Symposia
Health Psychology / Behavioral Medicine - Adult
Matthew C. Sullivan, Ph.D.
Massachusetts General Hospital/Harvard Medical School
Brookline, Massachusetts
Allison Labbe, PhD
Staff psychologist
Massachusetts General Hospital / Harvard Medical School
Boston, Massachusetts
Michael J. Zvolensky, Ph.D.
Professor
University of Houston
Houston, TX
Jasper Smits, Ph.D.
Professor
The University of Texas at Austin
Austin, Texas
Thomas Giordano, MD, MPH
Professor
Baylor College of Medicine
Houston, Texas
Conall O'Cleirigh, Ph.D.
Director, Behavioral Medicine
Harvard Medical School/ Massachusetts General Hospital,
Boston, Massachusetts
Background: People living with HIV (PLWH) who smoke cigarettes experience increased mortality and decreased quality of life relative to non-smoking PLWH. Smoking is also a risk factor for severe illness following COVID-19 infection. COVID-19 vaccination and reductions in cigarette smoking pose two pathways to reducing COVID-19 related harms. Yet, racial disparities in vaccine attitudes based in historical abuses by the medical establishment may threaten to exacerbate health disparities. This study therefore sought to characterize vaccine attitudes, vaccine uptake, and motivation to quit smoking by race among PLWH who smoke during the COVID-19 pandemic.
Methods: Participants were people aged 18 years or older living with HIV who reported past-year cigarette use. Recruitment was conducted in the greater Boston and Houston areas, primarily by clinic-based referrals in addition to community outreach and online advertisement. Eligible participants completed a computer-based survey between April 2021 and February 2022. The Vaccine Attitudes Examination (VAX) Scale was used to assess vaccine mistrust. Motivation to quit smoking was assessed on a 0-10 self-report scale.
Results: Seventy-six PLWH who reported past-year cigarette use completed the survey (58% Black/African American; 29% White; 18% Hispanic/Latinx; mean age 52.9 (SD: 9.7) years). Participants who identified their race as Black reported greater vaccine mistrust than other participants in the sample (t(72) = 2.46, p = 0.016). COVID-19 vaccine coverage was nevertheless high in this sample, with 94% (n=70) of all participants having received a vaccine against COVID-19. In the total sample, a significant minority of participants (37.5%) indicated that they were smoking less than their lifetime average in the past week, whereas 16 (20%) indicated that they were smoking more than their lifetime average. Black PLWH tended to report lower motivation to quit smoking (t(47.7) = 2.33, p = 0.024), although they did not differ from others in the sample in terms of lifetime smoking trends or past-week cigarettes smoked (p’s > 0.05).
Conclusion: COVID-19 vaccination and reductions in smoking pose two pathways to reducing COVID-19-related harms among PLWH who smoke. In this sample, we found greater vaccine mistrust and lower smoking cessation motivation among Black PLWH. Vaccine uptake was nevertheless high across the sample. Further research is warranted to examine whether relationships with HIV care providers may serve to overcome vaccine mistrust and increase vaccine uptake.