitan, suburban, and rural areas. No matter their other differences, they all share the experience of living with HIV and trying to quit smoking.”

Marhefka said that video-conferencing presents an opportunity to also increase intervention reach.

“Perhaps most exciting is that it allows us to centralize facilitators, keeps quality high and training costs low, and has tremendous scalability potential,” she said.

Participants liked accessing PSF-VG from home and viewed participation as low risk, Marhefka said, and quit rates were greater than other tobacco cessation programs for PLWH.

“If a program like this was rolled out at a broader scale, we would be able to serve a large number of people over a relatively short time-frame. We could even give participants the option of being in a group only with people outside of their state,” she said. “If Barbara lives in Florida and doesn’t want others in Florida to know she has HIV, she could elect to be in a group with no other Floridians. This would ease her concerns about being in a group with someone who lives in her community and might tell others she knows that she is living with HIV. That’s a huge advantage, given that fear of stigma is one of the greatest concerns people living with HIV express.”


Marhefka, S. L., Turner, D., Lockhart, E., Rivara, A., Wang, W., Shuter, J. (2017). Meeting Our Patients “Where They Are”: Video-Group Smoking Cessation for People Living With HIV. Journal of the Association of Nurses in AIDS Care, 2: 338-344.


Story by Anna Mayor, USF College of Public Health