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Associations Between Multiple Forms of Discrimination and Tobacco Use Among People Living With HIV: The Mediating Role of Avoidance Coping

Crockett, Kaylee, B., PhD; Rice, Whitney, S., DrPH; Turan, Bulent, PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1, 2018 - Volume 78 - Issue 1 - p 9–15
doi: 10.1097/QAI.0000000000001636
Prevention Research

Background: People living with HIV (PLWH) have higher levels of tobacco use compared with the general population, increasing their risk of morbidity and mortality. PLWH also face potential chronic stressors related to the stigma and discrimination associated with HIV and other characteristics (eg, race and sexual orientation). These experiences may be associated with harmful health behaviors, such as tobacco use. The purpose of the current study is to explore the psychosocial context of tobacco use in PLWH, examining avoidance coping as a mediator in the relationship between multiple forms of discrimination and tobacco use.

Setting: Participants included 202 PLWH recruited from an HIV primary care clinic in Birmingham, AL, between 2013 and 2015.

Methods: Participants responded to parallel items assessing experiences of discrimination related to HIV status, race, and sexual orientation, as well as items assessing avoidance coping. Data on current tobacco use were obtained from participants' clinic records. Mediation models for each form of discrimination (HIV, race and sexual orientation) adjusting for demographic variables and the other forms of discrimination were evaluated.

Results: The indirect effect of HIV-related discrimination on likelihood of tobacco use through avoidance coping was significant, suggesting that avoidance coping mediates the association between HIV-related discrimination and tobacco use. However, the indirect effects of the other forms of discrimination were not significant.

Conclusions: Given the disparity in tobacco use in PLWH, behavioral scientists and interventionists should consider including content specific to coping with experiences of discrimination in tobacco prevention and cessation programs for PLWH.

Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL.

Correspondence to: Kaylee B. Crockett, PhD, Department of Psychology, University of Alabama at Birmingham, 415 Campbell Hall, Birmingham, AL 35294-1170 (e-mail: kburnham@uab.edu).

Supported by the University of Alabama at Birmingham Center for AIDS Research, a National Institutes of Health (NIH)–funded program (P30 AI027767) that was made possible by the following institutes: NIAID, NCI, NICHD, NHLBI, NIDA, NIA, NIDDK, NIGMS, and OAR. K.B.C. and W.S.R. are supported by a T32 in Health Services, Outcomes, and Effectiveness Research (Agency for Healthcare Research and Quality [AHRQ] T32HS013852). Investigator support (B.T.) for this study was also provided by the National Institute of Mental Health (R01MH104114).

The contents of this publication are the sole responsibility of the authors and do not represent the official views of the NIH or AHRQ.

The authors have no funding or conflicts of interest to disclose.

Received November 21, 2017

Accepted January 12, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.