title: Mediators of a smoking cessation intervention for persons living with HIV/AIDS.
abstract: BACKGROUND
  Cigarette smoking among persons living with HIV (PLWH) is a pressing public health concern, and efforts to evaluate cessation treatments are needed. The purpose of the present study was to assess potential mechanisms of a cell phone-delivered intervention for HIV-positive smokers.
  
  
  METHODS
  Data from 350 PLWH enrolled in a randomized smoking cessation treatment trial were utilized. Participants were randomized to either usual care (UC) or a cell phone intervention (CPI) group. The independent variable of interest was treatment group membership, while the dependent variable of interest was smoking abstinence at a 3-month follow-up. The hypothesized treatment mechanisms were depression, anxiety, social support, quit motivation and self-efficacy change scores.
  
  
  RESULTS
  Abstinence rates in the UC and CPI groups were 4.7% (8 of 172) and 15.7% (28 of 178), respectively. The CPI group (vs. UC) experienced a larger decline in depression between baseline and the 3-month follow-up, and a decline in anxiety. Self-efficacy increased for the CPI group and declined for the UC group. Quit motivation and social support change scores did not differ by treatment group. Only self-efficacy met the predefined criteria for mediation. The effect of the cell phone intervention on smoking abstinence through change in self-efficacy was statistically significant (p<0.001) and accounted for 17% of the total effect of the intervention on abstinence.
  
  
  CONCLUSIONS
  The findings further emphasize the important mechanistic function of self-efficacy in promoting smoking cessation for PLWH. Additional efforts are required to disentangle the relationships between emotional, distress motivation, and efficacious smoking cessation treatment.
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States. Electronic address: dvidrine@mdanderson.org.
authors.forename: Damon J
authors.initials: DJ
authors.lastname: Vidrine
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: George
authors.initials: G
authors.lastname: Kypriotakis
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Liang
authors.initials: L
authors.lastname: Li
authors.affiliation: Division of Infectious Diseases, The University of Texas Health Science Center at Houston Medical School, Houston, TX, United States.
authors.forename: Roberto C
authors.initials: RC
authors.lastname: Arduino
authors.affiliation: Community Health Sciences Division, University of Illinois at Chicago, School of Public Health, Chicago, IL, United States.
authors.forename: Faith E
authors.initials: FE
authors.lastname: Fletcher
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Irene
authors.initials: I
authors.lastname: Tamí-Maury
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Ellen R
authors.initials: ER
authors.lastname: Gritz
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological / Q000379:methods; D008297:Male; D008875:Middle Aged; D020377:Self Efficacy; D012907:Smoking / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology*; D012944:Social Support; D016896:Treatment Outcome
keywords: Cell phone intervention; HIV/AIDS; Mediation; Smoking cessation; This trial has been registered at clinicaltrials.gov [NCT00502827].