Self-efficacy to quit in HIV-infected smokers

Introduction: Tobacco use is epidemic among persons living with HIV (PLWH), and several studies have shown self-efficacy (SE) to be a predictor of successful cessation. This study examined sociobehavioral correlates of SE and its predictive value for successful cessation in a group of PLWH smokers.

Methods: The study was conducted on combined patient data from 2 separate randomized controlled trials of tobacco treatment for PLWH smokers. Both trials utilized the same SE scale at the same timepoints, and both had the same smoking cessation endpoint (biochemically confirmed, 7-day, point prevalence abstinence at 3 months). Univariate and multivariate techniques were used to analyze the merged dataset.

Results: Baseline SE data were available for 272 subjects. The Self-Efficacy/Temptations Scale-Long Form demonstrated good internal reliability with overall and subscale Cronbach's alpha of .77-.92. Younger age, HIV risk other than injection drug use, recent alcohol use, and higher scores for anxiety, depression, loneliness, and nicotine dependence were all significantly correlated with lower baseline SE. Posttreatment SE was significantly predictive of successful cessation, whereas baseline SE was not. Subjects randomized to the treatment interventions were significantly more likely to quit (AOR = 2.99 [1.26-7.01], p = .01), and logistic regression suggested a possible mediating effect of posttreatment SE.

Conclusions: SE is tightly correlated with a number of modifiable affective and behavioral factors in PLWH smokers, and measures aimed at increasing the SE to abstain in such individuals may enhance the effect of targeted tobacco treatment strategies.