People with HIV are dying from cigarette smoking: Is video treatment the answer?

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The Great American Smokeout is November 21.

According to the Centers for Disease Control and Prevention (CDC), nearly 40 percent of people living with HIV are cigarette smokers—at least twice the rate of the general public. What’s more, people with HIV are less likely than others to quit smoking and are more likely to suffer from smoking-related health complications such as cancer, heart disease and stroke.

Dr. Stephanie Marhefka, a USF College of Public Health professor and assistant dean for research, was recently awarded a five-year, $2.9 million grant from the National Institutes of Health’s National Cancer Institute to study whether those with HIV who smoke can kick the habit with the help of evidence-based, facilitator-led small groups designed for people with HIV. The groups build skills for quitting and share information and social support.

Marhefka and her team will soon begin recruiting nearly 500 participants from around the state for the project. Half the group will be randomly selected to partake in eight small-group smoking-cessation sessions lasting 90-minutes each. Four “booster” sessions will also be provided.

“Booster sessions will enable us to help participants even after the main program is over. By meeting with the groups several times after the primary sessions are completed, we can reinforce important skills and help participants get back on track if they’ve had a slip,” Marhefka said.

The other half of participants will receive an equal number of sessions, including booster sessions, but they’ll focus on more general information about healthy living with HIV. Participants in both groups will be offered nicotine patches.

Stephanie Marhefka, PhD, examines how video treatment can impact smoking cessation in people living with HIV. (Photo by Caitlin Keough)

Unlike other group smoking-cessation programs, sessions will be accessed via video-conferencing, a key component to the project, says Marhefka, who is a behavioral scientist trained in clinical and health psychology.

Participants will be able to access the sessions from their homes and through their own electronic devices (versus those available at a public, shared space, such as a health clinic, for example). “This is important,” said Marhefka. “It’s a way of reaching people where they are—they don’t have to leave home to take part in the sessions and they can pick a device they’re comfortable using. This strategy was selected to optimize their engagement in the program.”

Marhefka points out that while the study’s main aim is to examine what works and what doesn’t when it comes to smoking cessation in those living with HIV, a secondary benefit will be gathering data on the effectiveness of group-based video sessions in changing behavior among those with HIV, be it quitting smoking or making other healthy choices.

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“Both groups get the same amount of HIV-specific social support from peers and group leaders—the only thing that’s different is the content they receive,” explained Marhefka. “If they all get HIV-specific social support over video groups, are those who receive sessions focused on smoking cessation more likely to quit smoking and make it stick? And in comparison, are those whose content is directed toward healthy living—making decisions about disclosing their HIV status and reducing risky sex —more likely to change HIV disclosure and sexual risk behaviors?”

Another key component of the study is follow-up. Marhefka and her team will periodically check in with study participants to see if they maintain any changes they make.

“After their sessions end, we’ll be reaching out to them every 45 days or so throughout the year,” said Marhefka. “This is something that makes our study unique—few researchers testing programs for smokers with HIV have tracked their smoking behaviors for an entire year. We’ll be looking at who can stop smoking after the program and why, who stops and then starts again and what characteristics differentiate those who are able to quit and stay ‘quit’ versus those who aren’t. This is an incredible opportunity to expand our knowledge base.”

Story by Donna Campisano, USF College of Public Health