title: Decreased awareness of current smoking among health care providers of HIV-positive compared to HIV-negative veterans.
abstract: BACKGROUND
  Cigarette smoking is an important risk factor for morbidity and mortality in HIV-positive patients on combination antiretroviral therapy.
  
  
  OBJECTIVE
  To determine whether awareness of smoking differs between HIV and non-HIV providers, and to identify factors associated with failure to recognize current smoking.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  801 HIV-positive and 602 HIV-negative patients, 72 HIV and 71 non-HIV providers enrolled in the Veterans Aging Cohort 5 Site Study.
  
  
  METHODS
  Data sources included patient and provider questionnaires; electronic medical records; and the national administrative VA database. We calculated sensitivity, specificity, and measures of agreement between patient- and provider-reported smoking, and examined factors associated with failure to recognize current smoking using logistic regression.
  
  
  RESULTS
  Whereas most providers were correct when they identified a patient as a current smoker (specificity > or = 90%), HIV providers missed current smoking more often (sensitivity 65% for HIV vs. 82% for non-HIV). Kappa scores for current smoking were significantly lower for HIV compared to non-HIV providers (0.55 vs. 0.75, p < .001). In models adjusted for age, gender, race, and other differences, patient HIV status and provider specialty in infectious diseases were independent predictors of a provider's failure to recognize current smoking. Comorbid illnesses, cough/dyspnea, degree of immune competence and HIV viral suppression did not impact recognition of current smoking. Only 39% of HIV providers reported confidence in their ability to influence smoking cessation compared to 62% of non-HIV providers (p = .049).
  
  
  CONCLUSIONS
  Interventions to increase HIV provider awareness of current smoking and skills to influence smoking cessation are needed. Efforts should also target patient populations with smoking-related comorbid diseases who would especially benefit from smoking cessation.
authors.affiliation: Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Goulet
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Gibert
authors.forename: Adeel A
authors.initials: AA
authors.lastname: Butt
authors.forename: R Scott
authors.initials: RS
authors.lastname: Braithwaite
authors.forename: Robin
authors.initials: R
authors.lastname: Peck
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D001364:Awareness; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D011364:Professional Practice; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016540:Smoking Cessation; D014728:Veterans
chemical_list: D019380:Anti-HIV Agents