title: Tobacco use and nicotine dependence among HIV-infected and uninfected injection drug users.
abstract: BACKGROUND
  Urban U.S. populations are burdened by intersecting epidemics of HIV infection, injection drug use, and cigarette smoking. Given the substantial morbidity attributable to tobacco in these populations, we characterized smoking behaviors, nicotine addiction, and tobacco exposure among HIV-infected and HIV-uninfected injection drug users (IDUs) in Baltimore, Maryland.
  
  
  METHODS
  Smoking behaviors among participants in the ALIVE Study were assessed using interviewer-administered questionnaires. Smoking history and nicotine dependence (Fagerstrom Index scores) were compared by HIV and drug injecting status. Serum cotinine (a nicotine metabolite) was measured for a sample of participants by enzyme immunoassay.
  
  
  RESULTS
  Among 1052 participants (29.7% HIV-infected, 39.8% active injectors), 85.2% were current smokers and 9.3% were former smokers. Smoking prevalence, age at smoking initiation, and cumulative tobacco exposure were similar by HIV status. Median Fagerstrom scores of 4 for HIV-infected and HIV-uninfected smokers indicated moderate nicotine dependence. Daily cigarette consumption was identical by HIV status (median 10 cigarettes), although HIV-infected participants were less likely to smoke 1+ pack daily compared to HIV-uninfected participants (18.0% vs. 26.9%, p=0.001). Compared to former injectors, active injectors had higher smoking prevalence (90.5% vs. 81.7%, p=0.0001), greater daily cigarette consumption (30.7% vs. 19.6% smoked 1+ pack daily, p=0.0001), and slightly higher Fagerstrom scores (median 5 vs. 4). Cotinine levels paralleled self-reported cigarette consumption.
  
  
  CONCLUSIONS
  Tobacco use is extremely common among inner-city IDUs. Smoking behavior and nicotine dependence did not materially differ by HIV status but were associated with active drug injection. Cessation efforts should target the dual dependence of cigarettes and drugs experienced among this population.
authors.affiliation: Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States. mariahm111@gmail.com
authors.forename: Mariah M
authors.initials: MM
authors.lastname: Marshall
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
authors.forename: Neil E
authors.initials: NE
authors.lastname: Caporaso
authors.forename: Meredith C
authors.initials: MC
authors.lastname: McCormack
authors.forename: Christian A
authors.initials: CA
authors.lastname: Merlo
authors.forename: John C
authors.initials: JC
authors.lastname: Hague
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.forename: Eric A
authors.initials: EA
authors.lastname: Engels
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012650:Self Disclosure; D012907:Smoking / Q000453:epidemiology*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000453:epidemiology*; D014504:Urban Health; D055815:Young Adult