Date of Award


Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Claire Adams Spears, Ph.D.

Second Advisor

Richard Rothenberg, MD


INTRODUCTION: The rate of smoking is significantly higher among people living with HIV (PLWH) in comparison to the general population (CDC, 2017b; Humfleet et al., 2009). Tobacco use among PLWH heightens the risk for HIV-related symptoms and is a pertinent public health issue. Smokers living with HIV are also more likely to develop non-AIDS-related illness in comparison to non-smokers living with HIV. Smoking cessation interventions are desperately needed to cater towards PLWH. This warrants the need for patient-provider interactions in healthcare facilities regarding smoking cessation.

AIM: To document rates of smoking and visitations to healthcare facilities among persons living with and without HIV in higher vs. lower-risk areas and to examine associations among healthcare visitations, stressors, and smoking in these sub-samples (i.e., PLWH in higher-risk areas, PLWH in lower-risk areas, people without HIV in higher-risk areas, people without HIV in lower-risk areas).

METHODS: Secondary analyses were conducted using data from a network-based, HIV endemic study that was conducted in Metro Atlanta (Rothenberg, Dai, Adams & Heath, 2017). The study included 927 participants from 10 Atlanta zip codes (5 lower-risk and 5 higher-risk based on reported HIV cases). Participants provided information on their smoking status and healthcare visitations, as well as whether they had experienced several stressors (e.g., violence, homelessness, being threatened with a weapon, lack of transportation). Descriptive analyses and frequency distributions were conducted and presented on key variables. Logistic regression analyses were conducted to examine associations between key variables and smoking.

RESULTS: Overall, the rate of smoking was quite high in this study. Seventy-four percent of the sample smoked, which is almost five times the smoking rate among the general adult U.S. population (CDC, 2016a). The smoking rate was strikingly high among PLWH in the higher-risk areas (95%). In unadjusted analyses, participants who were older, male, homeless, and do not drive their own car were more likely to smoke. In the adjusted analyses age, gender, and lack of transportation remained significant predictors of smoking. Visitations to healthcare facilities were not significantly associated with smoking or other variables in this study.

DISCUSSION: Smoking appears quite common among PLWH, especially those living in higher-risk areas. This study provided important information on the extent to which persons living with and without HIV in higher and lower-risk areas of Atlanta are receiving healthcare services, as well as how demographic factors and stress relate to smoking in these sub-samples. Future research is needed to develop and disseminate effective smoking cessation programs among smokers living with HIV.