Tobacco Use in the MMC ID Clinic Population: Clinical and

Research Activities

AECOM/MMC Tobacco Think Tank

September 8, 2009

Cigarette smoking is epidemic among PLWHAs in the USA. 60% of the MMC ID Clinic patients are active cigarette smokers.

State and national statistics are describing significant increases in incidences of cardiac events, COPD/emphysema, lung, and oropharyngeal cancer in this population.

American Legacy Foundation 2006-7

• Shuter, Moadel, Bernstein• Study of the biobehavioral bases of smoking and

quitting in a random sample of PLWHA smokers and ex-smokers

• 60 smokers and 30 ex-smokers completed in-depth, one-on-one structured interviews

• A smoking cessation brochure was developed in response to the information gathered

American Legacy Foundation 2007-2008

• Shuter, Moadel, Bernstein• Used data collected in Year 1 to develop the

Positively Smoke Free intensive cessation program curriculum, and piloted it in six groups of PLWHA smokers

• Matching funds: Latino Commission on AIDS (NYSDOH), Bronx BREATHES (Bernstein)

American Legacy Foundation 2008-2009

• Shuter, Strecher (U. Michigan)• Developed Positively Smoke Free on the

Web, the first and only web-based cessation program that targets smokers living with HIV/AIDS

• www.positivelysmokefree.com

American Legacy Foundation 2009-2010

• Shuter, Strecher (U. Michigan)• Develop a Spanish version of Positively

Smoke Free on the Web• Incorporate a library of provider resources

on the website• Matching funds AECOM Cancer Prevention

and Control Research Program (Rapkin)

RCT of Positively Smoke Free on-site Intensive Intervention

• R21 NIDA (Shuter, Moadel, Bernstein, Arnsten)

• Will create a revised version of the curriculum that incorporates buddy support into the treatment model

• RCT of intensive intervention vs. standard of care (85 per study condition)

• Primary outcome=3 month abstinence

Motivating Latinos to Quit Smoking

• R01 NIDA (Niaura/Stanton PIs [Brown University], Shuter, Moadel co-Inv.)

• RCT of one-on-one culturally tailored counseling sessions versus standard of care

• Projected MMC enrollment=100• Primary endpoint=12 month abstinence

Translational Research

• Exhaled DNA methylation in HIV-infected vs. uninfected individuals

• CFAR-AECC pilot grant (Spivack, Shuter)• Plan to enroll 100 PLWHA subjects

(smokers, ex-smokers, never smokers)• 17 enrolled to date

Tobacco Use and Antiretroviral Adherence

Provider Attitudes and Beliefs about Tobacco Use

• Unfunded study: Shuter, Moadel• Survey of the HIVMA on-line provider

registry• 363 completed surveys (75%) from

providers caring for 75,000 PLWHAs in 46 states

• Analysis is ongoing

Pending Application

• R01 (Shuter, Stanton, Moadel, Strecher, Niaura): RCT of a tailored web-based smoking cessation vs. standard care for PLWHA smokers